Bladder Stones
Bladder stones occur when minerals in urine become crystallized, often as a result of not being able to effectively empty the bladder. The history of the removal of bladder stones or perineal lithotomy dates to well before the time of Classical Greece. If stones are blocking the passage of urine, death can result, so the removal was, unlike many other surgical procedures, often worth the risk.
Hippocrates, author of the Hippocratic Oath, told physicians to leave the removal of stones to the practitioners or surgeons. By 200 BCE, the surgeon Ammonius Lithotomus had developed a specialized tool that allowed him to break up large stones to keep the incision smaller while removing the stones. In the 1st century CE, Aulus Cornelius Celsus described the process of perineal lithotomy. The classical method was in use throughout the Middle Ages in the Middle East; however, a church council in 1215 banned surgery for physicians in the west.
In the 16th century, Pierre Franco developed the suprapubic lithotomy method, entering the bladder through an abdominal incision. Efforts at improving the procedure continued with the lateral vesical stone lithotomy in 1727 developed by William Cheselden, cutting from the bladder through the prostate to release stones into the rectal cavity. He was said to be able to perform the entire procedure in under a minute.
The mortality rate of these procedures was, for the state of surgery at the time, surprisingly low at around 25 percent. The change to more thorough and careful procedures in the late 19th century reduced that rate to 2.4 percent with the introduction of anesthesia. Over the course of the 20th century, new, less invasive surgical options were developed to limit the damage caused by urinary stones.