Throughout history stones have formed in the urinary tract (kidney and bladder). A list of some of the notable names in history to have formed stones can be found here.
One of the earliest recorded stones was found in an Egyptian mummy dating from 4800BC.
The earliest written references to stone surgery are from Hippocrates (c460-370BC). Indeed, the oath attributed to him includes the phrase:
"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"
in which he recognises that stone surgery was a specialist craft!
Until the 19th century bladder stones were removed via the perineum (area between genitals and anus) and were performed without anaesthesia. There was a high risk of death from bleeding or infection.
This picture shows how 3 men were required to hold down a patient for the procedure. This position is called the lithotomy position and is still used to describe the position that patients are placed in for surgery today.
There are many famous practitioners of stone surgery through the ages who described and modified the technique:
The next major step forward was fragmenting the stone transurethrally (via the waterpipe). This was performed blind. Some surgeons described passing a nail up the urethra and then cracking the stone by striking the nail with a hammer! Later, lithotrite devices were developed to grasp and crush the stone before removing it via the urethra (waterpipe).
Jean Civiale (1792-1867) was a French urologist who invented the lithotrite in 1832. He was a pioneer of modern urological and surgical practice.
- First example of minimally invasive surgery
- Civiale founded the first urology service in the world, at the Necker Hospital in Paris.
- Conducted evidence based medicine across Europe to prove to the surgical community that his technique was safer than the old lithotomy procedure. He demonstrated that his technique had a mortality of 2.2% compared to the traditional technique that had a mortality of 18.8%. One of Civiale's students, Sir Henry Thompson, brought the instrument and the technique to the UK.
In the last 30 years there have been great advances in the technology used to treat kidney stones. In the early 1980s the first lithotripters were used clinically and in the last 20 years flexible and semi-rigid ureteroscopes have been developed to look up inside the ureter and kidney and fragment stones. Also percutaneous nephrolithotomy (PCNL) has been developed as a minimally invasive method of removing large stones from the kidney. These procedures are generally very safe and effective in removing stones.