Science.gov

Sample records for wave lithotripsy swl

  1. Damage mechanisms in shock wave lithotripsy (SWL)

    NASA Astrophysics Data System (ADS)

    Lokhandwalla, Murtuza

    Shock wave lithotripsy is a 'non-invasive' therapy for treating kidney stones. Focused shock waves fragment stones to a size that can be passed naturally. There is, however, considerable tissue injury, and the mechanisms of stone fragmentation and tissue injury are not well understood. This work investigates potential tissue damage mechanisms, with an aim towards enhancing stone fragmentation and minimizing tissue damage. Lysis of red blood cells (RBC's) due to in vitro exposure to shock waves was investigated. Fluid flow-fields induced by a non-uniform shock wave, as well as radial expansion/implosion of a bubble was hypothesized to cause cell lysis. Both the above flow-fields constitute an unsteady extensional flow, exerting inertial as well as viscous forces on the RBC membrane. The resultant membrane tension and the membrane areal strain due to the above flow-fields were estimated. Both were found to exert a significantly higher inertial force (50--100 mN/m) than the critical membrane tension (10 mN/m). Bubble-induced flow-field was estimated to last for a longer duration (˜1 microsec) compared to the shock-induced flow (˜1 ns) and hence, was predicted to be lytically more effective, in typical in vitro experimental conditions. However, in vivo conditions severely constrain bubble growth, and cell lysis due to shock-induced shear could be dominant. Hemolysis due to shock-induced shear, in absence of cavitation, was experimentally investigated. The lithotripter-generated shock wave was refocused by a parabolic reflector. This refocused wave-field had a tighter focus (smaller beam-width and a higher amplitude) than the lithotripter wave-field. Cavitation was eliminated by applying overpressure to the fluid. Acoustic emissions due to bubble activity were monitored by a novel passive cavitation detector (HP-PCD). Aluminum foils were also used to differentiate cavitational from non-cavitational mode of damage. RBC's were exposed to the reflected wave-field from

  2. Management of Large Proximal Ureteral Stones: A Comparative Clinical Trial Between Transureteral Lithotripsy (TUL) and Shock Wave Lithotripsy (SWL)

    PubMed Central

    Rabani, Seyed Mohammadreza; Moosavizadeh, Ali

    2012-01-01

    Background A review of the related medical journals indicates that there is no definite evidence-based option for managing large proximal ureteral stones, although many procedures such as transureteral lithotripsy (TUL), shock wave lithotripsy (SWL), percutaneous nephrolithotripsy, laparoscopic ureterolithotomy, and open ureterolithotomy are currently used to treat this urological problem. Objectives In this study, we tried to determine the most appropriate treatment plan for proximal ureteral stones larger than 12 mm by comparing the two most commonly used procedures. Patients and Methods Between February 2005 and April 2011, 62 patients including 40 males and 22 females (mean age 39.5 years, range 19 to 64) with proximal ureteral stones larger than 12 mm (12–26 mm) with a mean size of 17.64 mm were prospectively divided into two groups consisting of 32 patients who underwent TUL (group A) and 30 who underwent SWL (group B). In unsuccessful cases, repeat SWL or TUL was planned. Patients who could not tolerate the lithotomy position, younger than 18 years, had undergone coagulopathy, had concurrent renal and ureteral stones, were pregnant, or had sepsis were excluded from this study. Results Stone access was successful in 28 patients and the treatment was efficient in 18 patients (56.25%) in group A. For the patients with successful stone access but unsuccessful TUL, a DJ was inserted and a second ureteroscopic intervention was performed. The second intervention was successful in 7 patients (21.87). SWL was successful in 14 patients (46.66%) in the first attempt and in 7 additional patients in the second intervention (23.33%). Conclusions In this study, we showed different success rates for SWL and TUL because of the larger size of the stones. We achieved a success rate of 56.25% in the first attempt in the TUL group, and the overall success rate (after the second TUL) was 78.12%. In comparison, the SWL group had a success rate of 46.66% in the first attempt, and

  3. Acoustic Shielding by Cavitation Bubbles in Shock Wave Lithotripsy (SWL)

    NASA Astrophysics Data System (ADS)

    Pishchalnikov, Yuri A.; McAteer, James A.; Bailey, Michael R.; Pishchalnikova, Irina V.; Williams, James C.; Evan, Andrew P.

    2006-05-01

    Lithotripter pulses (˜7-10 μs) initiate the growth of cavitation bubbles, which collapse hundreds of microseconds later. Since the bubble growth-collapse cycle trails passage of the pulse, and is ˜1000 times shorter than the pulse interval at clinically relevant firing rates, it is not expected that cavitation will affect pulse propagation. However, pressure measurements with a fiber-optic hydrophone (FOPH-500) indicate that bubbles generated by a pulse can, indeed, shield the propagation of the negative tail. Shielding was detected within 1 μs of arrival of the negative wave, contemporaneous with the first observation of expanding bubbles by high-speed camera. Reduced negative pressure was observed at 2 Hz compared to 0.5 Hz firing rate, and in water with a higher content of dissolved gas. We propose that shielding of the negative tail can be attributed to loss of acoustic energy into the expansion of cavitation bubbles.

  4. Shock wave lithotripsy (SWL) induces significant structural and functional changes in the kidney

    NASA Astrophysics Data System (ADS)

    Evan, Andrew P.; Willis, Lynn R.; Lingeman, James E.

    2003-10-01

    The foundation for understanding SWL-injury has been well-controlled renal structural and functional studies in pigs, a model that closely mimics the human kidney. A clinical dose (2000 shocks at 24 kV) of SWL administered by the Dornier HM3 induces a predictable, unique vascular injury at F2 that is associated with transient renal vasoconstriction, seen as a reduction in renal plasma flow, in both treated and untreated kidneys. Unilateral renal denervation studies links the fall in blood flow in untreated kidneys to autonomic nerve activity in the treated kidney. SWL-induced trauma is associated with an acute inflammatory process, termed Lithotripsy Nephritis and tubular damage at the site of damage that leads to a focal region of scar. Lesion size increases with shock number and kV level. In addition, risk factors like kidney size and pre-existing renal disease (e.g., pyelonephritis), can exaggerate the predicted level of renal impairment. Our new protection data show that lesion size can be greatly reduced by a pretreatment session with low kV and shock number. The mechanisms of soft tissue injury probably involves shear stress followed by acoustic cavitation. Because of the perceived enhanced level of bioeffects from 3rd generation lithotripters, these observations are more relevant than ever.

  5. Using Helical CT to Predict Stone Fragility in Shock Wave Lithotripsy (SWL)

    SciTech Connect

    Williams, James C. Jr.; Zarse, Chad A.; Jackson, Molly E.; McAteer, James A.; Lingeman, James E.

