R.M. Engel and R.S. Waldbaum chaired this session. It emphasized aspects of sexuality related to urology.

This session began with a most unusual presentation by J.J. Mattelaer on "The Circumcision of Jesus Christ". In accordance with Jewish law of the time, Christ was circumcised on his 8th Day. The "anti-circumcision" movements in Christianity were confirmed in the year 48 AD, and the Rite of circumcision was replaced by Baptism. Early Christian art always showed Jesus clothed, but after the 15th Century, he appeared in the nude and always uncircumcised, because "he had to be kept intact". Amongst many relics related to Jesus, the foreskin is prominent, so much so that foreskin relics are said to exist in 21 different places. There seems to be no way to assess authenticity. One great question concerned whether Jesus was re-united with his foreskin in heaven. After years of debate, Pope Innocent III settled the question by declaring that only God could know this answer.

L Jones spoke on Kaldi's Legacy: Coffee and Sexuality. Kaldi was a shepherd who noted that his flock became more active when they ate a certain bean. He ultimately developed the extract known as coffee. Early Islam prohibited this beverage, but Pope Clement said that it should be used. Charles II said that Coffee Houses were evil and closed them, but Frederick the Great simply began taxing them in 1777. In terms of sexuality, female rats return to the male for sexual mating more quickly after doses of coffee. However, there is no conclusive evidence that coffee affects human sexual behavior.

F. H. Moll reviewed the "Spermatorrhea-masturbation-neurasthenia Complex and the urologist - a historical reflection." Another term has been "seminal weakness", which refers to nocturnal emission or masturbation. St. Thomas Equinus in about 1200 emphasized that such weakness had "negative sex aspects" and therefore was a sin. The first American "Sexual Hygiene" pamphlet was published in Boston in 1724, and in 1762, Rousseau's classic "Emile" was published. From this point, one could say that sexual behavior was "medicalized". As an example, Freud mentioned "immoderate masturbation" as one cause of psychiatric problems. Circumcision became one method of treating masturbation complexes, and various "anti-masturbation" devices such as steel genital belts arose. Amongst his other approaches to health, Kellogg of cereal fame promoted sexual health as a segment of overall hygiene. Now, however, the Internet is rampant with references to masturbation, and the sin and psychological damage concepts seem to have waned.

M. Omar followed with his talk on the "History of Eugenics and lessons for Andrologists Today". Eugenics may be the concept of "improving genetic quality by management of breeding, especially in humans." It began in England in about 1907 (perhaps as a result of Darwin's theories), traveled to the United States, but became prevalent in the Nazi approaches of the 1930's. He notes that even in the USA, 29 states had laws against inter-racial marriages. Some states even adopted "eugenics sterilization laws" wherein prisoners and insane persons were sterilized. He states that over 60,000 persons received such maiming. And in Nazi Germany, over 400,000 received involuntary sterilization. It is fortunate that such programs are not prominent today, but he ended by stating, "Any ethical problems must be evaluated in an impassionate way."

AW Shindel then reviewed the "Treatment of Hysteria in the 19th and 20th Centuries." Certainly in the 19th Century, the "wandering uterus" or hysteria was believed to be related to all kinds of sexual problems. One therapy was vulval/clitoral massage done by hand or machine (he showed several machines) until "hysterical paroxysm occurs". Other approaches included hydrotherapy, vaginal electrodes and "vibrating theaters" that required elaborate apparatus. Soon, however, vibrators became smaller and were sold as "therapeutic applications' in the Sears Catalog. So the vibrator was a revolutionary medical breakthrough before it became a sexual toy.

P. Kumar continued the session with his "History of Castration - Mythology to Modern Day." Perhaps the beginning was the mythical castration of Uranus by Chronos. In the 18th Century, eunuchs guarded the Turkish harems, and in the 19th Century the Chinese created penile and testicular eunuchs to guard their harems. Also in the later 18th Century, surgical technique for repair of bilateral hernia involved castration, but Percival Pott chastised his colleagues who performed this approach. In Italy, the "Castrato" tenor was revered, and this technique continued as late as the 1920's. But finally, Huggins demonstrated the benefits of castration for treating prostate cancer. Hence, the circle of castration from damaging the male to curing the male became complete.

