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Michibata U, Maruyama M, Tanaka Y, Yoshimura M, Yoshikawa HY, Takano K, Furukawa Y, Momma K, Tajiri R, Taguchi K, Hamamoto S, Okada A, Kohri K, Yasui T, Usami S, Imanishi M, Mori Y. The impact of crystal phase transition on the hardness and structure of kidney stones. Urolithiasis 2024; 52:57. [PMID: 38563829 PMCID: PMC10987347 DOI: 10.1007/s00240-024-01556-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 03/06/2024] [Indexed: 04/04/2024]
Abstract
Calcium oxalate kidney stones, the most prevalent type of kidney stones, undergo a multi-step process of crystal nucleation, growth, aggregation, and secondary transition. The secondary transition has been rather overlooked, and thus, the effects on the disease and the underlying mechanism remain unclear. Here, we show, by periodic micro-CT images of human kidney stones in an ex vivo incubation experiment, that the growth of porous aggregates of calcium oxalate dihydrate (COD) crystals triggers the hardening of the kidney stones that causes difficulty in lithotripsy of kidney stone disease in the secondary transition. This hardening was caused by the internal nucleation and growth of precise calcium oxalate monohydrate (COM) crystals from isolated urine in which the calcium oxalate concentrations decreased by the growth of COD in closed grain boundaries of COD aggregate kidney stones. Reducing the calcium oxalate concentrations in urine is regarded as a typical approach for avoiding the recurrence. However, our results revealed that the decrease of the concentrations in closed microenvironments conversely promotes the transition of the COD aggregates into hard COM aggregates. We anticipate that the suppression of the secondary transition has the potential to manage the deterioration of kidney stone disease.
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Affiliation(s)
- Uta Michibata
- Graduate School of Engineering, Osaka University, 2-1, Yamadaoka, Suita, 565-0871, Japan
| | - Mihoko Maruyama
- Graduate School of Engineering, Osaka University, 2-1, Yamadaoka, Suita, 565-0871, Japan.
- Graduate School of Life and Environmental Sciences, Kyoto Prefectural University, 1-5, Hangi-cho, Shimogamo, Sakyo-ku, Kyoto, 606-8522, Japan.
| | - Yutaro Tanaka
- Graduate School of Engineering, Osaka University, 2-1, Yamadaoka, Suita, 565-0871, Japan
- Department of Nephro-urology, Graduate School of Medical Sciences, Nagoya City University, 1-Kawasumi, Mizuho- cho, Mizuho-Ku, Nagoya, 467-8601, Japan
| | - Masashi Yoshimura
- Institute of Laser Engineering, Osaka University, 2-6, Yamadaoka, Suita City, 565-0871, Osaka, Japan
| | - Hiroshi Y Yoshikawa
- Graduate School of Engineering, Osaka University, 2-1, Yamadaoka, Suita, 565-0871, Japan
| | - Kazufumi Takano
- Graduate School of Life and Environmental Sciences, Kyoto Prefectural University, 1-5, Hangi-cho, Shimogamo, Sakyo-ku, Kyoto, 606-8522, Japan
| | - Yoshihiro Furukawa
- Department of Earth Science, Tohoku University, 6-3 Aza-Aoba, Aramaki, Aoba-ku, Sendai, 980-8578, Japan
| | - Koichi Momma
- National Museum of Nature and Science, 4-1-1 Amakubo, Tsukuba, 305-0005, Japan
| | - Rie Tajiri
- Tajiri Thin Section Laboratory, 3-1-11 Sannose, Higashiosaka, 577-0849, Osaka, Japan
| | - Kazumi Taguchi
- Department of Nephro-urology, Graduate School of Medical Sciences, Nagoya City University, 1-Kawasumi, Mizuho- cho, Mizuho-Ku, Nagoya, 467-8601, Japan
| | - Shuzo Hamamoto
- Department of Nephro-urology, Graduate School of Medical Sciences, Nagoya City University, 1-Kawasumi, Mizuho- cho, Mizuho-Ku, Nagoya, 467-8601, Japan
| | - Atsushi Okada
- Department of Nephro-urology, Graduate School of Medical Sciences, Nagoya City University, 1-Kawasumi, Mizuho- cho, Mizuho-Ku, Nagoya, 467-8601, Japan
| | - Kenjiro Kohri
- Department of Nephro-urology, Graduate School of Medical Sciences, Nagoya City University, 1-Kawasumi, Mizuho- cho, Mizuho-Ku, Nagoya, 467-8601, Japan
| | - Takahiro Yasui
- Department of Nephro-urology, Graduate School of Medical Sciences, Nagoya City University, 1-Kawasumi, Mizuho- cho, Mizuho-Ku, Nagoya, 467-8601, Japan
| | - Shigeyoshi Usami
- Graduate School of Engineering, Osaka University, 2-1, Yamadaoka, Suita, 565-0871, Japan
| | - Masayuki Imanishi
- Graduate School of Engineering, Osaka University, 2-1, Yamadaoka, Suita, 565-0871, Japan
| | - Yusuke Mori
- Graduate School of Engineering, Osaka University, 2-1, Yamadaoka, Suita, 565-0871, Japan
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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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