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Mosquera Seoane L, Ortiz Salvador JB, Budia Alba A, Perez Fentes DA. Technological innovations in shock wave lithotripsy. Actas Urol Esp 2024; 48:105-110. [PMID: 37858618 DOI: 10.1016/j.acuroe.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 09/15/2023] [Indexed: 10/21/2023]
Abstract
INTRODUCTION Since 1980, extracorporeal shock wave lithotripsy (SWL) has been employed in the treatment of urolithiasis, offering noninvasive alternatives to surgical techniques. In addition to being limited by the size and location of the stones, its efficacy is influenced by several factors. Despite the advancement of other surgical techniques, SWL could maintain its position with new improvements. Our objective is to review the existing literature on the latest advances in the extracorporeal treatment of lithiasis. MATERIAL AND METHODS A non-systematic literature review was carried out from 2017 to 2023 to obtain 26 articles on three different emerging technologies in extracorporeal lithotripsy: Burst Wave Lithotripsy (BWL), Histotripsy, and Microbubble Lithotripsy (ML). RESULTS The BWL uses sinusoidal bursts of US waves delivered at lower and higher frequencies than conventional SWL. Its mechanism of action generates a higher quality fragmentation (fine fragments) instead of generating tensile stresses for stone fracture resulting in larger fragments, as in traditional SWL. Studies in pigs and humans have shown effective fragmentation with a good safety profile. Based on High Intensity Focused Ultrasound (HIFU) technology, histotripsy fragments tissue through cavitation. Good in vitro results have been shown, but the formation of microbubbles between the stone and ultrasound waves hinders the progress of this technique. Microbubble Lithotripsy (ML) combines microbubbles and ultrasound for safe and effective stone fragmentation. In vitro and pig results are promising. This technique can help optimize treatments and reduce energy levels. CONCLUSIONS Technological innovation is not only being applied to endourological techniques, but also to ESWL. New techniques such as BWL, histotripsy and ML are promising, with good results in the research phase.
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Affiliation(s)
- L Mosquera Seoane
- Servicio de Urología, Complexo Hospitalario Santiago de Compostela, Santiago de Compostela, La Coruña,España
| | - J B Ortiz Salvador
- Servicio de Urología, Hospital Universitario y Politécnico La Fe, Valencia, Espana
| | - A Budia Alba
- Servicio de Urología, Hospital Universitario y Politécnico La Fe, Valencia, Espana.
| | - D A Perez Fentes
- Servicio de Urología, Complexo Hospitalario Santiago de Compostela, Santiago de Compostela, La Coruña,España
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2
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Qiu M, Zhang T, Zhang Y, Liang T, Chen J, Gao H. Physical Techniques to Remove Residual Stone Fragments in the Urinary System. Urol Int 2023; 108:9-19. [PMID: 38008076 PMCID: PMC10836958 DOI: 10.1159/000535298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 10/26/2023] [Indexed: 11/28/2023]
Abstract
BACKGROUND Although significant progress has been made in treatment techniques for renal and ureteral calculi, residual fragments (RF) persisting long after treatment pose a serious threat to patients' health. A variety of novel physical techniques and extraction devices are currently being developed to promote the removal of RF from the urinary system, and a series of in vivo experiments have demonstrated their safety and efficacy. SUMMARY External physical vibration lithecbole, magnetic extraction, biocompatible stone adhesive-based methods, and ultrasonic propulsion technologies are examples of innovative therapies that can promote the clearance of RF and improve the stone-free rate. In conclusion, the physical treatment of these RF needs to be optimized and improved. They are a promising technique for improving the efficiency of endovascular urology, and further in vivo studies are needed to confirm their safety and efficacy. KEY MESSAGES We have summarized the literature on removal of RF by physical methods in recent years, especially the new progress.
