120-Year-Old History of Modern Endoscopy
Ten years after the first planned in 1869 and performed nephrectomy and his Viennese instrument maker created a technically mature cysto-scope (1879). This development ushered in a new era in endoscopic diagnostics and therapy and at the same time marked the birth of urology. In the 120-year-old history of modern endoscopy have such minimally invasive procedures, partly as independent operative techniques, partly as auxiliary measures, one experience increasing importance. The endoscopic access route with its
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Use Of Endoscopic Instruments
Ultimately, the range of urological operations has sustained lower morbidity influenced. Further technical developments of the Nitze-cystoscope enabled its use of endoscopic instruments in the therapy of urinary obstruction, inflammation of the kidneys, bladder tumors and benign prostatic hyperplasia (BPH). It is that Credit to the urologists for driving the development and use of resecto-scopes for endoscopic therapy of the bladder and prostate.
Transurethral electro-resection of the prostate (TURP) gives a significant boost by the resecto-scope constructed by (1925). Despite this, this technology was only hesitant to establish itself. The refinement of the mechanics (Mauermayer), the development of more powerful optics (Hopkins) and the improvement in high-frequency technology (Flachenecker) have made TURP the so- called gold standard in the surgical treatment of BPH.
Minimally Invasive Access to The Kidneys
The search for a direct and minimally invasive access to the kidneys ended developed the percutaneous surgical techniques on the kidney in the 1970s. This technique primarily uses for stone therapy, but now also uses for the therapy of Disorders of urine transport and tumors of the upper urinary tract.
Only a little later, thanks to an improvement in the instruments, it became a logical consequence Introduction of ureteroreno-scopy into clinical practice. All requirements for this already give with correspondingly thin children’s cysto-scopes. The step for endoscopy of the ureter with an elongates and stiff optic proposes by in 1970, 12 years after a flexible ureteroreno-scope first describes by (1968). The retrograde instrumentation with flexible Uretero-scopes is an integral part of diagnostics and therapy stones, strictures, and tumors of the upper urinary tract.
Use Of Shock Wave Lithotripsy
A kind of revolution in the treatment of urinary calculi achieves with the first clinical introduces the use of shock wave lithotripsy for non-contact destruction of kidney stones in 1980. This completely new therapy concept with the transmission of shock waves that generates outside the body to break up urinary stones has almost completely replaced open stone surgery. Extracorporeal shock wave lithotripsy (ESWL) is a prime example of the implementation of non-invasive therapy concepts to the benefit of the patient. If “non-contact” stone therapy is unsuccessful, preference should give to therapy alternatives using the minimally invasive endoscopic approach.
Diagnostic And Therapeutic Laparoscopy
At the outset we indicated that urological endoscopy paved the way for laparoscopy. Interestingly, the Nitze- cystoscope uses by the (1901) for the first attempts at coelio-scopy. Surprisingly, the urologists were interested in diagnostic and therapeutic laparoscopy compared to the gynecological and surgical colleagues despite familiarity with endoscopic surgical procedures was rather small until the end of the 1980s. First describes the use of laparoscopy for diagnostics in 1976 of cryptorchidism and to clarify intersexes. Publishes 1979 their experiences with the laparoscopic retroperitoneal uretero-lithotomy. Performs the laparoscopic removal of a cast stone for the first time in 1985 from a pelvic kidney.
Beginning Of the Laparoscopic Surgery
Leaving aside these early case reports, the beginning of the laparoscopic Surgery in urology equated with the first pelvic lymphadenectomy, in October 1989. Another A milestone in urological laparoscopy was the first laparoscopic nephrectomy, performs and co-workers in June 1990. Have since 1992 laparoscopic surgical procedures in urology are spreading rapidly.
Laparoscopy As a Therapeutic Alternative
The increasing familiarity with the method together with the constant improvement of the technology and the instruments led to an expansion of the range of indications. Were initially almost exclusively diagnostic (cryptorchidism) and ablative operations for benign diseases (nephrectomy, Adrena-lectomy) performs. So, you expanded the field of application laparoscopic Interventions also on plastic-reconstructive (kidney pelvis plastic, ureter plastic). Later also oncological (tumor nephrectomy, retroperitoneal lymphadenectomy) interventions.
Not all intervention mentions have caught on quickly report about “Tumor seeding” after laparoscopic removal of ovarian carcinoma or Sigma carcinomas also led to doubts in our field about the oncological safety of laparoscopy as a therapeutic alternative for urological malignancies.
Laparoscopy In the Treatment of Urological Malignancies
However, long-term observations after laparoscopic tumor nephrectomy have shown that if important onco-surgical guidelines observe (“no-touch” technique, use of penetration- tight retrieval bags). The laparoscopic procedure offers the same oncological safety as conventional incision operations. Another motivation for using laparoscopy in the treatment of urological malignancies was the establishment of laparoscopic radical prostatectomy.
The fact that radical prostatectomy, as the most common uroonco-logical intervention, has a relatively high morbidity, not least because of high blood loss, has led to a rethink among opponents of laparoscopic surgical procedures. Due to the convincing advantages of laparoscopy. The combination of ablative surgery (prostatectomy) with subsequent intra-corporeal reconstruction of the urinary tract (Urethra Bladder Anastomosis) illustrates the renewed leap in quality in the Urological Laparoscopy.
In this respect, the use of laparoscopy in the context of most demanding urological intervention, the radical cystectomy with construction of an incontinent or continent urine reservoir is a logical consequence.
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