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Holmes AE, Chew BH, Laughlin R, Buckley J, Kiewice E, Dancel MJ, Blasko D, Wong VKF, Halawani A, Koo KC, Corl D, Fasolo P, Levy O, Thiel J, Bailey MR, Eichman J, Meegan JM, Haulena M. Application of novel burst wave lithotripsy and ultrasonic propulsion technology for the treatment of ureteral calculi in a bottlenose dolphin (Tursiops truncatus) and renal calculi in a harbor seal (Phoca vitulina). Urolithiasis 2024; 52:21. [PMID: 38189835 PMCID: PMC10774161 DOI: 10.1007/s00240-023-01515-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 11/29/2023] [Indexed: 01/09/2024]
Abstract
Marine mammals may develop kidney stones, which can be challenging to treat. We describe burst wave lithotripsy (BWL) and ultrasonic propulsion to treat ureteral calculi in a 48-year-old female bottlenose dolphin (Tursiops truncatus) and to reduce renal stone burden in a 23-year-old male harbor seal (Phoca vitulina). BWL and ultrasonic propulsion were delivered transcutaneously in sinusoidal ultrasound bursts to fragment and reposition stones. Targeting and monitoring were performed with real-time imaging integrated within the BWL system. Four dolphin stones were obtained and fragmented ex vivo. The dolphin case received a 10-min and a 20-min BWL treatment conducted approximately 24 h apart to treat two 8-10 mm partially obstructing right mid-ureteral stones, using oral sedation alone. For the harbor seal, while under general anesthesia, retrograde ureteroscopy attempts were unsuccessful because of ureteral tortuosity, and a 30-min BWL treatment was targeted on one 10-mm right kidney stone cluster. All 4 stones fragmented completely to < 2-mm fragments in < 20 min ex vivo. In the dolphin case, the ureteral stones appeared to fragment, spread apart, and move with ultrasonic propulsion. On post-treatment day 1, the ureteral calculi fragments shifted caudally reaching the ureteral orifice on day 9. On day 10, the calculi fragments passed, and the hydroureter resolved. In the harbor seal, the stone cluster was observed to fragment and was not visible on the post-operative computed tomography scan. The seal had gross hematuria and a day of behavior indicating stone passage but overall, an uneventful recovery. BWL and ultrasonic propulsion successfully relieved ureteral stone obstruction in a geriatric dolphin and reduced renal stone burden in a geriatric harbor seal.
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Affiliation(s)
- Arturo E Holmes
- Dept. of Urology, University of Washington School of Medicine, Seattle, WA, USA
| | - Ben H Chew
- Department of Urological Sciences, University of British Columbia, Stone Centre at Vancouver General Hospital, British Columbia, Vancouver, Canada
| | - Robert Laughlin
- The Mirage Hotel, Hard Rock International, Las Vegas, NV, USA
| | - Jean Buckley
- Department of Urological Sciences, University of British Columbia, Stone Centre at Vancouver General Hospital, British Columbia, Vancouver, Canada
| | - Erica Kiewice
- The Mirage Hotel, Hard Rock International, Las Vegas, NV, USA
| | | | - David Blasko
- The Mirage Hotel, Hard Rock International, Las Vegas, NV, USA
| | - Victor K F Wong
- Department of Urological Sciences, University of British Columbia, Stone Centre at Vancouver General Hospital, British Columbia, Vancouver, Canada
| | | | - Kyo Chul Koo
- Department of Urology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | | | | | | | - Jeff Thiel
- Ctr. for Industrial and Medical Ultrasound, Applied Physics Lab, Univ. of Washington, Washington, USA
| | - Michael R Bailey
- Dept. of Urology, University of Washington School of Medicine, Seattle, WA, USA.
