INTRODUCTION
The management of urological diseases has undergone a colossal change since the time Philipp Bozzini first visualized the interior of the bladder using a candle and lens. Now transurethral procedures and minimally invasive procedures, as such, have become sine qua non of urology practice. This necessitates the budding urologists to have a thorough basic knowledge of transurethral procedures at the beginning of their career.
The initial instrument designed by Bozzini—an obstetrician, used a wide mouthed funnel with its wide end attached to a lamp stand with beeswax candle. This “Lichtleiter” (1806) was cumbersome to use and not put into wide clinical practice. It was modified by Pierre Salomon Segalas (1826) to increase the illumination by using candles and mirror.
The “Father of cystoscopy”, Antonin Jean Désormeaux (1953), a French urologist further modified it by replacing the candle with a lamp and first coined the word “endoscope”. He performed the first transurethral procedure—removal of urethral papilloma. His instruments focused the brighter lamp light through multiple mirrors into the lumen with minimal loss of luminosity.
The next major breakthrough was the use of prisms and lenses in the endoscope by Nitze. This created a clearer and wider panoramic image. He also used a platinum loop light source at the tip of the scope for better illumination. The drawback of this design was the need for a cooling system for light source. This was further improved by the advent of tungsten incandescent lamp with better qualities and efficiencies.
Boisseau du Rocher modified the cystoscope to have components—the sheath and lens system. This helped in insertion of instruments like catheters through a channel. These “primitive” instruments were deemed functional by the development of resectoscope by Maximilian Stern in 1926. Prostate and bladder tumor resections became feasible.
Physicist Harold Hopkins brought in the next major advance in the endoscope era—the rod lens system of optics. He changed the optics by 2using long cylindrical rods with antireflection coatings as transmission medium and intervening small air columns as lenses. This produced clearer, brighter images. The discovery by Lamm that light can be transmitted through flexible glass fibers without loss of luminosity, helped in the development of fiber optics, flexible scopes and cold light sources.
Transurethral resections form majority of the uroendoscopic procedures. With benign prostatic hypertrophy being one of the most common urological problems affecting the elderly, transurethral resection of the prostate (TURP) forms the crux of urosurgical training. Review articles bring forth the fact that the average size of the gland subjected for TURP is increased, with the advent of alpha blockers and 5-alpha reductase inhibitors in the management of benign prostatic hyperplasia (BPH). Hence, better and safe resection practices are necessary for better patient outcome.
Newer modalities of “prostate ablation”, other than electric current are available, like lasers, which have some benefits over the classical monopolar diathermy. They are useful in large prostates and in those with medical conditions that restrict the use of hypoosmolar irrigants during the procedure.