    2007-04-05

    Great variability exists in the response of urinary stones to SWL, and this is true even for stones composed of the same mineral. Efforts have been made to predict stone fragility to shock waves using computed tomography (CT) patient images, but most work to date has focused on the use of stone CT number (i.e., Hounsfield units). This is an easy number to measure on a patient stone, but its value depends on a number of factors, including the relationship of the size of the stone to me resolution (i.e., the slicewidth) of the CT scan. Studies that have shown a relationship between stone CT number and failure in SWL are reviewed, and all are shown to suffer from error due to stone size, which was not accounted for in the use of Hounsfield unit values. Preliminary data are then presented for a study of calcium oxalate monohydrate (COM) stones, in which stone structure-rather than simple CT number values-is shown to correlate with fragility to shock waves. COM stones that were observed to have structure by micro CT (e.g., voids, apatite regions, unusual shapes) broke to completion in about half the number of shock waves required for COM stones that were observed to be homogeneous in structure by CT. This result suggests another direction for the use of CT in predicting success of SWL: the use of CT to view stone structure, rather than simply measuring stone CT number. Viewing stone structure by CT requires the use of different viewing windows than those typically used for examining patient scans, but much research to date indicates that stone structure can be observed in the clinical setting. Future clinical studies will need to be done to verify the relationship between stone structure observed by CT and stone fragility in SWL.

  6. Comparison of shock wave lithotripsy (SWL) and retrograde intrarenal surgery (RIRS) for treatment of stone disease in horseshoe kidney patients

    PubMed Central

    Gokce, Mehmet Ilker; Tokatli, Zafer; Suer, Evren; Hajiyev, Parviz; Akinci, Aykut; Esen, Baris

    2016-01-01

    ABSTRACT Objectives In this study it is aimed to compare the success and complication rates of SWL and RIRS in treatment of HSK stone disease. Materials and methods In this retrospective study data of 67 patients treated with either SWL (n=44) or RIRS (n=23) for stone disease in HSK between May 2003 to August 2014 was investigated. age, gender, stone size and multiplicity, stone free status, renal colic episodes and complication rates of the SWL and RIRS groups were compared. Results Mean age of the population was 42.5±8.2 (range: 16-78) years and mean stone size was 16.9±4.1 mm. SWL and RIRS groups were similar with regard to demographic characteristics and stone related characteristics. SFR of the SWL and RIRS groups were 47.7%(21/44 patients) and 73.9% (17/23 patients) respectively (p=0.039).Renal colic episodes were observed in 3 and 16 patients in the RIRS and SWL groups respectively (p=0.024). No statistically significant complications were observed between the SWL (8/44 patients) and RIRS (4/23) groups (p=0.936). Conclusions In HSK patients with stone disease, both SWL and RIRS are effective and safe treatment modalities. However RIRS seems to maintain higher SFRs with comparable complication rates. PMID:27136473

  7. Uncovering the Secret of Shock Wave Lithotripsy

    NASA Astrophysics Data System (ADS)

    Zhong, P.

    Shock wave lithotripsy (SWL) is an engineering innovation that has revolutionized the treatment of kidney stone disease since the early 1980s [1] - [3]. Today, SWL is the first-line therapy for millions of patients worldwide with renal and upper urinary stones [3, 4].

  8. Lithotripsy

    MedlinePlus

    ... have, their size, and where in your urinary system they are. Most of the time, lithotripsy removes all the stones. Alternative Names Extracorporeal shock wave lithotripsy; Shock wave lithotripsy; Laser lithotripsy; Percutaneous lithotripsy; Endoscopic lithotripsy; ESWL; Renal calculi- ...

  9. The Efficacy of Medical Expulsive Therapy (MET) in Improving Stone-free Rate and Stone Expulsion Time, After Extracorporeal Shock Wave Lithotripsy (SWL) for Upper Urinary Stones: A Systematic Review and Meta-analysis.

    PubMed

    Skolarikos, Andreas; Grivas, Nikolaos; Kallidonis, Panagiotis; Mourmouris, Panagiotis; Rountos, Thomas; Fiamegos, Alexandros; Stavrou, Sotirios; Venetis, Chris

    2015-12-01

    In this meta-analysis, we included randomized studies on medical expulsive therapy implemented following shock wave lithotripsy for renal and ureteral stones. Pooled results demonstrated the efficacy of α-blockers, nifedipine, Rowatinex, and Uriston in increasing stone clearance. In addition, the time to stone elimination, the intensity of pain, the formation of steinstrasse, and the need for auxiliary procedures were reduced mainly with α-blockers. Expulsion rate was not correlated with the type of α-blocker, the diameter, and the location of stone. Our results show that medical expulsive therapy for residual fragments after shock wave lithotripsy should be implemented in clinical practice. PMID:26383613

  10. Effect of Shock Wave Lithotripsy on Renal Hemodynamics

    NASA Astrophysics Data System (ADS)

    Handa, Rajash K.; Willis, Lynn R.; Evan, Andrew P.; Connors, Bret A.

    2008-09-01

    Extracorporeal shock wave lithotripsy (SWL) can injure tissue and decrease blood flow in the SWL-treated kidney, both tissue and functional effects being largely localized to the region targeted with shock waves (SWs). A novel method of limiting SWL-induced tissue injury is to employ the "protection" protocol, where the kidney is pretreated with low-energy SWs prior to the application of a standard clinical dose of high-energy SWs. Resistive index measurements of renal vascular resistance/impedance to blood flow during SWL treatment protocols revealed that a standard clinical dose of high-energy SWs did not alter RI during SW application. However, there was an interaction between low- and high-energy SWL treatment phases of the "protection" protocol such that an increase in RI (vasoconstriction) was observed during the later half of SW application, a time when tissue damage is occurring during the standard high-energy SWL protocol. We suggest that renal vasoconstriction may be responsible for reducing the degree of tissue damage that normally results from a standard clinical dose of high-energy SWs.

  11. Herpes zoster reactivation after extracorporeal shock wave lithotripsy: A case report

    PubMed Central

    Hariharan, Krishnamoorthy; Pillai, Biju S.; Bansal, Devesh

    2016-01-01

    Herpes zoster is a reactivated varicella-zoster virus (VZV) infection of the sensory nerve ganglion, peripheral nerve, and its branches. Mechanical trauma to the nervous system can reactivate VZV. It is well known that extracorporeal shock wave lithotripsy (SWL) can produce mechanical damage to the tissue. We report a rare case of herpes zoster reactivation after SWL for treatment of 1.2 cm size renal stone in a 63-year-old male patient. PMID:27555686

  12. Herpes zoster reactivation after extracorporeal shock wave lithotripsy: A case report.

    PubMed

    Hariharan, Krishnamoorthy; Pillai, Biju S; Bansal, Devesh

    2016-01-01

    Herpes zoster is a reactivated varicella-zoster virus (VZV) infection of the sensory nerve ganglion, peripheral nerve, and its branches. Mechanical trauma to the nervous system can reactivate VZV. It is well known that extracorporeal shock wave lithotripsy (SWL) can produce mechanical damage to the tissue. We report a rare case of herpes zoster reactivation after SWL for treatment of 1.2 cm size renal stone in a 63-year-old male patient. PMID:27555686

  13. Strategies to optimize shock wave lithotripsy outcome: Patient selection and treatment parameters

    PubMed Central

    Semins, Michelle Jo; Matlaga, Brian R

    2015-01-01

    Shock wave lithotripsy (SWL) was introduced in 1980, modernizing the treatment of upper urinary tract stones, and quickly became the most commonly utilized technique to treat kidney stones. Over the past 5-10 years, however, use of SWL has been declining because it is not as reliably effective as more modern technology. SWL success rates vary considerably and there is abundant literature predicting outcome based on patient- and stone-specific parameters. Herein we discuss the ways to optimize SWL outcomes by reviewing proper patient selection utilizing stone characteristics and patient features. Stone size, number, location, density, composition, and patient body habitus and renal anatomy are all discussed. We also review the technical parameters during SWL that can be controlled to improve results further, including type of anesthesia, coupling, shock wave rate, focal zones, pressures, and active monitoring. Following these basic principles and selection criteria will help maximize success rate. PMID:25949936

  14. The Acute and Long-Term Adverse Effects of Shock Wave Lithotripsy

    PubMed Central

    McAteer, James A.; Evan, Andrew P.

