The history of rigid optical urologic endoscopes is well documented and is covered in this text in Chap. 3 [16]. Philipp Bozzini developed his lichtleiter, or “light conductor” in 1806 for viewing orifices in the human body [17]. Antonin Desormeaux (who has been called “the father of endoscopy”) would develop an open tube endoscope to examine the bladder in 1867, using his device to perform the first endoscopic surgery [16]. Maximilian Nitze and Joseph Leiter, in 1879, are credited with developing the first modern cystoscope [18]. In the late 1950s, Harold Hopkins invented the rod-lens system, which reduced the air space in between lenses with long rods of glass thereby improving the clarity and resolution of the image [19, 20]. The advances in optics led to better cystoscopes which were in turn used as the early nephroscopes. In the 1980s the rigid cystoscope would be replaced by offset nephroscopes with a large straight working channel allowing the use of numerous adjunctive instruments from triradiate graspers to electrohydraulic lithotripters [4].

Advances in illumination would play a significant role in improving the cystoscope as it evolved from indirect illumination to heated platinum wires followed by the incandescent lightbulb [16, 21]. The first fiber-optic endoscope was developed by Basil Hirschowitz in 1957 for use in gastroenterology [22]. Victor Fray Marshall would perform the first antegrade nephroscopy and ureteroscopy using a fiberscope during an open exploration to visualize the pelvis and distal ureter in 1960 [23]. Modern fiberoptics, introduced in the 1960s, coincided with the development of flexible endoscopy/nephroscopy, and aided in less invasive stone clearance. Improvements in imaging culminated with the development of the charged couple device (CCD) by George Smith and Willard Boyle in 1969 for electronic video recording [16].

Man has been breaking stone since the beginning of time. With improvements in technology, we have become increasingly efficient and safer in our ability to pulverize larger and harder stones. Thus the modern development of various lithotripsy devices and the introduction of the holmium laser have improved the efficiency of stone fragmentation and clearance [9]. In the early 1970s the ultrasonic lithotrite was developed. Karl Kurth in 1977 provided a means for removing large stones through a nephrostomy tract when he described the use of an ultrasonic lithotrite, previously developed for bladder stones, during PCNL to fragment a staghorn calculus [24]. In 1913 Reinhold Wappler would make the observation that “when a spark is brought into contact with both the hard and soft species of bladder calculi, it causes them to disintegrate” [9]. However it would not be until 1950 that LA Yutkin would obtain a patent for the application of electrohydraulic shock waves. He called his discovery the “electro-hydraulic effect,” to describe the submerged powerful high-voltage arc discharge in a liquid [25]. Pneumatic lithotripsy was introduced in the early 1990s with the development of the Swiss Lithoclast (Boston Scientific) [26]. Combined devices utilizing both ultrasonic and pneumatic lithotripsy would be developed to help facilitate stone fragmentation. The CyberWand lithotripter , a dual ultrasonic driller/corer was developed via a joint venture between Jet Propulsion Laboratories and Cybersonics, Inc. It was created in 2000 to acquire samples from planets, asteroids and comets using low power and a low axial load to drill a 0.5 in. hole in hard rocks such as basalt. It relied on a novel mechanism using piezoelectric wafers to produce high frequency vibrations which were converted to a hammering action at low frequency. The drill was used successfully to obtain core samples from locations varying from Antarctica to Mars (via the Curiosity rover). It has since been modified and revised to its current dual ultrasonic probe design to be used for PCNL [27].

Light amplification by stimulated emission of radiation (LASER) was originally described by Albert Einstein in 1917. It was not until 1954 that J.P. Gordon and C.H. Townes at Bell Laboratories generated the first stimulated emissions of microwave radiation (MASER ). Medical lasers first appeared in the early 1960s [9]. The Nd:YAG, a solid state laser was developed in 1961. Mulvaney and Beck in 1968 carried out the first attempt at calculus destruction using a ruby laser [28, 29]. The introduction of the Holmium:YAG laser represented a major advance in laser lithotripsy devices as it has been shown to effectively fragment all types of urinary calculi. With the combination of flexible nephroscopy and holmium laser lithotripsy, urologists could access and fragment stones in other calyces independent of the initial renal access.

Radiological advances would play a significant role in the development of PCNL [30]. In 2002, Dr. Segura would write:

“…it was the wide spread availablility of fluoroscopy that was the key to the popularity the percutaneous nephrostomy tube placement enjoys today. I believe that had there existed something like an “endourology table” in those days, we and not radiology, would be putting these tubes in today” [31].

In 1895 Wilhelm Röentgen observed that a high electric voltage passing through a covered vacuum tube in a dark room caused a platinocyanide covered screen to emit fluorescent light which he termed “x-rays.” Röentgen’s work would serve as the foundation for the field of radiology and he would be awarded the first Nobel Prize in Physics in 1902 [32]. The development of fluoroscopes, machines which consisted of a cone with an eyepiece at one end and a screen at the other end that could convert x-rays to light, in 1896, allowed one to observe an object without having to process a film or x-ray plate. The development of the image intensifier tube by J.W. Coltman from Westinghouse in the 1948, allowed an image to be intensified nearly 500 times, thus allowing the image on the screen to be visible during normal lighting [32]. Improvements in fluoroscopy would lead to the development of today’s C-arms that would further aid in renal access for PCNL.

Knowledge of renal anatomy is paramount to safe access into the collecting system. In the 1990s, Francisco Sampaio’s casts of the renal collecting system and vascular anatomy in human cadavers would further aid urologists by helping establish the paradigm that access to the collecting system should be obtained via direct puncture into the fornix of a calyx and not the infundibulum in order to minimizing the risk of bleeding. It would allow better characterization of the renal collecting system in comparison to the vasculature in a 3-dimensional model [33]. Besides the radiologic innovations leading to safer and more accurate renal access, the development of computed tomography by an engineer, Sir Godfrey Hounsfield (who would win the Nobel Prize in Physiology and Medicine in 1979) and a neuroradiologist, Dr. James Ambrose, would over time lead to improvements in pre-surgical planning as well as evaluation of stone free status post-operatively [34, 35].

A number of advances in technique and technology would continue to challenge how to better treat renal calculi. Dr. John Wickham reported the first tubeless PCNL in 1984 but it didn’t gain acceptance until 1987 and the studies by Bellman [36, 37]. A percutaneous renal access robot (PAKY ) was developed by Dr. Louis Kavoussi at Johns Hopkins for robotic needle puncture into the collecting system [38]. Supine PCNL was first described by Gabriel Valdivia in 1987 [39].