Human beings have known of bladder stones for thousands of years, and have attempted to treat them for almost as long. The oldest bladder stone that has been found was discovered in Egypt in 1901, and it has been dated to 4900 BC.[1] The earliest written records describing bladder stones are in papyrus dating from 1500 BC in Ancient Egypt.[1] Disease caused by the formation of stones was described in Mesopotamia from 3200 to 1200 BC; the first description of a surgical procedure to treat stones was described in the Sushruta Samhita by Sushruta around 600 BC.[1]
The presence of specialist lithotomists is described by Hippocrates, and is also included in the famous Hippocratic Oath: "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," a clear warning for physicians against the "cutting" of persons "laboring under the stone"; an act that was better left to surgeons, as distinct from physicians. Lithotomy at the time involved operations to remove bladder stones via the perineum; like other surgery before the invention of anesthesia, these were intensely painful for the patient, and since antibiotics were not yet available, often resulted in deadly infection and inflammation as well.[1][2]
Ammonius, who practiced lithotomy in Alexandria circa 200 BC, coined the term lithotomy, and acquired the sobriquet Lithotomus from the instrument he developed for fragmenting stones too large to pass through a small perineal incision.[3][4][1] He used a small hook to keep the stone in one position, and then a blunt instrument to crush it.[1]
Aulus Cornelius Celsus (1st century), and the Hindu surgeon Susruta produced early descriptions of bladder stone treatment using perineal lithotomy.[5][6] The 7th-century Byzantine Greek physician Paulus Aegineta's Medical Compendium in Seven Books contains a description of lithotomy that closely follows that of Celsus.[citation needed]
Albucasis in the tenth century AD describes a procedure different from previous ones, using an incision to the side of the midline,[1] and with a knife that is "sharp on two sides" (Spinks and Lewis say it is difficult to reconcile the drawing of the knife to the procedure).[2] Albucasis also adds using forceps instead of the scoop and chisel of Ammonius to break up the stone. Albucasis also uses a "drill" for stones impacted in the urethra, a technique not recorded earlier.[2] Techniques described as similar to Albucasis' were seen for the next eight hundred years.[1]
Middle Ages to modern times
Little changed in technique or instruments throughout the Middle Ages. Most lithotomists were commercial travellers, conducting procedures in places able to be attended by onlookers.[1] In the 16th century, Laurent Colot and Pierre Franco (1505–1578) were pioneers in the suprapubic lithotomy method, in which an incision is made above the bladder.[7][1]Frère Jacques Beaulieu (also known as Frère Jacques Baulot[8][9]) developed an operation that went in laterally to remove the bladder stones in the late 16th century. Beaulieu was a travelling lithotomist and a Dominican Friar, with scant knowledge of anatomy. Beaulieu performed the procedure frequently in France into the late 16th century. A possible connection between the French nursery rhyme Frère Jacques and Frère Jacques Beaulieu, as claimed by Irvine Loudon[10] and many others, was recently explored without finding any evidence for a connection.[11] French composer Marin Marais wrote "Tableau de l'opération de la taille" ("tableau of a Lithotomy"), a musical description of the operation, in 1725.[12]
A less invasive technique was described by Ottoman surgeons Sabuncuoğlu Serafettin and Ahi Ahmed Celebi in the sixteenth century, involving accessing the bladder through the urethra, and then washing it with fluid.[1]
Lithotomy was successfully performed by some practitioners in the 17th century, for example Johann Andreas Eisenbarth (1663–1727). Other important names in its historical development were Jean Zuléma Amussat (1796–1856), Auguste Nélaton (1807–1873), Henry Thompson (1820–1904) and William Cheselden (1688–1752). The latter invented a technique for lateral vesical stone lithotomy in 1727, whereupon he was said to perform the operation in about one minute (an important feat before anesthesia).
In England, William Thornhill performed his first suprapubic operation on a boy privately on 3 February 1722 (O.S.; 14 February 1723 N.S.)[13] The records of his work, published by his colleague, John Middleton, M.D., prove that his experience in the operation and his success were greater than any contemporary English surgeon could show.
Special surgical instruments were designed for lithotomy, consisting of dilators of the canal, forceps and tweezers, lithotomes (stone cutters) and cystotomes (bladder cutters), urethrotomes (for incisions of the urethra) and conductors (grooved probes used as guides for stone extraction). The patient is placed in a special position on a lithotomy operating table, called the lithotomy position (which retains this name to the present day, when the same position is used for other unrelated medical procedures).
Move to less invasive procedures
Transurethral lithotripsy, which was much simpler and with lower morbidity, complication and mortality rates, was invented by FrenchsurgeonJean Civiale (1792–1867) and largely substituted for surgical lithotomy, unless the crushing of calculi was difficult or impossible.
↑ Greive, James; Celsus, Aulus Cornelius; Royal College of Physicians of Edinburgh (1814). Of medicine in eight books. Royal College of Physicians in Edinburgh. Edinburgh: Dickinson and company.
↑ Androutsos G (2004). "[Pierre Franco (1505–1578): famous surgeon and lithotomist of the 16th century]". Prog Urol (in French). 14 (2): 255–9. PMID15217153.
↑ Evers S (1993). "[Tableau de l'opération de la taille by Marin Marais (1725)—a bladder calculus operation represented in music]". Urologe A (in German). 32 (3): 254–9. PMID8511837.