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Affiliation(s)
- Minhua Qiu
- Graduate School, Guangxi University of Chinese Medicine, Nanning, China
| | - Ting Zhang
- Graduate School, Guangxi University of Chinese Medicine, Nanning, China
- Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine, Nanning, China
| | - Yingying Zhang
- Graduate School, Guangxi University of Chinese Medicine, Nanning, China
- Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine, Nanning, China
| | - Taisheng Liang
- Graduate School, Guangxi University of Chinese Medicine, Nanning, China
- Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine, Nanning, China
| | - Jibing Chen
- Graduate School, Guangxi University of Chinese Medicine, Nanning, China
- Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine, Nanning, China
| | - Hongjun Gao
- Graduate School, Guangxi University of Chinese Medicine, Nanning, China
- Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine, Nanning, China
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3
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Maxwell AD, Kim GW, Furrow E, Lulich JP, Torre M, MacConaghy B, Lynch E, Leotta DF, Wang YN, Borofsky MS, Bailey MR. Development of a burst wave lithotripsy system for noninvasive fragmentation of ureteroliths in pet cats. BMC Vet Res 2023; 19:141. [PMID: 37660015 PMCID: PMC10474658 DOI: 10.1186/s12917-023-03705-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 08/24/2023] [Indexed: 09/04/2023] Open
Abstract
BACKGROUND Upper urinary tract stones are increasingly prevalent in pet cats and are difficult to manage. Surgical procedures to address obstructing ureteroliths have short- and long-term complications, and medical therapies (e.g., fluid diuresis and smooth muscle relaxants) are infrequently effective. Burst wave lithotripsy is a non-invasive, ultrasound-guided, handheld focused ultrasound technology to disintegrate urinary stones, which is now undergoing human clinical trials in awake unanesthetized subjects. RESULTS In this study, we designed and performed in vitro testing of a modified burst wave lithotripsy system to noninvasively fragment stones in cats. The design accounted for differences in anatomic scale, acoustic window, skin-to-stone depth, and stone size. Prototypes were fabricated and tested in a benchtop model using 35 natural calcium oxalate monohydrate stones from cats. In an initial experiment, burst wave lithotripsy was performed using peak ultrasound pressures of 7.3 (n = 10), 8.0 (n = 5), or 8.9 MPa (n = 10) for up to 30 min. Fourteen of 25 stones fragmented to < 1 mm within the 30 min. In a second experiment, burst wave lithotripsy was performed using a second transducer and peak ultrasound pressure of 8.0 MPa (n = 10) for up to 50 min. In the second experiment, 9 of 10 stones fragmented to < 1 mm within the 50 min. Across both experiments, an average of 73-97% of stone mass could be reduced to fragments < 1 mm. A third experiment found negligible injury with in vivo exposure of kidneys and ureters in a porcine animal model. CONCLUSIONS These data support further evaluation of burst wave lithotripsy as a noninvasive intervention for obstructing ureteroliths in cats.
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Affiliation(s)
- Adam D Maxwell
- 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
| | - Ga Won Kim
- Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, Seattle, WA, USA
| | - Eva Furrow
- Department of Veterinary Clinical Sciences, University of Minnesota, St. Paul, MN, USA
| | - Jody P Lulich
- Department of Veterinary Clinical Sciences, University of Minnesota, St. Paul, MN, USA
| | - Marissa Torre
- Department of Veterinary Clinical Sciences, University of Minnesota, St. Paul, MN, USA
| | - Brian MacConaghy
- Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, Seattle, WA, USA
| | - Elizabeth Lynch
- Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, Seattle, WA, USA
| | - Daniel F Leotta
- Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, Seattle, WA, USA
| | - Yak-Nam Wang
- Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, 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.
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4
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Rassweiler-Seyfried MC, Mayer J, Goldenstedt C, Storz R, Marlinghaus E, Heine G, Alken P, Rassweiler JJ. High-frequency shock wave lithotripsy: stone comminution and evaluation of renal parenchyma injury in a porcine ex-vivo model. World J Urol 2023; 41:1929-1934. [PMID: 37284842 PMCID: PMC10352427 DOI: 10.1007/s00345-023-04441-9] [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: 02/19/2023] [Accepted: 05/12/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND The electrohydraulic high-frequency shock wave (Storz Medical, Taegerwilen, Switzerland) is a new way to create small fragments with frequencies up to 100 Hertz (Hz). This study evaluated the efficacy and safety of this method in a stone and porcine model. MATERIALS AND METHODS BEGO stones were put in a condom in a specifically designed fixture treated with different modulations to see stone comminution. Standardized ex vivo porcine model with perfused kidneys with 26 upper and lower poles of 15 kidneys was treated with the following modulations: voltage 16-24 kV, capacitor 12 nF and frequency up to 100 Hz. 2000-20,000 shock waves were applied to each pole. The kidneys were perfused with barium sulfate solution (BaSO4) and x-ray was performed to quantify the lesions using pixel volumetry. RESULTS There was no correlation between the number of shock waves and the powdering degree or the applied Energy and the grade of pulverization in the stone model. Regarding the perfused kidney model, the number of shock waves, applied voltage and frequency had no direct correlation with the occurrence of parenchymal lesions The detected lesions of the renal parenchyma were minimal, technical parameters had no significant impact and the lesions did not differ from the results of former experiments using 1-1.5 Hz in the same model. CONCLUSIONS High-frequency shock wave lithotripsy can produce small stone fragments to pass in a very short time. The injury to the renal parenchyma is comparable to the results of the conventional SWL using 1-1.5 Hz.
