In memoriam: Prof. Jose Maria Gil-Vernet (1922-2020)

Professor José Maria Gil-Vernet passed away on March 5, 2020, in Barcelona, at the age of 97. Born in 1922, he once said that he had not been a good student in the difficult years of hardship that followed the Spanish civil war of 1936-1939, and the financial and political isolation of Spain from the European reconstruction after the end of the Second World War. But he succeeded in studying medicine in Barcelona and graduating in 1947.

He presented his PhD thesis in Madrid in 1951 and returned to Barcelona, ​​where he was greatly influenced by his father, the anatomist and urologist Salvador Gil Vernet. In the 1950s his father had made one of the most important modern contributions to the knowledge of the anatomy, pathology and function of the lower urinary tract and the prostate. Terence Millin referred to him as Vernet in his 1945 Lancet paper presenting the first results of retropubic prostatic enucleation, which improved on earlier approaches to the removal of prostatic hyperplasia.

Figure 1. José Maria Gil-Vernet (left) in the surgical theater.

Stone surgery

Since the mid-1950s, José Maria Gil-Vernet led the group of urologists attached to the Hospital Clinic in Barcelona, ​​and since 1973 he directed the urology training school that his father had started, mentoring numerous disciples who later practiced urology in Spain and Latin America, mainly. His ten international courses of urology with surgical operations, kidney transplant courses, and the reception of clinical visitors, were very popular among urologists around the world in 1987 (see figure 1).

Urinary stones, urinary tuberculosis and neoplasms where by then the more prevalent genito-urinary diseases. The experience and inventiveness of José Maria Gil-Vernet in surgery for coraliform renal lithiasis stood out, in this arena he promoted the delicate dissection of the renal pelvis, renal sinus, and renal calyces, with their subsequent reconstruction, exhausting all possibilities of leaving the kidney stone-free (sinus approach to renal stones). At that time, it was not so easy to check the stone position intraoperatively, and Gil-Vernet made recommendations for an optimal radiological exploration of the stone-bearing kidney, exposed in a lumbotomy. His contribution to the progress of the surgery was recognised as extraordinary by influential surgeons of his time such as John Blandy, who claimed that he had not seen anyone performing surgery for complex lithiasis as Gil-Vernet did at a meeting in London.

In the late 1980s, urological surgery went through extraordinary developments, with the rise of endoscopic surgery for ureter stones and percutaneous surgery for kidney stones. Almost simultaneously, extracorporeal shock wave lithotripsy showed its possibilities (first lithotripsy center launched in Munich in 1982, first cases treated in Spain, in Barcelona in 1984). Together, these new techniques, completely relegated the indications for open surgery of urinary stones to unusual cases.

Gil-Vernet also published on the radical treatment of bladder cancer and urinary diversion with use the of the intestine (ileocecal segment), at a time when cystectomy was still a major intervention, and simple uretero-sigmoidostomy was a frequent urinary diversion. He was also one of the first to use the small intestine to replace the injured ureter.

Figure 2. Gil-Vernet's first transplant technique (1965): pyelo-pielic anastomosis (the recipient's ureter would preserve its vascularity); anastomoses of the renal vein to the cava and the renal artery to the internal iliac artery.

Transplants

After animal studies made in the operating rooms of the Barcelona Zoo, done without official aid, with the sole aim of improving the fate of patients with kidney failure who had a short life expectancy, Gil-Vernet and his kidney transplant team successfully did for the first time in Spain, in July 1965, a cadaveric donor kidney transplant, in which the recipient's upper urinary tract was completely preserved, with a pyelopielic anastomosis to the pelvis of the donor kidney (see figure 2). (The first successful transplant between twins had been performed in Boston in 1954.)

This presented him with many legal problems, since it was a time when dialysis was still in its infancy, and organ transplantation raised numerous ethical, religious and legal questions that had to be resolved in the following years. He was a strong supporter of producing scientific films to teaching and training other surgeons, that later could reproduce a precise surgical technique. Luckily, numerous surgical documents of the time can be seen in the collection available online (see http://videos-gilvernet.org/), kept by his son Dr. José M. Gil-Vernet Sedó, who has also takes care to preserve his grandfather’s surprising anatomical, anatomical-pathological, functional legacy and illustrations of the lower urinary tract (see: http://www.salvadorgilvernet.com/).

José Maria Gil-Vernet remained in the urology service of the Hospital Clínico de Barcelona until 1987, and his last surgery course took place in 1987. He then retired, although he continued to attend a selected clientele at the Sant Josep Clinic in Barcelona, ​​which disappeared in 2003.

A life of achievement

In my formative years, when social networks did not yet exist and it was not so easy to choose role models, I found that José Maria Gil-Vernet was the only Spanish urologist, living or dead, who appeared in the Encyclopedia Britannica, at the time a source of general information such as Wikipedia is today. Gil-Vernet recognised that he was not a good communicator, his interviews are few, and he maintained great discretion during his active life, both about his achievements and the attention to the prominent characters he attended to. Fortunately, he was recognised by his contemporaries and disciples (see figure 3).

Among the many awards with which he was recognised in recent years, it is worth highlighting the distinctions of the EAU Innovators in Urology Award in 2016, the Distinguished Career Award of the Société Internationale d'Urologie in 2009, and the Francisco Díaz medal of the Asociación Española de Urologia in 2002.

Figure 3. José Maria Gil-Vernet and Prof. Willy Grégoire from Brussels (Secretary-General of the EAU 1972-1984), visiting Prof. Nikolay A. Lopatkin (1924-2013) in Moscow.

Pictures and illustrations courtesy of Dr. José Maria Gil-Vernet Sedó.