Urology, since its beginnings, has had a vocation for minimally invasive surgery.
The non-invasive career began in 1870, when Max Nitze invented the cystoscope, coupled with T. Alba Edison’s incandescent lamp. At last the urologist could see the lower urinary tract clearly. In 1931 Davis designed a scalpel capable of cutting under water and in 1943 Stern and MacCarthy designed the first truly operative resector in history, thus was born the famous TUR (transurethral resection) for the treatment of bladder tumors, benign prostate tumors and years later, urethral strictures (Sachse).
It took a century from the creation of the cystoscope until the ureteroscope was described in Spain (Pérez-Castro), with which the urologist could access the upper urinary tract, and see and treat the 50% that was missing. This instrument is used to treat ureteral stones, some urothelial tumors, to remove foreign bodies and to diagnose complex renal or ureteral processes.
As luck would have it, this ureteroscope was joined by two other techniques described at the same time, which made it possible to complete the circle, especially in relation to stones.
I am referring to none other than Extracorporeal Lithotripsy (Christian Chaussy-Germany), the famous “bathtub”, which breaks up kidney stones very well, but has greater difficulty with ureteral stones, for which ureteroscopy is ideal, especially if the stone is in the lower part of the ureter.
The “bathtub” could break any stone, but if the size was large, problems of obstruction of the ureter arose, and to try to avoid them, percutaneous nephrolitectomy was created (Peter Alken-Germany). With this technique we could endoscopically and reaching the kidney from the back, treat coralliform kidney stones, so called because of their resemblance to coral.
The fragments detached in either of the two German techniques could produce obstructive fragments in the ureter, which was called lithiasic street because of its resemblance to cobblestones, and this was also solved by ureteroscopy in an elegant way.
So, by mastering the three techniques, urologists had gone from having to operate with classic surgery on 100% of the stones to having to operate on approximately 0%: undoubtedly, a revolution.
The next giant step was laparoscopy, but this is another story.