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Affiliation(s)
- Marie-Claire Rassweiler-Seyfried
- Department of Urology and Urosurgery, Medical Faculty Mannheim, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, Mannheim, Germany.
| | | | | | | | | | | | - Peter Alken
- Department of Urology and Urosurgery, Medical Faculty Mannheim, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, Mannheim, Germany
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5
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Yang H, Stoller M. Re: Fragmentation of Stones by Burst Wave Lithotripsy in the First 19 Humans. Eur Urol 2022; 82:569. [PMID: 35933243 DOI: 10.1016/j.eururo.2022.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 07/14/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Heiko Yang
- Department of Urology, University of California-San Francisco, San Francisco, CA, USA.
| | - Marshall Stoller
- Department of Urology, University of California-San Francisco, San Francisco, CA, USA
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6
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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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7
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Maxwell AD, Hunter C, Cunitz BW, Kreider W, Totten S, Wang YN. Factors Affecting Tissue Cavitation during Burst Wave Lithotripsy. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:2286-2295. [PMID: 34078545 PMCID: PMC8259501 DOI: 10.1016/j.ultrasmedbio.2021.04.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 03/26/2021] [Accepted: 04/20/2021] [Indexed: 06/12/2023]
Abstract
Burst wave lithotripsy (BWL) is a technology under clinical investigation for non-invasive fragmentation of urinary stones. Under certain ranges of ultrasound exposure parameters, this technology can cause cavitation in tissue leading to renal injury. This study sought to measure the focal pressure amplitude needed to cause cavitation in vivo and determine its consistency in native tissue, in an implanted stone model and under different exposure parameters. The kidneys of eight pigs were exposed to transcutaneous BWL ultrasound pulses. In each kidney, two locations were targeted: the renal sinus and the kidney parenchyma. Each was exposed for 5 min at a set pressure level and parameters, and cavitation was detected using an active cavitation imaging method based on power Doppler ultrasound. The threshold was determined by incrementing the pressure amplitude up or down after each 5-min interval until cavitation occurred/subsided. The pressure thresholds were remeasured postsurgery, targeting an implanted stone or collecting space (in sham). The presence of a stone or sham surgery did not significantly impact the threshold for tissue cavitation. Targeting parenchyma instead of kidney collecting space and lowering the ultrasound pulse repetition frequency both resulted in an increased pressure threshold for cavitation.
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Affiliation(s)
- Adam D Maxwell
- Department of Urology, University of Washington School of Medicine, Seattle, Washington, USA; Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, Seattle, Washington, USA.
| | - Christopher Hunter
- Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, Seattle, Washington, USA
| | - Bryan W Cunitz
- Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, Seattle, Washington, USA
| | - Wayne Kreider
- Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, Seattle, Washington, USA
| | - Stephanie Totten
- Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, Seattle, Washington, USA
| | - Yak-Nam Wang
- Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, Seattle, Washington, USA
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8
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Abstract
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.
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9
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Ramesh S, Chen TT, Maxwell AD, Cunitz BW, Dunmire B, Thiel J, Williams JC, Gardner A, Liu Z, Metzler I, Harper JD, Sorensen MD, Bailey MR. In Vitro Evaluation of Urinary Stone Comminution with a Clinical Burst Wave Lithotripsy System. J Endourol 2020; 34:1167-1173. [PMID: 32103689 DOI: 10.1089/end.2019.0873] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objective: Our goals were to validate stone comminution with an investigational burst wave lithotripsy (BWL) system in patient-relevant conditions and to evaluate the use of ultrasonic propulsion to move a stone or fragments to aid in observing the treatment endpoint. Materials and Methods: The Propulse-1 system, used in clinical trials of ultrasonic propulsion and upgraded for BWL trials, was used to fragment 46 human stones (5-7 mm) in either a 15-mm or 4-mm diameter calix phantom in water at either 50% or 75% dissolved oxygen level. Stones were paired by size and composition, and exposed to 20-cycle, 390-kHz bursts at 6-MPa peak negative pressure (PNP) and 13-Hz pulse repetition frequency (PRF) or 7-MPa PNP and 6.5-Hz PRF. Stones were exposed in 5-minute increments and sieved, with fragments >2 mm weighed and returned for additional treatment. Effectiveness for pairs of conditions was compared statistically within a framework of survival data analysis for interval censored data. Three reviewers blinded to the experimental conditions scored ultrasound imaging videos for degree of fragmentation based on stone response to ultrasonic propulsion. Results: Overall, 89% (41/46) and 70% (32/46) of human stones were fully comminuted within 30 and 10 minutes, respectively. Fragments remained after 30 minutes in 4% (1/28) of calcium oxalate monohydrate stones and 40% (4/10) of brushite stones. There were no statistically significant differences in comminution time between the two output settings (p = 0.44), the two dissolved oxygen levels (p = 0.65), or the two calyx diameters (p = 0.58). Inter-rater correlation on endpoint detection was substantial (Fleiss' kappa = 0.638, p < 0.0001), with individual reviewer sensitivities of 95%, 86%, and 100%. Conclusions: Eighty-nine percent of human stones were comminuted with a clinical BWL system within 30 minutes under conditions intended to reflect conditions in vivo. The results demonstrate the advantage of using ultrasonic propulsion to disperse fragments when making a visual determination of breakage endpoint from the real-time ultrasound image.
