Patel R. et al., 2023: Five historical innovations that have shaped modern urological surgery.

Wednesday, 27 March 2024

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Patel R, Desai C, Acharya R, Raveshia D, Shah S, Panesar H, Patel N, Singh R.J
Department of Trauma and Orthopaedics, Shrewsbury and Telford Trust, The Princess Royal Hospital, Apley Castle, Telford, UK.
Department of Trauma and Orthopaedics, The Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, UK.
Department of Urology, Walsall Manor Hospital, Walsall Healthcare NHS Trust, Walsall, UK.
Department of Intensive Care, Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
Department of General Surgery, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
Department of Otolaryngology, The Princess Royal Hospital, Apley Castle, Telford, UK.
Hull York Medical School, York, UK.

Abstract

Throughout history, many innovations have contributed to the development of modern urological surgery, improving patient outcomes and expanding the range of treatment options available to patients. This article explores five key historical innovations that have shaped modern urological surgery: External shockwave lithotripsy, transurethral resection of prostate, cystoscope, perioperative prostate-specific antigen and robotic surgery. The selection of innovations for inclusion in this article was meticulously determined through expert consensus and an extensive literature review. We will review the development, impact and significance of each innovation, highlighting their contributions to the field of urological surgery and their ongoing relevance in contemporary and perioperative practice.

Perioper Pract. 2023 Dec 27:17504589231214388. doi: 10.1177/17504589231214388. Online ahead of print. PMID: 38149615

Comments 1

Hans-Göran Tiselius on Wednesday, 27 March 2024 10:00

This article is a review of some innovations that provide the basis for modern urology. The five developments that were chosen by the authors were as follows:

External shock wave lithotripsy
Transurethral resection of the prostate
Cystoscope
PSA
Robotic surgery
These five inventions have emerged at very different times in history with very different impact on urology. Thus, it can be concluded that the cystoscope and associated optical improvements as well as subsequent endourological developments have been important not only for urology, but also for gynecology and later various applications of videoendoscopic surgery as well as robotic surgery.

My purpose, however, is only to briefly comment on extracorporeal shock wave lithotripsy. As a non-invasive surgical approach this method dramatically revolutionized surgical management of patients with urinary tract stones.
The authors state that “…machines progressively became smaller and more efficient”. It is correct that the lithotripters became smaller, less expensive and were considered as more user-friendly. Whether they became more efficient than the original unmodified Dornier HM3 device, is a conclusion that must be discussed.

With less need of pain treatment, the modern devices are easier to handle, and it became easier to disintegrate particularly small stones. Nevertheless, the capacity of stone disintegration obviously decreased with the technical modifications, and it became necessary to adapt clinical guidelines to what really was possible to achieve with the modern lithotripters and methods. The latter step can be expressed as “improved patient selection.”

But in my opinion recent years of development of SWL rather aimed at low or no anesthesia than improved stone disintegrating capacity. In this regard the development has not been entirely in favor of optimal stone disintegration, because there is no doubt that the Dornier HM3 lithotripter, used with analgesics and sedatives, was more efficient than any modern lithotripter currently on the market.

The use of ultrasound propulsion to reposition fragments has been poorly described in the literature but might be of great importance for elimination of fragments from the lower calyces.

Hans-Göran Tiselius

This article is a review of some innovations that provide the basis for modern urology. The five developments that were chosen by the authors were as follows:

External shock wave lithotripsy
Transurethral resection of the prostate
Cystoscope
PSA
Robotic surgery
These five inventions have emerged at very different times in history with very different impact on urology. Thus, it can be concluded that the cystoscope and associated optical improvements as well as subsequent endourological developments have been important not only for urology, but also for gynecology and later various applications of videoendoscopic surgery as well as robotic surgery.

My purpose, however, is only to briefly comment on extracorporeal shock wave lithotripsy. As a non-invasive surgical approach this method dramatically revolutionized surgical management of patients with urinary tract stones.
The authors state that “…machines progressively became smaller and more efficient”. It is correct that the lithotripters became smaller, less expensive and were considered as more user-friendly.  Whether they became more efficient than the original unmodified Dornier HM3 device, is a conclusion that must be discussed.

With less need of pain treatment, the modern devices are easier to handle, and it became easier to disintegrate particularly small stones. Nevertheless, the capacity of stone disintegration obviously decreased with the technical modifications, and it became necessary to adapt clinical guidelines to what really was possible to achieve with the modern lithotripters and methods. The latter step can be expressed as “improved patient selection.”

But in my opinion recent years of development of SWL rather aimed at low or no anesthesia than improved stone disintegrating capacity. In this regard the development has not been entirely in favor of optimal stone disintegration, because there is no doubt that the Dornier HM3 lithotripter, used with analgesics and sedatives, was more efficient than any modern lithotripter currently on the market.

The use of ultrasound propulsion to reposition fragments has been poorly described in the literature but might be of great importance for elimination of fragments from the lower calyces.

Hans-Göran Tiselius

This article is a review of some innovations that provide the basis for modern urology. The five developments that were chosen by the authors were as follows: External shock wave lithotripsy Transurethral resection of the prostate Cystoscope PSA Robotic surgery These five inventions have emerged at very different times in history with very different impact on urology. Thus, it can be concluded that the cystoscope and associated optical improvements as well as subsequent endourological developments have been important not only for urology, but also for gynecology and later various applications of videoendoscopic surgery as well as robotic surgery. My purpose, however, is only to briefly comment on extracorporeal shock wave lithotripsy. As a non-invasive surgical approach this method dramatically revolutionized surgical management of patients with urinary tract stones. The authors state that “…machines progressively became smaller and more efficient”. It is correct that the lithotripters became smaller, less expensive and were considered as more user-friendly. Whether they became more efficient than the original unmodified Dornier HM3 device, is a conclusion that must be discussed. With less need of pain treatment, the modern devices are easier to handle, and it became easier to disintegrate particularly small stones. Nevertheless, the capacity of stone disintegration obviously decreased with the technical modifications, and it became necessary to adapt clinical guidelines to what really was possible to achieve with the modern lithotripters and methods. The latter step can be expressed as “improved patient selection.” But in my opinion recent years of development of SWL rather aimed at low or no anesthesia than improved stone disintegrating capacity. In this regard the development has not been entirely in favor of optimal stone disintegration, because there is no doubt that the Dornier HM3 lithotripter, used with analgesics and sedatives, was more efficient than any modern lithotripter currently on the market. The use of ultrasound propulsion to reposition fragments has been poorly described in the literature but might be of great importance for elimination of fragments from the lower calyces. Hans-Göran Tiselius

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