“It is often said or implied that in our profession, a man cannot be practical and scientific; science and practice seem to the people to be incompatible. Each man, they say, must devote himself to the one or the other. The like of this has long been said, and it is sheer nonsense.”

Sir James Paget

Ahmed Ali Mustafa Shafik was born on 10 May 1933 in Menoufia, Egypt and died on 31 October 2007 in Paris, France at the age of 74 years – a lifespan that is, coincidentally, nearly equal to that of his Victorian counterpart Sir James Paget (1814–1889), the renowned surgeon, scientist and philosopher. Ahmed Shafik was educated at the Faculty of Medicine, Cairo University, Cairo, Egypt and qualified with honors in 1957. He first worked as a Registrar in Surgery at Cairo University Teaching Hospital from 1958 to 1960. He was then awarded a Doctorate Fellowship at the Department of Surgery, Faculty of Medicine, Cairo University from 1960 to 1962 and obtained his MD degree in 1962. Subsequently, he was Assistant Professor from 1962 to 1970, Associate Professor from 1970 to 1975 and Professor from 1975 onward at the Department of Surgery, Faculty of Medicine, Cairo University. He also became the Chairman of the Department of Surgery and Experimental Research, Faculty of Medicine, Cairo University in 1990, a position that he kept until his death.

Shafik served on many national, regional and international organization and association committees and executive boards. To name a few, he was the Honorary President of the Mediterranean Society of Coloproctology, the Mediterranean Society of Pelvic Floor Disorders and La Société de Perineologie. He received Honorary Fellowships from the Italian Academy of Coloproctology and La Société Nationale Française de Coloproctologie. He was one of the co-founding members of the International Society of University Colon and Rectal Surgeons (ISUCRS), serving as a Chairman of various committees before becoming the President Elect from 2004 to 2006. Shafik also became the personal physician to many dignitaries and world leaders and was invited to demonstrate his operative techniques worldwide. He was awarded the prestigious Egyptian State Prize for Science and Art of the first order in 1977 and was often considered by the public as the vibrant icon of the Egyptian Society of Surgeons. In return, in 1989 he established the Ahmed Shafik Foundation for Science, a non-profit organization that provides financial support to junior biomedical scientists and promotes community health care research in Egypt.

Shafik was a strong advocate of the missions of the International Urogynecological Association (IUGA), the International Continence Society (ICS) and the American Urological Association (AUA) and was an invited speaker and active participant at several of their annual meetings and workshops. Despite his busy schedule, he was a dedicated peer-reviewer for this journal. He was also a member of the editorial board of many high-impact scientific journals in surgery, coloproctology, andrology and reproduction.

Over his professional career, Ahmed Shafik authored and co-authored approximately 500 peer-reviewed and indexed original articles and reviews involving experimental and clinical studies in many fields of surgery, particularly the patho-physiological description of colorectal, lower urinary tract and genital diseases in both males and females. However, it will be his work in the area of female pelvic floor disorders that will be best remembered by the readership of this journal. His hypothesis was that reverse interaction and close integration exists between neighboring pelvic organs and pelvic floor support mechanisms that could be related to their embryological origins. The distinct feature of his research was methodological rigor: he first piloted his ideas in animal models then supported his preliminary findings with a series of cadaveric dissections in order to provide a theoretical and empirical rationale for clinical diagnosis and therapeutic intervention in a controlled trial. He revisited the gross and microscopic anatomy of the pelvic floor musculature and highlighted more than 100 reflexes that regulate and coordinate pelvic organ functions such as urinary and fecal continence, voiding, defecation and sexual performance. His monographs about the pelvic floor became a constant feature of standard texts in surgery and anatomy. He concluded his holistic approach to pelvic floor research by publishing the first theory on the pathogenesis of female stress urinary incontinence, the “Common Sphincter Concept,” in 1984. His studies expanded our knowledge on female urethral, anal canal and sexual functions and improved our clinical assessment of urinary and fecal incontinence, voiding disorders, constipation, chronic pelvic pain and sexual dysfunction in women.

Shafik was a master pelvic surgeon who made the most of his working knowledge of the morphologic, topographic and functional anatomy of the pelvis to develop many novel techniques such as the cutaneous uretero-ureterostomy urinary diversion (“Shafik I”) in 1964 and the perineal ileo-urethral neo-bladder (“Shafik II”) in 1967. He was the first, in 1991, to describe the “pudendal canal syndrome” caused by entrapment of the pudendal nerve in the pudendal canal, and pioneered treatment by surgical decompression. This relieved intractable pain and suffering in many patients with idiopathic proctalgia, scrotalgia, prostatodynia and vulvodynia. Erectile dysfunction and fecal incontinence, which are frequently associated with pudendal neuropathy, also responded favorably to this line of management. Shafik was fully aware of new operative procedures in urogynecology and with great insight realized their transdisciplinary potential. He thus investigated the role of submucosal connective tissue of the anal canal in fecal control, similar to the urethra, and the value of injecting bulking agents into the anal submucosa to increase the resting anal closure pressure in patients with idiopathic fecal incontinence.

Ahmed Shafik had the great personal qualities of all true scholars: humor, philanthropy, diligence, modesty, integrity and wisdom. Besides his significant and global contributions to the art and science of pelvic floor medicine, an important achievement of Ahmed Shafik was his ability to set an example of how, as an apt clinician, an academic career can be pursued whilst working in the developing world amid the complex, interrelated and often poorly understood local problems that challenge health care research, such as minimal incentives for academic accomplishments as opposed to full-time clinical service, shortage of research funding and infrastructure, limited access to health informatics and constrained human resources. I met Ahmed Shafik for the first time during the 17th Biennial Congress of the ISUCRS in Malmo, Sweden in June 1998 and discussed these concerns. His response was sharp: “Never give up your academic responsibilities and always try to strike a balance between clinical practice and academic commitments.... Remember that your job as a faculty is a physician and a scientist”. His advice for aspiring clinical academicians, particularly from developing countries, is as relevant today as it was 10 years ago. From 1998 onward, Ahmed Shafik was my mentor, senior colleague and close friend. Our last communication was two weeks prior to his death after reviewing a manuscript for the journal. As always, his appraisal was prompt, credible and instructive.

Ahmed Shafik will be sorely missed by his friends, colleagues and mentees throughout the whole world. On behalf of the urogynecologic community, I would like to send our condolences to his wife, Professor Olfat El-Sibai, and his sons, Dr. Ali Shafik and Dr. Ismail Shafik.