Moving on From Retzius: A Call for Change

Not many urologists are familiar with the racist legacy of Anders and Gustaf Retzius, 19^th century anatomists and principal engineers of the pseudo-science of racial biology.¹ The Retzius space designation is a minor accomplishment of Anders Retzius. The brothers notably studied human crania to support a notion of “racial biology,” implying the superiority of Nordic and Germanic races.² The far-reaching implications were foundational to Nazi eugenics, slavery, and the forced pseudo-tribalization of Africa. It is time urologists erase the Retzius eponym from our field.  

First, propagating the Retzius eponym is an overt perpetuation of racial science by commemorating men who used scientific authority to justify racial injustice. Such actions provided the foundation for medical racism and discrimination that still exist. Some physicians in the US believe Black patients have higher pain tolerance due to anatomic differences.³ These falsehoods lead to subpar medical care, harm, and death in Black patients. Our tacit acceptance of racist pseudoscience is a nidus of medical racism, causing physical, psychological, and emotional harm to our minority colleagues.

Second, eponyms honor those who have made advancements in their field but should only be maintained if done ethically. It is easy to view the actions of historical figures through a lens of moral superiority when reflecting on their lives in totality. Still, throughout history, there have frequently been opposers of immoral actions. For example, numerous syndromes named for Nazi scientists have been renamed as we attempt to respect the painful history of Jewish descendants.⁵ Perpetuating these eponyms dismisses the historical context surrounding their discovery and the emotional impact on others from immortalizing scientists with malicious and murderous intent.

This is not a call to erase history but for urologists to stop memorializing those who had little influence on our field and helped cause profound social upheaval. There is no reason to celebrate the Retzius’ for their minuscule contribution to urology. The recent popularity of Retzius-sparing prostatectomy is the most obvious example. However, Retzius never performed a prostatectomy. Pelvic fascial attachments within the Retzius space, not the space itself, preserve continence. Therefore, taking a cue from the upcoming PARTIAL trial, we suggest the more accurate term “Pelvic Fascia Sparing Prostatectomy.”⁴

Historical names can feel simultaneously important and innocuous for the non-marginalized majority not affected by racial stereotyping. Historical names can also be a constant and oppressive reminder of pervasive structural inequities that still exist. Small actions like erasing an eponym of minor importance can speak volumes to colleagues about our motivations. With that in mind, Retzius must be erased from our urologic vocabulary.

References

1. Martin LH, Cooley K, Seideman CA. The complex history of retzius: more than a preperitoneal eponym. Urology. 2022;169:6–8. https:// doi.org/10.1016/j.urology.2022.07.055. PMID: 35995239.
2. Kyllingstad JR. The origin of the long-skulled germanic race. Measuring the Master Race: Physical Anthropology in Norway 1890-1945. 1st ed. Washington DC: Open Book Publishers; 2014:1–16. http://www. jstor.org/stable/j.ctt15m7nd4.6. Accessed 10/25/22.
3. Hoffman KM, Trawalter S, Axt JR, Oliver MN. Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites. Proceed Nat Acad Sci. 2016;113:4296–4301.
4. Hu, J. C. (December 2021 - ).Clinical Trial of Approaches to Prostate Cancer Surgery (PARTIAL).  IdentifierNCT05155501. https://clinicaltrials.gov/ct2/show/NCT05155501
5. Karwacka W. The declining use of medical eponyms associated with the Nazi regime: a case study of changes in the international classification of diseases of the world health organization. Beyond Philol Int J Linguist Literary Stud Eng Langu Teach. 2021;18:77–102.
6. Image: Ansari, Maulana Mohammed. (2017). Retzius Space: Not A Single Anatomical Entity: New Insights, Simplified & Illustrated in A Laparoscopic Study during TEPP Hernioplasty for Inguinal Hernia. Annals of International Medical and Dental Research (AIMDR). 4. 63-73.

Authors

Belen Mora-Garijo, Keiko Cooley, Benjamin J. Davies, and Keith J. Kowalczyk
E-mail: Belen.mora@medstar.net (B. Mora-Garijo)