On October 8, 1902, Young, who had honed his perineal approach by developing a specially crafted "tractor" to draw out the prostate, used his technique on Hawaii patient Samuel Alexander. Previously, Alexander had visited Baltimore and, upon talking with Young, requested that he perfect his technique and encouraged him to refine the procedure. Alexander was an inspiration to Young, who later wrote, "My indebtedness to him is great."
Others, such as Britain's Terence Millin, added their own techniques. Millin perfected and popularized today's retropubic operation in 1945, pursuing an abdominal cut directly into the prostate.
But not all prostatectomies involved incisions. In introducing his "punch" procedure, April 1, 1909, Young produced an endoscopic alternative to "big" operations for small tissue. Using his own remodeled urethroscope, Young made an incision into the urethra, caught the obstruction and sheared off the enlargement with a snug cutting tube. Once the enlargement had been removed, his patient urinated freely.