ABSTRACT
The suprapubic approach to the bladder via a low midline abdominal incision, with the bladder distended to push away the peritoneum, is the usual open method employed in the removal of bladder stone. There are three possible surgical approaches to remove a stone from the bladder. First by cutting down on to the base of the bladder through the perineum, immediately in front of the rectum; second by passing crushing instruments into the bladder along the urethra; and third by opening the bladder through the lower abdomen. Patients teased by the agonies of bladder stone and surgeons dissatisfied with the difficulties and dangers of cutting for the stone dreamed of some means of removing the calculus through the natural passage from the bladder – the urethra. About 1520, a new technique of lithotomy was introduced by the Italian surgeon Franciscus de Romanis of Cremona.