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Affiliation(s)
- Shivani Ramesh
- Applied Physics Laboratory, Center for Industrial and Medical Ultrasound, University of Washington, Seattle, Washington, USA
| | - Tony T Chen
- Department of Urology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Adam D Maxwell
- Applied Physics Laboratory, Center for Industrial and Medical Ultrasound, University of Washington, Seattle, Washington, USA.,Department of Urology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Bryan W Cunitz
- Applied Physics Laboratory, Center for Industrial and Medical Ultrasound, University of Washington, Seattle, Washington, USA
| | - Barbrina Dunmire
- Applied Physics Laboratory, Center for Industrial and Medical Ultrasound, University of Washington, Seattle, Washington, USA
| | - Jeff Thiel
- Applied Physics Laboratory, Center for Industrial and Medical Ultrasound, University of Washington, Seattle, Washington, USA
| | - James C Williams
- Department of Anatomy, Cell Biology and Physiology and Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Anthony Gardner
- Department of Anatomy, Cell Biology and Physiology and Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Ziyue Liu
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Ian Metzler
- Department of Urology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Jonathan D Harper
- Department of Urology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Mathew D Sorensen
- Division of Urology, VA Puget Sound Health Care System, Seattle, Washington, USA
| | - Michael R Bailey
- Applied Physics Laboratory, Center for Industrial and Medical Ultrasound, University of Washington, Seattle, Washington, USA.,Department of Urology, University of Washington School of Medicine, Seattle, Washington, USA
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10
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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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11
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Maxwell AD, Wang YN, Kreider W, Cunitz BW, Starr F, Lee D, Nazari Y, Williams JC, Bailey MR, Sorensen MD. Evaluation of Renal Stone Comminution and Injury by Burst Wave Lithotripsy in a Pig Model. J Endourol 2019; 33:787-792. [PMID: 31016998 DOI: 10.1089/end.2018.0886] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: Burst wave lithotripsy is an experimental technology to noninvasively fragment kidney stones with focused bursts of ultrasound (US). This study evaluated the safety and effectiveness of specific lithotripsy parameters in a porcine model of nephrolithiasis. Methods: A 6- to 7-mm human kidney stone was surgically implanted in each kidney of three pigs. A burst wave lithotripsy US transducer with an inline US imager was coupled to the flank and the lithotripter focus was aligned with the stone. Each stone was exposed to burst wave lithotripsy at 6.5 to 7 MPa focal pressure for 30 minutes under real-time image guidance. After treatment, the kidneys were removed for gross, histologic, and MRI assessment. Stone fragments were retrieved from the kidney to determine the mass comminuted to pieces <2 mm. Results: On average, 87% of the stone mass was reduced to fragments <2 mm. In three of five treatments, stones were completely comminuted to <2-mm fragments. In two of five treatments, stones were partially disintegrated, but larger fragments remained. One stone was not treated because no suitable acoustic window was identified. No injury was detected through gross, histologic, or MRI examination in the parenchymal tissue, although petechial damage and surface erosion were identified on the urothelium of the collecting system limited to the area around the stone. Conclusion: Burst wave lithotripsy can consistently produce stone fragments small enough to spontaneously pass by transcutaneous administration of US pulses. The data suggest that such exposures produce minimal injury to the kidney and urinary tract.
