THE FASCINATING HISTORY OF UROLOGY
By Stanley Hopkins, MD
UROLOGY IN ANCIENT TIMES
Urology is an important medical specialty, requiring knowledge of the entire internal and external pathology and therapy of the genitourinary tract. It also touches on other fields such as dermatology, internal medicine, and surgery. The word “urology” comes from the Greek οὖρον ouron, meaning “urine” and -λογία -logia, meaning “study of.”
Man has been interested in the function of the bladder since prehistoric times. The collection and observation of a person’s urine was often used as evidence of overall health and well-being, as well as the presence of disease. Hippocrates observed that a change in the amount of water a person consumed could alter the state of that person’s urine. By the Middle Ages, there were several written works on the art of analyzing urine for clarity, color, density, and smell. Examining the characteristics of urine is still being done, and many diseases can be linked to the excretions from the kidneys.
Conditions and afflictions of the urinary system, as well as ancient ceremonial rituals related to the phallus, have been recorded throughout history. Ancient Hindu texts describe surgery for bladder stones. The ancient Vedic system of medicine also notes the use of catheters. There are stories of urological diseases and treatments in ancient Armenian, Babylonian, Chinese, Hebrew, and Persian literature. (1)
The oldest proof of a urological health condition is a bladder stone dating from 5000 B.C., which was discovered by archaeologists among the pelvic bones of a teenage boy in Egypt in 1901. Bladder stones have been found in Egyptian mummies dating to several millennia BCE, and the rite of circumcision is thought to have been practiced in Egypt as early as 4000 BCE.
In the Middle Ages, students of anatomy were not usually allowed to dissect human bodies, and this may have contributed to a lack of knowledge of the prostate and other urinary tract organs. Leonardo da Vinci’s sketches and drawings do not show the prostate.
Hippocratic writers describe in detail several afflictions of the urinary tract, with emphasis on the color of urine and urinary sediment. They did not perform surgery, because of the Oath of Aesculapius to “do no harm,” which states, in part: “I will not cut for the stone, but will commit that affair entirely to the surgeons.” However, it is believed this type of surgery was done by others, possibly the ancient Greeks. (2)
The Roman Aulus Cornelius Celsus (50 BC –50 AD) described the need for a “wide incision to remove stones without uncontrolled rupture of tissue, potentially causing urinary fistula.” (3) For centuries, attempts at surgery resulted in significant pain and post-operative complications, and it was generally considered difficult and dangerous until modern, more reliable treatment methods were developed.
Obstructions of the bladder have been documented in ancient Egypt, China, Rome, and India. Roman and Egyptian physicians reportedly used catheters made of hollow reeds. Rigid urinary catheters were used primarily in ancient times, and it was not until the end of the seventeenth century that a Dutch surgeon, Von Solingen, invented a spirally wound, flat silver wire catheter that was shaped to fit the contours of the urethra. Fifty years later, Benjamin Franklin invented a similar catheter for his brother, who suffered from bladder stones. Later, Franklin would need this catheter for his own condition. It has only been in the last 500 years that the prostate has been identified as a cause of urine flow obstruction.
The first attempts to make the urethra visible to the human eye go back to the Frankfurt physician Philipp Bozzini, but it wasn’t until the nineteenth century that the urinary tract could be inspected by technical means.
WHAT DISEASES DO UROLOGISTS TREAT?
Urology is also known as “genitourinary surgery.” This branch of medicine focuses on medical diseases of the male and female urinary tract system and male reproductive organs requiring surgery. The organs under the domain of urology include the kidneys, adrenal glands, ureters, urinary bladder, urethra, and the male reproductive organs (testes, epididymis, vas deferens, seminal vesicles, prostate, and penis).
Urologists treat both men and women. Forty percent of the patients who consult urologists are women with conditions such as kidney stones, genitourinary cancers, urinary incontinence, blood in the urine, renal cysts, and masses in the kidneys.
Sixty percent of the patients who consult urologists are men with conditions such as kidney stones, enlarged prostrate (BPH, or benign prostatic hyperplasia), urinary retention, cancer, urinary incontinence, erectile dysfunction, and infertility.
Urologists also treat children for nocturnal and daytime incontinence, and they often work together with nephrologists, who treat medical diseases of the kidneys.
UROLOGY IN THE MODERN ERA
During the nineteenth century, the development of new urological instruments and techniques helped lay the groundwork to establish urology as a separate medical specialty. The development of the cystoscope ushered in the modern era of urology, as we know it today. Originally, the cystoscope was designed using candle illumination, and then the use of mirrors was employed. But it wasn’t until 1877 that the German urologist Max Nitze invented the forerunner of the modern cystoscope. After Edison invented the incandescent lamp in 1880, further refinements to the practice of urology ensued.
Modern-day urologists are well-trained in open and minimally invasive techniques, employing real-time ultrasound guidance, fiber-optic endoscopic equipment, and various lasers in the treatment of multiple benign and malignant conditions. In addition, urologists are pioneers in the use of robotics in laparoscopic surgery.
Urology is one of the most competitive and highly sought-after surgical specialties physicians can choose, with new urologists comprising less than 1.5 percent of U.S. medical school graduates each year. In Canada, urology is an exceedingly difficult specialty to match, with less than 0.1 percent of the available positions dedicated to urology. Urologic surgeons, or urologists, undergo a period of rigorous post-graduate surgical training for a minimum duration of five years, of which 12 months must be completed in general surgery, and 36 months must be completed in clinical urology. The remaining 12 months are spent in general surgery, urology, or other relevant clinical disciplines. Upon successful completion of a residency program, many urologists choose to undergo further advanced training in a subspecialty area of expertise through a fellowship lasting an additional 12 to 36 months.
Urology began with extremely dangerous kidney stone surgeries, but has now progressed to safe lasers and ultrasound techniques that do not penetrate the body. The practice of urology has advanced substantially since the days when reeds were used to relieve obstructions of the bladder. Once human anatomy was explored, doctors began to understand how the various organs functioned. Anesthetics and penicillin improved surgical outcomes, and fewer side effects were achieved through the use of modern surgery and robotics. Currently, the medical community is focused on the prevention of conditions such as prostate cancer, and the minimization of the side effects urology treatment has on a patient’s quality of life.
- Murphy, Leonard J. T. and Desnos, Ernest, The History of Urology, Charles C. Thomas Publisher, Springfield, Illinois, 1972.
- Neuburger, Max and Riesman, David, The Early History of Urology, Bull Med Libr Assn. 1937; Feb; 25(3); 147-165.
- Nahon, Irmina and Waddington, Gordon, et al., The History of Urologic Surgery, Urol Nurs. 2011; 31(3):173-180.