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Ravini Lighted Urethral Speculum

The RaViNi is a self-retaining, lighted urethral speculum (Surgipros LLC) purpose-built for deep, narrow-corridor reconstructive urology — most prominently female urethroplasty through the introitus and posterior-urethral dissection through a perineal incision. The instrument family is sized in French calibre, with beak diameter, length, angle, and tip-style variants (council-tip, blunt-suction) selected to the specific anatomic problem at hand.[1][2]

Design​

  • Self-retaining blades hold the corridor open without an assistant or separate Lone Star elastic-stay hook system, freeing both surgeon hands for the reconstruction.
  • Integrated distal light source at the tip — direct illumination at the working surface, not the back-table line-of-sight illumination of an overhead light.
  • French calibre sizing — the standard RaViNi is 14 Fr; smaller and larger variants exist for pediatric / atretic and dilated / post-radiation anatomy respectively.
  • Tip-style variants (see below) for different dissection strategies.

Variant Family​

VariantDistinguishing featureBest fit
RaViNi14 Fr standardRoutine female urethroplasty / introital corridor work
RaViNi-BBlunt tip with integrated suction adapterBlood-and-irrigation-clearing during ongoing dissection; posterior urethroplasty after stricture has been opened[2]
RaViNi-C12 Fr Council-tip for over-the-wire placementInitial stricture engagement — the device is passed over a previously placed guidewire, then sequential incisions are made through the stricture until the lumen accepts the larger RaViNi-B[2]
RaViNi-πExtra-long shaft"Pi-in-the-sky" cases — deep perineal corridors, complex posterior reconstruction, high distraction defects

Reconstructive-Urology Uses​

Female Urethroplasty​

The instrument's design problem: the female urethra is short, narrow, and angled cephalad through the introital corridor — conventional vaginal retractors (Heaney, Breisky-Navratil, Auvard weighted speculum) open the vaginal canal but do not provide a self-retaining illuminated channel into the urethra itself. The Ravini operationalizes that specific exposure.

Reported workflow for female substitution urethroplasty:[1][2]

  1. Cystoscopy + guidewire placement across the stricture.
  2. RaViNi-C (over-the-wire, 12 Fr) is advanced into the stricture; sequential incisions are made under direct illumination.
  3. Once the lumen accommodates a larger calibre, switch to RaViNi-B for the graft inset and full reconstruction.

The first dedicated AUA video-abstract series reported ~ 71% success across an initial 7-patient female-urethroplasty cohort.[1] Small numbers, but representative of the targeted niche and consistent with broader female-urethroplasty success ranges where exposure quality is rate-limiting.

Posterior Urethroplasty / Deep Perineal Dissection​

The Kaldany / Cedars / Nikolavsky 2025 technique paper on substitution urethroplasty for posterior urethral stenosis describes the RaViNi-B and RaViNi-C as core deep-perineal instruments — "specifically designed for deep perineal dissection… their use in the posterior urethra greatly facilitates dissection and visualization."[2] The integrated light and suction at the working tip address the two main bottlenecks of perineal posterior-urethroplasty exposure: visibility at the bulbomembranous corner and blood / irrigation clearance during meticulous dissection.

Other Reconstructive Uses​

  • Female urethral diverticulum resection — alternative to the conventional weighted vaginal speculum + Scott / Lone Star hook ring approach when the diverticulum sits high in the urethra and the standard retractor cannot expose the proximal extent.[3]
  • Urethrovaginal fistula repair — when high-lying defects require an introital corridor narrower than a standard speculum can hold.
  • Transvaginal mesh excision at the proximal urethral wall — narrow illuminated corridor for precise dissection along the urethral plane.
  • Bladder-neck reconstruction in the female — exposure of the bladder neck through the introitus during BNR or pubovaginal-sling revision.

Technique Pearls​

  • Match the variant to the dissection phase — RaViNi-C over-the-wire for stricture engagement; RaViNi-B once the lumen is open enough for the blunt-suction tip.[2]
  • Position the patient in high lithotomy — the speculum's light projects axially down the urethra; angles flatter than lithotomy waste the illumination advantage.
  • Wipe the lens or LED tip between activations — blood adherence at the distal optic dims the projected light disproportionately.
  • Pair with a Lone Star ring for vulvar-skin retraction; the Ravini exposes the urethra but does not handle vulvar tissue.
  • Re-tension intermittently — the self-retaining mechanism can creep during long cases; recheck blade position every 20–30 min.

Limitations​

  • Single-axis exposure — the Ravini opens the urethral corridor but does not retract the vaginal walls or labia; supplement with a Lone Star or assistant retraction for the wider field.
  • No published comparative data vs nasal speculum (Hoag 2016 vaginal-sparing technique[4]) or vs ring-retractor-only exposure — choice remains operator preference.
  • Per-instrument cost is meaningful (~ several thousand USD list, lower with institutional pricing) — adoption is biased toward high-volume reconstructive-urology centers.
  • Single-vendor instrument (Surgipros LLC) — substitution with a similar self-retaining lighted speculum requires institutional purchasing approval.

Alternatives for Female-Urethroplasty Exposure​

InstrumentSelf-retainingIntegrated lightBest fit
Ravini lighted speculumYesYesDefault purpose-built option[1]
Nasal speculumNo (assistant-held)NoLow-cost / non-Ravini institutions; Hoag 2016 vaginal-sparing ventral BMG technique[4]
Weighted vaginal speculum + Scott / Lone StarYes (gravity / elastic)NoDiverticulum resection, broader vaginal exposure when urethral corridor is not the limiting step[3]
Heaney / Breisky-Navratil retractorNo (handheld)NoApical vaginal exposure; does not address introital-urethral corridor

Historical / Manufacturer Context​

The RaViNi family is manufactured by Surgipros LLC. Published literature attributing the original design to a named surgeon is not yet established — the Kaldany 2025 paper notes the posterior-urethroplasty use case had not been previously published as of that report.[2] The instrument's diffusion has paralleled the broader 2020s expansion of female substitution urethroplasty and the increasing volume of complex posterior reconstruction at GURS / URPS fellowship centers.

See also: Female Urethra, Female Urethroplasty, Female Urethral Diverticulum Repair, Lone Star Retractor, Nasal Speculum.

References​

1. "Use of self-retaining lighted urethral speculum in female urethroplasty." J Urol. 2024;211(5S Suppl):V06-11. doi:10.1097/01.JU.0001109896.28753.9f.11

2. Kaldany A, Cedars B, Nikolavsky D. "Substitution urethroplasty for posterior urethral stenosis." Transl Androl Urol. 2025;14(12):3962. doi:10.21037/tau-24-664

3. Crescenze IM, Goldman HB. "Female urethral diverticulum: current diagnosis and management." Curr Urol Rep. 2015;16(10):71. doi:10.1007/s11934-015-0540-8

4. Hoag N, Gani J, Chee J. "Vaginal-sparing ventral buccal mucosal graft urethroplasty for female urethral stricture: a novel modification of surgical technique." Investig Clin Urol. 2016;57(4):298–302. doi:10.4111/icu.2016.57.4.298