Ultrasound in the field of urology

Urological surgery has a long history. Bladder stones have been detected in the mummies of ancient Egypt dating back to 7,000 years ago. Papyrus Ebers, which is said to be the oldest medical book in the world (1550 BC), includes statements about urinary retention and urinary incontinence. In India, a medical monograph written by Susurta (600 BC) refers to urethral bougie and cystolithotomy, which is considered to be the first surgery performed in the world. In Greece, the Oath of Hippocrates (450–370 BC) includes the following statement: ‘‘Assign treatment of stones to specialists.’’ This statement suggests that cystolithotomy was performed often in ancient Greece. In the nineteenth century, anesthesia and sterilization were developed, leading to the beginning of surgical procedures similar to those often performed in the present age. Later, Nitze developed a cystoscope for clinical use, thus opening the path to endoscopic examinations and surgery. Since the advent of two-dimensional ultrasonography and computed tomography (CT) in the 1970s, diagnostic imaging has progressed. In the 1980s, treatment of stones was markedly modified. Extracorporeal shock wave lithotripsy (ESWL) and endoscopic surgery such as percutaneous nephrolithotripsy (PNL) and transurethral ureterolithotripsy (TUL) were introduced. These new procedures were the precursors of minimally invasive treatments not requiring open surgery. In the 1990s, laparoscopic nephrectomy began to be performed. In 1993, Go et al. performed adrenalectomy under laparoscopic guidance for the first time in Japan. At present, endoscopic surgery is the standard treatment for kidney and adrenal gland diseases. Many other urological surgical procedures are also beginning to be performed endoscopically. As illustrated above, surgery in the field of urology has advanced in an accelerated manner in the decades since the 1980s, following the long history of this kind of surgery beginning in 600 BC. Above all, ultrasound has played an important role in such changes in urological surgery. The advent of diagnostic ultrasound devices has allowed urological diseases such as kidney disease and urinary tract stones to be diagnosed easily. In addition, techniques for ultrasound-guided puncture were developed as an application of diagnostic technology and have been available for renal biopsy, PNL, percutaneous drainage, and so on. Transrectal ultrasonography was developed in Japan, stimulating the global spread of ultrasonic diagnosis of prostate disease. Transrectal ultrasonography has been shown to be useful particularly as a means of diagnostic imaging of prostate cancer and for prostate biopsy under ultrasound guidance. Later, Doppler ultrasonography was also developed, enabling the observation of vascular lesions, tumor blood flow distribution, and so on. More recently, elastography, which is capable of visualizing tissue hardness, has also begun to be used for the diagnosis of prostate cancer. The most important application of ultrasound to urological treatment is probably extracorporeal shock wave lithotripsy (ESWL). ESWL is used to treat urinary-tract stones by crushing the stones with shock waves (ultrasound) focused on them. The advent of this treatment technique resulted in innovative changes in the treatment of urinary tract stones. Furthermore, ultrasound is also used for lithotripters for endoscopic treatment techniques such as PNL and TUL, which were developed simultaneously with the development of ESWL. ESWL, PNL, and TUL spread across the world soon after their development. For Y. Itoh (&) Department of Urology, Kyoto Second Red Cross Hospital, 355-5 Haruobi, Kamigyo, Kyoto 602-8026, Japan e-mail: vanpra@aol.com