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Affiliation(s)
- Adam D Maxwell
- Department of Urology, University of Washington School of Medicine, Seattle, Washington.,Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, Seattle, Washington
| | - Yak-Nam Wang
- Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, Seattle, Washington
| | - Wayne Kreider
- 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
| | - Frank Starr
- Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, Seattle, Washington
| | - Donghoon Lee
- Department of Radiology, University of Washington School of Medicine, Seattle, Washington
| | - Yasser Nazari
- Department of Radiology, University of Washington School of Medicine, Seattle, Washington
| | - James C Williams
- Department of Anatomy and Cell Biology, Indiana University Purdue University at Indianapolis, Indianapolis, Indiana
| | - Michael R Bailey
- Department of Urology, University of Washington School of Medicine, Seattle, Washington.,Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, Seattle, Washington
| | - Mathew D Sorensen
- Department of Urology, University of Washington School of Medicine, Seattle, Washington.,Division of Urology, Department of Veterans Affairs Medical Center, Seattle, Washington
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12
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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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13
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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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14
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Bailey MR, Wang YN, Kreider W, Dai JC, Cunitz BW, Harper JD, Chang H, Sorensen MD, Liu Z, Levy O, Dunmire B, Maxwell AD. Update on clinical trials of kidney stone repositioning and preclinical results of stone breaking with one system. PROCEEDINGS OF MEETINGS ON ACOUSTICS. ACOUSTICAL SOCIETY OF AMERICA 2018; 35:020004. [PMID: 32612741 PMCID: PMC7328990 DOI: 10.1121/2.0000949] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Our goal is an office-based, handheld ultrasound system to target, detach, break, and/or expel stones and stone fragments from the urinary collecting system to facilitate natural clearance. Repositioning of stones in humans (maximum 2.5 MPa, and 3-second bursts) and breaking of stones in a porcine model (maximum 50 cycles, 20 Hz repetition, 30 minutes, and 7 MPa peak negative pressure) have been demonstrated using the same 350-kHz probe. Repositioning in humans was conducted during surgery with a ureteroscope in the kidney to film stone movement. Independent video review confirmed stone movements (≥ 3 mm) in 15 of 16 kidneys (94%). No serious or unanticipated adverse events were reported. Experiments of burst wave lithotripsy (BWL) effectiveness on breaking human stones implanted in the porcine bladder and kidney demonstrated fragmentation of 8 of 8 stones on post mortem dissection. A 1-week survival study with the BWL exposures and 10 specific-pathogen-free pigs, showed all findings were within normal limits on clinical pathology, hematology, and urinalysis. These results demonstrate that repositioning of stones with ultrasonic propulsion and breaking of stones with BWL are safe and effective.
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Affiliation(s)
- M R Bailey
- Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, 1013 NE 40th St., Seattle, WA 98105, USA
- Department of Urology, University of Washington School of Medicine, 1959 NE Pacific Street, Box 356510, Seattle, WA 98195
| | - Y N Wang
- Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, 1013 NE 40th St., Seattle, WA 98105, USA
| | - W Kreider
- Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, 1013 NE 40th St., Seattle, WA 98105, USA
| | - J C Dai
- Department of Urology, University of Washington School of Medicine, 1959 NE Pacific Street, Box 356510, Seattle, WA 98195
| | - B W Cunitz
- Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, 1013 NE 40th St., Seattle, WA 98105, USA
| | - J D Harper
- Department of Urology, University of Washington School of Medicine, 1959 NE Pacific Street, Box 356510, Seattle, WA 98195
| | - H Chang
- Department of Urology, University of Washington School of Medicine, 1959 NE Pacific Street, Box 356510, Seattle, WA 98195
| | - M D Sorensen
- Department of Urology, University of Washington School of Medicine, 1959 NE Pacific Street, Box 356510, Seattle, WA 98195
- Division of Urology, Department of Veteran Affairs Medical Center, 1660 S Columbian Way, Seattle, WA 98108
| | - Z Liu
- Department of Biostatistics, Indiana University-Purdue University Indianapolis, 410 W. Tenth St., Suite 3000., Indianapolis, IN 46202, USA
| | - O Levy
- SonoMotion, Inc., 415 Grand Ave, Suite 302, South San Francisco, CA 94080
| | - B Dunmire
- Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, 1013 NE 40th St., Seattle, WA 98105, USA
| | - A D Maxwell
- Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, 1013 NE 40th St., Seattle, WA 98105, USA
- Department of Urology, University of Washington School of Medicine, 1959 NE Pacific Street, Box 356510, Seattle, WA 98195
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