A pivotal study to evaluate the safety and effectiveness of Applaud Acoustic Enhancer when used in conjunction with conventional ureteroscopic laser lithotripsy (URS-LL) in the treatment of subjects with urinary stones.

The AEROLITH Clinical Study will evaluate the safety and effectiveness of Applaud Acoustic Enhancer when used in conjunction with conventional ureteroscopic laser lithotripsy (URS-LL) in the treatment of subjects with urinary stones. The clinical study is a prospective, multi-center, two-arm, randomized, double blinded study.

A total of 196 subjects will be enrolled in this study at up to 27 investigational sites located in the U.S.

Inclusion Criteria:

1. Male or female aged ≥ 18 years to ≤ 75 years
2. Provides written informed consent
3. Patients with at least one urinary stone measuring 6mm or greater (but no more than a cumulative diameter of 20mm) located proximally to the iliac vessels on one side may be treated.
4. Urinary stone(s) should be apparent on a CT scan within 60 days prior to study enrollment. Stone assessment will be conducted using CT imaging following CLIN-0025: AEROLITH IDE Study Screening Guide.
5. Patients with bilateral stones are allowed but only one side may be treated. Only the treated side will be evaluated for safety and effectiveness
6. Patients may enter the study with a stent in place.
7. Patients presenting with absence of a Urinary Tract Infection as confirmed using urinalysis

Exclusion Criteria:

1. Patients with stones exceeding a cumulative diameter of 20mm on the side to be treated. Note: Punctate stones measuring ≤ 2mm do not count in the cumulative diameter limit.

2. Patients with ureteral stones located distal to the iliac vessels on the side to be treated

3. Diagnosis of radiolucent stones (on the side to be treated) on KUB or Scout CT Imaging

4. For patients who have a ureteral stent in place, patient is excluded if stent is calcified or encrusted as verified using standard of care imaging (e.g. KUB X-ray)

5. Patients who have had prior URS-LL within 3 months on the side to be treated at the time of consent.

6. History of cystinuria

7. Urine pH is < 5.5.

8. Patients with known history of recurrent uric acid stones

9. Untreated urinary tract infection (UTI)

10. History of drug-resistant chronic UTI

11. If female, pregnant as confirmed using urine test to be conducted on the day of the procedure.

12. Patient has an American Society of Anesthesiologists (ASA) physical classification level of 4 or greater.

13. Known sensitivity to possible medications used before, during, or after the URS Laser Lithotripsy procedure, including but not limited to the following: sedative agents, general anesthetics, topical anesthetics, and opioid analgesics

14. Stones suspected in calyceal diverticula

15. Horseshoe kidney

16. Congenitally ectopic pelvic kidneys

17. Full staghorn calculi >2cm

18. Patients with elevated serum creatinine > 1.5mg/dl

19. Patients with a solitary kidney

20. Malrotated kidney on the side with urinary stone

21. Duplicated collecting system or duplicated ureters

22. Patients who are currently involved in any investigational drug or device trial or have been enrolled in such trials within 30 days of index procedure

23. Patients who are actively taking antiplatelet and anti-coagulation except low dose aspirin

24. Prostate biopsy within the last 3 months

25. History of radiation therapy of abdomen and pelvis

26. History of urinary tract reconstruction

27. Other factors that the investigator feels would interfere with the participation and completion of the study such as:

    • Inability to provide voluntary consent
    • Inability to understand the clinical investigation or cooperate with investigational procedures
    • Planned relocation or unable to return for required follow-up visits
    • Vulnerable individuals (mentally disabled, physically disabled, prisoner, etc.)