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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

While the surgery took only 40 minutes, patient Margarete Kleb's infection-riddled recuperation lasted six months. Kleb survived, exposing her incision in one of medicine's best known illustrations.

Nephrectomies for stone disease didn't catch on immediately. Physicians were handicapped by infections, insufficient diagnostic tests and limited knowledge of physiology or renal function. Simon's first nephrectomy for stones in 1871, for instance, ended with his patient's death from sepsis.

Yet, outcomes improved as X-rays and the cystoscope allowed urologists to locate calculi and visualize procedures. Surgery became well-established because of better techniques, a fuller understanding of anatomy and the advent of antiseptics and antibiotics.

By the 1970s, however, less-invasive techniques overtook open operations, with "big" stone surgeries involving gentler percutaneous approaches. Today, kidney stone patients, should they require surgery, experience smaller incisions, shorter hospital stays and smoother recoveries.

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