In memoriam: Prof. Adolphe Steg (1926-2021)

Born in 1925, Adolphe Steg, son of poor Jewish immigrants, arrived in France aged 6 speaking only Yiddish. He soon became a star pupil of the French education system. Having narrowly escaped the tragic round-up of the Paris Jews in 1942, he later escaped prison, survived thanks to a Catholic priest and joined the French Resistance. After the war, reunited with his family (his father survived the Holocaust) he joined the Paris Medical school. On the occasion of a rotation in Urology as a resident, he met the man who was to be his mentor and would change his life: Prof. Pierre Aboulker. Aboulker recognised his potential and had him join the faculty of his department as Assistant Professor. Ady Steg rose to full professorship and served as Aboulker’s adjunct for over a decade. In this period he assisted his mentor when he operated President De Gaulle with open prostatectomy for BPH in 1965.

In 1976, Steg became Chief of Urology after the death of Aboulker and ran for 20 years an extremely successful department of Urology at the Hospital Cochin in Paris. Here he operated with the same dedication on the famous (including President Mitterrand) and the poor. Residents rotating in Steg’s department were taught that the satisfaction and well-being of the patient had priority over the surgeon’s satisfaction, a message not always easily heard by young, eager surgeons in training. Steg performed with great skill and taught the then-current urological procedures, particularly the Hryntschak procedure for open BPH, which in his hands almost never required blood transfusion, which was quite an achievement in this period. At the same time he had the vision to leave his faculty free to explore new avenues in urology: endo-urology developed by Thierry Flam, reconstructive surgery, urethral strictures, artificial sphincters, and radical prostatectomy, where I recall him observing me negotiating my learning curves with great generosity.

Ady Steg was definitely a ‘Humanist Urologist’: his extraordinary mix of French and Jewish cultures allowed him to be a visionary. Exceptionally curious and openminded, always on the lookout for new things beyond his teaching at the bedside and in the operating room. He introduced and popularised major innovations that were controversial at the time. Franzen’s Cytoaspiration of the prostate when the diagnosis of cancer relied on DRE, LHRH agonists to replace the cardiotoxic DES, endo-vesical BCG to treat high-risk superficial bladder tumours, x-ray guided percutaneous kidney cysts puncture to avoid open surgery (which was current practice at the time), and was instrumental in developing ESWL in France.

All these achievements seem far away in times of robotic surgery, augmented reality, and various ‘omics’ but what remains today as one of Steg’s major achievements is his seminal role in the development of the EAU. In 1984 Steg became the second Secretay General of the EAU, succeeding Willy regoir. At this time the EAU, created in the early 1970s, was a kind of ‘old boys’ group counting 200 members, with a congress every other year. During his ten-year mandate, Steg increased, from meeting to meeting, the visibility of the EAU to the initially indifferent Urological Societies of ‘big’ countries who took their time to accept the added value of the Association. Finally, in the first issue of European Urology Today published in March of 1991 he was able to underline the success of the EAU in bringing together more and more Urologists from all over Europe, free to travel since the fall of the Berlin Wall. At this time the dialectically minded Secretary General realised that the future spectacular increase of the EAU membership required a profound overhaul of the organisation (modification of quantity induces transformation in quality). He also realized that the Secretary General to achieve it should belong to the younger generation and gifted with excellent organisational skills. One name came on top of the list: Frans Debruyne. Debruyne had spectacularly organised the EAU’s Amsterdam congress in 1990, and, as the saying goes, the rest is history.

On top of these multiple achievements, and having received numerous honours (member of the French National Academy of Medicine, Grand Officer of the Légion d’Honneur to name but two), Ady Steg devoted a considerable amount of his time to the Jewish community, serving as President of several national and international institutions and gaining here again respect, gratitude and a wide recognition for his achievements.

In addition to the above obituary by Prof. Boccon-Gibod in European Urology Today Vol. 33 No. 2, many tributes reached us about our former Secretary General. Please find below further memories from his colleagues and friends from all across Europe.

Prof. Marc Zerbib (Paris, FR)Former Head of Urology at Cochin Hospital, ParisMember of the EAU Video Committee (1998-2006)

Professor Ady Steg has passed away. He was a brilliant Urological Surgeon, Head of Department of the Urological Clinic at Cochin Hospital in Paris, where he had succeeded Professor Pierre Aboulker. He was the leader of a large School of Urology which trained dozens of urologists, and taught during the Urology Days at Cochin Hospital, to hundreds of other Urologists from all over the world.

He was endowed with a practical intelligence based on flawless reasoning but always inspired by ethical considerations putting respect for the human person in the foreground. His personality shone beyond the French borders and he was one of the pioneers of European Urology, as General Secretary of EAU. He thus worked for the development of Urology in Eastern European countries of which he was a child. He will remain for me, as for all of his collaborators, a Master who has guided my professional and personal life.

