Lithotomy (Gr. lithos, 'a stone;' tomē, 'the act of cutting'), the technical name for the surgical operation popularly called cutting for the stone. As most of the symptoms of stone in the bladder (which are noticed in the article CALCULUS) may be simulated by other diseases of the bladder and adjacent parts, it is necessary to have additional evidence regarding the true nature of the case before resorting to so serious an operation as lithotomy. This evidence is afforded by sounding the patient—a simple preliminary operation, which consists in introducing into the bladder, through the natural urinary passage (the urethra), a metallic instrument, by means of which the stone can be plainly felt and heard.
Lithotomy has been performed in various ways at different times, both in the perineum and above the pubes. The earliest form of lithotomy is known as cutting on the gripe, or Celsus's method. It received the former name from the stone, after being fixed by the pressure of the fingers in the anus, being directly cut upon and extracted. The Marian method, founded on the erroneous idea that membranous parts would not heal after incision, while their dilatation was comparatively harmless, was the operation mainly in vogue for nearly 200 years, till Frère Jacques introduced what is essentially the method now in use. Cheselden (1727) and Liston in the first half of the 19th century perhaps most deserve mention among the many surgeons who have subsequently improved upon the original operation.
The lateral operation, so called from the lateral direction in which the incision is made into the skin of the perineum and the neck of the bladder, in order to avoid wounding the rectum, is that which, with various minor modifications, is generally employed at the present day. Frère Jacques seems to have devised the method and to have practised it with much success; and in 1702 he published a description of it. The advantage of this operation, by which a free opening, sufficiently large for the extraction of all but very large stones, can be made into the bladder without laceration of the parts or injury to the rectum, was immediately recognised by the leading surgeons of the time, and the Marian process was at once universally given up. Other varieties of the perineal operation are termed median, bilateral, &c.
The suprapubic or high operation was first performed by Pierre Franco in 1561, and has occasionally been employed ever since. It has recently been proposed by some surgeons to use it in preference to perineal lithotomy in the majority of cases; but it is generally reserved for stones of large size which cannot be crushed and are difficult to remove through the outlet of the pelvis.
From the shortness of the female urethra and the extent to which it can be dilated, and, additionally, from the comparative rarity of calculous affections in women, the operation of lithotomy is seldom required in the female sex.
The danger of the operation increases with the age of the patient. Statistics of 1827 cases of lateral lithotomy in England, collected by Sir
Henry Thomson, show a mortality gradually rising from 5.7 per cent. in the patients under twelve years of age to more than 31 per cent. in those over seventy. The more general adoption of lithotripsy has greatly diminished the number of cases in which lithotomy has to be resorted to.