Civiale pioneered the theory that stones could be crushed, and he made the first successful attempt to crush calculi by passing a steel tube through the male urethra into the bladder, grasping the stone with three-pronged pincers, and pulverizing it with a drill. Fellow Frenchman James Leroy d'Etiolles produced a similar model in 1822 while Baron L.S. Heurteloup introduced a long instrument with "jaws" to break stones a decade later.
Civiale's instrument lowered mortality to 3 percent. But it was Boston surgeon Henry J. Bigelow who introduced major safety features in his 1872 litholapaxy—which crushed the stone and flushed it out of the bladder in one procedure—and humane stone extractions. Witnessing the first public demonstration of ether anesthesia in 1842, Bigelow eventually applied it to his stone patients, taking up to two hours for his extractions. While ether ushered in powerful instruments and forceful evacuations, it also lowered complications and death.
But the bigger impact was in ending the taboo against renal or kidney surgery. German Gustav Simon performed the first nephrectomy on August 2, 1869 for a uretero-cutaneous fistula.