Maximilian Nitze introduced the first direct-vision cystoscope in 1877, which markedly improved vision inside the bladder but offered limited operating capability [5]. Never satisfied, from 1891 to 1894, Nitze designed and constructed the first practical operating cystoscope (Fig. 6.1). He became the first to coagulate a bladder polyp visualized with Edison’s new light bulb and using cold and hot wire loops for galvanocautery. He initiated systematic cystoscopic treatment of bladder tumors and reported removal of tumors from 150 cases with only 1 death and 20 recurrences. Using curette, cutting forceps, cautery, and wire loop, he was able to remove many papillary tumors cleanly [6]. Others followed his lead, and in 1905, Weinrich reported treating 101 cases of bladder tumors by the Nitze method with 71% recoveries without a recurrence. The procedure was mostly excision of pedunculated tumors with a portion of mucosa or else twisting off the pedicle at its base. For most European and American urologists, however, the Nitze cystoscope was cumbersome to manipulate, and galvanic cautery using the wire loop proved to be an unreliable means of tissue destruction. With advent of diathermy in the United States, surgery of bladder tumors using Nitze’s operating cystoscope was practically abandoned.

Nagelschmidt and Doyen in the United States were the first to advocate use of electrically induced heat to treat cancerous growths. Nagelschmidt devised an adequate apparatus for this purpose and is credited with originating the term diathermy. But it was Edwin Beer of New York who really founded electrosurgery of the bladder.

In 1908, Beer, convinced that Nitze’s earlier transurethral treatment of bladder tumors was superior to open surgery, conceived the idea of using high-frequency electric current through a catheterizing-cystoscope to coagulate bladder tumors. He used a two-channel Nitze cystoscope (one channel for a 6F copper electrode and the other for irrigation of the bladder) and a monopolar (Oudin) current derived from a resonator made by the American cystoscope maker, Reinhold Wappler. Direct current was applied at various points to papillary growths for 15–30 s at a time, while the bladder was distended with sterile water. Beer treated two women and saw no spark when the full current was thrown on without resistance. Tumor tissue was dessicated at cautery points even under water, and patients experienced no more discomfort than during ordinary cystoscopy. Beer concluded that coagulation was simpler than loop treatment, and in 1910, he reported his successful cases in a landmark article, claiming fulguration to be “proven effective in the cure of bladder papilloma” [7].