    2009-01-01

    Shock wave lithotripsy (SWL) has proven to be a highly effective treatment for the removal of kidney stones. Shock waves (SW’s) can be used to break most stone types, and because lithotripsy is the only non-invasive treatment for urinary stones SWL is particularly attractive. On the downside SWL can cause vascular trauma to the kidney and surrounding organs. This acute SW damage can be severe, can lead to scarring with a permanent loss of functional renal volume, and has been linked to potentially serious long-term adverse effects. A recent retrospective study linking lithotripsy to the development of diabetes mellitus has further focused attention on the possibility that SWL may lead to life-altering chronic effects 1. Thus, it appears that what was once considered to be an entirely safe means to eliminate renal stones can elicit potentially severe unintended consequences. The purpose of this review is to put these findings in perspective. The goal is to explain the factors that influence the severity of SWL injury, update current understanding of the long-term consequences of SW damage, describe the physical mechanisms thought to cause SWL injury, and introduce treatment protocols to improve stone breakage and reduce tissue damage. PMID:18359401

  15. Observation of cavitation during shock wave lithotripsy

    NASA Astrophysics Data System (ADS)

    Bailey, Michael R.; Crum, Lawrence A.; Pishchalnikov, Yuri A.; McAteer, James A.; Pishchalnikova, Irina V.; Evan, Andrew P.; Sapozhnikov, Oleg A.; Cleveland, Robin O.

    2005-04-01

    A system was built to detect cavitation in pig kidney during shock wave lithotripsy (SWL) with a Dornier HM3 lithotripter. Active detection, using echo on B-mode ultrasound, and passive cavitation detection (PCD), using coincident signals on confocal, orthogonal receivers, were equally sensitive and were used to interrogate the renal collecting system (urine) and the kidney parenchyma (tissue). Cavitation was detected in urine immediately upon SW administration in urine or urine plus X-ray contrast agent, but in tissue, cavitation required hundreds of SWs to initiate. Localization of cavitation was confirmed by fluoroscopy, sonography, and by thermally marking the kidney using the PCD receivers as high intensity focused ultrasound sources. Cavitation collapse times in tissue and native urine were about the same but less than in urine after injection of X-ray contrast agent. Cavitation, especially in the urine space, was observed to evolve from a sparse field to a dense field with strong acoustic collapse emissions to a very dense field that no longer produced detectable collapse. The finding that cavitation occurs in kidney tissue is a critical step toward determining the mechanisms of tissue injury in SWL. [Work sup ported by NIH (DK43881, DK55674, FIRCA), ONRIFO, CRDF and NSBRI SMS00203.

  16. Shock Wave Injury to the Kidney in SWL: Review and Perspective

    NASA Astrophysics Data System (ADS)

    McAteer, James A.; Evan, Andrew P.; Willis, Lynn R.; Connors, Bret A.; Williams, James C.; Pishchalnikov, Yuri A.; Lingeman, James E.

    2007-04-01

    Shock wave lithotripsy (SWL) is a first-line option for treatment for urinary calculi—particularly effective for the removal of uncomplicated stones from the upper urinary tract. The success of lithotripsy is tempered, however, by the occurrence of acute injury that has been reported to progress to long-term complications. SW trauma to the kidney is a vascular lesion characterized by parenchymal and subcapsular bleeding. The acute lesion is dose-dependent, and typically localized to the focal volume of the lithotripter. Cavitation has been implicated in vessel rupture, but SW-shear has the potential to be a primary mechanism for damage as well. Possible chronic adverse effects of SWL may include new-onset hypertension, development of diabetes, and exacerbation of stone disease. If acute trauma could be reduced, it seems likely that serious long-term effects could be minimized, or even eliminated. Reducing the dose of SW's needed for stone breakage is one option. Improved coupling improves stone breakage, and slowing SW rate significantly improves stone-free outcomes. Experiments with animals now show that treatment protocols can be designed to protect against tissue injury. Initiating treatment with low energy SW's dramatically reduces lesion size, and reducing the rate of SW delivery virtually eliminates SW trauma altogether. SWL stands to gain from new advances in technology, as lithotripters become safer and more effective. Perhaps the greatest progress will be made when we have determined the physical mechanisms of SW action both for stone breakage and tissue damage, and have better characterized the biological response to SW's—as this will provide the principles needed to achieve the best combination of safety and efficiency with whatever lithotripter is at hand.

  17. Kidney stones - lithotripsy - discharge

    MedlinePlus

    Extracorporeal shock wave lithotripsy - discharge; Shock wave lithotripsy - discharge; Laser lithotripsy - discharge; Percutaneous lithotripsy - discharge; Endoscopic lithotripsy - discharge; ESWL - discharge

  18. The Future of SWL: A Global Perspective

    NASA Astrophysics Data System (ADS)

    Köhrmann, Kai Uwe

    2007-04-01

    The future relevance of shock wave lithotripsy (SWL) to the treatment of urinary stones has been questioned by some. This paper reviews recent developments with an aim to predict the level of usefulness of SWL for the future. The incidence of urolithiasis is increasing throughout the world, and existing metaphylaxis is not widely effective. This results in an increasing need for active stone removal. SWL was and is a well established treatment modality for urolithiasis in the upper urinary tract. For most stone situations there will remain a reasonable choice between SWL versus endoscopic procedures, and it is unlikely that endoscopic procedures will displace SWL completely in general practice. In conclusion, SWL will continue to play an established, if slightly reduced, role in stone treatment in the future.

  19. Modification of the edge wave in shock wave lithotripsy

    NASA Astrophysics Data System (ADS)

    Zhou, Yufeng

    2012-10-01

    To reduce the bubble cavitation and the consequent vascular injury of shock wave lithotripsy (SWL), a new method was devised to modify the diffraction wave generated at the aperture of a Dornier HM-3 lithotripter. Subsequently, the duration of the tensile wave was shortened significantly (3.2±0.54 μs vs. 5.83±0.56 μs). However, the amplitude and duration of the compressive wave of LSW between these two groups as well as the -6 dB beam width and the amplitude of the tensile wave are almost unchanged. The suppression on bubble cavitation was confirmed using the passive cavitation technique. At the lithotripter focus, while 30 shocks can cause rupture of blood vessel phantom using the HM-3 lithotripter at 20 kV; no rupture could be found after 300 shocks with the edge extender. On the other hand, after 200 shocks the HM-3 lithotripter at 20 kV can achieve a stone fragmentation of 50.4±2.0% on plaster-of-Paris stone phantom, which is comparable to that of using the edge extender (46.8±4.1%, p=0.005). Altogether, the modification on the diffraction wave at the lithotripter aperture can significantly reduce the bubble cavitation activities. As a result, potential for vessel rupture in shock wave lithotripsy is expected.

  20. Shock wave lithotripsy: advances in technology and technique

    PubMed Central

    Lingeman, James E.; McAteer, James A.; Gnessin, Ehud; Evan, Andrew P.

