O1

HISTORY OF UROLOGY 1

Wednesday, 18 March, 12.45-14.15, Room K2

Urology in ancient Egypt

Hydrocele testis treatment - 2000 years of water into

wine

Al-Rifaei M.A.A.
University of Alexandria, Faculty of Medicine, Dept. of Urology, Alexandria,
Egypt
Introduction & Objectives: In ancient Egypt, there was a university and
also medical schools called houses of life, and specialized doctors.
Material & Methods: In the field of urology, for the first time, they described
the relation between the spinal cord and the genitourinary organs, in Edwin
Smith Papyrus, 3000 years B.C. you may examine a man suffering from
dislocation of vertebra of his neck, he has no sensation in his arms and
legs, he is incontinent for urine, his penis is erect and there is emission of
semen from his penis, the author differentiates between dislocation and
contusion which had a better prognosis in Ebers Papyrus (1550 BC),the
author describes the kidneys with 2 vessels which conduct urine to the
bladder crypt, which is located as a separate organ in the frontal position
in the abdomen. He describes hematuria and suggests that it me parasitic
in origin yaya, and advises antimony for its treatment, and a remedy for
hemorrhage. After circumcision. Some paragraphs are devoted to diseases
of the urinary tract, i.e. cystitis, urethritis, retention and incontinence of
urine. In Hearst papyrus (1350 B.C.), the author describes the treatment
of burning micturition and incontinence of urine. Ancient Egyptians
manufactured many surgical instruments including knives, spoons,
scalpels, spatulas, probes, forceps, sounds and catheters. Instruments are
drawn on the walls of the temples and some instruments are preserved
in the Egyptian museum. Study of the mummies showed urinary calculi
atrophic kidneys, renal abscesses and bilharziasis.

Wimpissinger F., Stackl W.

Rudolfstiftung Hospital, Dept. of Urology, Vienna, Austria
Introduction & Objectives: There are a wide variety of surgical techniques to treat
testicular hydrocele. The number of conservative measures is even greater. All
together, even contemporary procedures date back centuries of colorful reports of
treating the water of the testis.
Material & Methods: Books, journals, and online resources have been studied for
reports on hydrocele therapy with a focus on primary sources of contemporary
operative techniques.
Results: Historically, testicular hydrocele has mainly been treated conservatively by
different draining methods as well as infusion of a many different fluids. The idea of
inducing inflammation to prevent recurrence primarily achieved with fluid infusions
was the background of almost all open surgical procedures. The first descriptions
of treating cysts and fluid filled cavities dates back to Aulus Cornelius Celsus (25
B.C.). Lambert of Marseilles described drainage and fluid infusion as early as 1677.
He emphasized the induction of inflammation through this procedure. Many different
reports on conservative techniques followed by J. Earle 1791, A. Monro 1871, T.
Kocher 1882, A. Valpeau 1893, W.L. James 1941, or J.A. Rhind 1951. Monro went
as far as infusing red wine into the serosal cavity of the testis. The history of open
surgery is much shorter and starts with the focus on antiseptic wound treatment by
R. von Volkmann 1878 actually published by Volkmanns student A. Genzmer. E.
von Bergmann performed resection of the parietal tunica 1886 further improved by
E.W. Andrews 1907 and H.H. Young in 1940. D.E. van Doyen (1895), K. Winkelmann
(1898), and M. Jaboulay (1902) employed eversion of the tunica often related to
as the bottleneck procedure. The latest revolution came 1964 with Peter H. Lords
minimal invasive technique with tunica sutures without dissecting the hydrocele
sack. In 1966 J.E. Wright emphasized incision in the median scrotal raphe minimizing
bleeding complications.
Conclusions: Surgery of testicular hydrocele is historically remarkable in two
respects: 1) the principles of treating a water filled cavity have been discussed
some 2000 years ago; 2) contemporary surgical techniques are at least 40 years old;
Bergmanns procedure even dates back to 1886.

