Two centuries of cystoscopy: the development of imaging, instrumentation and synergistic technologies

Abstract

The cystoscope used today is the product of centuries of development. The desire to view the cavities of the body was first described several centuries ago. The earliest true prototype was Bozinni's 1805 urethral viewing tube, on which many others were based. These primitive instruments were challenging to use for the operator, uncomfortable for the patient, and dangerous for both. Patient positioning was based on the method of bladder distension and the goal of the operation, rather than comfort. Images visualized by early models were inverted and backwards, and required the operator to be skilled in correcting this image. Reflected candlelight was used for illumination, and objects appeared small and distant. With the advent of lenses, prisms and the incandescent light, cystoscopy advanced to Nitze's prototype, a forerunner of the current cystoscope. Once the image quality was improved, instrumentation through the cystoscope was introduced, broadening the scope of urology, from the management of venereal disease to a premier surgical speciality. Finally, the invention of fibre optics and digital imaging provided the cystoscope used by urologists worldwide, giving unparalleled image quality, allowing for educational opportunities and a quality of patient care unimaginable to the early pioneers. An understanding of this past brings not only an appreciation of the technology currently available, but also a glimpse into what the cystoscope has the potential to become. From this past, it is clear that today's cystoscope is merely a forerunner of that which the future will bring.