- Ctr. for Industrial and Medical Ultrasound, Applied Physics Lab, Univ. of Washington, Washington, USA.
| | - Jammy Eichman
- National Marine Mammal Foundation, San Diego, CA, USA
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Raskolnikov D, Bailey MR, Harper JD. Recent Advances in the Science of Burst Wave Lithotripsy and Ultrasonic Propulsion. BME FRONTIERS 2022; 2022. [PMID: 37090444 PMCID: PMC10117400 DOI: 10.34133/2022/9847952] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Nephrolithiasis is a common, painful condition that requires surgery in many patients whose stones do not pass spontaneously. Recent technologic advances have enabled the use of ultrasonic propulsion to reposition stones within the urinary tract, either to relieve symptoms or facilitate treatment. Burst wave lithotripsy (BWL) has emerged as a noninvasive technique to fragment stones in awake patients without significant pain or renal injury. We review the preclinical and human studies that have explored the use of these two technologies. We envision that BWL will fill an unmet need for the noninvasive treatment of patients with nephrolithiasis.
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Affiliation(s)
- Dima Raskolnikov
- Department of Urology, University of Washington School of Medicine, Seattle, WA, USA
| | - Michael R. Bailey
- Department of Urology, University of Washington School of Medicine, Seattle, WA, USA
- Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, Seattle, WA, USA
| | - Jonathan D. Harper
- Department of Urology, University of Washington School of Medicine, Seattle, WA, USA
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Abstract
PURPOSE OF REVIEW Burst wave lithotripsy and ultrasonic propulsion of kidney stones are novel, noninvasive emerging technologies to separately or synergistically fragment and reposition stones in an office setting. The purpose of this review is to discuss the latest refinements in technology, to update on testing of safety and efficacy, and to review future applications. RECENT FINDINGS Burst wave lithotripsy produced consistent, small passable fragments through transcutaneous applications in a porcine model, while producing minimal injury and clinical trials are now underway. A more efficient ultrasonic propulsion design that can also deliver burst wave lithotripsy effectively repositioned 95% of stones in 18 human participants (18 of 19 kidneys) and clinical trials continue. Acoustic tractor beam technology is an emerging technology with promising clinical applications through the manipulation of macroscopic objects. SUMMARY The goal of the reviewed work is an office-based system to image, fragment, and reposition urinary stones to facilitate their natural passage. The review highlights progress in establishing safety, effectiveness, and clinical benefit of these new technologies. The work is also anticipating challenges in clinical trials and developing the next generation of technology to improve on the technology as it is being commercialized today.
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Affiliation(s)
- Tony T. Chen
- Department of Urology, University of Washington, Seattle, WA, USA
| | | | | | - Michael R. Bailey
- Department of Urology, University of Washington, Seattle, WA, USA
- Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, Seattle, WA, USA
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Dai JC, Sorensen MD, Chang HC, Samson PC, Dunmire B, Cunitz BW, Thiel J, Liu Z, Bailey MR, Harper JD. Quantitative Assessment of Effectiveness of Ultrasonic Propulsion of Kidney Stones. J Endourol 2019; 33:850-857. [PMID: 31333058 PMCID: PMC6798799 DOI: 10.1089/end.2019.0340] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: Ultrasonic propulsion is an investigative modality to noninvasively image and reposition urinary stones. Our goals were to test safety and effectiveness of new acoustic exposure conditions from a new transducer, and to use simultaneous ureteroscopic and ultrasonic observation to quantify stone repositioning. Materials and Methods: During operation, ultrasonic propulsion was applied transcutaneously, whereas stone targets were visualized ureteroscopically. Exposures were 350 kHz frequency, ≤200 W/cm2 focal intensity, and ≤3-second bursts per push. Ureteroscope and ultrasound (US) videos were recorded. Video clips with and without stone motion were randomized and scored for motion ≥3 mm by independent reviewers blinded to the exposures. Subjects were followed with telephone calls, imaging, and chart review for adverse events. Results: The investigative treatment was used in 18 subjects and 19 kidneys. A total of 62 stone targets were treated ranging in size from a collection of "dust" to 15 mm. Subjects received an average of 17 ± 14 propulsion bursts (per kidney) for a total average exposure time of 40 ± 40 seconds. Independent reviewers scored at least one stone movement ≥3 mm in 18 of 19 kidneys (95%) from the ureteroscope videos and in 15 of 19 kidneys (79%) from the US videos. This difference was probably because of motion out of the US imaging plane. Treatment repositioned stones in two cases that would have otherwise required basket repositioning. No serious adverse events were observed with the device or procedure. Conclusions: Ultrasonic propulsion was shown to be safe, and it effectively repositioned stones in 95% of kidneys despite positioning and access restrictions caused by working in an operating room on anesthetized subjects.