Prof. Remigio Vela Navarette (Madrid, ES)Chair of the EAU Strategy Planning Office and EAU Board member (1998-2006)

We had the privilege of meeting Adolphe Steg for the first time in 1969. At the time, he was working at the Cochin Hospital under the direction of Professor Aboulker, and he was interested in the metabolic aspects of lithiasis. So was Luis Cifuentes at the Fundacíon Jiménez Díaz in Madrid, and we invited him to visit us there. It was a real pleasure to discover that, in addition to the metabolic aspects of lithiasis, we had many scientific interests in common such as the treatment of CIS with instillations of BCG, in which he was an expert.

Another pleasure was to discover that Adolphe Steg spoke Spanish, which allowed fluid and fruitful communication. Thus began a long and productive personal and institutional relationship, with successive invitations from the Spanish Association of Urology. In 1994, at the 59th Congress of the Spanish Urological Association in Mallorca, Steg received the Francisco Díaz medal in recognition of his valuable contribution. I could continue with many memories of his teaching, academic and scientific achievements, but shall leave that happy task to other participants in this memorial.

My personal admiration, respect, and friendship for Steg went on for many years. I had the pleasure of accompanying him on various national and international trips, enjoying both his company and that of his wife Gilberte, whose charming Spanish showed echoes of the old Ladino Spanish [Judaeo-Spanish], evoking memories of the 16th century Sepharad.

Steg possessed immense humanity, a deep vocation for service and a generous attitude towards life. He believed in a close relationship with patients, and his evident concern for them inspired great confidence. Such was my confidence in Steg that I put family members in France in his hands, and I am happy to add that he put his friends residing in Spain in mine.

He remains in my memory as a benchmark of virtues, solid convictions and enormous capacity for human relations.

Members of the EAU Executive and the EAU's Management Committee (a precursor of the EAU Board) meet in Berlin in 1993 to help prepare for the 1994 EAU Congress. From left to right: Profs. Ackermann, Bollack, Borkowski, Nagel (1994 Congress President), Debruyne, Steg, Puppo and Sole Balcells.

Prof. Claude Schulman (Brussels, BE)Editor Emeritus of European Urology (1975- 2005)

Professor Adolphe (Ady) Steg was a pillar of the foundation of the EAU in 1974 which was a closed society of selected leading university professors in Europe. At that time the main challenge was to integrate countries of Western and Eastern Europe and their universities.

He was a founding member of the EAU Board of which Professor Willy Gregoir (Brussels) acted as Secretary General and Professor Georg Mayor (Zürich) as Treasurer - the EAU Board had six members.

The EAU’s first Congress in 1974 in Padua (Italy) gathered about 150 highly selected academic professors from Europe, including Russia and other then Eastern-bloc countries. It was during this first Congress that European Urology was founded as its official journal and its first issue was published in early 1975, and I served as Editor-in-chief of its Board.

Prof .Steg succeeded Prof. Gregoir as the second Secretary General of the EAU. As Secretary General of the EAU he was very supportive to stimulate his colleagues to publish in European Urology that progressively gained increasing international attention as a new journal in Urology.

The initial period of a new journal was very challenging and together with Prof. Gregoir, Prof. Steg helped to attract good clinical and research articles from leading European academiccentres that had previously only considered American publications as important. As Secretary General of the EAU, Prof. Steg was succeeded by Prof. Frans Debruyne, who opened up and changed completely the EAU as a former club to become the large open and influential association that it is now.

A person only really disappears when forgotten, and those who had the chance to know Ady Steg will always remember him.

Prof. Louis Denis (Antwerp, BE)Member of the EAU Scientific Committee (1992-1996)

The sad news that Prof. Steg had passed away on April 11, 2021 prompted reflections beyond the loss of a famous colleague and friend at the venerable age of 96. The first reflection focused on the man as one of the founders of European Urology (EAU). Even for me, with EAU membership nr. 103, he radiated the originally core of 100 urological leaders ready to create one voice of urology in Europe after the trauma of WWII. We still addressed him as Dr. Steg. Years later, during a congress in Singapore, a US-trained urologist tried to make fun of me as John Wayne in a scientific debate. I played the role, enjoyed the humour and won the debate easily. However Prof. Steg took me discretely apart to tell me never to react to cheap provocation and keep our culture representative in public debate and manners. It was typical of the man who never ever uttered even a hint on the fate of his most famous patient.

The end of an era, a mere 4 years of difference of age is even more obvious in his official biography. I ended the war years as a child where Adolphe and Gilberte sacrificed their youth to the final victory of democracy and freedom. Prof. Steg never mentioned this traumatic experience in any of our hundreds of meetings.