Historical review of Fournier`s gangrene: Baurienne,

1764 and Herod the Great, 4 B.C.
Medina Polo J.1, Gonzlez-Rivas Fernndez A.2, Blanco lvarez M.1, Tejido Snchez A.1,
Leiva Galvis O.1
Hospital Universitario 12 De Octubre, Dept. of Urology, Madrid, Spain, 2Universidad
Complutense de Madrid, Dept. of Classical Philology, Madrid, Spain

Introduction & Objectives: In 1883, Jean Alfred Fournier described a necrotizing fasciitis
of the genital area, which is nowadays known as Fourniers gangrene. However, in 1764,
Baurienne reported a case of scrotal gangrene, which is considered to be the first case
published in literature. Further back in time, some authors have suggested that the cause of
death for Herod the Great was Fourniers gangrene. The purpose of this study is to review
these cases.
Material & Methods: We have reviewed and analysed the article titled Sur une Plaie
contuse qui sest termine par le sphacele de tout le scrotum, published by Baurienne in
1764. We have also reviewed the literature published about the disease of Herod the Great;
including the description by Flavius Josephus, using the Greek edition of his books Jewish
Antiquities (Ant.) and Jewish War (BJ.).
Results: The scrotal gangrene described by Baurienne was a result of an injury caused
by the horns of an ox. Although Baurienne performed a first debridement, the patient got
worse. A more extensive debridement was required, the right testicle was removed but
the left testicle wasnt affected. Finally, the patient recovered and new skin cells covered
the wound surface. Flavius Josephus described in Jewish Antiquities that Herod the Great
suffered gangrene of his privy parts that produced worms (Ant. 17. 169). Some authors
have proposed that the cause of Herods genital gangrene was Fourniers gangrene.
However, some historical circumstances must be taken into account; for instance, the fact
that Josephus was Jewish and he felt hostility to Herod; moreover, Jews of Josephus time
used to relate medical symptoms with moral faults, so ulcers were usually related to sexual
offenses. Consequently, in this case, the global analysis of all the symptoms is not useful in
order to get a diagnosis.

Pattison fascia: The forgotten eponym?

Schultheiss D.
Protestant Hospital, Dept. of Urology, Giessen, Germany
Denonvilliers fascia is known to every urologist as one of the most
important structures of the pelvis separating the posterior surface of the
prostate and the bladder from the anterior aspect of the rectum. The
French anatomist and surgeon Charles-Pierre Denonvilliers (1808-1872)
from Paris introduced this Aponvrose prostato-peritoneale for the first
time in 1836, without discussing its surgical importance. When prostate
surgery evolved at the beginning of the 20th century authors in America,
e.g. Hugh Hampton Young in Baltimore, as well as in Europe, e.g. Robert
Proust and Joaquin Albarran in Paris, referred to Denonvilliers writings
and coined this eponym. It is not widely known that already in 1820 the
Scotsman Granville Sharp Pattison (1791-1851), at that time lecturing
as a professor of surgery in Baltimore, had described this Fascia of the
prostate gland as a structure to be preserved during perineal lithotomy, a
frequently performed procedure in those days. According to Pattison the
intraoperative damage of this fascia and subsequent urine extravasation
with infection of the anterior rectum was the main reason for the high
mortality of this operation at that time. Therefore, it is surprising that the
eponym of this fascia is not related with the name of Pattison today. This
presentation reveals the extraordinary biography of Pattison and tries to
find an explanation why his work was well-known in his days, but did not
find acceptance at later times.

Conclusions: Bauriennes article shows the management of the scrotal gangrene from
the point of view of a surgeon. In line with his conclusions, all the affected tissues have
to be removed, having in mind that testicles are not frequently affected. However, the
case described by Baurienne was a consequence of a previous trauma, so it was not an
idiopathic Fournier gangrene. On the other hand, the description of Herod the Greats death
by Josephus probably emphasizes his uncontrolled sexuality, so it seems also unlikely that
he suffered Fourniers gangrene. Therefore, we believe that neither of these cases can be
defined as the gangrene originally described by Fournier.

Eur Urol Suppl 2009;8(4):121