Five historical innovations that have shaped modern urological surgery.

Throughout history, many innovations have contributed to the development of modern urological surgery, improving patient outcomes and expanding the range of treatment options available to patients. This article explores five key historical innovations that have shaped modern urological surgery: External shockwave lithotripsy, transurethral resection of prostate, cystoscope, perioperative prostate-specific antigen and robotic surgery. The selection of innovations for inclusion in this article was meticulously determined through expert consensus and an extensive literature review. We will review the development, impact and significance of each innovation, highlighting their contributions to the field of urological surgery and their ongoing relevance in contemporary and perioperative practice.

Transfer of Knowledge in Urology: A Case Study of Jacob Eduard Polak (1818-1891) and the Introduction of Contemporary Techniques of Lithotomy and Lithotripsy from Vienna to Persia in the Mid-19th Century: A New Analysis of Scientific Papers from the 19th Century.

The middle of the 19th century marks the beginning of a global process of science and knowledge transfer from -Europe to the rest of the world. During the phase of globali-zation, Austrian physician and ethnographer Jacob E. Polak (1818-1891) played a key role in the transmission of practical and scientific reasoning, leading to the development of medical science and clinical care in Persia. In 1851, Polak was commissioned by the Persian court to work as an academic teacher at the first secular institution of higher learning in Teheran, the Dar al-Fonun. After 4 years of teaching and working as a doctor and surgeon, Polak was appointed personal physician to the Qajar king, Naser-ad-Din Shah (r. 1848-1896). During Polak's 9 year stay in Persia, he performed numerous surgical operations with specific focus on lithotomies on men and women of all ages. He documented each operation and collected samples of bladder calculi for the purpose of chemical analysis. After his return to Austria, he published a detailed report on his practice of lithotomy in Persia. This extensive documentation is, we believe, the only known historical evidence that currently exists of the introduction of modern urology to Persia. This study will present Polak's role as a pioneer of modern medicine and lithotomy, and will examine how he introduced the latest achievements of Viennese medicine in the field of operative urology to Persia.

The modern history and evolution of percutaneous nephrolithotomy.

INTRODUCTION: Serendipity, innovative physicians, evolving techniques for renal access, and improvements in equipment and radiology led to the evolution of percutaneous nephrolithotomy (PCNL). METHODS: We searched urology texts and the literature for sources pertaining to the history and development of PCNL. RESULTS: In 1941, Rupel and Brown performed the first nephroscopy when a rigid cystoscope was passed into the kidney following open surgery. Willard Goodwin, in 1955, while trying to perform a renal arteriogram, placed a needle into the collecting system of a hydronephrotic kidney and performed the first antegrade nephrostogram. He left a tube to drain the kidney, thereby placing the first nephrostomy tube. By 1976, Fernström and Johansson were the first to describe a technique for extracting renal calculi through a percutaneous nephrostomy under radiological control. In 1978, Arthur Smith, would describe the first antegrade stent placement when he introduced a Gibbons stent through a percutaneous nephrostomy in a patient with a reimplanted ureter. Dr. Smith would coin the term "endourology" to describe closed, controlled manipulation of the genitourinary tract. His collaboration with Kurt Amplatz, an interventional radiologist and medical inventor, would lead to numerous innovations that would further advance PCNL. In the 1980s the process of renal access and tract dilation was improved upon and the use of a rigid cystoscope was replaced by offset nephroscopes with a large straight working channel. Radiographic innovations, including improvements in fluoroscopy would further aid in renal access. The development of various lithotripsy devices and the introduction of the holmium laser improved the efficiency of stone fragmentation and clearance. The increased clinical experience and utilization of PCNL would lead to the characterization of stone-free rates and complications for the procedure. CONCLUSION: Serendipity, innovations in renal access, optics, radiology, and improvements in lithotripsy all contributed to the modern day PCNL.

[Richard Strauß: a contribution on the occasion of his 150th birthday from an urological point of view]. / Richard Strauß: Ein Beitrag zu seinem 150. Geburtstag aus urologischer Sicht.

Richard Strauß is one of the most important composers of the first half of the 20th century. In this article, his life is represented with special emphasis on the points of contact with urology and on the field of conflict of the time. We give a detailed description of the composer's urological illness, which finally lead to his death. The last works of the master, composed at the beginning and during his last illness, are appreciated as touching creations of his parting. Finally, we compare the treatment of the prominent patient with the contemporary level of urology.

Civiale, stones and statistics: the dawn of evidence-based medicine.

