Young, the founder of The Journal of Urology® (the official journal of the AUA), performed his first cancer surgery on April 7, 1904, removing the gland and adjacent tissue of an elderly preacher. Young did achieve some cures, though many prostate malignancies of the time were already well-advanced when diagnosed. But his approach continues its long history. Only when Britain's Terence Millin touted his retropubic approach—essentially Young's operation through a lower abdominal incision rather than a perineal one—in 1945 did surgeons have a second choice.
Yet these options, particularly Millin's, were infamous for their side effects, which could be life-threatening when bleeding was profuse. Virtually all men became impotent; 15-25 percent suffered severe incontinence. Not surprising, by the 1950s doctors had turned to radiation therapy—in lieu of surgery—for its fewer complications, even if it didn't cure the disease.
Walsh put Young and Millin's approaches back on the treatment map by applying his nerve-sparing technique. By defining the periprostatic anatomy, he showed surgeons how they could remove the gland without disturbing the adjacent vessels, nerve bundles, and sphincter mechanisms.