In 1989 I received an offer to establish a council, the International Prostate Health Council (IPHC), with the mission to establish an education source of benign prostate disease for the medical profession and lay public. Especially attractive was the fact that I could chose my own team, no strings attached and no financial contribution except meeting expenses, only financial support for jointly approved projects covering all aspects of benign, prostatic diseases, sharing and serving in collaboration and important leaving implementation to existing decisionmakers.

We will remember Prof. Steg as a profile of courage, tolerant with kindness, caring with compassion and a monument of the French spirit with a great sense of humour. For our IPHC team he remains the example of a loyal team player and a trusted friend using pension time as payback to our shared dream of urological service to mankind.

Prof. Frans M.J. Debruyne (Nijmegen, NL)Secretary General of the EAU (1992-2004)

The death of Professor Steg, with great respect for his age, came nevertheless unexpected. He passed away on April 11^th, 2021. It was a very sad event for his wife, family, colleagues and friends, who are numerous. It also immediately evoked to me uncountable memories of his remarkable personality and achievements.

Professor Steg (Adolphe as we use to say) entered my professional life in the early eighties of the previous century. I was a (very) young professor of urology at the faculty of medicine Radboud university in Nijmegen, a provincial town in the middle of The Netherlands. At that time I was professionally (“urologically”) practically unknown, but I did attend on a regular basis urological events and congresses, more particularly the scientific activities of the EAU (European Association of Urology). This then rather small scientific society was indisputably managed by Prof. Steg as its Secretary General.

Right from the start, I was impressed by his knowledge, guidance, amicability and above all his superb eloquence in transcendent French sentences which unfolded his indelible erudition. Professor Steg was the leader of European urology with a clear vision about the development of our specialty and the future of the EAU as a pan-European professional organization.

Almost nobody was at that time aware of his Jewish descent, and he never mentioned it. But he was firm and emotionally steadfast when I travelled in the late eighties, before the Iron Curtain opened, together with him to Poland, where so much tragedy took place for the Jewish community under Nazi occupation. I was flabbergasted and very impressed by the serenity of his address in Warsaw in the rebuilt and now ceremonial presidential palace. It still gives me goosebumps. What dignity!

He was instrumental in my nomination as his successor as Secretary General of the EAU in 1992. I managed to succeed thanks to his leadership and friendship. He did not impose on me but gave me (and my colleagues of the EAU board) complete freedom to develop the EAU to what it has become today: a major and prime scientific urological association in the global urological community. Professor Steg had the vision of such a future development and we succeeded in realising his views and opinions. Above all we established close relationships with the Eastern European countries, an endeavour he started without the possibilities we had once the Iron Curtain disappeared. We realised an EAU as he had envisaged. He stimulated us almost spontaneously and was very proud of every step forward we made. Almost every step was based on, and a consequence of, his original ideas. Urology was in his heart and was his professional passion. He was the first to make our profession a respected international specialty and organisation. He was a mentor and leader, a perfect teacher with enthralling qualities to follow almost spontaneously his visionary ideas.

Professor Steg was a urological master both in France and abroad. I know him above all from his international achievements which are still recognised on a global scale. It is almost a miracle that he was able to combine these professional realizations with such an extremely friendly, gentlemanly attitude and the many other activities and responsibilities he is now widely recognised and acknowledged for. He was and will remain a urological and human giant to all who have known him.

Dr. Johan J. Mattelaer (Kortrijk, BE)Former Chairman of the History Office of the EAU (1994-2002)

As a member and former Chairman of the EAU’s History Office I have to underline the exceptional merits of Prof. Adolphe Steg in the organisation and evolution of the EAU.

Although he was not a founding father of the EAU, in 1984 Prof. Steg succeeded Prof. Gregoir as only the second Secretary General of the young and small organisation that the EAU was in the 1980’s.

As a clinical urologist and a medical doctor I have to emphasise his great personality and role as a teacher in surgery and urology. He played an essential role in the formation of dozens of urologists in France and over the whole world and annually organised the well-attended ‘Journées de l’Hôpital Cochin’ in Paris. He also introduced ‘internationality’ within the urological European community.

As a human being I will express my admiration for his great personality. Formed and influenced by the terrible personal tragedy during the Second World War, he developed a fantastic but always uncomplicated personality. As a medical doctor he was always aware and warned against medical technicity and overconsumption. Invited at a urological symposium organised at our department in the 1970s, he presented with full conviction his paper ‘l’acharnement thérapeutique’ or ‘medical relentlessness’. Medical technicity is useful but has its limits. It was one of his favourite quotes.

He was what they call in France: a real ‘Grand Maître’ and a ‘Grand Monsieur’ (great master or sir). We have to remember him as an important personality and great urologist with a real influence on the development of urology in Western Europe in the 20th century.

If ever the EAU will have a gallery of her most important members, he should be one of them.