Tag: history of an enlarged prostate

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Enlarged Prostate

Development of Surgical Tools

Technology led to the creation of non-invasive BPH procedures such as prostate artery embolization. But before that, there were new tools.

Long before the development of the technology that led to the creation of non-invasive procedures to treat benign prostate hyperplasia, the major medical advancements were the creation of new surgical tools. And, a real game changer was the creation of the resectoscope.

The resectoscope was introduced in the late 1920s by Maximilian Stern. Stern was able to utilize the direct vision made available by inserting the tool, which had a tungsten wire loop on one end into the cystoscope. He then used an electrical cutting current in order to use the loop to successfully cut away excess prostate tissue.

As with all great inventions, the resectoscope left room for further innovation, such as a modified version by Theodore Davis, which had a larger viewing area and a wider loop, as well as a foot pedal attached to it that allowed him to switch between currents that cut and currents that cauterized.

Further improvements included that of Joseph McCarthy who combined Davis’s improved resectoscope with the phonendoscope- which had an even better viewing system.

By combining these two advancements, McCarthey created what would become known as the Stern-McCarthy resectoscope.

Though it arguably should have been called the Stern-Davis-McCarthy resectoscope, the Stern-McCarthy resectoscope is credited with being the first practical cutting-loop resectoscope, and as a result, transurethral prostatectomy emerged as the dominant method used to treat enlarged prostate for the next 70 years

This method, also known as TURP (Transurethral resection of the prostate ), which is still done today- would not have been possible without all of this innovation.

In fact, it wouldn’t have been possible without many inventions that preceded it. Such as Dr. Young’s cystoscope, as well as the first practical incandescent light bulb, the fenestrated tube, and the application of high-frequency electrical current underwater.

These inventions and surgical procedures led the way to more advanced methods which use fiber optics, video cameras, laser energy, and others.

Though TURP is still used as a treatment procedure for an enlarged prostate, more and more, it is being replaced by newer medical therapies and less invasive procedures such as genicular artery embolization.

In our next article, we will begin to look at the most common present-day surgical and non-invasive surgical procedures to treat an enlarged prostate.

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Enlarged Prostate

Improving Prostate Treatment with Innovation

One of the turning points in the treatment of benign prostate hyperplasia was the invention of the irrigating cystoscope.

One of the turning points in the treatment of benign prostate hyperplasia was the invention of the irrigating cystoscope, and the many improvements made to it by Dr. Hampton Young, of Johns Hopkins University Hospital.

Following the development of the irrigated cystoscope and other critical tools, physicians continued to experiment with all sorts of other methods for treating an enlarged prostate. This included high-frequency currents to treat bladder tumors.

In roughly 1926, a physician by the name of Maximilian Stern introduced another innovative instrument to be used in prostatic procedures called the resectoscope.

A resectoscope is a tool that is inserted through the cystoscope sheath and has a tungsten wire loop on one end. Under direct vision by way of the cystoscope, Dr. Stern was able to cut slivers of prostate tissue with the loop, through which flowed an electrical cutting current.

Unlike cautery heat, these high-frequency currents did not penetrate and damage the surrounding tissue nearly as much. As a result, patients reported having fewer side effects and a lower risk of complications such as hemorrhage.

Though the electric current cut well, some physicians took issue with it not coagulating deep enough. Thus making it, in some cases, just as effective as using a knife.

This led to the invention of a modified resectoscope by a South Carolina urologist, with a background in electrical engineering, named Theodore Davis.

Not only did Davis use a larger instrument with a larger viewing window and a wider loop, but he also is credited with incorporating a current that cuts and coagulates. Davis even went so far as to invent a foot pedal, which allowed him to switch between the two during surgery.

Around the same time that Davis was improving the resectoscope, another doctor by the name of Joseph McCarthy was busy making further improvements.

Dr. McCarthy was able to successfully combine the improved resectoscope with the phonendoscope, which had a greatly improved viewing system.

By combining these two advancements, McCarthey created what would become known as the Stern-McCarthy resectoscope.

In our next article, we will take a look at the Stern-McCarthy resectoscope and its use in the treatment of an enlarged prostate, and also begin to look at the dominant treatment methods that emerged, some of which are still performed today.

 

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Enlarged Prostate

Inventions to Treat BPH

It is estimated that at some point in their lives, 8 out of 10 men will experience the uncomfortable symptoms caused by an enlarged prostate.

It is estimated that at some point in their lives, 8 out of 10 men will experience the uncomfortable symptoms caused by an enlarged prostate. However, this occurrence isn’t anything new.

Doctors have been working to find cures and develop treatments for this very common condition for centuries.

In fact, in our last few articles, we took a deeper look at the origin of the diagnosis of an enlarged prostate, and when it was first documented. And, we looked at some of the many attempts to treat or even cure the condition- Some of which actually made things worse.

Fortunately, as time went on, and medical advancements continued to be made, medical experts and physicians were able to find newer and better ways to treat men with this prostate condition.

A real turning point in the development of treatment procedures for an enlarged prostate, occurred in 1904 when Dr. Hampton Young perfected the surgical procedure known as a “radical perineal prostatectomy”.

By perfecting the perineal approach and developing specialized instruments for the procedure, Dr. Young was able to lower the mortality rate for those undergoing prostate surgery.

While open surgeries for treating an enlarged prostate continued to develop, another method was emerging called the transurethral method.

The transurethral method is a treatment based on the idea of increasing the lumen of the prostatic urethra by destroying or damaging the prostatic tissue so that it would contract.

