Historical evolution of transurethral resection at the University of Iowa: Alcock and Flocks.

PURPOSE

In 1935 Nathaniel G. Alcock proclaimed that transurethral resection of the prostate "...cannot be taught and can be learned only by hard, tedious experience." However, his resident assistant, Rubin H. Flocks, added basic science and anatomical knowledge to Alcock's surgical experience to create a body of work that even today provides insight into the complexities of transurethral prostatic resection.

MATERIALS AND METHODS

Even as Alcock studied preoperative and postoperative urethrography images to provide demonstration of the enlarged prostate, he firmly believed in the learning curve of surgical proficiency. However, when Alcock and Flocks began studying autopsy material they were able to pinpoint distribution of the prostatic blood supply, and demonstrate techniques to control bleeding and perform transurethral resection in an organized fashion. Autopsy specimens also demonstrated the previously unrecognized correlation between incomplete resection and complicated wound healing. Flocks' further work with surgical illustrations demonstrated an optimal technique.

RESULTS

In his 1932 report to the American Urological Association Alcock detailed not only his surgical success, but also his mortality rate related to resection and prostatic obstruction and its complications. In autopsy specimens with barium sulfate injections into prostatic blood vessels Flocks demonstrated that complete resection of prostate adenoma was possible and produced the desired outcome with good wound healing.

CONCLUSIONS

The strong collaboration between Alcock and Flocks, particularly during the 1940s, culminated in a movie presentation of the prostatic resection technique as viewed from inside the bladder antegrade toward the prostate that remains a model for surgical practice today.