'Cutting for the stone': the ancient art of lithotomy.

Overview

OBJECTIVE: Bladder stone was a common ailment plaguing mankind from antiquity to the 20th century. Largely forgotten today, lithotomy relieved the anguish of bladder stones and identified urology as a medical specialty nearly 2500 years ago. METHODS: The historical literature pertaining to lithotomy was reviewed. Translated and original documents describing operative techniques and developments pertaining to the history of lithotomy were obtained through the internet and library sources. RESULTS: The ancient art of lithotomy was first recorded by the Greeks and evolved through five phases: the Celsian method, or 'lesser operation'; the Marian, or 'greater operation'; the lateral operation; suprapubic cystotomy, or 'high operation', and proctocystotomy. The practice of open lithotomy ceased to exist owing to better minimally invasive alternative methods and most notably by the virtual disappearance of bladder stones in modern man. CONCLUSIONS: The history of lithotomy is a fascinating story of how early surgeons forced by the culture and customs of the time dealt with common but devastating bladder stones. Out of their efforts, urology was born.