Minimally Invasive Urology
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Urology since its inception, has had a vocation of minimal surgical invasion.
The non-invasive race begins in 1870, when Max Nitze invents the cystoscope , coupling the T incandescent lamp. Alba Edison. Finally the Urologist could see the lower urinary tract clearly. In 1931 Davis designed a scalpel capable of cutting under water and in 1943 Stern and MacCarthy designed the first truly operational resector in history, and the famous TUR (transurethral resection) was born for the treatment of bladder tumors, benign prostate tumors and years later, urethral strictures (Sachse).
A century had to pass from the creation of the cystoscope, until in Spain the ureteroscope (Pérez-Castro) was described, with which the urologist could access the upper urinary system, and see and treat the 50% that we lacked. This instrument treats ureter stones, some urothelial tumors, foreign bodies are extracted and complex renal or ureteral processes are diagnosed.
The luck was that this ureteroscope was joined by two other techniques described in the same dates, which allowed to complete the circle, especially in relation to the stones.
I am referring to nothing less than the Extracorporeal Lithotripsy (Christian Chaussy-Germany), the famous "bathtub", which breaks the kidney stones beautifully, but has greater difficulty with the ureteral ones, for which ureteroscopy is ideal, fundamentally if the Stone is in the lower part of the ureter.
The " bathtub " could break any stone, but if the size was large, there were problems of obstruction of the ureter, and to try to avoid them, percutaneous nephrolitectomy was created (Peter Alken-Germany). With this technique we could endoscopically and reach the kidney from the back, to treat the kidney-shaped calculus, so called because of its resemblance to coral.
The fragments detached in either of the two German techniques could produce obstructive fragments in the ureter , which was called the lithiasic street due to its similarity with cobblestone paving, and this was also resolved by ureteroscopy in an elegant way.
So, dominating the three techniques, urologists had gone from having to operate with classic surgery to 100% of the stones to having to do it at approximately 0%: undoubtedly, a revolution.
The next giant step was laparoscopy, but this is another story.
