The end of "Cutting for Stone"? Using the lithoclast trilogy for cystolitholapaxy on a 4 cm bladder stone per urethra.

We present a case of cystolitholapaxy using the LithoClast Trilogy lithotripter device per urethra via a rigid 26F nephroscope in a 36-year-old female with chondrodysplasia, paraplegia, contractures, and history of bladder augment managed with clean intermittent catheterization. The stone was 4cm in diameter with an average of 1300 Hounsfield Units, and composed of 45% calcium phosphate, 40% struvite, and 15% ammonium urate. Advantages include faster fragmentation time versus holmium laser, improved safety with suction extraction and improved vision, ability to treat larger stones endoscopically, and control of all variables by one surgeon with only a single foot pedal.