R.E.
Abdel-Halim
Urology
Unit, King Abdul.Aziz University Hospital, Jeddah / Saudi Arabia
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PROCEEDINGS
The Third
Congress of The International Society of Urologic Endoscopy together with World
Health Organization (W.H.O.) Collaborating Centre For Urinary Bladder And Prostatic Cancer and with
European Organization Of Research
On The Treatment Of Cancer (E. O. R. T. C.) Genito-Urinary Tract Cancer
Cooperative Group.
August 26-
30,1984
Centre Of
Physics , University Of Karlsruhe
Karlsruhe
Federal
Republic Of Germany
President E.
Matouscheck, Karlsruhe
W.H.O.
Director F.
Edsmyr , Stockholm
E. 0. R. T.
C. /GU-Group Chairman
L.
Denis, Antwerpen
Local
Secretary R.-D.
Huber, Karlsruhe
Scientific
Program E.
Matouscheck, Karlsruhe
M. A. Reuter, Karlsurhe
Publisher Baden
Baden, bua-Verlag,
Werner Steinbruck (1985), pp 474-476
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Summary
Lithotripsy is
looked upon as one of the modern discoveries. However, in this paper we will trace the idea back to its
roots and review its progress with the subsequent modification of the
intstruments used until it attained its modern shape.
The idea of Lithotripsy lives too exclusively in the contemplation
of the so-called modern discoveries. Therefore, in this paper we will try to
follow the idea back to its roots.
Cumston (1968) attributes the silence of all Greek medical
literature as to the technique of Lithotomy to Hippocrate's teaching of
avoiding cystotomy. This doctrine according to Dimopolous et al (1980) lasted
several centuries after his death.
Therefore,
though the technique of Ammonius (200 B.C) for splitting a large stone through
a perineal cystotomy by using a scoop, chisel and hammer was described only by
Celsus (50A.D,), it may be considered as the earliest trial for crushing a
stone.
Celsus recommended it. However, it seems that the idea was not
popular as Charaka, Antyllus and Susruta up till the fourth century advised
against breaking a stone or even scratching it and Paulus in the seventh
century who is looked upon as summed up all medical knowledge accumulated up to
his time, did not mention a word about splitting a large stone.
From the ninth to the fourteenth century according to Cumston
(1968), Margotta (1968), Bickers (1969) and Desnos (1972), in Europe the
Graeco-Roman medicine came to an end and no progress was made in medical
science. However, in the East, Dickinson (1875), Cumson (1968) and Kirkup
(1981) stated that with the firm establishment of the Muslem supremacy, the
study of medicine along with other branches of science revived and acquired a
scientific nature.
In accordance with this, AI Razi who lived between 841-926 A.D.
described in full details a new technique for breaking a large stone, in the
tenth volume of his twenty three volumes book, "The Continens”, which
represents his principal contribution to medicine. He used a strong pincer to
hold firmly on a part of the stone made to protrude through a perineal
cystotomy and break it away. The process was repeated at different angles until
the stone is small enough to come out.
AI Razi's technique was not only an advance on classical
procedures as shown by Adams (1846) in his chronological review of lithotomy,
but also a landmark in the process of crushing a stone.
Afterwards, Albucasis, who lived between 930-1013 A.D. carried Al
Razi's originality further by designing a special forceps, AI Kalalib, by which
he could grasp firmly on a stone through a perineal cystotomy and with manual
compression break it into fragments. Therefore, Kirkup (1981) described
Albucasis forceps as the primitive lithotrite.
On the other hand, unlike Celsus, Paulus and AI Razi, in the case
of impacted urethral stone, Albucasis designed a fine drill AI Mishaab.. He
revolves it gently upon the stone, perforating it until piercing it through to
the other side, then by
the other
hand outside the penis, squeeze the remnants which will be washed out by the
urine.
Cumston (1981), Spink and Lewis (1973) and El- Faquih and Wallace
(1978) admitted that Albucasis' device represents the foundation of true
Lithotripsy.
In fact, Cumston (1968), Desnos (1972), Spink and Lewis (1973),
Campbell (1974), Ullmann (1978) and Montagnani (1983), stated that Albucasis
was not a mere compiler but rather a skillful surgeon who completely integrated
surgery into scientific medicine and his thirty volumes book AI Tasrif was
translated to Latin and greatly influenced the European medieval schools of
medicine well into the eighteenth century.
However, in Europe, the nineteenth century as Ellis ( 1969) and
Desnos (1972) stated, opened a period of ingenuity on the part of surgeons and
surgical instrument makers.
Therefore,
by the notion of getting at the stone while actually within the bladder,
Albucasis' idea of drilling by AI Mishaab which was introduced to the bladder
along a metal canula was the foundation of the Litholepte of Fournier de
Lempdes (1812), the instrument of Gruithuisen (1813), Civiale's trilabe (1818),
Leroy d'Etoilles' curved trilabe (1827) and the Brise Coque of Rigal de Jaillac
(1829) (Fig.
1). They differed only in their mode of stone fixation.
Then the final modification to Albucasis' idea of drilling was in
the replacement of AI Mishaab with a rotating burr as in Leroy d'Etoilles
Lithoprione (1822) and Civiale's Lithontripteur (1823).
On the other hand. AIbucasis' idea of Lithotrity was taken
further. The Lithotrite introduced by Andreas a Cruce, in the early eighteenth
century, was in fact, a modification of AIbucasis lithotrite in which the
manual compression on the handle was replaced by a screw action (Fig.
2).
In 1822, Amussat took the idea further by applying it
transurethrally instead of through a perineal cystotomy.
By 1832 Albucasis' principle of a pair of jointed serrated blades
to crush was replaced by the modem principle of parallel blades, first
advocated by Heurteloup in his percussion lithotrite. Then the percussion was
replaced by a sucessful screw action by 1834. Then further efforts were
directed towards the most efficient evacuation of fragments and by 1878,
according to Desnos (1972), Lithotripsy was recognized as a valuable and safe
surgical operation.
In conclusion, as Littre pointed out, "There is nothing in
the most advanced contemporary medicine whose embryo cannot be found in the
medicine of the past".
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