ABSTRACT
The introduction of transurethral prostate resection and intravenous urography changed the clinical presentation and preoperative evaluation of patients with prostatic obstruction. Herman Kretschmer and Fay Squire’ (Presbyterian Hospital, Chicago) recognized these changes and studied them in 408 patients seen from 1933–1947. Their primary goal was to study the frequency and extent of hydronephrosis in these patients with prostatic enlargement. In addition, they reported the radiographic changes seen in the course of the ureter. The ‘changes consist[ed] of lateral displacement, angulation and elevation of the ureters at the point of their entrance into the bladder.’ 1 In the figures illustrating the article, this is described as a ‘fishhook course’ (Figure 1). Many other terms including J-shaped or hockey stick (Figure 2) have also been used. (The hockey stick analogy was taught to me, during my medical student days, by Robert Spellman, a urologist at St Elizabeth’s Hospital in Brighton, Massachusetts.) Kretschmer and Squire’ emphasized that, ‘The recognition of these changes in the ureters may be of diagnostic aid or value in some … cases.’ This sign is still valuable for recognizing prostate enlargement from either hypertrophy or tumor. ‘Note high insertion of left ureter and fishhook course.’ Reprinted from Kretschmer and Squire<xref ref-type="bibr" rid="ref40_1"> <sup>1</sup> </xref>. The incidence and extent of hydronephrosis in prostatic obstruction. <italic>J.</italic> <italic>Urol.,</italic> 1948,60, 1–6, with permission of Williams & Wilkins https://s3-euw1-ap-pe-df-pch-content-public-p.s3.eu-west-1.amazonaws.com/9781003076568/34c29fd5-5662-4e8f-b58c-badd7fa5d724/content/fig40_1_B.jpg"/> ‘One of the sticks used in early hockey matches (circa 1860).’<xref ref-type="bibr" rid="ref40_2"> <sup>2</sup> </xref> Courtesy of Hockey Hall of Fame Archives https://s3-euw1-ap-pe-df-pch-content-public-p.s3.eu-west-1.amazonaws.com/9781003076568/34c29fd5-5662-4e8f-b58c-badd7fa5d724/content/fig40_2_B.jpg"/>
