THEFASCINATINGHISTORYOFUROLOGY

ByStanleyHopkins,MD
UROLOGYINANCIENTTIMES
Urologyisanimportantmedicalspecialty,requiringknowledgeoftheentireinternaland
externalpathologyandtherapyofthegenitourinarytract.Italsotouchesonotherfields
suchasdermatology,internalmedicine,andsurgery.Thewordurologycomesfromthe
Greekouron,meaningurineandlogia,meaningstudyof.
Manhasbeeninterestedinthefunctionofthebladdersinceprehistorictimes.The
collectionandobservationofapersonsurinewasoftenusedasevidenceofoverall
healthandwellbeing,aswellasthepresenceofdisease.Hippocratesobservedthata
changeintheamountofwaterapersonconsumedcouldalterthestateofthatpersons
urine.BytheMiddleAges,therewereseveralwrittenworksontheartofanalyzingurine
forclarity,color,density,andsmell.Examiningthecharacteristicsofurineisstillbeing
done,andmanydiseasescanbelinkedtotheexcretionsfromthekidneys.
Conditionsandafflictionsoftheurinarysystem,aswellasancientceremonialrituals
relatedtothephallus,havebeenrecordedthroughouthistory.AncientHindutexts
describesurgeryforbladderstones.TheancientVedicsystemofmedicinealsonotesthe
useofcatheters.Therearestoriesofurologicaldiseasesandtreatmentsinancient
Armenian,Babylonian,Chinese,Hebrew,andPersianliterature.(1)

Theoldestproofofaurologicalhealthconditionisabladderstonedatingfrom5000
B.C.,whichwasdiscoveredbyarchaeologistsamongthepelvicbonesofateenageboyin
Egyptin1901.BladderstoneshavebeenfoundinEgyptianmummiesdatingtoseveral
millenniaBCE,andtheriteofcircumcisionisthoughttohavebeenpracticedinEgyptas
earlyas4000BCE.
IntheMiddleAges,studentsofanatomywerenotusuallyallowedtodissecthuman
bodies,andthismayhavecontributedtoalackofknowledgeoftheprostateandother
urinarytractorgans.LeonardodaVinci'ssketchesanddrawingsdonotshowtheprostate.
Hippocraticwritersdescribeindetailseveralafflictionsoftheurinarytract,with
emphasisonthecolorofurineandurinarysediment.Theydidnotperformsurgery,
becauseoftheOathofAesculapiustodonoharm,whichstates,inpart:I will not cut
for the stone, but will commit that affair entirely to the surgeons.However,itisbelieved
thistypeofsurgerywasdonebyothers,possiblytheancientGreeks.(2)
TheRomanAulusCorneliusCelsus(50BC50AD)describedtheneedforawide
incisiontoremovestoneswithoutuncontrolledruptureoftissue,potentiallycausing
urinaryfistula.(3)Forcenturies,attemptsatsurgeryresultedinsignificantpainand
postoperativecomplications,anditwasgenerallyconsidereddifficultanddangerous
untilmodern,morereliabletreatmentmethodsweredeveloped.
ObstructionsofthebladderhavebeendocumentedinancientEgypt,China,Rome,and
India.RomanandEgyptianphysiciansreportedlyusedcathetersmadeofhollowreeds.

Rigidurinarycatheterswereusedprimarilyinancienttimes,anditwasnotuntiltheend
oftheseventeenthcenturythataDutchsurgeon,VonSolingen,inventedaspirally
wound,flatsilverwirecatheterthatwasshapedtofitthecontoursoftheurethra.Fifty
yearslater,BenjaminFranklininventedasimilarcatheterforhisbrother,whosuffered
frombladderstones.Later,Franklinwouldneedthiscatheterforhisowncondition.It
hasonlybeeninthelast500yearsthattheprostatehasbeenidentifiedasacauseofurine
flowobstruction.
ThefirstattemptstomaketheurethravisibletothehumaneyegobacktotheFrankfurt
physicianPhilippBozzini,butitwasntuntilthenineteenthcenturythattheurinarytract
couldbeinspectedbytechnicalmeans.