The statistical research on bladder stones conducted by Paris urologist Jean Civiale in the early 19th century provided historical roots for evidence-based medicine. Translations of original documents by Civiale describing his work on treating bladder stones, and the discussion by members of the Paris Academy of Sciences that commented on his results in 1835, were reviewed. By collecting statistical data on a wide scale throughout Europe, Civiale argued that his new transurethral procedure, called lithotripsy, was superior to the more widely used but highly morbid technique, lithotomy. The Paris Academy of Sciences commented on his research and chose the occasion to debate whether or not numerical reasoning and statistics had any place in medical and surgical practice. Civiale's insights and methods espoused similar concepts and ideas driving today's new paradigm of evidence-based medicine.

'Crushing the stone': a brief history of lithotripsy, the first minimally invasive surgery.

OBJECTIVE: To trace the history of lithotripsy, marking the start of minimally invasive surgery. METHODS: Primary and secondary sources describing the development of lithotripsy as a method to treat common bladder stones were reviewed. RESULTS: Lithotripsy emerged in the early 19th century as an alternative to the morbid and frequently fatal perineal lithotomy practised for thousands of years to relieve sufferers of bladder stones. Lithotripsy developed in stages, first by learning how to pass a straight hollow sound, then drilling stones to break them up, later by crushing them, followed by means to evacuate the fragments, finally by integrating the lithotrite with the cystoscope, permitting surgery under direct vision. CONCLUSIONS: Lithotripsy evolved as the first minimally invasive surgical procedure owing to the ingenuity and skill of our urological forebears.

'Cutting for the stone': the ancient art of lithotomy.

OBJECTIVE: Bladder stone was a common ailment plaguing mankind from antiquity to the 20th century. Largely forgotten today, lithotomy relieved the anguish of bladder stones and identified urology as a medical specialty nearly 2500 years ago. METHODS: The historical literature pertaining to lithotomy was reviewed. Translated and original documents describing operative techniques and developments pertaining to the history of lithotomy were obtained through the internet and library sources. RESULTS: The ancient art of lithotomy was first recorded by the Greeks and evolved through five phases: the Celsian method, or 'lesser operation'; the Marian, or 'greater operation'; the lateral operation; suprapubic cystotomy, or 'high operation', and proctocystotomy. The practice of open lithotomy ceased to exist owing to better minimally invasive alternative methods and most notably by the virtual disappearance of bladder stones in modern man. CONCLUSIONS: The history of lithotomy is a fascinating story of how early surgeons forced by the culture and customs of the time dealt with common but devastating bladder stones. Out of their efforts, urology was born.

[The history of extracorporeal shockwave lithotripsy in Spain]. / Historia de la litotricia por ondas de choque en España.

We give a historical outline of urinary lithiasis with emphasis in the alternative therapeutic options to surgery. We expose the previous steps that led to the birth of extracorporeal shockwave lithotripsy and its implementation in our country.

[Bladder stone surgery in antiquity]. / Blaeresteinskirurgi i antikken.

Bladder stone with subsequent urinary retention was a common and challenging disease up to the 19 th century, and still is in tropical countries. Surgery has been used to remove stones (lithotomy) or to break them into small pieces (lithotripsy) since antiquity. If surgery was impossible, the urinary retention could be relieved with a catheter. The surgical technique for bladder stone remained unchanged up to the 16 th century, and some of its principles are still employed in urology. This article translates parts of Aulus Cornelius Celsus' treatise on bladder stone, found in his encyclopedia "De Medicina". The text is compared with archaeological findings from Pompeii.

Lithotomy by empirical doctors in the 19th century: a traditional surgical technique that lasted through the centuries.

PURPOSE: Lithotomy is an ancient surgical procedure, well-known in the history of urology. We describe the method as it was performed by empirical doctors in Greece during the 19th century and compare it to older techniques. MATERIALS AND METHODS: The original Greek text of a doctor's autobiography includes a description of a lateral perineal cystotomy performed by empirical doctors in 1818. The technique is compared with that described by Celsus and Byzantine medical writers. RESULTS: A study of the sources revealed that the 2 itinerant doctors who specialized in lithotomy used a lateral perineal cystotomy to remove stones from the bladder. Consent was obtained from the parents of the patient. The patient adopted the standard lithotomy position, the surgeon located the stone with his finger via the anus and immobilized it, and made a lateral perineal incision to remove it. A newly killed fowl was then placed on the wound. CONCLUSIONS: The ancient surgical lithotomy technique seems to have been passed on almost unchanged from father to son and has influenced urology in Europe since the time of Celsus (1st century AD) and the Byzantine surgeon Paul of Aegina (7th century AD). Postoperative therapy is similar to that of other Byzantine techniques, and it is interesting that written informed consent was obtained, signed in the presence of witnesses.

