A Brief History of Urology

Henrietta Strickland
September 30, 2019

 

Urology the study of the male and female urinary tracts and male sexual organs has a rich and fascinating history. The earliest known example of a urological surgical procedure comes from an ancient Egyptian bas-relief in which two men are depicted performing circumcisions. 

Since then, urology has evolved to incorporate everything from nanotechnology to 3D printing. To celebrate Urology Awareness month, here is a brief history of Urology from the dawn of civilisation to the present day.


Urology in Ancient Times


As previously mentioned, the first recorded example of urology in practise – a circumcision operation - comes from an ancient Egyptian relief carving. But it wasn’t long before the Ancient Indians began to carry out their own urological procedures too.


In fact, the
first reference to a specific urological disease was made in the Atharva Veda – an ancient Indian Vedic text. The text suggests treating urinary retention problems with camphor and herbs rubbed onto the abdomen whilst chanting specific hymns.


It also recommends several remedies for sexual dysfunction. Before the days of Viagra sexual dysfunction problems such as erectile dysfunction (ED) could not simply be treated with sildenafil (the active ingredient in Viagra). Instead, natural herbs were used for their supposed erection-boosting benefits. The Atharva recommends consuming certain roots boiled in milk whilst chanting hymns to restore sexual vigour.


In the 9th century BC, ancient Indian medicine (Ayurveda) was heavily influenced by two key figures: Charaka and Susruta. The works of Charaka, called the Charaka Samhita, explore relatively advanced urological techniques such as urinalysis (the analysis of urine) and the causes of conditions like urinary retention.


Susruta, on the other hand, wrote the Susruta Samhita – a Sanskrit medical text regarded as one of the earliest known teachings of surgery. Not only does it highlight multiple urological diseases, but it also describes sophisticated medical equipment such as urethral probes, dilators, and irrigating syringes used to deliver medicines.

 

 

As the centuries rolled on by, other countries around the world began to offer their own solutions to urological diseases. 

 

Ancient Mesopotamians treated incontinence of urine by passing medication through a bronze tube that was inserted into the urethra. In ancient Greece, Hippocrates (who is often referred to as “the father of medicine”) made many urological breakthroughs that we now know to be true today, including the well-known fact that urine is made in the kidneys and flows into the bladder. Ancient Israelites treated bladder stones by taking three drops of tar, leek juice, and clear wine, and applying them to the affected man’s penis or inside the affected woman’s urethra. 

 

But urology still had a long way to go before it became a recognised and distinguished branch of medicine... 


Urology from the 17th to the 19th century

 

The 17th century was known as the era of “travelling lithotomists”. These travelling “surgeons” would journey the country removing bladder stones - without using anaesthesia. They would remove the stones though insertions in the perineum (the delicate area between the genitals and the anus) whilst the patient was pinned to a table by the surgeon’s assistants. 

 

Perhaps the most famous person to have gone under the lithotomists’ knife was Samuel Pepys, a Member of Parliament and famous diarist. He survived the procedure (which was lucky, as it was common for patients to die during the operation) and a stone the size of a billiard ball was extracted from his bladder.

After just five weeks Pepys made a full recovery (although it is believed the lithotomy may have left him infertile). Bizarrely, he kept the stone as a momento and even held a yearly banquet - which he named the “stone feast” - in honour of the success of the operation.   

 

Lithotomy was so common during the 17th and 18th centuries that “cutting the stone” became synonymous with urology. However in the 19th century a breakthrough was made that would change urology forever. In 1807, Philipp Bozzini created the cystoscope - a device that allowed urologists to see into body cavities (like the bladder) without cutting them open. 

 

The first cystoscope, which Bozzini called the Lichtleiter ("light conductor"), was a thin metal tube that used mirrors and the light from a candle to illuminate the inside of orifices such as the urethra. 

 

Although it did not work very well, it prompted the development of more efficient and practical variations of the cystoscope. Urologist Max Nitze created a cystoscope that used a heated platinum wire and illuminated the bladder from the inside. However, this version of the cystoscope was too hot and burned out too quickly. 

 

It wasn’t until Thomas Edison’s invention of the lightbulb in 1880 that cystoscopes became more efficient. Various models of the cystoscope were developed using this new technology, including the Brown-Buerger cystoscope, which used a lamp to see into the urethra and bladder. 

 

The Brown-Buerger cystoscope was quickly adopted by surgeons and became the “staple cystoscope of the American urologist for nearly six decades”. But in the middle of the 20th century, a new and improved competitor entered the market...

 

Urology in the 20th century 

 

By a twist of fate, two of the most significant contributions in the history of urology were discovered by accident in the 20th century. The first was the Hopkins rod-lens system. 

 

In 1951 Harold Horace Hopkins was on a quest to make attaching lenses to cystoscopes easier. He also wanted to make the lenses more stable than the ones in traditional cystoscopes, which contained thin glass lenses.

 

In his quest to improve the existing cystoscopes, Hopkins accidentally developed thicker lenses that not only improved image quality and light transmission, but also made lens mounting and holding much easier. 

 

After unveiling it in a lecture in Cologne in 1965, he was contacted by Karl Storz, a young German businessman. Storz purchased the patent for the product, modified its original design by adding flexible fibre optics to the system, and revealed the new and improved instrument at the International Society of Urology in 1967. It eclipsed the competition and generated widespread demand. To this day, urologists still use the Hopkins lens technology to diagnose, and ultimately treat, urological diseases.

 

The second accidental-yet-revolutionary urological breakthrough was the invention of Viagra. Before 1998 there were no oral treatments for erectile dysfunction (ED). The only “cures” available were an injection into the penis or a prosthetic implant. 

 

When the little blue pill burst onto the scene in 1998, men were presented with a new and more convenient way to treat their ED. However, before it shot to fame Viagra started life as the humble blood pressure medication UK92480.

 

The treatment was originally intended to relieve chest pain caused by angina. But patients quickly discovered that the medication came with an unexpected side effect — harder erections. 

 

Astonished by the influx of patients reporting this baffling side effect, Pfzier (the creators of Viagra) decided to investigate further. After undergoing various lab experiments, Viagra exploded onto the market and racked up $1 billion in its first year. 

 

Urology today 

 

There have been some pretty dramatic technological advances in urology since Hopkins' cystoscope. Scientists recently showed that gold nanoparticles are effective in treating prostate cancer. Engineers at Purdue University developed a nappy that can detect urinary tract infections (UTIs). Scientists at ETH Zurich created a 3D printed stent that can be implanted into the urethrae of fetuses to prevent urethral strictures (narrowing of the urethra caused by injury, a birth defect, or infection). 

 

Significant developments have also been made in the sphere of ED treatments. In 2003 the patent held by Viagra expired, allowing other companies to sell sildenafil under their own brand names. 

 

Since then, a whole host of men’s wellness companies have sprung up to provide their own solutions to ED. One of the freshest contenders is Numan. Not only does it offer a range of ED treatments, but it also provides editorial content to help men and women understand the condition in greater detail.  

 

Urology is constantly evolving. The progress made within the field of urology is incredibly important, as it is estimated that 1 in 2 of us will be affected by a urology condition in our lifetime. 

 

Even though advances in technology are making it easier to treat certain urological conditions, diseases like prostate cancer still kill millions of men worldwide. UTIs affect infants and the elderly alike. ED is a source of frustration for many couples. 

 

Awareness of the importance of urology and good urological health will go a long way to ensure urological conditions are nipped in the bud as soon as they arise, and that the discipline of urology continues to progress for years to come. 















 

 

 

 

 

 

 

 

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