Special article: calculus breakability--fragility and durility

Prior to the use of lithotripsy techniques, there was no requirement for a vocabulary to describe the relative breakability of a urinary calculus. With the introduction of lithotripsy, we became aware that calculi of different radiologic appearances or chemical compositions varied in their susceptibility to fragmentation. Because all truly new distinctions require new expressions to characterize them, we had to create a term to express this new distinction, and the term we chose was "stone fragility." Currently, if we see a 1-cm calcium oxalate dihydrate stone, we say it appears fragile ("easily broken," from the Latin frangere, "to break", but if we see a dense brushite or a cystine stone, we can describe it only in terms of fragile; i.e., "not fragile" or, incorrectly, "hard": an antonym for "fragile" does not exist. In the interest of common understanding and more accurate quantitation of stone breakability, a neologism is suggested that has an appropriate Latin root, is easily spoken, sounds authentic, and is useful. It is proposed that, in the interest of accuracy and as a reflection of our greater sophistication regarding stone breakability, we use the Latin root dur (hard, difficult) and a suffix ile (of, like, pertaining to) to create the terms "durile" (adj; pertaining to or capable of being difficult to break) and "durility" (noun; a quality of being difficult to break or fragment).