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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

The most remarkable breakthrough, however, may be extracorporeal shock wave lithotripsy, (ESWL). Introduced in 1983 by Dornier, this "stone bath" utilizes targeted shock waves traveling harmlessly through water and soft tissue to crumble calculi into sand-like particles that are flushed out naturally.

Lithotripsy remains a well-tolerated outpatient procedure but it is not the only approach to stone treatment. Since the 1980s, ultrasound, laser and electrohydraulic lithotripsy have allowed great versatility in targeting calculi, based on size and site. Unlike lithotripsy, these modes require energy-transmitting probes to make contact with stones.

In any case, recovery these days is relatively swift and generally safe. What's more, reccurrence rates are low because urologists can peer around corners and pull out fragments of calculi that might grow again. Such precautions are tantamount to prevention since scientists have yet to find a drug to stop stones from forming.

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