For the modern urologist, the history of our craft is an unknown world. The limitations and challenges that our predecessors faced in the care of their patients are often difficult to imagine, let alone understand. Today, the practices of the past are often greeted with condemnations of heresy. While that may be a valid argument to make with our conventional wisdom about the workings of the human body, it is these early innovators and their unparalleled drive to advance patient care that have allowed our specialty not only to flourish but to push the frontiers of medicine with a marriage of the most modern technology and our best understanding of human physiology. This chapter presents a historical perspective on percutaneous renal surgery. It highlights the earliest experiences and the key turning points that have shaped the modern practice of endourology and minimally invasive urological surgery. The intellectual and procedural challenges of the early actors are highlighted, and perhaps can serve as an inspiration for today's researchers.