In the early twenties the first Urology Department was established at the Somerset Hospital in Cape Town with Bernard Fuller in charge. Fuller was a General Surgeon with a special leaning towards Urology. Soon after his arrival to start practice in Cape Town he was appointed as visiting Honorary Surgeon at the New Somerset Hospital. Under the guidance of Fuller, urological cases gradually became a separate entity and a department was established in 1924. Lionel Goldschmidt was appointed as Assistant Urological Surgeon under Bernard Fuller in 1925.

When Goldschmidt confined himself to Urology he was struck by the fact that this speciality was thriving in America and was more readily recognised there as a distinct entity than in Britain. He therefore undertook a study tour of the United States in 1930 and was particularly impressed with the newly established endoscopic techniques, especially at the Mayo Clinic, where Braasch and Bumpus developed the cold punch transurethral prostatectomy. He brought their ideas and instruments (including the Braasch cystoscope) back with him. He achieved great skill and success in the punch technique, but maintained that an urologist is a surgeon and strongly resisted attempts to turn urologists into mere endoscopists, with the general surgeons doing the open procedures (as practiced at the Mayo clinic at the time). In his view giving way on this principle would make of Urology an inferior speciality. Goldschmidt also stressed that careful and reasoned evaluation of radiological evidence of disease is an essential component in the assessment of the patient.

With the retirement of Fuller he became Head of Department of Urology at the New Somerset Hospital in 1931 and on 3 February 1938 the department (with all the other departments) transferred to the newly built Groote Schuur Hospital (GSH). Goldschmidt had outstanding ability as a surgeon and organiser and the department flourished. Not only did “students flock” to his clinics but graduates vied with one another to become his house surgeon. Goldschmidt played a major role in the fund raising, selection of the site planning of the Red Cross War Memorial Children’s Hospital. He resigned at the end of 1947.