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Twenty two patients who had developed an adverse cutaneous reaction to the Moderna or Pfizer vaccine underwent biopsies. Each case was assessed light microscopically and in select biopsies spike glycoprotein and cytokine assessment were also conducted. The patients developed self-limited cutaneous reactions often described clinically as urticarial or eczematous within one day to 4 weeks after receiving the first or second dose of the Pfizer or Moderna vaccine. Classic clinical and morphologic depictions of type IV cutaneous hypersensitivity with features of dermatitis, interface dermatitis, granulomatous inflammation and/or lymphocytic vasculitic component were observed. Clinical and/or histologic features of perniosis, pityriasis rosea, pityriasis rubra pilaris and guttate psoriasis were seen in select cases. In two cases the dominant picture was urticarial vasculitis, possibly reflective of an Arthus type III immune complex action. The biopsies of normal skin post-vaccine and skin affected by the post vaccine eruption showed rare deep microvessels positive for spike glycoprotein without complement deposition contrasting with greater vascular deposition of spike protein and complement in skin biopsies from severe COVID-19 patients. It is concluded that self-limited hypersensitivity reactions to the vaccine occur possibly due to a substance found in the vaccine vehicle such as polyethylene glycol. An immune response that is directed against human-manufactured spike has to be considered since some of the reactions clinically and or histologically closely resemble mild COVID-19. Finally, vaccine associated immune enhancement largely attributable to the adjuvant properties of the vaccine may unmask certain inflammatory milieus operational in psoriasis, atopic dermatitis and subclinical hypersensitivity.

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Purpose of review The purpose of this review is to summarize recent developments in the array of devices which are commonly used by urologists in the surgical management of kidney stones. To accomplish this goal, an extensive review of recent endourology literature, conference abstracts, and publicly available documents from manufacturers and the United States Food and Drug Administration was collected and reviewed. Recent findings Recent developments in the holmium:yttrium-aluminum-garnet (Ho:YAG) laser lithotripsy include the introduction of pulse modulation. This technique delivers the laser energy in an asymmetric manner such that an initial bubble is created (the ‘Moses effect’) through which the remainder of the energy can then travel through without being absorbed by surrounding water. Even more novel is the thulium fiber laser, which is produced in a fundamentally different way than traditional Ho:YAG lasers and is not yet available for clinical use. Finally, novel mechanical lithotrites which effectively combine ultrasonic energy, ballistic energy, and suction capability appear to be highly effective for stone clearance in recent benchtop and clinical studies. Summary With the introduction of both new modifications of time-tested technologies as well as completely novel modalities, the practicing urologist's armamentarium of devices for the surgical management of kidney stones continues to grow. As the popularity of ‘mini’ procedures continues to grow, the adaptability of these technologies to these procedures will be critical to maintain maximum relevance.