    2010-01-01

    Shock wave lithotripsy (SWL) is the only noninvasive method for stone removal. Once considered as a primary option for the treatment of virtually all stones, SWL is now recognized to have important limitations that restrict its use. In particular, the effectiveness of SWL is severely limited by stone burden, and treatment with shock waves carries the risk of acute injury with the potential for long-term adverse effects. Research aiming to characterize the renal response to shock waves and to determine the mechanisms of shock wave action in stone breakage and renal injury has begun to suggest new treatment strategies to improve success rates and safety. Urologists can achieve better outcomes by treating at slower shock wave rate using a step-wise protocol. The aim is to achieve stone comminution using as few shock waves and at as low a power level as possible. Important challenges remain, including the need to improve acoustic coupling, enhance stone targeting, better determine when stone breakage is complete, and minimize the occurrence of residual stone fragments. New technologies have begun to address many of these issues, and hold considerable promise for the future. PMID:19956196

  1. 3D dynamic simulation of crack propagation in extracorporeal shock wave lithotripsy

    NASA Astrophysics Data System (ADS)

    Wijerathne, M. L. L.; Hori, Muneo; Sakaguchi, Hide; Oguni, Kenji

    2010-06-01

    Some experimental observations of Shock Wave Lithotripsy(SWL), which include 3D dynamic crack propagation, are simulated with the aim of reproducing fragmentation of kidney stones with SWL. Extracorporeal shock wave lithotripsy (ESWL) is the fragmentation of kidney stones by focusing an ultrasonic pressure pulse onto the stones. 3D models with fine discretization are used to accurately capture the high amplitude shear shock waves. For solving the resulting large scale dynamic crack propagation problem, PDS-FEM is used; it provides numerically efficient failure treatments. With a distributed memory parallel code of PDS-FEM, experimentally observed 3D photoelastic images of transient stress waves and crack patterns in cylindrical samples are successfully reproduced. The numerical crack patterns are in good agreement with the experimental ones, quantitatively. The results shows that the high amplitude shear waves induced in solid, by the lithotriptor generated shock wave, play a dominant role in stone fragmentation.

  2. Comparison of High, Intermediate, and Low Frequency Shock Wave Lithotripsy for Urinary Tract Stone Disease: Systematic Review and Network Meta-Analysis

    PubMed Central

    Kang, Dong Hyuk; Cho, Kang Su; Ham, Won Sik; Lee, Hyungmin; Kwon, Jong Kyou; Choi, Young Deuk

    2016-01-01

    Objectives To perform a systematic review and network meta-analysis of randomized controlled trials (RCTs) to determine the optimal shock wave lithotripsy (SWL) frequency range for treating urinary stones, i.e., high-frequency (100–120 waves/minute), intermediate-frequency (80–90 waves/minute), and low-frequency (60–70 waves/minute) lithotripsy. Materials and Methods Relevant RCTs were identified from electronic databases for meta-analysis of SWL success and complication rates. Using pairwise and network meta-analyses, comparisons were made by qualitative and quantitative syntheses. Outcome variables are provided as odds ratios (ORs) with 95% confidence intervals (CIs). Results Thirteen articles were included in the qualitative and quantitative synthesis using pairwise and network meta-analyses. On pairwise meta-analyses, comparable inter-study heterogeneity was observed for the success rate. On network meta-analyses, the success rates of low- (OR 2.2; 95% CI 1.5–2.6) and intermediate-frequency SWL (OR 2.5; 95% CI 1.3–4.6) were higher than high-frequency SWL. Forest plots from the network meta-analysis showed no significant differences in the success rate between low-frequency SWL versus intermediate-frequency SWL (OR 0.87; 95% CI 0.51–1.7). There were no differences in complication rate across different SWL frequency ranges. By rank-probability testing, intermediate-frequency SWL was ranked highest for success rate, followed by low-frequency and high-frequency SWL. Low-frequency SWL was also ranked highest for low complication rate, with high- and intermediate-frequency SWL ranked lower. Conclusions Intermediate- and low-frequency SWL have better treatment outcomes than high-frequency SWL when considering both efficacy and complication. PMID:27387279

  3. Management of impacted proximal ureteral stone: Extracorporeal shock wave lithotripsy versus ureteroscopy with holmium: YAG laser lithotripsy

    PubMed Central

    Khalil, Mostafa

    2013-01-01

    Objective: Prospective evaluation of the efficacy and safety of the extracorporeal shock wave lithotripsy (SWL) and ureteroscopy with Holmium: YAG laser lithotripsy (URSL) as a primary treatment for impacted stone in the proximal ureter. Patients and Methods: A total of 82 patients with a single impacted stone in the proximal ureter were included in the study. Patients were allocated into two groups according to patient preference for either procedure. The first group included 37 patients who were treated by SWL and the second group included 45 patients treated by URSL. The preoperative data and treatment outcomes of both procedures were compared and analyzed. Results: There was no difference as regards to patient and stone characters between the two groups. There was significantly higher mean session number and re-treatment rate in the SWL group in comparison to URSL group (1.5 ± 0.8 vs. 1.02 ± 0.15 session, and 43.2% vs. 2.2%, respectively). At one month, the stone-free rate of the URSL group was statistically significantly higher than that of the SWL group (80% vs. 67.6%, respectively). The stone-free rate at three months was still higher in the URSL group, but without statistically significant difference (80.2% vs. 78.4%, respectively). There was no statistically significant difference in the rate of complications between the SWL and URSL (24.3% vs. 15.6%, respectively). Conclusion: Both procedures can be used effectively and safely as a primary treatment for impacted stone in the proximal ureter; however, the URSL has a significantly higher initial stone-free rate and lower re-treatment rate. PMID:23798864

  4. Effect of urine pH on the effectiveness of shock wave lithotripsy: A pilot study

    PubMed Central

    Majzoub, Ahmad; Al-Ani, Ammar; Gul, Tawiz; Kamkoum, Hatem; Al-Jalham, Khalid

    2016-01-01

    Aim: Shock wave lithotripsy (SWL) is a well-established modality in the treatment of urolithiasis. Studying the effect of urine pH on SWL success is appealing as pH can be manipulated before SWL to insure a better outcome. Materials and Methods: This is a prospective study performed at a tertiary medical center. Patients presenting to the SWL unit with a single renal stone <2 cm in size were included in this study. In addition to standard laboratory and radiologic investigations, urine pH measurement was performed on all patients before their procedure. The number of sessions performed, and the stone-free rate (SFR) were assessed. Patients were divided into two groups according to stone clearance. Group 1 was stone-free, whereas Group 2 had residual stones after three sessions of SWL. Data was also classified according to different pH ranges. Influential factors were compared among the study groups and pH ranges. Results: A total of 175 patients were included in this study. The SFR was 54.3%. The mean number of sessions performed was 2.2 ± 0.8. Group 1 included 95 patients, whereas Group 2 had eighty patients. Among all studied factors, stone size (P = 0.03) and skin to stone distance (P = 0.04) significantly affected SFR with SWL. Urine pH was not found to have a statistically significant influence on SWL outcome (P = 0.51). Conclusion: Urine pH was not found in this study population to influence the effectiveness of SWL. Further experimental studies are required to help investigate this notion. PMID:27453649

