World Federation of Societies for Paediatric Urology

Progress Medels

Progress Medal 2003 is awarded to
Prem Puri

MBBS, LRCP & S (Edin.), DCH, MS, FRCS, FRCS (Edin.) FACS.

Presently Director of Research Children's Research Centre, OUr Lady's Hospital for Sick Children Dublin, Ireland The volume-6 of Progress in Paediatric Urology is devoted to the state-of-the-art practices in vesico-ureteric reflux (VUR). Our understanding of VUR has changed dramatically over the past decades due to the immense contribution of individuals such as Stephens, Ransley, Belman, Koff and Puri. Even though we have a wide knowledge of the aetiology, pathogenesis and natural history of VUR, there is still a large group of patients who are prone to severe impairment of renal function with subsequent dependence on chronic dialysis.


The management of VUR has been controversial. The International Reflux Study Group in Children (European Section) and the American UrologicalAssociation report on VUR has clearly shown a low spontaneous resolution rate in high-grade VUR after 5 years of medical treatment. Open surgery in VUR pioneered by Politano and Leadbetter, and Cohen has enjoyed a high grade of success, but it is not free of complications even in the best of hands. Every one of us who has operated on a child with VUR knows what it means for the child and his parents: a long postoperative stay in the ward, barely resolving postoperative pain due to bladder contractions and the parents' anticipation of the outcome of surgery. The introduction of endoscopic procedures for the treatment of reflux was a radical departure from the standard surgical intervention and observational therapy to the minimally invasive outpatient procedure. In 1984, Puri and O'Donnell reported successful correction of experimentally produced VUR by subureteric polytetrafluorethylene injection. The authors named their operation STING. Since then, thousands of children worldwide have been successfully treated utilizing this procedure. Since the first report of the use of STING in clinical practice, Prem Puri has made enormous efforts to popularize this procedure and make STING a standard of care in the management of VUR. Although this procedure had gained popularity in Europe and its creator was granted in 1984 the highest Irish national award-People of the Year Award-paediatric urologists in the North American continent were reluctant to use STING. The advent of a new tissue-augmented substance Deflux® approved by the FDA has changed the attitude of our American colleagues to endoscopic treatment and made them even more enthusiastic about STING than the Europeans.

It is an honour for me and a great privilege to write this tribute to Professor Prem Puri. Professor Puri is currently a Director of the Children's Research Centre at Our Lady's Hospital for Sick Children, Dublin and Consultant Paediatric Surgeon. He is a Council Member of the prestigious World Federation of Societies for Paediatric Urology (W.O.F.S.O.U.) and Honorary Member of the Asian Society for Paediatric Urology (A.S.P.U.) and Indian Society for Paediatric Urology (I.S.P.U.). He is also a member of other learned and scientific societies including Honorary Member of the American, Austrian, Argentinean, South African and Indian Association of Paediatric Surgeons. Professor Puri is the Editor-in-Chief of Pediatric Surgery International and Associate Editor of the Journal of Pediatric Surgery. I would like to express my warm approval of Prem's efforts to organize and develop basic and clinical research in paediatric urology and surgery; his interests are boundless. Professor Puri is the author of 9 monographs, 68 chapters and over 300 articles in peer-reviewed journals. Since 1985, more than 50 research fellows from around the world have worked and been trained in research under his supervision at the Children's Research Centre. Prem is our dearest mentor and friend.

Since the introduction of the endoscopic treatment of reflux, Prem and his group have been conducting research on the genetics of VUR and the pathogenesis of renal damage associated with VUR. We anticipate that a better understanding of the mechanism of renal damage will open new horizons in the management of VUR and renal scarring, and will allow us not only to fix the reflux but also to prevent renal damage at an early stage

Children with VUR and their parents, urologists and paediatric surgeons and physicians around the world owe a debt of gratitude to Professor Puri for his persistent and challenging treatment strategies in VUR over the past 20 years. I convey to Prem my personal warmest congratulations on the publication of this book with the sincere hope that paediatric urology will continue to benefit from his profound insight and tremendous working capacity, and we will be able to continue our fruitful collaboration and friendship for many years to come. With this in mind, the current volume of Progress in Paediatric Urology is dedicated to Mr. Prem Puri, Professor, MS, FRCS, FRCS (EDIN.), FACS.

A tribute by Boris Chertin, MD