"Urethrolithotomy": an ingenious approach of the ancients

A major postoperative complication of the surgical removal of urethral calculi is formation of a fistula. Celsus, a Roman medical author living around the turn of the millennium, discussed a procedure for removing such stones that all but eliminated this complication. Preoperatively, the flaccid skin of the penis is pulled distally and bound in an advanced position with a ligature, as the penis itself is pushed proximally. Incisions are made ventrally into the penis and urethra. The stone can then be removed and the ligature cut, allowing the penile skin to assume its natural position. The effect of this procedure is to avoid 2 overlying incisions, greatly reducing the chance for fistula formation. Today the 2 incisions mentioned by Celsus would be closed with sutures, although in his time the wounds were left open and allowed to heal spontaneously.