  5. A heuristic model of stone comminution in shock wave lithotripsy

    PubMed Central

    Smith, Nathan B.; Zhong, Pei

    2013-01-01

    A heuristic model is presented to describe the overall progression of stone comminution in shock wave lithotripsy (SWL), accounting for the effects of shock wave dose and the average peak pressure, P+(avg), incident on the stone during the treatment. The model is developed through adaptation of the Weibull theory for brittle fracture, incorporating threshold values in dose and P+(avg) that are required to initiate fragmentation. The model is validated against experimental data of stone comminution from two stone types (hard and soft BegoStone) obtained at various positions in lithotripter fields produced by two shock wave sources of different beam width and pulse profile both in water and in 1,3-butanediol (which suppresses cavitation). Subsequently, the model is used to assess the performance of a newly developed acoustic lens for electromagnetic lithotripters in comparison with its original counterpart both under static and simulated respiratory motion. The results have demonstrated the predictive value of this heuristic model in elucidating the physical basis for improved performance of the new lens. The model also provides a rationale for the selection of SWL treatment protocols to achieve effective stone comminution without elevating the risk of tissue injury. PMID:23927195

  6. Previous shock-wave lithotripsy treatment does not impact the outcomes of flexible ureterorenoscopy

    PubMed Central

    Yürük, Emrah; Binbay, Murat; Akman, Tolga; Özgör, Faruk; Berberoğlu, Yalçın; Müslümanoğlu, Ahmet Yaser

    2014-01-01

    Objective: Shock-wave lithotripsy (SWL) is the first-line treatment for the active removal of small and medium-sized kidney stones. Flexible ureterorenoscopy (fURS) is recommended after failed SWL treatment. The aim of this retrospective analysis is to evaluate whether prior unsuccessful SWL treatments affect the outcomes of fURS. Material and methods: Data from 206 patients who underwent fURS for the treatment of renal stones between September 2009 and January 2011 were collected, and the patients were divided into two groups according to their previous SWL treatment. The patient demographics, stone characteristics, operation and fluoroscopy times, stone-free rates and complications were compared. Results: Of the patients, 114 (55.3%) did not undergo SWL prior to fURS (Group 1), whereas 92 (44.6%) completed a minimum of 3 sessions of SWL and waited at least 2 weeks before the fURS operation (Group 2). Although the mean stone number was higher in Group 2, this difference was not significant (p=0.06). The mean operation (p=0.12) and fluoroscopy times (p=0.69) were similar between the groups. The mean operation time per mm2 stone and fluoroscopy time per mm2 stone were not significantly different (p=0.64 and p=0.76, respectively). The length of the hospitalization and the overall complication rates were similar. After the third postoperative month, the stone-free rates were not different between the groups (82.5% and 86.9%, respectively, p=0.38). Conclusion: The stone-free and complication rates of fURS were not affected by previous SWL therapy. PMID:26328180

  7. Mechanism by which shock wave lithotripsy can promote formation of human calcium phosphate stones

    PubMed Central

    Evan, Andrew P.; Coe, Fredric L.; Connors, Bret A.; Handa, Rajash K.; Lingeman, James E.

    2015-01-01

    Human stone calcium phosphate (CaP) content correlates with higher urine CaP supersaturation (SS) and urine pH as well as with the number of shock wave lithotripsy (SWL) treatments. SWL does damage medullary collecting ducts and vasa recta, sites for urine pH regulation. We tested the hypothesis that SWL raises urine pH and therefore Cap SS, resulting in CaP nucleation and tubular plugging. The left kidney (T) of nine farm pigs was treated with SWL, and metabolic studies were performed using bilateral ureteral catheters for up to 70 days post-SWL. Some animals were given an NH4Cl load to sort out effects on urine pH of CD injury vs. increased HCO3− delivery. Histopathological studies were performed at the end of the functional studies. The mean pH of the T kidneys exceeded that of the control (C) kidneys by 0.18 units in 14 experiments on 9 pigs. Increased HCO3− delivery to CD is at least partly responsible for the pH difference because NH4Cl acidosis abolished it. The T kidneys excreted more Na, K, HCO3−, water, Ca, Mg, and Cl than C kidneys. A single nephron site that could produce losses of all of these is the thick ascending limb. Extensive injury was noted in medullary thick ascending limbs and collecting ducts. Linear bands showing nephron loss and fibrosis were found in the cortex and extended into the medulla. Thus SWL produces tubule cell injury easily observed histopathologically that leads to functional disturbances across a wide range of electrolyte metabolism including higher than control urine pH. PMID:25656372

  8. The comparison of laparoscopy, shock wave lithotripsy and retrograde intrarenal surgery for large proximal ureteral stones

    PubMed Central

    Ozturk, M.D. Ufuk; Şener, Nevzat Can; Goktug, H.N. Goksel; Gucuk, Adnan; Nalbant, Ismail; İmamoglu, M. Abdurrahim

    2013-01-01

    Introduction In this study we compare the success rates and complication rates of shock wave lithotripsy (SWL), laparoscopic, and ureteroscopic approaches for large (between 1 and 2 cm) proximal ureteral stones. Methods: In total, 151 patients with ureteral stones between 1 and 2 cm in diameter were randomized into 3 groups (52 SWL, 51 laparoscopy and 48 retrograde intrarenal surgery [RIRS]). The groups were compared for stone size, success rates, and complication rates using the modified Clavien grading system. Results: Stone burden of the groups were similar (p = 0.36). The success rates were 96%, 81% and 79%, respectively in the laparoscopy, SWL, and ureteroscopy groups. The success rate in laparoscopy group was significantly higher (p < 0.05). When these groups were compared for complication rates, RIRS seemed to be the group with the lowest complication rates (4.11%) (p < 0.05). SWL and laparoscopy seem to have similar rates of complication (7.06% and 7.86%, respectively, p = 0.12). Interpretation: To our knowledge, this is the first study to compare the results of laparoscopy, SWL and RIRS in ureteral stones. Our results showed that in management of patients with upper ureteral stones between 1 and 2 cm, laparoscopy is the most successful method based on its stone-free rates and acceptable complication rates. However, the limitations of our study are lack of hospital stay and cost-effectiveness data. Also, studies conducted on larger populations should support our findings. When a less invasive method is the only choice, SWL and flexible ureterorenoscopy methods have similar success rates. RIRS, however, has a lower complication rate than the other approaches. PMID:24282455

  9. Lithotripsy

    MedlinePlus

    ... Laser lithotripsy; Percutaneous lithotripsy; Endoscopic lithotripsy; ESWL; Renal calculi-lithotripsy ... Lingeman JE. Surgical management of upper urinary tract calculi. In: Wein AJ, ed. Campbell-Walsh Urology . 10th ...

  10. Acute pancreatitis and development of pancreatic pseudo cyst after extra corporeal shock wave lithotripsy to a left renal calculus: A rare case with review of literature

    PubMed Central

    Mylarappa, Prasad; Javali, Tarun; Prathvi; Ramesh, D.