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Affiliation(s)
- Jessica C. Dai
- Department of Urology, University of Washington, Seattle, Washington
| | - Mathew D. Sorensen
- Department of Urology, University of Washington, Seattle, Washington
- Division of Urology, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
| | - Helena C. Chang
- Department of Urology, University of Washington, Seattle, Washington
| | - Patrick C. Samson
- Department of Urology, University of Washington, Seattle, Washington
| | - Barbrina Dunmire
- Center for Industrial and Medical Ultrasound, Applied physics Laboratory, University of Washington, Seattle, Washington
| | - Bryan W. Cunitz
- Center for Industrial and Medical Ultrasound, Applied physics Laboratory, University of Washington, Seattle, Washington
| | - Jeff Thiel
- Center for Industrial and Medical Ultrasound, Applied physics Laboratory, University of Washington, Seattle, Washington
| | - Ziyue Liu
- Department of Biostatistics, Indiana University, Indianapolis, Indiana
| | - Michael R. Bailey
- Department of Urology, University of Washington, Seattle, Washington
- Center for Industrial and Medical Ultrasound, Applied physics Laboratory, University of Washington, Seattle, Washington
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Prezioso D, Barone B, Di Domenico D, Vitale R. Stone residual fragments: A thorny problem. Urologia 2019; 86:169-176. [DOI: 10.1177/0391560319860654] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Urolithiasis represents a widespread and common disorder among the world population, with a predicted increase in affected patients in the coming years. Treatment of renal and ureteral stones varies widely, and achieving true stone-free status in all patients is still difficult. Moreover, imaging used to assess residual fragments following procedure impacts the diagnosed stone-free rate percentage considerably. In particular, the use of computed tomography scans has led to a better evaluation of residual fragments as well as so-called clinically insignificant residual fragments, which in a considerable number of cases are, despite their definition, causes of adverse urological events, thus creating a thorny problem for both patients and urologists. Currently, there is no gold standard or validated protocol regarding the management, clearance and prevention of residual fragments. In this article, we review the current literature regarding residual fragments, clinically insignificant residual fragments and their natural history, reporting on diagnostic methods, incidence, complications and outcome with the use of less invasive procedures, taking into consideration viable treatment and management of patients affected.
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Affiliation(s)
- Domenico Prezioso
- Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy
| | - Biagio Barone
- Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy
| | - Dante Di Domenico
- Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy
| | - Raffaele Vitale
- Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy
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Dai JC, Bailey MR, Sorensen MD, Harper JD. Innovations in Ultrasound Technology in the Management of Kidney Stones. Urol Clin North Am 2019; 46:273-285. [PMID: 30961860 PMCID: PMC6461360 DOI: 10.1016/j.ucl.2018.12.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
This article reviews new advances in ultrasound technology for urinary stone disease. Recent research to facilitate the diagnosis of nephrolithiasis, including use of the twinkling signal and posterior acoustic shadow, have helped to improve the use of ultrasound examination for detecting and sizing renal stones. New therapeutic applications of ultrasound technology for stone disease have emerged, including ultrasonic propulsion to reposition stones and burst wave lithotripsy to fragment stones noninvasively. The safety, efficacy, and evolution of these technologies in phantom, animal, and human studies are reviewed herein. New developments in these rapidly growing areas of ultrasound research are also highlighted.
