Diseases & Procedures Room

Cutting For The Stone (Lithotomy)
Cutting for bladder stones is the oldest, elective operation. The earliest bladder stone found was discovered in Egypt around 1900 and has been dated to 4900 BC. The earliest written records describing bladder stones date to before the time of Hippocrates (circa 460-370 BC).

The Hippocratic Oath includes the phrase: "I will not cut for stone, even for the patients in whom the disease is manifest; I will leave this operation to be performed by practitioners, specialists in this art."

Cystoscopy
The story of cystoscopy is the story of light itself. Shining a light into the bladder, so that its reflection allowed the interior to be visualised, was the very basis of cystoscopy.

Subsequent developments in the generation, focussing and amplification of light allowed the cystoscope to progress, resulting in a safe and useable instrument.

Radical Prostatectomy
The first radical prostatectomy for prostate cancer was carried out by Hugh Hampton Young on 7th April 1904 in Johns Hopkins Hospital. The perineal route was used. Young was assisted by his boss William Halstead.

This was the first radical operation carried out for carcinoma of the prostate with the intent of cure. The patient was symptomatically improved for eight months but died of sepsis after a litholapaxy for a stone that formed on one of the silk sutures.

Transurethral Bladder Stone Treatment
Stone destruction within the bladder and evacuation via the urethra represents the earliest attempt at minimally invasive surgery and endoscopic urology.

The story begins with early attempts at stone extraction, proceeds through the invention of lithotrity in the first part of the nineteenth century, advances to single-stage litholapaxy in the 1870’s and culminates in the clarity offered by the cystoscope.

John Hunter and his nephew, Everard Home (1756 - 1832), were the first to describe the prostate as a source of urinary outflow obstruction. Prior to this, surgeons such as Ambroise Paré thought there were urethral carnosities and tried to scrape them out using a sharp sound.

The TURP as we know it today developed from a combination of procedures including, prostatic and bladder neck incision, punches and cautery.

Nephroscopy & PCNL
Nephroscopy was first described by Rupel and Brown in 1941; by pushing a paediatric panendoscope over a nephrostomy tube into the kidney, a stone was removed with Lowsley’s biopsy forceps.

Nephrostomy was revisited in the 1970s as an open procedure; the nephroscope was introduced via an open pyelotomy.

PCNL was first described by Fernstrom and Johansson in 1976. The technique was championed in Britain by John Wickham who published a series of four cases of PCNL in 1981.