    2014-01-01

    Extracorporeal shock wave lithotripsy (SWL) is considered the standard of care for the treatment of small upper ureteric and renal calculi. A few centers have extended its use to the treatment of bile duct calculi and pancreatic calculi. The complication rates with SWL are low, resulting in its wide spread acceptance and usage. However, some of the serious complications reported in 1% of patients include acute pancreatitis, perirenal hematoma, urosepsis, venous thrombosis, biliary obstruction, bowel perforation, lung injury, rupture of aortic aneurysm and intracranial hemorrhage. To our knowledge, only six cases of acute pancreatitis or necrotizing pancreatitis following SWL have been documented in the literature. Herein, we report a rare case of acute pancreatitis and formation of a pseudo cyst following SWL for left renal pelvic calculus. PMID:24497695

  11. Unilateral versus bilateral ultrasound-guided transversus abdominis plane blocks during ureteric shock wave lithotripsy: A prospective randomized trial

    PubMed Central

    Elnabtity, Ali Mohamed Ali; Shabana, Waleed Mansour

    2016-01-01

    Background: Ultrasound-guided transversus abdominis plane (TAP) block has been used for intra- and post-operative analgesia during abdominal operations and for ureteric shock wave lithotripsy (SWL) as well. Aim: This study aimed at comparing ultrasound-guided unilateral versus bilateral TAP blocks as analgesic techniques for unilateral ureteric SWL. Settings and Design: Prospective randomized comparative study. Patients and Methods: Sixty patients scheduled for unilateral ureteric SWL were randomly allocated into two groups: Group (U) received unilateral TAP block in the form of 25 ml of bupivacaine 0.25% (i.e., 62.5 mg), and Group (B) received bilateral TAP blocks in the form of 25 ml of bupivacaine 0.25% (i.e., 62.5 mg) on each side. Statistical Analysis: This was performed using SPSS program version 19 ((IBM Corp., Armonk, NY, USA) and EP 16 program. Results: The mean values of intra- and post-procedural visual analog scale at different time intervals were around (30), which was statistically insignificant between groups (P > 0.05). There were no significant differences between groups regarding cardiopulmonary stability, postanesthesia care unit time, the total amount of rescue fentanyl and patient satisfaction scores (P > 0.05). There were no significant side effects in both groups. Conclusion: Ultrasound-guided unilateral TAP block is as safe and effective analgesic technique as bilateral TAP blocks during unilateral ureteric SWL. It can be used as the sole analgesic technique during ureteric SWL. PMID:27453645

  12. The Effect of Terpene Combination on Ureter Calculus Expulsion After Extracorporeal Shock Wave Lithotripsy

    PubMed Central

    Kim, Dai Hee; Goh, Hyeok Jun; Lee, Ho Won; Kim, Kyu Shik; Kim, Yong Tae; Moon, Hong Sang; Lee, Seung Wook

    2014-01-01

    Purpose Terpene combination (Rowatinex) is known to help with the expulsion of urinary stones. The aim of this study was to determine how Rowatinex affects the expulsion of remnant stones after shock wave lithotripsy (SWL). Materials and Methods Clinical data were collected retrospectively from 499 patients with a diagnosis of ureteral stones who underwent SWL from January 2009 to August 2012. Ureteral stones were diagnosed in all patients by kidney, ureter, and bladder x-ray and abdominal computed tomography (CT). The progress of patients was documented every 2 weeks to confirm remnant stones after SWL. The patients with remnant stones underwent SWL again. Group 1 consisted of patients who were prescribed an analgesic, Tamsulosin 0.2 mg, and Rowatinex. Group 2 consisted of patients who were prescribed only an analgesic and Tamsulosin 0.2 mg. The expulsion rate of urinary stones was compared between groups. Results The expulsion rate of urinary stones was not significantly different between the two groups after 2 weeks. However, after 4 weeks, group 1 had a significantly higher expulsion rate (72.2% compared with 61.1%, p=0.022). Fifteen patients (10.2%) in group 1 and 40 (11.4%) in group 2 had to undergo ureteroscopic removal of the stone (p=0.756). Acute pyelonephritis occurred in one patient (0.7%) in group 1 and in one patient (0.3%) in group 2 (p=0.503). Conclusions The long-term administration of Rowatinex for 4 weeks increased the expulsion rate of urinary stones after SWL. PMID:24466395

  13. Shock Wave Lithotripsy: Effects on the Pancreas and Recurrent Stone Disease

    NASA Astrophysics Data System (ADS)

    Krambeck, Amy E.; Rohlinger, Audrey L.; Lohse, Christine M.; Patterson, David E.; Gettman, Matthew T.

    2007-04-01

    Long-term effects of shockwave lithotripsy (SWL) are unknown; however, we recently found an association between SWL and diabetes mellitus in a population based case control cohort. To further study the association between SWL and diabetes mellitus, we determined the immediate impact of SWL on the pancreas as well as the long-term natural history of stone disease following treatment. Chart review identified 630 patients treated with SWL at our institution in 1985. Questionnaires focusing on recurrent stone episodes after SWL were sent to 578 patients alive in 2004. To further assess impact of SWL on the pancreas, pancreatic enzyme measurements were performed on 24 symptomatic stone patients treated in 2006 with ureteroscopy (n=12) and SWL (n=12). Serum amylase and lipase were evaluated pre and post SWL. A⩾5 U/L increase in either lab value was considered significant. Among patients in the long-term SWL treatment group, the questionnaire response rate was 58.9% (288/489). Recurrent stone events were noted in 154 (53.5%) of the survey respondents. Characteristics associated with stone recurrences were: gender (p=0.004), age at SWL (p=0.022), BMI (p=0.007), SWL complications (p=0.009), and lower pole SWL (p=0.025). Recurrent stone disease was also associated with the development of diabetes mellitus (p=0.020). In the contemporary group of treated stone patients, pancreatic enzyme analysis demonstrated an increase in serum amylase and lipase in 3 (25.0%) SWL patients and 1 (8.3%) ureteroscopy patient (p=0.273). In conclusion, over half of the patients treated with SWL will develop recurrent stone events. We found a strong association between recurrent stone disease and the development of diabetes mellitus at long-term follow-up. Although not statistically significant due to small number, data in a contemporary treatment cohort suggest the possibility that the pancreas can be adversely affected by SWL.

  14. Changes in Urolithiasis Referral Patterns for Shock Wave Lithotripsy over a Decade: Was There Adherence to AUA/EAU Guidelines?

    PubMed Central

    Noureldin, Yasser A.; Elkoushy, Mohamed A.; Andonian, Sero

    2015-01-01

    Objective The primary objective was to assess changes in referral patterns of urolithiasis for shock wave lithotripsy (SWL) over a decade. The secondary objective was to evaluate the effect of the number of years of practice of referring physicians on these referral patterns. Methods A retrospective review of SWL database was performed for consecutive referrals for SWL at a tertiary stone center between December 1999 and December 2013. Patient demographics and stone characteristics were assessed. The stone location at the time of referral was used as the reference. Retreatments were excluded. In addition, years of practice of the referring physicians were calculated. The 2007 AUA/EAU guidelines on urolithiasis were considered as a reference. Results A total of 8,992 SWL treatments were included. After December 2007, there was a significant increase in the percentage of renal pelvic stones referred for SWL (23.0 vs. 27.1%, p < 0.001). Conversely, proximal ureteral stones significantly decreased after 2007 (24 vs. 18.2%, p < 0.001) including stones > 10 mm (5.1 vs. 2.9%, p < 0.001). Otherwise, there were no changes in the referral patterns for SWL of other stone locations before and after December 2007 (p > 0.05). Furthermore, percentage of stones referred for SWL by urologists practicing for less than 10 years significantly decreased after December 2007 (29.5 vs. 22.8%, p < 0.001). Conclusions The significant reduction in the referral of proximal ureteral stones after December 2007 corresponds to the latest AUA/EAU guidelines on management of ureteral stones. PMID:26889134

