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Chang HH, Lin YC, Li CC, Wu WJ, Liou WC, Lin YE, Huang KK, Chen WC. A clinical observational study of effectiveness of a solid coupling medium in extracorporeal shock wave lithotripsy. BMC Urol 2022; 22:56. [PMID: 35413871 PMCID: PMC9006431 DOI: 10.1186/s12894-022-01001-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 03/07/2022] [Indexed: 11/25/2022] Open
Abstract
This study aimed to investigate clinical effectiveness of stone disintegration by using isolation coupling pad (“icPad”) as coupling medium to reduce trapped air pockets during extracorporeal shock wave lithotripsy (ESWL). Patients underwent ESWL between Oct. 2017 and May 2018 were enrolled in this clinical observational study. An electromagnetic lithotripter (Dornier MedTech Europe GmbH Co., Germany) was used in this study. Patients were divided into icPad group P1, P2 and semi-gel group C by different coupling medium. The energy level and total number of shock wave (SW) for group P1 and C was set at level 2 and 3000 and group P2 at level 3 and 2500. The successful stone disintegration rate (SSDR) was determined to evaluate the treatment outcome. All patients were evaluated by KUB film and ultrasonography after 90 days. Complications during ESWL were recorded. A total of 300 patients satisfied the inclusion criteria. There were no significant differences in characteristics of patients and stone among three groups. The corresponding SSDRs for patients in group P1, P2 and C was 73.0%, 73.2% and 55.3%, respectively. The SSDR in group P1 was statistically higher than Group C. Comparing to semi-liquid gel, coupling medium using by icPad could achieve better treatment outcome of stone disintegration in ESWL.
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Affiliation(s)
- Hao-Han Chang
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yu-Chih Lin
- Division of General Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Ching-Chia Li
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wen-Jeng Wu
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wen-Chin Liou
- Department of Surgery, St. Joseph Hospital, Kaohsiung, Taiwan
| | - Yusen Eason Lin
- Graduate Institute of Human Resource and Knowledge Management, National Kaohsiung Normal University, Kaohsiung, Taiwan.,CleanWave Medical Co., LTD, Kaohsiung, Taiwan
| | - Kuo-Kuang Huang
- Department of Pharmacy and Master Program, Tajen University, No. 20, Weixin Rd., Yanpu Township, Pingtung County, 90741, Taiwan
| | - Wei-Chuan Chen
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan. .,Department of Pharmacy and Master Program, Tajen University, No. 20, Weixin Rd., Yanpu Township, Pingtung County, 90741, Taiwan. .,Division of Urology, Department of Urology, Kaohsiung Veterans General Hospital, No. 386, Dazhong 1st Rd., Zuoying Dist., Kaohsiung City, 813414, Taiwan.
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Wang CS, Li CC, Wu WJ, Liou WC, Lin YE, Chen WC. Newly designed solid coupling medium for reducing trapped air pockets during extracorporeal shock wave lithotripsy_ a phantom study. BMC Urol 2021; 21:79. [PMID: 33990213 PMCID: PMC8120698 DOI: 10.1186/s12894-021-00847-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 05/05/2021] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Air pockets between the lithotripter head and body surface are almost inevitably generated when applying a handful of gel onto the contact portion of the treatment head and that on the patient's skin during coupling procedure. These air pockets can compromise the transmission of acoustic energy of shock wave and may significantly affect efficacy of stone disintegration. Comparing to conventional gel, this study aims to investigate efficacy of stone disintegration by using a proprietary isolation-coupling pad ("icPad") as the coupling medium to reduce trapped air pockets during ESWL procedure. METHOD In this phantom study, Dornier lithotripter (Delta-2 RC, Dornier MedTech Europe GmbH Co., Germany) was used with a proprietary gel pads (icPad, Diameter = 150 mm, Thickness = 4 mm and 8 mm). The lithotripter was equipped with inline camera to observe the trapped air pockets between the contact surface of the lithotripter head. A testing and measuring device were used to observe experimental stone disintegration using icPad and semi-liquid gel. The conventional semi-liquid gel was used as control for result comparison. RESULTS The stone disintegration rate of icPad 4 mm and 8 mm after 200 shocks of energy at level 2 were significantly higher than that of the semi-liquid gel (disintegration rate 92.3%, 85.0% vs. 45.5%, respectively, p < 0.001). The number of shocks for complete stone disintegration by icPad of 4 mm and 8 mm at the same energy level 2 were significantly lower than that of the semi-liquid gel (the number of shocks 242.0 ± 13.8, 248.7 ± 6.3 vs. 351.0 ± 54.6, respectively, p = 0.011). Furthermore, quantitative comparison of observed air pockets under Optical Coupling Control (OCC) system showed that the area of air pockets in semi-liquid group was significantly larger than that of the group using icPad (8 mm) and that of the group using icPad (8 mm) after sliding (332.7 ± 91.2 vs. 50.3 ± 31.9, 120.3 ± 21.5, respectively, p < 0.05). CONCLUSION The advantages of icPad includes: (1) reduced the numbers of shock wave and increased stone disintegration rate due to icPad's superior efficacy; (2) significantly reduce trapped air pockets in ESWL coupling. Due to the study limitation, more data are needed to confirm our observations before human trials.
