RE: MANAGEMENT OF URINARY TRACT = INFECTIONS:=20 HISTORICAL PERSPECTIVE AND CURRENT STRATEGIES: PART 1-BEFORE=20 ANTIBIOTICS

Abdel-Halim, Rabie E.

Department of Surgery, Division of = Urology, King=20 Khaled University Hospital, P. O. Box 7805, Riyadh 11472, Saudi Arabia, = e-mail:=20 rabie@doctors.org.uk

To the Editor.

RE: MANAGEMENT OF URINARY TRACT = INFECTIONS:=20 HISTORICAL PERSPECTIVE AND CURRENT STRATEGIES: PART 1-BEFORE = ANTIBIOTICS

J. C. Nickel

J Urol, 173:=20 21-26, 2005

I read with interest this historical = article about=20 urinary tract infection. Nickel deserves to be congratulated on this=20 comprehensive review. However, additional clarification is needed in = relation to=20 the Ancient, Greco-Roman and Islamic civilization eras.

Catheterization. The use=20 of urethral catheters can be traced back to antiquity.1=20 A bronze S-shaped catheter with 1 terminal eye and size proportionate to = age and=20 sex was in common use since the Hippocratic period in Greece2=20 and the days of Charaka and Susruta in India,3=20 and up to the seventh century AD.4=20

From the ninth to the 14th centuries in = Europe the=20 development of Greco-Roman medicine came to an end and no progress was = made in=20 medical science.5-9=20 Meanwhile, in the East, with the spread of Islam, medicine and other = branches of=20 knowledge were revived and acquired a scientific nature.5,8,9=20 Under this influence in the ninth century new catheters made of gold, = silver and=20 copper with only 1 curve to follow the normal curvature of the male = urethra and=20 a smooth rounded terminal end with many lateral holes were in use.10=20 This design had the advantages of resisting incrustation by urine and = far fewer=20 incidences of blockage.10,11=20

A stylet in the lumen of the catheter = was first=20 thought of and used by al-Razi (Rhazes, 841 to 926 AD) to save patients = the=20 agony of repeat catheterization due to blockage.10=20 Then more malleable and subsequently safer catheters were made, first = from lead=20 by al-Razi,10=20 and afterward from the salve of white lead treated with ram blood to = make it=20 firmer so that it could be shaped, as described by ibn Sina (Avicenna, = 980 to=20 1037 AD).12=20 Also, the tanned skin of some marine or wild animals was tried and the = edges=20 were joined by cheese or fish glue.12=20 Meanwhile, the notion of a straight metal catheter was introduced and = designed=20 by Alzahrawi (Albucasis, 930 to 1013 AD).13=20 According to al-Baghdadi (1219 AD),14=20 straight or curved metal catheters made of gold, silver, copper or salve = of=20 white lead were more popular than the leather ones, as they were far = smoother.=20 Also, ibn Sina and al-Razi warned against catheterization in the = presence of=20 inflammation, as it increases swelling and pain.15=20

Cystolithotomy. During the=20 Islamic Era important progress was made in lithotomy.15-17=20 The innovations introduced, at first by al-Razi and then by Alzahrawi,15-17=20 made the operation easier and safer. Alzahrawi was the first to describe = in=20 detail the operative technique in women, and to recommend the 2-stage = operation=20 in complicated cases.17=20 His influence is vividly seen in the practice of the Italian lithotomist = Marianus Sanctus (16th century), the French lithotomist Jack De Beaulieu = (17th=20 century) and the English lithotomist Shelsden (18th century).17=20 Alzahrawi is also the founder of lithotripsy. He introduced al-Kalaleeb = forceps=20 to crush large bladder stones and al-Mishaab drill to fragment an = impacted=20 urethral stone.15-17=20

Finally, Aetius of Amida was a = Byzantine, not an=20 Arabian, physician.18=20

Respectfully,

Rabie E. Abdel-Halim

Department of Surgery

Division of Urology

King Khaled University Hospital

P. O. Box 7805

Riyadh 11472, Saudi Arabia

e-mail: rabie@doctors.org.uk

1. Abdel-Halim, R. E.: Urethral = catheters: a=20 historical review. Saudi Med J, 11: = 87, 1990=20