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The Pioneering and Diverse Contributions of Leonard N. Zinman, M.D. to Urology
Marianne Casilla-Lennon, MD1, Stephanie Hanchuk, MD1, Alyssa Grimshaw, M.S.1, Patrick Kenney, MD1, Alex J. Vanni, MD2, Jaime A. Cavallo, MD, MPHS1.
1Yale School of Medicine, New Haven, CT, USA, 2Beth Israel Lahey Health, Burlington, MA, USA.

BACKGROUND: Few surgeons have contributed as broadly to the field of urology as the visionary Leonard N. Zinman, M.D. We sought to chronicle the pioneering and diverse contributions of Dr. Zinman to renovascular surgery, urologic oncology, and most notably as one of the founding fathers of reconstructive urology.
METHODS: A systematic literature search for the published work of Leonard N. Zinman, M.D. was performed in Web of Science, Embase, Medline, Scopus, and Google Scholar. Data were abstracted from the literature search results.RESULTS: After completing his urologic training at the Massachusetts General Hospital, Zinman was recruited to the Lahey Clinic in 1964. Zinman collaborated with John Libertino, M.D. to describe a hepatorenal arterial bypass for use in patients with renovascular hypertension for whom an aortorenal bypass was not possible. Zinman and Libertino also introduced a reversible right colocystoplasty as a capacious reservoir with an antireflux mechanism for bladder replacement. Among his landmark contributions, Zinman was the first to apply the combined use of 5-fluorouracil and mitomycin with radiation therapy to the treatment of urethral squamous cell carcinoma. The Nigro chemoradiation protocol revolutionized the treatment of urethral squamous cell carcinoma from extirpative to genital-preserving therapy. Zinman pioneered the use of gracilis muscle interposition flaps in rectourethral fistula repairs, and gracilis muscle flaps as vascular beds for oral mucosa grafts in augmented urethroplasties. These innovative muscle flap applications converted previously irreparable fistulae and strictures requiring urinary diversion to reconstructable anatomy with excellent outcomes. Similarly, he significantly reduced the need for bladder neck reconstruction with the application of intralesional mitomycin C injections to endoscopic urethrotomy for recalcitrant contractures. He eliminated the need for bowel resection to procure rectal mucosa graft for urethral reconstruction by applying the transanal endoscopic microsurgery technique. He also described a novel urethral-preserving technique for the removal of Urolume stents. Zinman is a founding member of the Society of Genitourinary Reconstructive Surgeons, and is responsible for helping to define reconstructive urology as a urologic subspecialty.
CONCLUSIONS: As a urologist with mastery of reconstructive skills, an innovator with diverse landmark contributions to urology, and a leader who defined the field of reconstructive urology and educated generations of trainees, Leonard N. Zinman, M.D. has been one of the most valuable assets to the field of urology.


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