History of Urology Forum
Presentation Authors: Neil Pugashetti*, Robert Lurvey, Sacramento, CA
Introduction: Few cases of self-performed bladder stone surgery have been reported. We review the case of Colonel Martin in 1782 to shed light on the origin of transurethral surgery for stone disease, traditionally attributed to French Urologist Jean Civiale.
Methods: Primary literature including medical journals and newspapers as well as review articles chronicling stone surgery were reviewed using Pub Med and Google Scholar.
Results: Colonel Martin of Lucknow (1735-1800) was a successful officer for the French and later English East India Company. A multifaceted man, he was a successful soldier, architect, philanthropist, and later in life, amateur self-surgeon. Colonel Martin's urologic ailments began in 1770 when he developed epididymo-orchitis and urinary retention. In 1774, he was able to urinate more successfully by using a bougie, a rudimentary urinary catheter, acquired from French military surgeon James Daran. Dr. Rennet Murchison, a surgeon in Lucknow, later discovered stone fragments on the tip of this bougie, establishing a diagnosis of a calculus inside the Colonel's bladder. Dr. Murchison then attempted a variety of medical treatments to treat the stone which included oils from turpentine and scorpion, petroleum, lye, and pigeon droppings. Colonel Martin quickly abandoned these caustic agents as his health began to deteriorate. In 1782 he embarked on self-performed surgery by using a thin steel file he invented himself. The instrument measured ten inches, was shaped like a common sound, and consisted of materials such as whalebone and a knitting needle. The Colonel stated that he "[did] not think it possible for another to operate, as none but the patient can know where and how he can introduce the file." Surgical stone treatment during this era was typically performed using an open perineal approach, which carried significant morbidity and mortality. The Colonel, however, utilized a transurethral technique only known to have been performed by a Cistercian Monk, although details of the Monk's account are lacking. The Colonel introduced the file into his bladder and repeatedly filed the stone three to twelve times each day until it eroded six months later. He successfully remained asymptomatic for sixteen years until obstruction recurred and ultimately led to his death in 1800. Despite this account, it was the French Urologist Jean Civiale who is recognized for the invention of the first transurethral lithotrite in 1832.
Conclusions: There are few reported cases of self-performed surgery for bladder stones. The case of Colonel Martin likely influenced techniques used in endoscopic stone surgery in the modern era.
Source of Funding: None