YR Sheynkin discussed the "History of Vasectomy: from Eugenic and Rejuvenation to Family Planning." He first reviewed the anatomic discovery and naming of the vas - probably a name first used by de Carpi, but brought into common use by Mundimus. In 1737, Hunter first noted patients with absence of the vas. Later, Sir Astley Cooper showed that ligation of the vas in dogs caused no harm. This was then carried forward to humans. Harrison of London reported in 1894 that he had done "hundreds" of these procedures. Then Proust and Albarran popularized Steinach's belief that although vasectomy stopped sperm emission, it increased sexual function. Thus, many men were "Steinached". Vasectomy also replaced castration as a means for preventing procreation in "defectives' - prisoners and mental patients, through the early 20th Century until about 1960. Vasectomy for family planning began in the 1940's but did not gain full acceptance until the 1970's. Now, about 7% of couples choose this method of birth control, and he concludes, "It is the best technique for male contraception."

A.W. Shindel then spoke again, this time on Sexual Dysfunction in the 19th Century USA. Many doctors did "sexual medicine practice" in the late 1800's. Hammond in 1883 listed many sexual problems of males, and Martin in 1893 reviewed those of females. One treatment was a high fat diet, 2 glasses of wine, cold baths and doses of yohimbine. Some beliefs held that sexual activity 2 times/week was too much but others said that it was just right. Various urethral instillations of chemicals were used. Another approach used genital electrotherapy such that there be a "decided sense of discomfort". Vacuum assist devices were seen in the late 1800's, so they are not new gadgets. All in all there was much emphasis on treatment of sexual dysfunction during this era.

AC Lynch then reviewed Urogenital Surgery in Ancient India. She showed examples from texts as early as 3000 BC. Perhaps the Susruta Samihita most thoroughly described the practice of surgery. It included a description of a lateral perineal vesicolithotomy, many years before that emerged in Europe.

AR Rao provided a most interesting report on "History of Condoms: An Interesting Journey of the 'Rubber'". Penile sheaths have been known since 1350 BC, at which time women used a goat bladder inside the vagina. The Chinese used sheaths of oiled paper. Medieval men used small linen cloths to cover the glans penis. Later, sheaths of fine leather or even velvet appeared. Shakespeare referred to these as the "Venus glove". But in 1841, Goodyear developed a soft thin rubber that was kept moist by soaking in milk. Later, Mr. Schmid developed the soft thin condom of today that did not require soaking. By 1916, soldiers were encouraged to use these condoms. There was a decrease in condom usage in the mid-20th Century, but the advent of AIDS prevention restored the condom business.

Irwin Goldstein presented the annual Bicknell Lecture on the subject "Coming of Age of Sexual Medicine". He reviewed some of the history noted in the Shindel talk above. He then reviewed the great contributions of such physicians as Lowsley, Graffenburg, Kinsey, Boheri, Michal, Zorgniotti, Virag, Brindley and Masters and Johnson. Recently, he states, Bill Masters has agreed with him that most male erectile dysfunction is organic in nature. He noted the beneficial treatments that have been initiated for males, including hormonal manipulation, behavioral management and, of course, drugs for impotence. What in the past was considered a psychological disease is now confirmed to be almost all related to physical problems that a sexual specialist could treat. He noted also that women with sexual problems could be treated effectively, so that sexual medicine clinics for both sexes now function simultaneously.

M. Kendirci covered the Historical Journey of the Phallus: from 10,000 BC to Modern Times. It seems that the first and oldest Phallus statue from archeology appeared at about 12,000 BC. He then showed examples at 8000, 5000, 3000 and 2000 BC. By then, there was a phallic cult in Anatolia of modern day Turkey. Hence, "ancient Turkey is believed to be where the phallic cult began."

M. L. Miller discussed the use of "Injection, Ligation and Transplantation: the Search for the Glandular Fountain of Youth." She began with the Emerson quote: "All diseases run into one: old age." So everyone seeks the fountain of youth. She believes that modern endocrinology began with Brown-Sequard, who self-injected crushed testicles and "got new vigor". Physicians soon tried this on their patients. Then, (as noted above), the Steinach rejuvenation procedure of vasectomy also became popular. Voronoff went a step further by transplanting sliced ape/monkey testes into the abdominal wall. This became so popular that the French government eventually had to ban primate hunting in their colonies. So all forms of searching for the elixir of youth have been tried. Today, we have hormones of all types that can be given to males or females: androgens, estrogens, growth hormone, etc. Thus, we continue our search for the perfect "anti-aging medicine".