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Affiliation(s)
- Chien-Sheng Wang
- Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University Hospital, No.100, Shiquan 1st Rd., Sanmin Dist., Kaohsiung City 807, Taiwan
| | - Ching-Chia Li
- Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University Hospital, No.100, Shiquan 1st Rd., Sanmin Dist., Kaohsiung City 807, Taiwan
| | - Wen-Jeng Wu
- Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University Hospital, No.100, Shiquan 1st Rd., Sanmin Dist., Kaohsiung City 807, Taiwan
| | - Wen-Chin Liou
- Department of Surgery, St. Joseph Hospital, Kaohsiung City, Taiwan
| | - Yusen Eason Lin
- Graduate Institute of Human Resource and Knowledge Management, National Kaohsiung Normal University, Kaohsiung City, Taiwan.,CleanWave Medical Co., LTD, Kaohsiung City, Taiwan
| | - Wei-Chuan Chen
- Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University Hospital, No.100, Shiquan 1st Rd., Sanmin Dist., Kaohsiung City 807, Taiwan. .,Department of Surgery, St. Joseph Hospital, Kaohsiung City, Taiwan.
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El Khoury C, Dumas I, Tailleur A, Morice P, Haie-Meder C. Adjuvant brachytherapy for endometrial cancer: advantages of the vaginal mold technique. Brachytherapy 2014; 14:51-5. [PMID: 25183208 DOI: 10.1016/j.brachy.2014.07.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Revised: 07/25/2014] [Accepted: 07/31/2014] [Indexed: 11/17/2022]
Abstract
PURPOSE Treatment of endometrial carcinoma in the adjuvant setting includes in most cases vaginal brachytherapy. In our institution, we use the customized vaginal mold technique. Herein, we report the advantages of this personalized applicator in terms of target coverage, normal tissue preservation, the incidence of air pockets, and its potential impact on dosimetry. METHODS AND MATERIALS A total of 15 patients receiving postoperative vaginal cuff high-dose-rate brachytherapy with the mold applicator technique were enrolled in this prospective data collection study. Patients were treated with either two or four fractions of 5 Gy prescribed to the clinical target volume, which consisted of an irradiation of the vaginal cuff and the upper third of the vagina. Target coverage; dose to organs at risk, in addition to the volume; and the dosimetric impact of air pockets surrounding the mold were evaluated. RESULTS In 15 patients, a total of 27 air pockets were identified. The average number of air pockets per patient was 1.8 (range, 0-4), with the average total air pocket volume being 0.1 cc (range, 0.01-0.54). The average dose reduction at 5mm from the air pocket was 26% (range, 6-45%). The minimal clinical target volume coverage reported was 95% and the maximal dose received by 2 cc of the bladder, rectum, and sigmoid never exceeded 110% of the prescribed dose. CONCLUSIONS Vaginal cuff high-dose-rate brachytherapy using the molded applicator provides personalized tailored treatment in terms of anatomical conformity. This translates into a dosimetrical advantage with smaller and fewer air pockets than reported in the literature with the use of cylinders.
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Affiliation(s)
- Clement El Khoury
- Department of Radiation Oncology, Brachytherapy Unit, Gustave Roussy Cancer Campus, Villejuif, France.
| | - Isabelle Dumas
- Department of Medical Physics, Gustave Roussy Cancer Campus, Villejuif, France
| | - Anne Tailleur
- Department of Radiation Oncology, Brachytherapy Unit, Gustave Roussy Cancer Campus, Villejuif, France
| | - Philippe Morice
- Department of Surgery, Gynecology Unit, Gustave Roussy Cancer Campus, Villejuif, France
| | - Christine Haie-Meder
- Department of Radiation Oncology, Brachytherapy Unit, Gustave Roussy Cancer Campus, Villejuif, France
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