Instruments Used in Endoscopic Cystolithotomy
Cystolithotomy Cluster · Endoscopy Silo · Colombia 2026
Instruments Used in Endoscopic Cystolithotomy: A Complete Guide
From the rigid cystoscope to nitinol baskets and the Ellik evacuator — all the instruments involved in endoscopic cystolithotomy and the function of each
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GSMED Imaging Technical Team — Urological Endoscopy Colombia
Based on: EAU Guidelines on Urolithiasis 2025, Olympus Medical catalogs (cystoscopes) and Karl Storz (urological instruments), Swiss LithoClast (pneumatic), and endoscopic cystolithotomy clinical literature 2024.
A successful endoscopic cystolithotomy depends on having the right instruments, in the right conditions, and understanding what each one is used for. This guide describes in detail each instrument involved — from the cystoscope to the final drainage catheter — with its technical specifications and its function in the procedure.
1. The Rigid Cystoscope — The Main Instrument
The rigid cystoscope is the central instrument of endoscopic cystolithotomy. Unlike the flexible cystoscope (which is used for diagnosis and minor procedures), the rigid cystoscope offers a larger working channel diameter (up to 10 French in the working channel, within a 24–26 French cystoscope) that allows the introduction of larger caliber laser fibers and the extraction instruments necessary for cystolithotomy.
| Component | Specification | Function in Cystolithotomy |
|---|---|---|
| Outer sheath | 22–26 French · stainless steel | Provides transurethral access to the bladder · Continuous irrigation and drainage channel |
| Obturator | Blunt or conical tip | Facilitates the atraumatic introduction of the sheath through the urethra |
| Rod lens (Hopkins) | 0°, 30° or 70° viewing angle | Provides the image of the inside of the bladder · 30° is the most used in cystolithotomy |
| Working bridge | 6–10 French working channel | Allows the passage of the laser fiber, baskets, forceps, and lithotriturators |
| Irrigation connections | Side ports | Continuous irrigation during the procedure to maintain visibility |
2. Energy Sources — Fragmentation Instruments
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Ho:YAG Laser Fiber
200–550 micron silica silicate fiber. It is introduced through the working channel of the cystoscope. The end of the fiber rests on the stone and the laser fragments it into powder (dust effect) or small fragments depending on the energy and frequency settings. The fibers are single-use (disposable) — they are not re-sterilized.
→ 200–550 μm · Disposable · Dust effect
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Pneumatic Lithotriturator Probe
2.5–5 French rigid metal probe that vibrates by compressed pneumatic energy and mechanically impacts the stone. The Swiss LithoClast (EMS) allows the simultaneous use of pneumatic and ultrasonic energy (Swiss LithoClast Master). Very effective for large and hard stones that resist the laser alone.
→ Large fragments → extract · Ideal for stones >2 cm
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Electrohydraulic Electrode (EHL)
3–9 French probe that generates a hydraulic shock wave when discharging between two electrodes in contact with the irrigation fluid. Very powerful for soft stones (urate, struvite), but with a risk of damage to the bladder mucosa if the electrode touches the wall. Caution is required.
→ Soft stones · Mucosa caution · No direct contact
3. Extraction and Evacuation Instruments
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Nitinol Basket (Dormia)
Nitinol wire basket (nickel-titanium alloy) that opens inside the bladder to capture stone fragments and extract them through the working channel. Nitinol is thermoestable — it does not melt with the laser — which allows it to be used while fragmenting. Available in different sizes (3–10 mm opening). For cystolithotomy, baskets with a larger opening than in ureteroscopy are used.
→ Thermoestable with laser · Extraction of fragments >3 mm
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Ellik Evacuator
Transparent silicone pear-shaped instrument that attaches to the cystoscope at the end of the procedure. By compressing and releasing the pear, it creates a pulsatile flow that sucks out the stone fragments and residual powder from the bladder. It is systematically used at the end of every cystolithotomy to ensure a clean bladder. Transparent to see the evacuated fragments.
→ Final evacuation · Pulsatile flow · Mandatory at the end
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Endoscopic Grasping Forceps
5–7 French forceps with teeth or with a cup to capture large individual stone fragments that do not fit in the basket. They are also used to position the stone during fragmentation when the stone "escapes" the field of vision.
→ Large individual fragments · Stone positioning
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Three-Way Urethral Catheter (3-Way Foley)
At the end of the procedure, a three-way urethral catheter (16–22 French) is left that allows continuous irrigation of the bladder during the first 12–24 hours. The third irrigation channel prevents the obstruction of the catheter by clots or residual fragments. It is removed in 24–48 hours depending on the hematuria.
→ Post-procedure · Continuous irrigation · 24–48 h
4. Monitoring and Safety Equipment
- Hydrophilic Guide: wire guide coated with a slippery hydrophilic material that facilitates transurethral access when there is urethral stenosis or difficulty of passage. It is introduced first through the urethra and the cystoscope advances over it.
- Irrigation Pressure Manometer: in some modern systems, the intravesical pressure is monitored during the procedure to prevent extravasation due to excessive pressure — especially important in long cystolithotomies.
- Laser Protection Goggles: mandatory for all operating room personnel during the use of the Ho:YAG or TFL laser — the Holmium wavelength (2,100 nm) can damage the retina if there is accidental reflection.
Can the flexible cystoscope be used for cystolithotomy?
The flexible cystoscope is possible but suboptimal for cystolithotomy. Its narrower working channel (3.6 French in most) limits the caliber of the laser fiber — it only allows 150–200 micron fibers, which reduces the effective power of the laser. In addition, the flexible channel does not allow the introduction of large baskets or the Ellik evacuator directly. Flexible cystolithotomy is used in patients in whom the urethra does not accommodate the rigid cystoscope, or in small stones (<1 cm) in which the thin laser fiber is sufficient.
Cystoscopes and Urological Instruments Available in Colombia
Olympus and Karl Storz systems for cystolithotomy with local technical support — GSMED Colombia.
View endoscopic instruments →
