Extraction of urinary bladder stone as described by Abul-Qasim Khalaf Abbas Alzahrawi [Albucasis] [325-404 H,930-1013 AD]. A translation of original text and a commentary

This is a detailed study of the technique of cystolithotomy as practiced by the Muslim surgeon Alzahrawi [Albucasis] in Cordova more than 1000 years ago. In addition to translating the relevant chapter in his book Al-Tasreef, his technique is critically evaluated comparing it with that of his predecessors and his successors. The study confirmed the originality of Alzahrawi who described operative steps and invented operative instruments not known in the Greco-Roman era. He was also the first to describe, in details, the operative technique in women and to recommend the 2-stage operation in complicated cases. His modifications and innovations greatly influenced surgery in Middle Ages Europe up to the 18th century which witnessed the beginnings of the modern method using the suprapubic, instead of the perineal, approach. Alzahrawi's influence is vividly seen in the practice of the Italian lithotomist "Marianus Sanctus" [16th century], the French "Jack De Beaulieu" [17th century] and the English "Shelsden" [18th century]. Alzahrawi is the founder of lithotripsy. He introduced Al-Kalaleeb forceps to crush large bladder stones and Al-Mishaab to drill and fragment an impacted urethral stone. Andreas a Cruce [18th century] only added screw action to Al-Kalaleeb lithotrite but Amussat managed in 1822 to apply it transurethrally. Similarly, by the notion of transurethrally getting at the stone while within the bladder, Alzahrawi's idea of drilling by Al-Mishaab was the foundation of the litholepte of Fournier de Lempdes [1812], the instrument of Gruithusien [1813], Civiale's trilabe [1818] and the brise coque of Rigal De Galliac [1829]

Extracorporeal shock wave lithotripsy for the rescue of post-endoscopic or surgically retained biliary duct stones: does saline irrigation affect the outcome!

Extracorporeal shock wave lithotripsy [ESWL] has been found valuable in situations where obstructing stones in the common bile or intrahepatic ducts are retained following surgery or attempted endoscopic removal. However, success rates are dependent on the type of ESWL system employed and upon a high, frequency rate of repeated treatment sessions. We outline our experience with 23 eases of retained, obstructing bile duct stones, ranging in size from 10 to 40 mm diameter, treated with Dornier HM3 ESWL. In the initial 12 patients in the series, successful stone fragmentation occurred in 83% of cases with a median 1.6 treatment sessions. In the latter 11 cases in the series, patients were treated prone and the stone-bearing biliary duct was irrigated with saline solution during ESWL delivery. With this technique, successful stone break up was achieved in all patients [100%] with a single treatment session. Endoscopic sphincterotomy is, however, a prerequisite for extracorporeal lithotripsy and, despite the high success rates now available with new techniques, we believe the ESWL should continue to be employed in support of primary endoscopic methods of management for obstructing bile duct stones

Clinical and aetiological aspects of chronic prostatitis in Saudi Arabia

The prevalence and aetiology of chronic prostatitis in the Arabian Peninsula has not yet been established. In this prospective study of 138 men referred to a special Prostatitis Clinic, 9 patients were excluded with a diagnosis of urethritis. Of the remaining 129, 112 patients had the diagnosis of chronic prostatitis established on the basis of fractional urinalysis and examination of the expressed prostatic secretion [EPS]. Of these, 40 patients were proven to have chronic bacterial prostatitis, through positive bacterial cultures of the EPS / fractional urine or positive chlamydial serology, whilst the remaining 72 were grouped as cases of chronic non-bacterial prostatitis. 17 patients were classified as having prostatodynia on the basis of their symptoms in the absence of evidence of prostatic inflammation. Factors such as marital circumstances and previous venereal urethritis were evaluated in relation to aetiology. The clinical manifestations of each group of patients presenting with a chronic prostatosis, including urodynamic investigation, are discussed