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A Brief History of Urology at Queen's University

A Brief History of Urology at Queen's University

Although Queen’s University was founded by Royal Charter granted on October 16, 1841, the Faculty of Medicine was not established until 1854 when 23 students were enrolled (including 9 students transferring from Trinity College in Toronto). Dr. Dickson was the first lecturer in surgery and presumably performed the urological procedures required for that time. However, in those days before the era of adequate anaesthesia and antisepsis, the mortality rate for any surgical intervention was high. Available interventions for urological disease were limited and primitive.

By the turn of the century in Kingston, as elsewhere throughout Canada, the scope of general surgical practice had increased due to improved hospital facilities and improved understanding of the pathological basis of disease, antisepsis and anesthesiology. General surgeons became proficient in the management of patients with renal masses and stones, abscesses of the prostate, perinephrium and periurethra and elderly men with prostatic enlargement. Many physicians became proficient in dilating post-gonococcal strictures and the passage of metal sounds for relief of urinary retention, continuing an art many centuries old.

The arrival of Dr. L.J. Austin (“Blimey”) to Queen’s as Professor of Surgery in 1920 brought the advent of endoscopic urological surgery.  In 1924 he diagnosed  cystoscopically  and treated with open fulguration a bladder tumor in a patient presenting with hematuria. The patient survived another 43 years before succumbing to metastatic disease in 1967.  Although he had experience with ureteral catheterizations and retrograde injection of contrast for X-ray imaging of the urinary tract, he recognized his own limitations and recommended that an expert in the recently developed specialty of urology be appointed to the faculty. In 1930, Dr. Nathan E. Berry, a native of Southeastern Ontario and a graduate of Queen’s University accepted the appointment as Professor of Urology having completed postgraduate training in the specialty with Dr. D. W. MacKenzie at the Royal Victoria Hospital in Montreal. A condition of his appointment was his insistence that Urology have status as a separate department from Surgery  which it continues to enjoy  to this day.

Dr. Berry’s reputation spread to a large extent because of grateful patients and very quickly he was attracting referrals from throughout Eastern Ontario and northern New York State. His colleague, Dr. E. Perry White, described Dr. Berry as a “keen clinician, a talented surgeon, a stimulating teacher and a true friend to all his patients. Because of his rural background, he could talk to the farmers who made up the bulk of his practice and night after night he would be found sitting at a patient’s bedside discussing topics of mutual interest”.  Dr. Berry was particularly skilled at transurethral surgery, a technological advance which developed during the 1930’s. His contribution to the advancement of transurethral surgery in Canada was appreciable. Dr. E.P. White was appointed to the Department of Urology in 1946 following World War II although there had been attempts at recruiting him prior to the war.  

In 1948 a young intern from Aberdeen Scotland, Dr. Andrew W. Bruce, arrived at Queen’s to do a rotating internship. He showed a particular aptitude for the specialty of Urology and remained as a junior assistant resident in Urology for a further six months following completion of his internship. He returned to the United Kingdom to fulfill his military service obligation and also completed training in Urology. He was recruited back to Queen’s in 1960 as the second Professor of Urology following Dr. Berry’s retirement due to illness.  Dr. John P. Connolly was recruited to the department in 1964 with the understanding that 50% of his time would be spent on academic pursuits. He began the research laboratory activity at Queen’s in the field of urological oncology and established the Queen’s tradition of close collaboration between the laboratory and the clinical service.  During Dr. Bruce’s tenure the postgraduate residency program was developed initially as an affiliated program with McGill University and in 1971 as a fully accredited site for Urology training by the Royal College of Physicians and Surgeons of Canada. Dr. Ernest E. Ramsey was the first resident to complete his education in the new program in 1972. From the beginning, urological research was an important component of the residency program. Dr. Said Awad joined the department in 1973 and developed neuro-urology at Queen’s and established the first urodynamics laboratory in the region. Dr. Alvaro Morales joined the department in 1973 following urological training at Queen’s, Toronto and Aberdeen Scotland. During his education and following a year at the National Institutes of Health in Bethesda Maryland, he developed an interest in the immunology of urological malignant disease. His seminal publication in 1976 on the use of intravesical BCG for the prophylaxis of transitional cell carcinoma of the bladder, (Journal of Urology 116  180 1976)  paved the way for the use of this agent as standard therapy worldwide. His other research interests were wide ranging and during his career he made significant contributions in the fields of clinical oncology, male sexual dysfunction and the endocrinology of aging males. 

Dr. Awad left Queen’s in 1980 to become head of the Department of Urology at Dalhousie University in Halifax. Dr. Bruce resigned the position as Professor of Urology in 1981, to become Head of Department initially at McGill University and subsequently at the University of Toronto. Dr. Morales was appointed Head of Department at Queen’s in 1982. Dr. James Wilson was appointed to the department in 1983 following urological training at Queen’s and the Mayo clinic and brought skills in endourological surgery and urolithiasis research. Dr. J. Curtis Nickel was appointed in 1984 following urological training at Queen’s and research training in bacteriology in Calgary. Dr. Nickel’s contributions in the fields of infectious disease of the genito-urinary tract, prostatic disease and inflammatory diseases of the lower urinary tract have been wide ranging and internationally recognized. Dr. Jeremy Heaton was appointed in 1986 following Urology training at Queen’s and research training in Pharmacology at Oxford University. His research interests in male erectile dysfunction have been innovative and he made  significant contributions to this newly defined area of urological practice.  Dr. Andrew MacNeily was appointed in 1994 following Urology training at the University of British Columbia in Vancouver and further fellowship training in Paediatric Urology at Northwestern University and at the Institute of Urology, London. 

