Uroscopy in the middle ages
The study of urine and the management of diseases related to the urogenital or genitourinary tract, predate recorded history. The ancients assessed its smell, taste, colour, opacity (see top image, medieval uroscopy) and density, poked catheters made of reeds, metal and glass through the urethra to unblock obstructing stones and performed basic urogenital surgery in the form of circumcision and castration. Despite post-operative complications in the form of incontinence and the occasional death due to sepsis, post-Renaissance physicians operated on the bladder with increasing impunity. A perineal approach was generally preferred, but some of these pioneers used more advanced techniques including suprapubic approaches to manage bladder stones…all without antibiotics, sterile technique or anesthetics…ouch!
By the mid-1800s, an enlarged prostate was a recognized cause of urinary tract obstruction and strategies for managing prostatic hypertrophy devised. The first complete perineal prostatectomy was described in 1891, followed by a suprapubic prostatectomy at the dawn of the 20th century…now with sterile technique and anesthetics. Then, complications in the form of incontinence and erectile dysfunction were, and continue to be, the price one paid for relief of painful urinary obstruction.
A report in 2000 indicated that 8% of men were incontinent 18 months after radical prostatectomy and fully 60% were impotent. That dismal statistic changes, however, if one is highly selective in choosing candidates for the procedure.
The past two decades have seen a giant leap forward in treating urogenital disease, with the introduction of surgical robots (bottom image). These workstations use miniaturized instruments to perform procedures which were once difficult or even impossible with unassisted hands and unenhanced vision. Robotic surgery is now mainstream and the method of choice for managing urological disorders
Benefits of robotic surgery to patients compared to open surgery
• Shorter hospitalization
• Reduced pain and discomfort
• Faster recovery time and return to normal activities
• Smaller incisions, resulting in reduced risk of infection
• Reduced blood loss and transfusions
• Minimal scarring
Benefits of robotic surgery to surgeons
• Greater visualization
• Enhanced dexterity
• Greater precision
Urol Nurs. 2011;31(3):173-180.