Early Urology Practices
Although recognition of urology as a separate specialty or sub-specialty of general surgery is relatively recent, evidence of many diseases and even some surgical procedures dating to ancient times have been discovered, diseases that later came under the purview of urology. Bladder stones have been found in Egyptian mummies dating to several millennia BCE, and the rite of circumcision is thought to have been practiced in Egypt as early as 4000 BCE. Ritual circumcision on the eighth day of life was practiced by the ancient Hebrews as evidence of God’s covenant with Abraham. A more elegant artistic portrayal of this ancient rite may be seen in Rembrandt’s etching of the circumcision of Christ.
Bladder Stone Surgery
The practitioners referred to by Hippocrates tended to be concerned mainly with bladder stones, which are known to have been common in the Middle Ages and the Renaissance. These stones, were probably due to dietary deficiencies and bladder outlet obstruction, usually found in men.
Ancient Hindu surgeons attempted to remove bladder stones through a supra-pubic incision, but the operation lapsed until 1556 when Pierre Franco successfully performed this procedure on a child. Two centuries later, the preferred approach was through the perineum.
One French lithotomist known as Frere Jacques, was said to have performed this procedures in 45 seconds, a record for all time. The English surgeon William Cheselden perfected this approach in the 19th century. The great English diarist Samuel Pepys underwent this operation with outstanding success, relating that he not only was relieved of symptoms but subsequently attained a reputation for sexual prowess, which he attributed to the procedure. The term “lithotomy position” is derived from the perineal approach to the bladder.
Lithotrity & Uroscopists
The procedure for crushing a bladder stone is known as lithotrity, contrasted to the open lithotomy, the proverbial “cutting for the stone.” The first lithotrity was performed in 1824 by Jean Civiale in France. Another harbinger of the later development of urology as a specialty was the practice of “water casting,” which involved diagnosing a variety of diseases by the simple expedient of observing the patient’s urine in a flask; these practitioners were known as uroscopists or water casters.
Perhaps one thing that contributed to the splitting off of urology from general surgery was the development of the cystoscope in the 19th century. Beginning in 1807, a number of instruments were devised to peer into body cavities, but it was not until 1877 that Max Nitze, in collaboration with an instrument maker in Dresden, fabricated the first cystoscope. The improvement during the following years was after the invention of the incandescent lamp by Thomas Edison in 1880 and a miniaturization of an instrument similar to that was developed.