  15. New-onset diabetes mellitus after shock wave lithotripsy for urinary stone: a systematic review and meta-analysis.

    PubMed

    Deng, Tuo; Liao, Banghua; Tian, Ye; Luo, Deyi; Liu, Jiaming; Jin, Tao; Wang, Kunjie

    2015-06-01

    The purpose of the study was to evaluate the association between shock wave lithotripsy (SWL) for urinary stone and new-onset diabetes mellitus (DM). A comprehensive data collection was performed in the Pubmed database, Embase database, Chinese Biomedical database, Chinese National Knowledge Infrastructure database and VIP database. Difference in incidence of new-onset DM after SWL between cases and controls was evaluated by odds ratio (OR) with its 95% confidence interval (CI). And summary adjusted risk ratios (RRs) and 95% CIs were calculated to assess the strength of association between SWL and new-onset DM, and then subgroup analyses were conducted. Five studies were included in this meta-analysis. The incidence of new-onset DM after SWL is not higher than that in the population who do not receive SWL [OR = 1.59, 95% CI (0.92, 2.74), P = 0.10]. And statistical association between SWL and new-onset DM could not be found significantly [RR = 1.33, 95% CI (0.83, 2.13), P = 0.24], either. However, body mass index (BMI) [RR = 1.09, 95% CI (1.04, 1.14), P < 0.001] and family history of DM (FHx DM) [RR = 0.35, 95% CI (0.15, 0.80), P = 0.013] were found significantly associated with the development of DM in subgroup analyses. Our data suggests that there is no association between SWL for urinary stone and new-onset DM. PMID:25753541

  16. Optimizing Shock Wave Lithotripsy: A Comprehensive Review

    PubMed Central

    McClain, Paul D; Lange, Jessica N; Assimos, Dean G

    2013-01-01

    Shock wave lithotripsy is a commonly used procedure for eradicating upper urinary tract stones in patients who require treatment. A number of methods have been proposed to improve the results of this procedure, including proper patient selection, modifications in technique, adjunctive therapy to facilitate elimination of fragments, and changes in lithotripter design. This article assesses the utility of these measures through an analysis of contemporary literature. PMID:24082843

  17. Prospective randomized trial comparing shock wave lithotripsy and flexible ureterorenoscopy for lower pole stones smaller than 1 cm.

    PubMed

    Sener, Nevzat Can; Imamoglu, M Abdurrahim; Bas, Okan; Ozturk, Ufuk; Goktug, H N Goksel; Tuygun, Can; Bakirtas, Hasan

    2014-04-01

    In this study, we aimed to compare the success and complications of flexible ureterorenoscopy (F-URS) with its advanced technology and the accomplished method of shock wave lithotripsy (SWL) in the treatment of lower pole stones smaller than 1 cm. One hundred and forty patients were randomized as 70 undergoing SWL (Group 1) and 70 undergoing F-URS (Group 2). Patients were evaluated by plain X-ray and urinary ultrasound 1 week and after 3 months following SWL. The same procedure was done for F-URS patients 1 week after surgery and after 3 months. Success rates were established the day following the procedure and after 3 months. Fragmentation less than 3 mm was considered success. Mean operative time was 44 ± 7.4 min for Group 2 and mean fluoroscopy duration was 51 ± 12 s. In F-URS group, all the patients were stone free after 3 months (100 %). Group 1 had 2.7 ± 0.4 sessions of SWL. Sixty-four patients were stone free in that group after 3 months (91.5 %). The procedure yielded significant success in FURS group, even though patients underwent SWL for 2.7 ± 0.4 sessions and F-URS for 1 session (p < 0.05). With higher success and similar complication rates, fewer sessions per treatment, and advances in technology and experience, we believe F-URS has a potential to be the first treatment option over SWL in the future. PMID:24220692

  18. Ureteroscopy in proximal ureteral stones after shock wave lithotripsy failure: Is it safe and efficient or dangerous?

    PubMed Central

    Kilinc, Muhammet Fatih; Doluoglu, Omer Gokhan; Karakan, Tolga; Dalkilic, Ayhan; Sonmez, Nurettin Cem; Aydogmus, Yasin; Resorlu, Berkan

    2015-01-01

    Introduction: We assessed the effectiveness of ureteroscopy (URS) in proximal ureteral stones performed after shock wave lithotripsy (SWL) failure, and determined outcomes in terms of success rate, complications, and operation time. Methods: We analyzed data of patients with previous unsuccessful SWL (Group I) and the ones that did not have SWL or URS before (Group II) for proximal ureteral stones between December 2007 and August 2014. Group I included 346 patients who underwent complementary URS and Group II 209 patients who underwent primary URS. Success rates, operation time and complications were compared between groups. Results: Success rates of complementary and primary URS were 78.9% and 80.9%, respectively. The difference in success rates was not statistically significant between groups (p = 0.57). The complication rates of complementary URS was 12.1%, and 9.5% in primary URS (p = 0.49). No statistically significant differences were noted in terms of gender, age, stone size and side, or lithotripter type between groups. The mean operation time and need for balloon dilatation were higher in complementary URS group compared to the primary URS group, and the difference was statistically significant (p < 0.05). Conclusions: Complementary URS may be used safely after SWL failure in proximal ureteral stones. Its success rate and morbidities are similar to primary URS, except for longer operation time and an increased need for balloon dilatation. PMID:26664506

  19. Shock-wave lithotripsy in the elderly: Safety, efficacy and special considerations

    PubMed Central

    Philippou, Prodromos; Lamrani, D.; Moraitis, Konstantinos; Wazait, Hassan; Masood, Junaid; Buchholz, Noor

    2011-01-01

    Purpose Shock-wave lithotripsy (SWL) for elderly patients can be challenging. Patients often have a long-standing complex stone burden and significant comorbidities. We report a cohort of patients aged ⩾70 years who were treated by SWL, with special attention to treatment outcomes, complications and the need for adjuvant procedures. Patients and methods Over a period of 4 years, 2311 patients were treated with SWL in a tertiary referral centre. Among these patients, 137 were aged ⩾70 years (5.9%). Patient and stone data were obtained from an electronic database and the patients’ electronic medical records were reviewed. Results During the pre-procedural assessment, 29 patients (21.2%) were considered to be at high anaesthetic risk, due their comorbidities (American Society of Anesthesiology score 3+). In terms of stone burden, 16 stones (11.7%) were located in the distal ureter (mean stone diameter 7.9 mm) and 28 (20.4%) were in the proximal ureter (mean diameter 10.1 mm). In the kidney, 54 stones (39.4%) were in the renal pelvis, upper or mid calyx (mean diameter 10.6 mm), while 39 stones (28.5%) were in the lower calyx (mean diameter 10.1 mm). The median (range) number of SWL sessions per patient was 2.0 (1–3). The overall stone-free rate achieved by SWL alone was 63.5% (65.9% for ureteric stones and 62.4% for renal stones). In total, 38 patients (27.7%) had an adjuvant procedure to achieve stone clearance (ureteroscopy in 23, PCNL in 14 and laparoscopic ureterolithotomy in one case). Apart from six cases (4.3%) of ureteric obstruction due to steinstrasse, there were no severe complications noted. Conclusions The management of elderly patients presenting with urolithiasis is challenging, due to the presence of significant comorbidities. Careful assessment of an integrated management plan for geriatric patients with urolithiasis is essential, and SWL still remains a safe and efficient first-line tool in well-selected cases. PMID:26579264

  20. EFFECT OF RENAL SHOCK WAVE LITHOTRIPSY ON THE DEVELOPMENT OF METABOLIC SYNDROME IN A JUVENILE SWINE MODEL: A PILOT STUDY

    PubMed Central

    Handa, Rajash K.; Liu, Ziyue; Connors, Bret A.; Evan, Andrew P.; Lingeman, James E.; Basile, David P.; Tune, Johnathan D.

