Search

Background: Vaginal calculi are rare and can grow quite large if they remain undetected. Vaginal stones are caused by the pooling of urine in the vagina and can be classified as either primary or secondary, depending on the absence or presence, respectively, of a nidus. Primary stones without any urethrovaginal or vesicovaginal fistula are even more uncommon but appear to be more commonly reported in incontinent women with significant physical disabilities. Case Presentation: We present a case of an ∼11 cm primary vaginal stone in a 61-year-old woman with cerebral palsy. This was removed using a nephroscope and an endoscopic ultrasonic lithotrite through the vaginal introitus with subsequent analysis demonstrating a struvite stone composition. Conclusion: This case is unique not only for the large size of the calculi but also for our less invasive approach, using a nephroscope and endoscopic ultrasonic lithotrite to fragment and remove the stone. We hope that this report will assist other providers in the timely and accurate diagnosis and treatment of future vaginal stone patients.

INTRODUCTION AND OBJECTIVE:Holmium:YAG laser has been the lithotrite of choice for around 30 years in kidney stone surgery. The relatively high absorption in water is clinically useful but also lim...

Holmium:YAG laser has been the lithotrite of choice for around 30 years in kidney stone surgery. Lasers have evolved over the years to offer higher power, increased pulse frequencies and longer pulse durations. The drivers for change have been to improve stone ablation and to minimise retropulsion. We report on a new prototype Holmium laser that fires multiple “micro-pulses” in “pulse packets” and discuss the stone phantom ablation rate results utilizing a bench model. The prototype laser demonstrated impressive stone ablation rates in our bench testing across a range of power settings. We will discuss the details of these results supporting that pulse-modulation with packets of micro-pulses are a promising technological development. (Disclaimers: Bench Test results may not necessarily be indicative of clinical performance. The testing was performed by or on behalf of BSC.

INTRODUCTION AND OBJECTIVE:PCNL requires a lithotrite to efficiently break and remove stones. We set out to determine the efficacy and safety of a new lithotrite, the EMS Lithoclast Trilogy, in the...

Maintenance of flexible ureteroscopes can involve high costs and administrative burden. Instrument fragility necessitates eventual repair, rendering scopes inaccessible during refurbishment. We conducted a multi-institutional prospective cohort study to identify perioperative factors influencing flexible ureteroscope durability. Patients undergoing flexible ureteroscopy (URS) at six United States endourology centers were enrolled between August 2014 and June 2015. Surgeon self-reported concern and satisfaction with scope performance as well as upward and downward angles of deflection for each scope tip were measured before and after each procedure. The need for scope repair was determined by the operating surgeon at the time of the procedure and recorded. 424 URS cases using 74 flexible ureteroscopes were identified. Scope repair was required in 28 cases (6.6%) involving 26 scopes (35.1%). Upon univariate analysis, shorter patient height, absence of guidewire use, presence of a ureteral access sheath (UAS), longer procedure time, larger stone size, lithotrite type, surgeon training level, and self-reported concern were associated with scope repair. Upon multivariate analysis, UAS use (OR = 2.53, p = 0.005) and degree loss of scope upward flexion during a case (OR = 1.02, p = 0.03) increased the odds of a scope needing repair while the use of safety guidewire decreased the odds of a scope repair (OR = 0.50, p = 0.045). Lithotrite use and surgeon concern were associated with degree loss of scope upward flexion. The use of a UAS, absence of a safety guidewire, and the loss of upward ureteroscope flexion should be considered when evaluating means of optimizing reusable ureteroscope durability.

Introduction and Objective: Current available lithotrites have clinical stone clearance rates averaging 24 to 32 mm2/minute. The objective of this study was to critically evaluate the initial exper...

INTRODUCTION AND OBJECTIVES:Holmium:YAG laser is the current lithotrite of choice. Although improvements such as higher pulse frequency, longer pulse duration, and multi-pulse technology have advan...

A central component of percutaneous nephrostolithotomy is an endoscopic lithotrite that safely and efficiently clears stone of all compositions from the intrarenal collecting system. The current multicenter trial studied 3 lithotrite combinations employing both mechanical ballistic and ultrasonic energy to fragment and evacuate with suction stone debris. What is clear from this work is that, with regard to the timely clearance of the stone burden and peri-operative complications, there is minimal difference between the devices studied, nothing special and nothing new. The real question here is: are these devices sufficient, since the basic technologies employed are well over 10 years mature? Percutaneous nephrostolithotomy in the era of retrograde flexible ureteroscopic lithotripsy is relegated to those with the largest stone burdens, matrix stones requiring complete evacuation of this material at the time of the surgical intervention, and those who have failed ureteroscopic lithotripsy. With that in mind...