Cutting for the Stone

Shelley, Harry S.

doi:10.1093/jhmas/xiii.1.50

Cited by 9 publications

(7 citation statements)

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“…Bladder stones plagued mankind for ages, causing such unbearable suffering that people risked their lives for relief. For thousands of years before the 19th century, 'stone cutting', or lithotomy via a perineal incision, was the treatment of last resort, a gruesome procedure with frightful mortality [4]. Civiale became interested in bladder stones during his student days, and although he performed lithotomy, he deplored the brutality of the operation.…”

Section: Civiale and Lithotripsymentioning

confidence: 99%

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

Herr

2009

BJU International

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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.

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Section: Civiale and Lithotripsymentioning

confidence: 99%

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

Herr

2009

BJU International

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“…They caused such unbearable suffering that people were willing to risk their lives to get relief. For thousands of years before the 19th century, ‘cutting for the stone’ or lithotomy through a perineal incision was the treatment of last resort, a gruesome procedure, done without anaesthesia, and associated with frightful morbidity and mortality [1]. It took patients up to 3 months or longer to recover, many were left with erectile dysfunction, incontinence or persistent draining sinuses, and at least one of every four or five died, usually from bleeding or sepsis.…”

Section: Stones and Lithotomymentioning

confidence: 99%

“…However, about a century later, Haller mistook the cup for a drill and suggested that if a stone was too big to extract, it could be drilled. Although he never tried it nor is there any evidence that he passed his idea onto others, it appears that Haller (1708–1777), without realizing it, invented lithotresis, the drilling or boring holes in a calculus, and the first basic principle behind the first lithotrites [1].…”

Section: Basic Principlesmentioning

confidence: 99%

“…Most surgeons were hostile and contested the good results, calling it a blind operation, which it was. Boyer complained, ‘I see well the handle of the pan, but I do not see what is fried in it’[1]. Civiale castigated his colleagues for adhering to their old ways, calling them ‘butchers’ and too clumsy to carry out his delicate procedure.…”

Section: Civiale and Leroymentioning

confidence: 99%

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‘Crushing the stone’: a brief history of lithotripsy, the first minimally invasive surgery

Herr

2008

BJU International

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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.

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“…It can readily be surmised that if this operation were attempted on an adult with a well-devel oped prostate it would be fraught with danger, as there would be very little chance of pulling the adult male bladder into the perineum, while in a boy before puberty it might be accomplished without irreparable damage. Today we know that the average size of the prostate gland in a boy of 5 is 1.2 cm long, 1.5 cm wide, 0.9 cm thick; at puberty it starts to grow very rapidly, so that in an adult in his twenties the same measurements are 3.3, 4.1, and 2.4 cm, respectively [Shelley, 1958].…”

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confidence: 99%

The Operation of Lithotomy in Ancient Greece

Giannopoulos¹,

Kostakopoulos²,

Sofras³

et al. 1987

Urol Int

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Opening the bladder via the perineum in order to remove a bladder stone was practised by the ancient Greek surgeons in very early times, probably from the days of Homer. The technique of lithotomy was described for the first time by Celsus in the first century AD and has come to be known as the lesser operation or ‘apparatus parvus’, so called because only two instruments are needed for it, a knife and a hook. Two fingers of the surgeon’s left hand were introduced into the patient’s rectum while an assistant pressed on the lower abdomen to encourage descent of the stone near the neck of the bladder. A slightly curved incision was made in the skin near the anus and a second transverse incision was made through or immediately above the prostate, opening the bladder neck. The calculus was extracted from the wound by the fingers or by a hook. This ancient method of lithotomy as described by Celsus was the only one performed until the middle of the 16th century, and many surgeons advised the apparatus parvus as the operation of choice in young patients until the middle of the 18th century.

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Cutting for the Stone

Cited by 9 publications

References 0 publications

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

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

‘Crushing the stone’: a brief history of lithotripsy, the first minimally invasive surgery

The Operation of Lithotomy in Ancient Greece

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