ABSTRACT
The ancients, who thought that the bladder was divided by a horizontal septum, knew little about obstruction at its outflow, though Galen must have divided the prostate and bladder neck regularly when performing lateral lithotomy1. Oribasius of Pergamum, writing his synopsis at the command of the Emperor Julian in the fourth century AD, proposed to cut through the prostate by a perineal incision in cases of retention of urine where it was impossible to pass a catheter, considering that the risk of fistula after this operation was preferable to death from unrelieved retention. Ambroise Paré seems to have been aware of the entity of bladder neck obstruction, and devised catheters with a sharp cutting cup at the tip with which pieces of the bladder neck could be torn away (Fig. 1.1). Morgagni, Valsalva and Bartholin all wrote on the subject1-3, but it was John Hunter who demonstrated, in a series of specimens, the progressive effects and complications of prostatic obstruction. One of these was a classic example of obstruction by enlargement of the middle lobe4 which his brother-in-law Everard Home subsequently published and claimed as his own original observation-plagiary soon denounced by his contemporaries5 (Fig. 1.2).
