A History of Bladder Stone Removal

Hippocrates

Bladder stones have been treated both medically and surgically for many centuries. The oldest bladder stone discovered dates back to 4800 BC and was found by archeologists in Egypt around the turn of the 20th century. The first literary references to bladder stones date back to a time as early as, or earlier than, the time of Hippocrates. More than 23 centuries ago, Hippocrates warned that, “To cut through the bladder is lethal,” and part of the Hippocratic oath includes, “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.” His admonition to young physicians was to leave the risky and complicated procedure to the purveyors (ie, the lithotomists) of what could only be described as an art.

Famous historical figures who developed vesical calculi include King Leopold I of Belgium, Napoleon Bonaparte, Emperor Napoleon III, Peter the Great, Louis XIV, George IV, Oliver Cromwell, Benjamin Franklin, the philosopher Bacon, the scientist Newton, the physicians Harvey and Boerhaave, and the anatomist Scarpa.

Operations to remove bladder stones via the perineum were performed by Hindus, Greeks, Romans, and Arabs. Ammonius (200 BC), Celsus (first century), and the Hindu surgeon Susruta were among the first to write about perineal lithotomy to treat bladder calculi. They wrote excellent and sometimes detailed descriptions of the surgery, including preoperative and postoperative care and management. In the 1500s, Pierre Franco introduced suprapubic lithotomy. Frère Jacques Beaulieu developed the lateral approach to perineal vesicolithotomy in the late 1600s. An itinerant lithotomist with little anatomic understanding but impeccable character, Beaulieu performed the often-lethal procedure in France through the early 1700s. He is remembered by the urologic community as the subject of an old French nursery rhyme, although some have suggested that it was really written as a satirical mockery of the Jacobinic monks whose order was popular in France at the time.

In an attempt to avoid incisions, another form of surgical treatment, transurethral lithotrity, became more common in the early 1800s. Lithotrity was developed through creative applications of everyday tools. The Egyptian physicians were known to pass large wooden or cartilage cannulas through the urethra, followed by manual aspiration of the stones from the bladder. A popular technique of the 1700s involved passage of a long nail via the urethra; the nail was then struck with a blacksmith’s hammer, fracturing the stone.

Although many other creative and colorful transurethral instruments were developed, technological advancement in the modern era came in the form of the fenestrated lithotrite. This device allowed stones to be grasped and crushed so their fragments could be evacuated from the bladder via glass or metal suction bottles. Sir Philip Crampton was the first to introduce the manual crushing concept in Dublin (circa 1834). However, litholapaxy was not firmly established until Henry J. Bigelow, the famous professor of surgery at Harvard, performed (1876) and popularized (1878) the procedure. The mechanical crushing of stones remained popular through the 1960s and 1970s, although it was fraught with complications when performed by inexperienced urologists.

In the 1950s, endoscopic electrohydraulic lithotripsy (EHL) was first performed in the Soviet Union. Over the next 4 decades, multiple other modalities have been developed and allow safe transurethral or percutaneous stone ablation.

via Bladder Stones.

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2 Responses to A History of Bladder Stone Removal

  1. alfy says:

    Jim, you are too kind. I was touched that you did this post, just for me and left out all the nasty instruments.

  2. Deskarati says:

    Luckily Alfy, the procedure seems to have become quite commonplace and safe nowadays.

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