Most would agree that knowledge of the biological behavior of various diseases must be known in order to evaluate the need for, and the value of various types of therapy. However, there have been few studies of the biological behavior of many urinary tract disorders because the natural course of many diseases has been interrupted by some form of therapy, which has often been empirical. Symptomatic treatment of many diseases has been fostered by the belief that many forms of therapy may help, and atthe very least will do no harm. In addition, emphasis on treatment rather than diagnostics has been reinforced, by the philosophy espoused by some that "A chance to cut is a chance to cure". Unfortunately, the need for and value of many surgical procedures has not been evaluated by controlled clinical studies in which comparisons were made with medically managed and placebo managed groups of patients. The primary objective of this portion of the seminar is to emphasize the need for additional studies of the natural course of various urinary tract disorders, with emphasis on the indications for surgical intervention. We advocate the concept of being "thinking surgeons" rather than "cutting surgeons."
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