Evolution of Hypospadias Surgery: Historical Perspective
The term hypospadias is derived from the Greek. “Hypo” means under and “spadon” means a rent or fissure (Duckett and Baskin 1996; Zaontz and Packer 1997). Durham Smith (1997) mentioned the dictum “There is nothing new in surgery not previously described”,
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The term hypospadias is derived from the Greek. " Hypo" means under and "spadon" means a rent or fissure (Duckett and Baskin 1996; Zaontz and Packer 1997). Durharn Smith (1997) mentioned the dictum "There is nothing new in surgery not previously described", and this exactly summarises the efforts which were made in the past for the description, d assification, pathology and treatment of hypospadias. Many modern surgeons ment ion the originality of their ideas, but an investigation of historical pap ers, documents and books indicates that all current technique s, theoretical and pra ctical knowledge were described centuries ago by various surgeons. Egyptian Civilisation and Religious Documents
Man's interest in learn ing the treatment of genital abnormalities began with a simple procedure: circum cision. The first documentation on this subject was found in Egypt. The circumcision procedure as a ritu al is shown in the famous relief in the tomb of Ankhmahor at Saqqara, dating from the sixth dynasty, c. 2345 Be. This relief shows two young men or adolescents being circumcised. This is probably one of the best preserved documents that we have. There is a similar relief, severely dam aged, in the temple of Muten Asheru at Karnak (Filler 1995; Nunn 1996; Reeves 2001). In the Eber papyrus, discovered in 1872 near Luxor, there is a recipe for the treatment of bleeding resulting from circumcision (Rogers 1973). Bettmann and Hinch (1956) mention the application of fresh meat to stop the haemorrhage. In these documen ts, the anaesthetic action of carbon dioxide resulting from the acetic effect of vinegar put on Memphis limestone was used to relieve the pain of children during circumcision procedures. Analysis of these documents, however, reveals neither description nor treatment ofhypospadias, with the single exception of a finding in the temple of Kom Ombo. On one of the outer walls of this temple there is arelief of surgical
A. T. Hadidi et al. (eds.), Hypospadias Surgery © Springer-Verlag Berlin Heidelberg 2004
instruments, induding metal shears , surgical knives, spatul as, small hooks and forceps (Nunn 1996; Portman 2001;Reeves 2001). Although there are no seientifically acceptable data specifying the use of these tools for penile surgery, these tiny and fine surgical instru ments would seem to be efficacious for circumcision and similar surgical procedures. The ancient Iews may have learned the surgical technique of circumcision from Egyptian civilisation; and circumcision is the only surgical procedure mentioned in the Old Testament (Ellis 2001). According to Zeis, in ancient Iewish practice a deficient prepuce due to extensive circumcision or tumour may have been treated by reconstructive surgical procedures (Zeis 1963). In the texts of the Bible, the Apochrypha Pseudoepigrapha and the Talmud, any male whose penis was cut off or any man suffering an abnormal opening could not marry (Sussman 1967). Penile amputation was an operation practised in the past. Amputation of the male organ was a fairly c
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