TheHistoryofUrology,byLeonardJ.T.Murphy

WHATDISEASESDOUROLOGISTSTREAT?
Urologyisalsoknownasgenitourinarysurgery.Thisbranchofmedicinefocuseson
medicaldiseasesofthemaleandfemaleurinarytractsystemandmalereproductive
organsrequiringsurgery.Theorgansunderthedomainofurologyincludethekidneys,
adrenalglands,ureters,urinarybladder,urethra,andthemalereproductiveorgans(testes,
epididymis,vasdeferens,seminalvesicles,prostate,andpenis).

Urologiststreatbothmenandwomen.Fortypercentofthepatientswhoconsult
urologistsarewomenwithconditionssuchaskidneystones,genitourinarycancers,
urinaryincontinence,bloodintheurine,renalcysts,andmassesinthekidneys.
Sixtypercentofthepatientswhoconsulturologistsaremenwithconditionssuchas
kidneystones,enlargedprostrate(BPH,orbenignprostatichyperplasia),urinary
retention,cancer,urinaryincontinence,erectiledysfunction,andinfertility.
Urologistsalsotreatchildrenfornocturnalanddaytimeincontinence,andtheyoften
worktogetherwithnephrologists,whotreatmedicaldiseasesofthekidneys.
UROLOGYINTHEMODERNERA
Duringthenineteenthcentury,thedevelopmentofnewurologicalinstrumentsand
techniqueshelpedlaythegroundworktoestablishurologyasaseparatemedical
specialty.Thedevelopmentofthecystoscopeusheredinthemoderneraofurology,as
weknowittoday.Originally,thecystoscopewasdesignedusingcandleillumination,and
thentheuseofmirrorswasemployed.Butitwasntuntil1877thattheGermanurologist
MaxNitzeinventedtheforerunnerofthemoderncystoscope.AfterEdisoninventedthe
incandescentlampin1880,furtherrefinementstothepracticeofurologyensued.
Moderndayurologistsarewelltrainedinopenandminimallyinvasivetechniques,
employingrealtimeultrasoundguidance,fiberopticendoscopicequipment,andvarious
lasersinthetreatmentofmultiplebenignandmalignantconditions.Inaddition,
urologistsarepioneersintheuseofroboticsinlaparoscopicsurgery.

Urologyisoneofthemostcompetitiveandhighlysoughtaftersurgicalspecialties
physicianscanchoose,withnewurologistscomprisinglessthan1.5percentofU.S.
medicalschoolgraduateseachyear.InCanada,urologyisanexceedinglydifficult
specialtytomatch,withlessthan0.1percentoftheavailablepositionsdedicatedto
urology.Urologicsurgeons,orurologists,undergoaperiodofrigorouspostgraduate
surgicaltrainingforaminimumdurationoffiveyears,ofwhich12monthsmustbe
completedingeneralsurgery,and36monthsmustbecompletedinclinicalurology.The
remaining12monthsarespentingeneralsurgery,urology,orotherrelevantclinical
disciplines.Uponsuccessfulcompletionofaresidencyprogram,manyurologistschoose
toundergofurtheradvancedtraininginasubspecialtyareaofexpertisethrougha
fellowshiplastinganadditional12to36months.
Urologybeganwithextremelydangerouskidneystonesurgeries,buthasnowprogressed
tosafelasersandultrasoundtechniquesthatdonotpenetratethebody.Thepracticeof
urologyhasadvancedsubstantiallysincethedayswhenreedswereusedtorelieve
obstructionsofthebladder.Oncehumananatomywasexplored,doctorsbeganto
understandhowthevariousorgansfunctioned.Anestheticsandpenicillinimproved
surgicaloutcomes,andfewersideeffectswereachievedthroughtheuseofmodern
surgeryandrobotics.Currently,themedicalcommunityisfocusedonthepreventionof
conditionssuchasprostatecancer,andtheminimizationofthesideeffectsurology
treatmenthasonapatientsqualityoflife.
REFERENCES

1. Murphy,LeonardJ.T.andDesnos,Ernest,TheHistoryofUrology,CharlesC.
ThomasPublisher,Springfield,Illinois,1972.
2. Neuburger,MaxandRiesman,David,TheEarlyHistoryofUrology,BullMed
LibrAssn.1937;Feb;25(3);147165.
3. Nahon,IrminaandWaddington,Gordon,etal.,TheHistoryofUrologicSurgery,
UrolNurs.2011;31(3):173180.
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