Purpose: Birdwell Finlayson was a talented researcher and clinician whose pioneering work in the field of urolithiasis led him to worldwide prominence in urology. We researched his life and accomplishments to provide a historical account of his career. Materials and Methods: The archives of the Department of Urology and the University of Florida Health Science Center Library were searched for publications, photographs and other records relating to Doctor Finlayson. Additionally, we interviewed many of his friends and colleagues for more information. Results: Birdwell Finlayson was born in Pocatello Bannock, Idaho. He completed a urology residency and obtained a Ph.D. in biophysics at the University of Chicago. In 1967 he joined the faculty at the University of Florida. His interest in understanding the fundamentals of stone formation led to the discovery that crystal retention at a site of nephron injury was essential for stone formation. This fixed particle hypothesis continues to serve to as the foundation for urolithiasis research today. His computer model EQUIL is the gold standard for calculating urinary supersaturation with respect to kidney stone formation. Finlayson was 1 of the 6 original coinvestigators for shock wave lithotripsy in the United States. He is also remembered for his wit and his love of aeronautics, as he was a flight instructor and stunt pilot. Finlayson died unexpectedly of idiopathic hypertrophic cardiomyopathy on July 22, 1988. Conclusions: Birdwell Finlayson was an internationally renowned surgeon and stone disease expert whose research continues to serve as the basis of urolithiasis research at the University of Florida and worldwide.
Bibliographical noteFunding Information:
Finlayson joined the University of Florida, College of Medicine in 1967 as an assistant professor and attained full professorship by 1973. He was the director of the Kidney Stone Research Center at the University of Florida, which was 1 of 5 facilities in the United States designated by the National Institutes of Health as a Special Center of Research Excellence in urinary stone disease, and received several multimillion dollar grants to continue his research efforts. His interest in understanding the fundamentals of stone formation led to experiments that he conducted in 1976 to explore whether a free particle in a renal tubule could grow large enough to impede urinary flow within the tubule, which formed the basic premises of the free particle hypothesis. 3 Finlayson was clearly influenced by Platt in his report entitled “The Expectation of Free and Fixed Particles in Urinary Stone Disease” when he stated “inasmuch as it is usually difficult to prove something to be true, whereas, it is frequently possible to show something to be not true.” 3 In his discussion on the free vs fixed particle mechanisms of stone disease, Finlayson describes a mathematical model that he formulated to determine whether the free particle theory was plausible. Based on his calculations he concluded that the growth of crystals was not fast enough for their retention based only on their size ( fig. 2 ). 3 Finlayson and colleagues subsequently postulated that crystal retention at a site of nephron injury was essential for stone formation. This fixed particle hypothesis serves as the foundation for research in stone formation today. At that time several factors had already been investigated as the cause of stone formation including hypercalciuria, hyperuricosuria and hyperoxaluria, as well as the decrease in inhibitors of stone formation in the urine. Finlayson engineered a computer model referred to as EQUIL, written in FORTRAN (FORmula TRANslation) computer language, which was able to predict the supersaturation ratios for the important mineral components in kidney stones. 4 Subsequent updates to EQUIL have since been written and it continues to serve as the gold standard for urolithiasis research worldwide. Recognizing the need for a point of reference so that rational comparisons could be made, Finlayson and Dr. John R. Burns, one of his former fellows, suggested that researchers should use a standard artificial urine for their in vitro urolithiasis experiments. The technique to construct this reference artificial urine was described in 1980 by Finlayson and Burns, and the formulation is still used in various laboratories around the world today. 5 A portion of Finlayson’s career was devoted to studying the safety and efficacy of extracorporeal shockwave lithotripsy. In 1980 Dr. Christian Chaussey, in collaboration with the engineers at the Dornier Company in Munich, introduced the first extracorporeal shock wave lithotripter, one of the most significant inventions in the field of urology in the 20th century. After traveling to Munich to study ESWL under Chaussey, Finlayson brought the techniques he learned back to the University of Florida. In August 1984 the Dornier HM-3, a 7 ton lithotriptor costing $2 million, was installed at the University of Florida, which served as 1 of the 6 original primary investigation sites in the United States for ESWL ( Initially patients were hospitalized for 5 days, but after his experience with several hundreds of patients Finlayson determined that ESWL could safely be performed as an outpatient procedure. Finlayson was never afraid to speak his mind and was known to have once stood up at an AUA meeting to state his position that ESWL should be performed on an outpatient basis. He later received a letter of censure from the AUA stating they believed that ESWL should instead be performed as an inpatient procedure. He also studied the life span of an ESWL electrode. The Dornier Company had insisted that the electrode should be changed every 800 shocks. Finlayson demonstrated that an electrode could be used for 2,000 shocks while remaining effective. At a cost of several hundred dollars per electrode, this work saved each lithotripsy center large sums of money. Finlayson’s work, along with that performed at 5 other medical universities, resulted in the United States Food and Drug Administration approving ESWL as an accepted treatment for kidney stones. fig. 3 ). In August 1983 at the AUA Western Section meeting in Vancouver, British Columbia, Birdwell Finlayson, Patrick Hunter and Irvin F. Hawkins won the grand prize for scientific exhibits for their display titled “Retrograde Nephrostomy—A New Technique” ( Their innovation, called the Hawkins-Hunter retrograde transcutaneous nephrostomy, provided a direct pathway to renal stones, and allowed for great precision and control during stone removal. The technique involves cystoscopic placement of a 5 and 9Fr coaxial catheter into a selected minor calix under fluoroscopic guidance, through which a sheathed 20 or 21 gauge needle is advanced to exit at the skin and the tract dilated over the needle. fig. 4 ). 6 This sheathed needle concept originated from a technique developed by Dr. Irvin F. Hawkins at the University of Florida used for performing transvenous liver biopsies 7 and transvenous cholangiography. 8 The retrograde transcutaneous nephrostomy has since been updated with one current version using a ureteroscope to assist with targeting the intended calix for retrograde percutaneous access. 9 While most urologists use an antegrade approach for renal access today, the retrograde nephrostomy offers advantages for patients with difficult access (eg obese patients, nondilated systems or scarred kidneys). 9 However, placement of an access sheath adds to procedural time and costs, and the antegrade approach works well in a majority of cases. In addition to being an exceptional clinician and researcher, Finlayson was also an inventor. He was involved in the conception and development of a patented ureteral access sheath manufactured by Cook called the Finlayson Ureteral Access Set. This general ureteral dilator sheathing system consists of 4 coaxial Teflon® catheters with external dimensions of 6, 10, 14 and 17Fr that allows for the passage of instruments up to 16Fr in diameter to perform maneuvers in a retrograde manner that would otherwise require percutaneous techniques or other more invasive procedures ( fig. 5 ). 10 Finlayson’s contributions to the field of urolithiasis research won him international acclaim when he served as the chairman of the first Gordon Research Conference on calcium oxalate in 1986. The Gordon Research Conferences provide an international forum for the presentation and discussion of frontier research in the biological, chemical and physical sciences. Scientists with common professional interests gather for a week of intense discussion and examination of the most advanced aspects of their field. These conferences provide a valuable means of disseminating information and ideas in a way that cannot be achieved through publications or presentations at large scientific meetings. Finlayson was also recognized for his stone research efforts locally when he won the 1988 University of Florida, College of Medicine Clinical Research Prize.
- history of medicine
- urinary calculi