In 1997, the Department entered a new era with the resignation of Dr. Morales as Professor after 15 years as head of the department. Dr. Wilson was appointed Head, Department of Urology at Queen’s University and Chief, Department of Urology at Kingston General Hospital and Hotel Dieu Hospital. 

In 2000, we welcomed Dr. D. Rob Siemens to the department. Rob is a graduate of Queen’s University and did his residency in Urology at Queen’s. He joined the department after a 2 year fellowship in the Urological Research Labs at the University of Iowa with Dr. Timothy Ratliffe and Dr. Richard Williams. Rob brought expertise in the clinical and research aspects of urologic malignant disease. He has developed significant research expertise both independently in clinical urologic oncology but also the basic sciences of malignant disease in collaboration with Dr. Charles Graham of the Department of Biomedical and Molecular Science as well as several members in the Department of Oncology. 

Dr. Andrew MacNeily left Kingston in 2000 to assume the position as Head of Paediatric Urology at the University of British Columbia in Vancouver. During his tenure at Queen’s, Andrew rejuvenated the residency training program and provided enhanced paediatric services to the region. Among his legacies, he was instrumental in establishing the QUEST program for all Canadian final year residents preparing for the Royal College certification examinations. This two day program includes mock written and OSCE examinations as well as a didactic program to highlight key domains of urological practice relevant to chide residents. 

Dr. Morales received international recognition in 2002 through the Yamanouchi Award, the highest honour of the Societe Internationale d’Urologie which was presented at its annual meeting in Stockholm Sweden.  

Dr. Darren Beiko was appointed to the department in 2003 following residency training at Queen’s and fellowship training in endourology and laparoscopy at the University of Western Ontario under the guidance of Dr. John Denstedt. 

Dr. Morales retired from Queen’s University in 2004 and an invitational symposium was held in his honour which saw approximately 50 of his former students and residents return to Kingston to discuss the future of Urology and urological research. Dr. Heaton took a sabbatical from 2004-05 and on his return in the summer of 2005 decided that he did not wish to continue as a full time clinical urologist and resigned his position but stayed on as an adjunct for a further five years. 

The Centre for Applied Urological Research, which consolidated the various research activities of the department members in one location at 62 Barrie St. was opened in 2005  This centre had been the brain child of Dr. Morales and was completed following significant fund raising spearheaded by Dr. Morales. It has become the focus of the significant clinical research activities of the department and is the home of 5 research nurses and 4 associate research staff. 

In 2007 Dr. Nickel was appointed as the Canada Research Chair in Urology – the only urologist in Canada to hold such a position. This recognizes his significant contributions to our understanding and management of patients with inflammatory diseases of the lower urinary tract. This award was renewed in 2013. 

Dr. Stephen Steele, a graduate of the residency program at Queen’s,  filled in for Dr. Heaton during his sabbatical year then went to Halifax for fellowship training in functional urology under the guidance of Dr. Jerzy Gajewski. He returned to Queen’s in 2007 as Assistant Professor and was appointed Program Director of the residency program in 2011.

Dr. Jun Kawakami was appointed in 2005 having completed fellowship training in San Francisco in urological oncology under Dr. Peter Carroll. He left Queen’s in 2009 to accept a position in Calgary.  

Dr. Naji Touma was recruited to fill the vacant position in 2009 having completed residency training at Western and fellowship training in laparoscopic and minimally invasive surgery at McMaster University. He brought much needed expertise in the rapidly evolving field of minimally invasive urological surgery. 

Dr. Michael Leveridge was recruited in 2010 having completed residency at Queen’s and fellowship training in urological oncology in Toronto under the guidance of Dr. Michael Jewett. 

In 2011, Dr. Morales retired after a long and very successful career at Queen’s. He was honored by his adopted country by being appointed to the Order of Canada in July 2011. 

In 2012, Dr. Rob Siemens was appointed as the Head of the Department of Urology, only the fourth department head  in its 81 years of existence.  

In 2013, Dr. Jay Izard joined the department after residency education at Queen’s followed by fellowship training at the University of Washington in Seattle. He brings expertise in urological oncology particularly focusing on outcomes research. He strengthens the already strong group of oncologists in the department and with Dr. Siemens and Leveridge has developed important collaborations with the academic and clinical programs in cancer care at Queen’s. 

Since being established the Department of Urology at Queen’s has had an important impact on urological care and practice in Canada. Since 1971,  67 urologists hace graduated from the undergraduate program at Queen’s and entered into urological residency programs or completed training in Urology at Queen’s. These graduates practice throughout Canada – from Vancouver British Columbia to St. John’s Newfoundland. Queen’s graduates hold academic appointments at 10 of Canada’s 17 medical schools . For a small school this is a singular achievement  and can be attributed to the focus on high standards of clinical education for learners, high achievement in research and high quality urological care for patients.