Urology, also known as genitourinary surgery, is the branch of medicine that focuses on surgical and medical diseases of the urinary-tract system and the reproductive organs. Organs under the domain of urology include the kidneys, adrenal glands, ureters, urinary bladder, urethra, and the male reproductive organs.
Kidney stone disease, also known as renal calculus disease, nephrolithiasis or urolithiasis, is a crystallopathy where a solid piece of material develops in the urinary tract. Renal calculi typically form in the kidney and leave the body in the urine stream. A small calculus may pass without causing symptoms. If a stone grows to more than 5 millimeters, it can cause blockage of the ureter, resulting in sharp and severe pain in the lower back or abdomen. A calculus may also result in blood in the urine, vomiting, or painful urination. About half of people who have had a renal calculus are likely to have another within ten years.
A bladder stone is a stone found in the urinary bladder.
Abū al-Qāsim Khalaf ibn al-'Abbās al-Zahrāwī al-Ansari, popularly known as al-Zahrawi (الزهراوي), Latinised as Albucasis or Abulcasis, was a physician, surgeon and chemist from al-Andalus. He is considered one of the greatest surgeons of the Middle Ages.
Lithotripsy is a procedure involving the physical destruction of hardened masses like kidney stones, bezoars or gallstones, which may be done non invasively. The term is derived from the Greek words meaning "breaking stones".
Jean Civiale (1792–1867) was a French surgeon and urologist, who, in 1823, invented a surgical instrument and performed transurethral lithotripsy, the first known minimally invasive surgery, to crush stones inside the bladder without having to open the abdomen (lithotomy). To remove a calculus, Civiale inserted his instrument through the urethra and bored holes in the stone. Afterwards, he crushed it with the same instrument and aspired the resulting fragments or let them flow normally with urine.
Jean Zuléma Amussat was a French surgeon.
A calculus, often called a stone, is a concretion of material, usually mineral salts, that forms in an organ or duct of the body. Formation of calculi is known as lithiasis. Stones can cause a number of medical conditions.
A suprapubic cystostomy or suprapubic catheter (SPC) is a surgically created connection between the urinary bladder and the skin used to drain urine from the bladder in individuals with obstruction of normal urinary flow. The connection does not go through the abdominal cavity.
A urethrotomy is an operation which involves incision of the urethra, especially for relief of a stricture. It is most often performed in the outpatient setting, with the patient (usually) being discharged from the hospital or surgery center within six hours from the procedure's inception.
Stress incontinence, also known as stress urinary incontinence (SUI) or effort incontinence is a form of urinary incontinence. It is due to inadequate closure of the bladder outlet by the urethral sphincter.
Frère Jacques Beaulieu, OP ; 1651–1720), also known as Frère Jacques Baulot, was a travelling lithotomist with scant knowledge of anatomy and was also a Dominican friar. Beaulieu performed the frequently deadly procedure in France into the early 18th century.
Urethroplasty is the surgical repair of an injury or defect within the walls of the urethra. Trauma, iatrogenic injury and infections are the most common causes of urethral injury/defect requiring repair. Urethroplasty is regarded as the gold standard treatment for urethral strictures and offers better outcomes in terms of recurrence rates than dilatations and urethrotomies. It is probably the only useful modality of treatment for long and complex strictures though recurrence rates are higher for this difficult treatment group.
Sir Henry Thompson, 1st Baronet, was a British surgeon and polymath. His interest was particularly in the surgery of the genito-urinary tract.
The Michaab was an early medical device, invented by Al-Zahrawi, a form of lithotrite which was minimally-invasive. He was able to crush the stone inside the bladder without the need for a surgical incision. It was later modified by Jean Civiale, and was used to perform transurethral lithotripsy, the first known minimally invasive surgery, to crush stones inside the bladder without having to open the abdomen (lithotomy). To remove a calculus the instrument was inserted through the urethra and holes bored in the stone. Afterwards, it was crushed with the same instrument and resulting fragments aspirated or allowed to flow normally with urine.
Ammonius Lithotomos, of Alexandria, was a Greek lithotomist.
Joseph Souberbielle was a French surgeon. He was a relative of Jean Baseilhac (1703–1781), a surgeon who was a major influence to Souberbielle's career.
Claude-Nicolas Le Cat was a French surgeon and science communicator.
Johann Jakob Rau Latinized as Johannes Jacobus Rau was a Dutch surgeon and anatomist who made advances in lithotomy or the treatment of urinary stones.
Ancient Roman surgical practices developed from Greek techniques. Roman surgeons and doctors usually learned through apprenticeships or studying. Ancient Roman doctors such as Galen and Celsus described Roman surgical techniques in their medical literature, such as De Medicina. These methods encompassed modern oral surgery, cosmetic surgery, sutures, ligatures, amputations, tonsillectomies, mastectomies, cataract surgeries, lithotomies, hernia repair, gynecology, neurosurgery, and others. Surgery was a rare practice, as it was dangerous and often had fatal results. To perform these procedures, they used tools such as specula, catheters, enemas, bone levers, osteotomes, phlebotomes, probes, curettes, bone drills, bone forceps, cupping vessels, knives, scalpels, scissors, and spathas.
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