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Affiliation(s)
- Jessica C. Dai
- Department of Urology, University of Washington, Seattle, WA, USA
| | - Michael R. Bailey
- Department of Urology, University of Washington, Seattle, WA, USA
- Center for Industrial and Medical Ultrasound, University of Washington, Seattle WA, USA
| | - Mathew D. Sorensen
- Department of Urology, University of Washington, Seattle, WA, USA
- Puget Sound Veterans Affairs Hospital, Seattle, WA, USA
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Abstract
This comprehensive review updates the advances in extracorporeal lithotripsy, including improvements in external shockwave lithotripsy and innovations in ultrasound based lithotripsy, such as burst wave lithotripsy, ultrasonic propulsion, and histotripsy. Advances in endoscopic technology and training have changed the surgical approach to nephrolithiasis; however, improvements and innovations in extracorporeal lithotripsy maintain its status as an excellent option in appropriately selected patients.
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Affiliation(s)
- Tim Large
- Department of Urology, Indiana University, Methodist Hospital, 1801 Senate Boulevard, Suite 220, Indianapolis, IN 46202, USA
| | - Amy E Krambeck
- Department of Urology, Indiana University, Methodist Hospital, 1801 Senate Boulevard, Suite 220, Indianapolis, IN 46202, USA.
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Sapozhnikov O, Nikolaeva A, Bailey M. The effect of shear waves in an elastic sphere on the radiation force from a quasi-Gaussian beam. PROCEEDINGS OF MEETINGS ON ACOUSTICS. ACOUSTICAL SOCIETY OF AMERICA 2018; 32:045010. [PMID: 30294407 PMCID: PMC6171368 DOI: 10.1121/2.0000725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Ultrasound beams are capable of exerting radiation force on scattering or absorbing obstacles. Previously, our team developed a technology to reposition kidney stones using this approach. It is convenient to study the influence of different parameters using a theoretical model based on a spherical shape stone and a quasi-Gaussian acoustic beam. In such an approach, only two geometrical parameters are involved, namely the beam width and the sphere diameter. The radiation force depends on their ratio, as well as on the elastic properties of the liquid and the stone. In this work, numerical modeling was performed to calculate the force acting on an elastic sphere using previously developed theory. Our numerical modeling indicates that the force on a stone is strongest when the beam is slightly wider than the stone. Also, the force created by a narrow beam appears to be the strongest when the beam is targeted to the side of the sphere. These peculiarities of the radiation force are explained by more effective generation of shear waves inside the stone resulting from their effective coupling with the acoustic waves in liquid at the stone edge.
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Affiliation(s)
- Oleg Sapozhnikov
- Lomonosov Moscow State University, Moscow, 119991, RUSSIAN FEDERATION
| | | | - Michael Bailey
- Applied Physics Laboratory, University of Washington, Seattle, WA
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Cunitz BW, Dunmire B, Bailey MR. Characterizing the Acoustic Output of an Ultrasonic Propulsion Device for Urinary Stones. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2017; 64:1818-1827. [PMID: 28981413 PMCID: PMC5733808 DOI: 10.1109/tuffc.2017.2758647] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
A noninvasive ultrasound (US) system to facilitate the passage of small kidney stones has been developed. The device incorporates a software-based US platform programmed with brightness mode and Doppler for visualizing stones, plus long duration focused pulses for repositioning stones using the same transducer. This paper characterizes the acoustic outputs of the ultrasonic propulsion device. Though the application and outputs are unique, measurements were performed based on the regulatory standards for both diagnostic US and extracorporeal lithotripters. The extended length of the pulse, time varying pressure output over the pulse, the use of focused targeting, and the need to regulate the output at shallow depths, however, required modifications to the traditional acoustic measurement methods. Output parameters included spatial-peak intensities, mechanical index (MI), thermal index, pulse energy, focal geometry, and target accuracy. The imaging and Doppler operating modes of the system meet the Food and Drug Administration acoustic power and intensity limits for diagnostic US device. Push mode operates at a maximum MI of 2.2, which is above the limit of 1.9 for diagnostic US, but well below any lithotripsy device and an ISPTA of 548 mW/cm2, which is below the 720-mW/cm2 limit for diagnostic US.
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