Several instruments for transurethral removal of bladder neck obstruction by ‘valves’, were created, however, the procedure was done blindly, and though effective at times, it also came with the high risk of hemorrhage, and many patients were left with urinary incontinence.

Fortunately, physicians continued to develop better and better techniques for transurethral procedures, including using a wire loop cautery. As well as treatments that included a thermogalvanic destruction, which is when cautery is introduced through the urethra, requiring a cautery plate and a cautery knife.

However, one of the biggest issues with these methods was that,  just like with the previous procedures, all of them were done blindly. That is until various new instruments were invented and came into use, such as the irrigating cystoscope, which allowed for visual control during these procedures.

The irrigating cystoscope was a real game changer, even more so, as Dr. Young worked to modify it, making it better and bed.

Young is credited with adding illumination to the external end of the tube, by way of a small electric bulb. And then, just a few years later, Young replaced the cutting tube with an electrically heated cautery tube and made the outer tube double-walled so that water could circulate to cool it. Young’s basic design was the forerunner of a great variety of subsequent operations.

In our last article of this series on the history of diagnosing and treating an enlarged prostate, we will take a look at some of the procedures that emerged after Dr. Young’s irrigating cystoscope, and begin to explore the modifications and improvements that have been made to these techniques.

 

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Enlarged Prostate

Advances in Prostate Care

In the early 20th century, a young doctor developed a procedure that would revolutionize the way prostate conditions are treated.

In the early 20th century, located right here in our neck of the woods, a young doctor was developing a prostate procedure that would revolutionize the way prostate conditions are treated and open the door to the many other treatments that would follow.

This man was urologist Dr. Hugh Hampton Young, who due to his position as the chief of surgery in the Genitourinary Surgery Division at Johns Hopkins Hospital became known as the “Father of American Urology.”

Among his many contributions to male prostate health, Dr. Young is best known for his development and perfection of radical perineal prostatectomy, while working at The Johns Hopkins Hospital in 1904.

This procedure, which to this day, remains the oldest continuously employed treatment for prostate cancer, was developed at a critical time when previous open prostatectomy surgeries had a 20-percent mortality rate.

Fortunately, by perfecting the perineal approach and developing specialized instruments for the procedure, Dr. Young was able to reduce the mortality rate to 2 percent.

During his many years working at Johns Hopkins, Dr. Hampton Young developed a number of innovative instruments and techniques.

The first known instrument he created was known as the “punch,” which was used for the resection of an obstructing bladder neck, and prostatic tissue.

This then led to the development of numerous other punches, particularly at the Mayo Clinic where several of his students perfected the instrument.

In 1912, Dr. Young, using this instrument, successfully relieved railroad entrepreneur James Buchanan Brady’s prostate condition brought on by an obstructing bladder neck, and prostate tissue.

Upon doing so, Brady went on to fund the construction and creation of the Brady Urological Institute.

While there, Dr. Young went on to do much more, including establishing a new design for a urological operating table and developing a detailed approach to performing radical perineal prostatectomy which became the standard for prostate cancer surgery.

Dr. Young went on to found The Journal of Urology which he edited until his death in 1945. However, one of his biggest contributions was the creation of a detailed plan for the training of young urologists, which went on to become the model for all other training programs in the United States.

In our next article, we will continue our series on the history of treating benign prostate hyperplasia, by looking at some of the early surgeries, some of which are still performed today.

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Enlarged Prostate

Early Treatment Methods

By the late 1800s, physicians found a link between prostate size and a man's age, as well as between prostate growth and testosterone.

By the late 1800s, physicians had found a link between prostate size and a man’s age, as well as between prostate growth and testosterone.

This discovery set the foundation for developing various treatment methods in order to relieve the uncomfortable symptoms caused by an enlarged prostate.

Though it wasn’t until centuries later that the more effective treatments that we use today, such as transurethral resection of the prostate, medications, and prostate artery embolization, became available- These procedures owe a debt of gratitude to the many physicians that came before, who opened the path to finding the best treatment for what would later be known as benign prostate hyperplasia.

Unfortunately part of this journey involved making mistakes along the way.

One notable example is a procedure performed by some physicians in the 1800s who thought that the condition of an enlarged prostate could be cured by removing the testicles. Yikes.

Fortunately, this method fell out of practice shortly thereafter. And, fortunately, many other physicians did not use this technique, and instead, continued to study the enlarged prostate and the impact that it can have on a man’s health. All in an attempt to find the most effective and efficient way to treat the condition.

One of the turning points in the development of prostate procedures to treat an enlarged prostate, took place in 1891.

A physician in Arizona had found a way to treat the prostate condition by removing prostate tissue through an incision made in the perineum—the area between the scrotum and rectum. This would later be called a perineal prostatectomy.

Following this breakthrough procedure, all sorts of other prostate surgeries began to pop up.

Eugene Fuller, a New York City Physician, developed the  “suprapubic procedure.”

The suprapubic procedure is the surgical removal of the prostate through an incision made in the lower abdomen and bladder.

The suprapubic procedure showed promising results and opened the door for another physician, Hampton Young to get even better results by using the same perineal incision to remove the prostatic mass.

Dr. Young, a urologist at Johns Hopkins Hospital also discovered that if he pushed the gland upward from the rectum, it could ease and complete the excision, making the removal more complete.

Hampton Young went on to become known as the “Father of American Urology,” and continued to refine and perfect his technique for treating an enlarged prostate.

In our next article, we will continue looking at the history of treating benign prostate hyperplasia, by diving deeper into the impact that Dr. Hampton Young had on the treatment of it, as well as take a look at the advancements made by the many physicians that followed.