C. Nicholson continued the ideas of rejuvenation by filling out the discussion of Brown-Sequard's Elixir of Life: Pioneer Andrology and Genitourinary Endocrinology. The famous physician received his MD degree in 1846 and subsequently held positions in London, Paris and the USA. He is most famous for the description spinal cord hemi-transection and its resulting neurologic syndrome. But he also pursued the "Elixir of Life" and in 1889 reported on his studies of injection of a mixture of dog blood of the testicular veins, semen and juices of the testis. This resulted in increased strength, stronger limbs, better urination and so forth. Soon, over 12,000 physicians accepted and used his treatment on patients. However, reanalysis of this treatment in 2002 led to the determination that most probably little testosterone entered the human blood after this treatment, and that there must have been a significant placebo effect.

E.D. Vaughn continued with his review of "The Evolution of Adrenal Surgery". He showed the ancient anatomic drawing of the adrenal by Eustaceus in 1500. But only in 1899 was the first successful adrenalectomy performed. Several events thereafter led to improvements in adrenal surgery, including a monumental text by H. Wm. Scott on the Adrenal. Better and less damaging approaches, including laparoscopic, have greatly decreased morbidity and gained better results.

M. Omar took us on a Journey Through Time in his study of Bacillus Calmette Guerin (BCG) Immunotherapy. He first noted that Coley observed the disappearance of a sarcoma after a S. pyogenes infection. He then tried intentional inoculation of patients with variable results. After conversion to a vaccine, many physicians used "Coley's Toxin" in an attempt to fight cancer. Also, tuberculosis bacillus had been discovered, and Calmette and Guerin spent 13 years making over 230 subcultures of the bacillus to gain a non-virulent form that was used to vaccinate the first child in 1921. Pearl in 1929 noted decreased numbers of cancers in patients with tuberculosis. Then in 1966 Coe and Feldman found that the bladder could mount a hyperimmune reaction to BCG-like agents. Finally in 1972 Morales conducted the first human trial of 9 patients. Lamm in 1973 then conducted controlled studies in rat models. By 1980, there was a huge NCI trial that showed significant efficacy. So now BCG is an established treatment for bladder cancers of certain types, but Omar predicts that new agents or combinations will replace it in the future.

M. Moran followed by presenting the development of robotics, the beginnings. Indeed he started with a device conceived of by Leonardo Da Vinci. By 1769, the Prussians had developed a "robot' that could play chess using a pantograph to position the arm. Jaquet-Droz in 1774 made complex mechanical arms that performed many functions. But in 1939, at the San Diego Expo, Westinghouse revealed its electric robot that performed multiple functions. However, Goertz, between 1942 and 1951 developed most of the methods and terminology used today in robotics. Now, in addition to the robots used in urologic surgery, we see the development of neurally activated robotic arms and legs, so the field is advancing rapidly within medicine.

J. Hill then covered the Masters of Micturition: The Fullers of Ancient Rome. These individuals were the washers of linen, and to do so they collected vats of urine from the latrines and at street corners. Clothes were soaked in vats of warm water and a mixture of urine and soaps. In addition, urine was mixed with "Fuller's Earth" (a clay-like substance) and the resulting powder was used as a dry cleaning agent. Since their collections of urine were "free", Vespasian levied a tax upon them. His son said that "urine smells", but his father replied that "money doesn't smell".

S. Boorjian delighted the audience with his presentation on "The Lusk Kidney: Medical Student Hoax or Evidence of the Whitechapel Murders?" This occurred in the era of Jack the Ripper, the reputed killer of 5 prostitutes, who was never caught. In one of the victims, the left kidney was removed in an almost surgical manner. Hence, police considered at least two physicians to be suspects. Two weeks later, G. Lusk (an investigator) received ½ of a human kidney and a mocking note. First this was thought to be a hoax by students. But later a Board of 3 Doctors concluded that the kidney was from the victim, based on the anatomy of the severed artery and so forth. They also said that someone with medical training must have removed it. Still, however, the puzzling case remains unsolved.

To conclude the session, M. C. Ost reviewed "The Endourology Society: Liberty, Education, and a Model for International Relations." He stated that the organization began with the idea of promoting the concepts quoted by James Madison in 1822: "What spectacle can be more edifying or more seasonable than that of liberty and learning, each leaning on the other for their mutual & surest support." It began in 1979 with organizer Arthur Smith. From that time, International meetings have been held for exchange of ideas and information. Use of Visiting Lecturers and Faculty has made it accessible to all participants. Hence, The Endourology Society has fulfilled the concepts of Madison's quote successfully.

Written by George W. Drach, MD, a Contributing Editor with UroToday.

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