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Calculi (shown in cross-section) come in a variety of shapes and sizes - making removal complicated and unpredictable. Frontispiece, Kelly and Burnam's Diseases of the Kidney, Ureter & Bladder, 1914. Courtesy of The Johns Hopkins University

Frère Jacques Beaulieu—who became a monk and traveled the French countryside performing lithotomy for nominal fees and often proffered those funds to the poor—was the first to practice a lateral approach to perineal lithotomy. Frère Jacques performed more than 5,000 lithotomies in 30 years, though his mortality rates were quite high. He was one of the most celebrated lithotomists of his time, and his name lives on in children's song.

Thankfully, the evolution of lithotomy and stone treatments has been vast. Today new technology—lithotripsy—has radically transformed treatment by pulverizing stones with powerful bursts of energy. Yet before it emerged, urologists witnessed an evolution of surgical and other techniques.

While John Jones' perineal stone procedure (1760) initiated urology's formal history in America, the more fascinating footnote may be Philip Syng Physick's 1831 extraction of 1,000 calculi from Supreme Court Justice John Marshall's bladder. At age 76, Marshall returned to the courtroom after his surgery.

New instruments, such as Jean Civiale's lithontripteur (1823), eventually changed the way surgeons removed stones.

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