Methods of lithotripsy in ancient Greece and Byzantium.

PURPOSE: In this article we present the medical methods of lithotripsy applied by ancient Greek and Byzantine physicians, and their influence on the development of surgery after that time. MATERIALS AND METHODS: Study and analysis of the original texts of the Byzantine medical writers, written in Greek and containing the knowledge of the ancient Greek, Hellenistic and Roman periods, were performed. RESULTS: The Byzantine method of lithotripsy was the result of the eternal knowledge of the spasmolytic, analgesic and lithotriptic effect of various herbs, together with ancient surgical techniques of stone removal from Hellenistic and Roman periods. No operation was attempted for the extraction of stones from kidneys. Rather the idea was to drop the stones to the bladder or into the urethra, or dilute them into smaller pieces with various herbs. CONCLUSIONS: Ancient Greek and Byzantine physicians described conservative and surgical methods, derived from the texts of early surgeons, to which they added their own observations.

Franz von Paula Gruithuisen (1774-1852): lithotrity pioneer and astronomer. On the 150th anniversary of his death.

On the occasion of the 150th anniversary of the death of Franz von Paula Gruithuisen, the authors present his life and work. His most significant work in the fields of urology and lithotrity is examined, with special emphasis on the development of the latter field. He published his epoch-making historic study in 1813 in the Journal of Medicine and Surgery (Medicinisch-Chirurgische Zeitung). Franz von Paula Gruithuisen, the Bavarian physician and astronomer, led the way in the field of lithotrity. He developed crucial ideas on how to remove bladder stones transurethrally in a way that was safer and less likely to cause death. His instruments can be regarded as the model on which subsequent devices are based. Gruithuisen's influence on European medical scientists and, in particular, his rivalry with Jean Civiale are discussed.

Extraction of urinary bladder stone as described by Abul-Qasim Khalaf Ibn Abbas Alzahrawi (Albucasis) (325-404 H, 930-1013 AD). A translation of original text and a commentary.

This is a detailed study of the technique of cystolithotomy as practiced by the Muslim surgeon Alzahrawi (Albucasis) in Cordova more than 1000 years ago. In addition to translating the relevant chapter in his book Al-Tasreef, his technique is critically evaluated comparing it with that of his predecessors and his successors. The study confirmed the originality of Alzahrawi who described operative steps and invented operative instruments not known in the Greco-Roman era. He was also the first to describe, in details, the operative technique in women and to recommend the 2-stage operation in complicated cases. His modifications and innovations greatly influenced surgery in Middle Ages Europe up to the 18th century which witnessed the beginnings of the modern method using the suprapubic, instead of the perineal, approach. Alzahrawi's influence is vividly seen in the practice of the Italian lithotomist "Marianus Sanctus" (16th century), the French "Jack De Beaulieu" (17th century) and the English "Shelsden" (18th century). Alzahrawi is the founder of lithotripsy. He introduced Al-Kalaleeb forceps to crush large bladder stones and Al-Mishaab to drill and fragment an impacted urethral stone. Andreas a Cruce (18th century) only added screw action to Al-Kalaleeb lithotrite but Amussat managed in 1822 to apply it transurethrally. Similarly, by the notion of transurethrally getting at the stone while within the bladder, Alzahrawi's idea of drilling by Al-Mishaab was the foundation of the litholepte of Fournier de Lempdes (1812), the instrument of Gruithusien (1813), Civiale's trilabe (1818) and the brise coque of Rigal De Galliac (1829).

Extracorporeal shockwave therapy for chronic proximal plantar fasciitis.

Although much enthusiasm surrounds applying extracorporeal shock wave therapy for various musculoskeletal conditions, its effects are not well understood and warrant continued study. Certain body tissues or organs may be damaged either acutely or chronically by ESWT; however, it is unequivocal that lung tissue may be damaged. It is theorized that neovascularization is responsible for improvement in symptoms of plantar fasciitis. Neovascularization is the direct effect of macrophage stimulation through cytokines. ESWT has effects at the cellular level--does it interfere with metabolic activity or enhance it? The noninvasive nature and minimal complications of appropriately applied ESWT are its primary advantages. Symptoms may continue to improve for three weeks to six months after treatment; the effects of shock wave therapy seem to be time dependent. ESWT is an effective form of treatment for proximal insertional plantar fasciitis after exhaustive, conservative forms of treatment have failed.