    2014-01-01

    Purpose A pilot study was conducted to assess whether renal shock wave lithotripsy (SWL) influences the onset and severity of metabolic syndrome (MetS). Materials and Methods Three-month-old juvenile female Ossabaw miniature pigs were treated with SWL (2000 SWs, 24 kV, 120 SWs/min using the HM3 lithotripter; n=2) or sham-SWL (no SWs; n=2). SWs were targeted to the upper pole of the left kidney so as to model treatment that would also expose the pancreatic tail to SWs. Pigs were then instrumented for direct measurement of arterial blood pressure via an implanted radiotelemetry device, and later fed a hypercaloric atherogenic diet for ~7 months. The development of MetS was assessed from intravenous glucose tolerance tests (IVGTTs). Results The progression and severity of MetS was similar in the sham-treated and SWL-treated groups. The only exception was with respect to arterial blood pressure, which remained relatively constant in the sham-treated pigs but began to rise at ~2 months towards hypertensive levels in SW-treated pigs. Metabolic data from both groups were pooled to provide a more complete assessment of the development and progression of MetS in this juvenile pig model. IVGTTs revealed substantial insulin resistance with impaired glucose tolerance within 2 months on the hypercaloric atherogenic diet with signs of further metabolic impairment at 7 months. Conclusions These preliminary results suggest that renal SWL is not a risk factor for worsening of glucose tolerance or the onset of diabetes mellitus, but does appear to be a risk factor for early onset hypertension in MetS. PMID:25245490

  1. Clinical Nomograms to Predict Stone-Free Rates after Shock-Wave Lithotripsy: Development and Internal-Validation

    PubMed Central

    Kim, Jung Kwon; Ha, Seung Beom; Jeon, Chan Hoo; Oh, Jong Jin; Cho, Sung Yong; Oh, Seung-June; Kim, Hyeon Hoe; Jeong, Chang Wook

    2016-01-01

    Purpose Shock-wave lithotripsy (SWL) is accepted as the first line treatment modality for uncomplicated upper urinary tract stones; however, validated prediction models with regards to stone-free rates (SFRs) are still needed. We aimed to develop nomograms predicting SFRs after the first and within the third session of SWL. Computed tomography (CT) information was also modeled for constructing nomograms. Materials and Methods From March 2006 to December 2013, 3028 patients were treated with SWL for ureter and renal stones at our three tertiary institutions. Four cohorts were constructed: Total-development, Total-validation, CT-development, and CT-validation cohorts. The nomograms were developed using multivariate logistic regression models with selected significant variables in a univariate logistic regression model. A C-index was used to assess the discrimination accuracy of nomograms and calibration plots were used to analyze the consistency of prediction. Results The SFR, after the first and within the third session, was 48.3% and 68.8%, respectively. Significant variables were sex, stone location, stone number, and maximal stone diameter in the Total-development cohort, and mean Hounsfield unit (HU) and grade of hydronephrosis (HN) were additional parameters in the CT-development cohort. The C-indices were 0.712 and 0.723 for after the first and within the third session of SWL in the Total-development cohort, and 0.755 and 0.756, in the CT-development cohort, respectively. The calibration plots showed good correspondences. Conclusions We constructed and validated nomograms to predict SFR after SWL. To the best of our knowledge, these are the first graphical nomograms to be modeled with CT information. These may be useful for patient counseling and treatment decision-making. PMID:26890006

  2. Spectroscopy During Laser Induced Shock Wave Lithotripsy

    NASA Astrophysics Data System (ADS)

    Engelhardt, R.; Meyer, W.; Hering, P.

    1988-06-01

    In the course of laser induced shock wave lithotripsy (LISL) by means of a flashlamp pumped dye laser a plasma is formed on the stone's surface. Spectral analysis of the plasma flash leads to chemical stone analysis during the procedure. A time resolved integral analysis of scattered and laser induced fluorescence light makes stone detection possible and avoids tissue damage. We used a 200 μm fiber to transmit a 2 μs, 50 mJ pulse to the stone's surface and a second 200 μ fiber for analysis. This transmission system is small and flexible enough for controlled endoscopic use in the treatment of human ureter or common bile duct stones. Under these conditions the stone selective effect of lasertripsy leads only to minor tissue injury.

  3. Is scoring system of computed tomography based metric parameters can accurately predicts shock wave lithotripsy stone-free rates and aid in the development of treatment strategies?

    PubMed Central

    Badran, Yasser Ali; Abdelaziz, Alsayed Saad; Shehab, Mohamed Ahmed; Mohamed, Hazem Abdelsabour Dief; Emara, Absel-Aziz Ali; Elnabtity, Ali Mohamed Ali; Ghanem, Maged Mohammed; ELHelaly, Hesham Abdel Azim

    2016-01-01

    Objective: The objective was to determine the predicting success of shock wave lithotripsy (SWL) using a combination of computed tomography based metric parameters to improve the treatment plan. Patients and Methods: Consecutive 180 patients with symptomatic upper urinary tract calculi 20 mm or less were enrolled in our study underwent extracorporeal SWL were divided into two main groups, according to the stone size, Group A (92 patients with stone ≤10 mm) and Group B (88 patients with stone >10 mm). Both groups were evaluated, according to the skin to stone distance (SSD) and Hounsfield units (≤500, 500–1000 and >1000 HU). Results: Both groups were comparable in baseline data and stone characteristics. About 92.3% of Group A rendered stone-free, whereas 77.2% were stone-free in Group B (P = 0.001). Furthermore, in both group SWL success rates was a significantly higher for stones with lower attenuation <830 HU than with stones >830 HU (P < 0.034). SSD were statistically differences in SWL outcome (P < 0.02). Simultaneous consideration of three parameters stone size, stone attenuation value, and SSD; we found that stone-free rate (SFR) was 100% for stone attenuation value <830 HU for stone <10 mm or >10 mm but total number SWL sessions and shock waves required for the larger stone group were higher than in the smaller group (P < 0.01). Furthermore, SFR was 83.3% and 37.5% for stone <10 mm, mean HU >830, SSD 90 mm and SSD >120 mm, respectively. On the other hand, SFR was 52.6% and 28.57% for stone >10 mm, mean HU >830, SSD <90 mm and SSD >120 mm, respectively. Conclusion: Stone size, stone density (HU), and SSD is simple to calculate and can be reported by radiologists to applying combined score help to augment predictive power of SWL, reduce cost, and improving of treatment strategies. PMID:27141192

  4. Drugs for Pain Management in Shock Wave Lithotripsy

    PubMed Central

    Bach, Christian; Zaman, Faruquz; Kachrilas, Stefanos; Kumar, Priyadarshi; Buchholz, Noor; Masood, Junaid

    2011-01-01

    Objective. With this review, we provide a comprehensive overview of the main aspects and currently used drugs for analgesia in shockwave lithotripsy. Evidence Acquisition. We reviewed current literature, concentrating on newer articles and high-quality reviews in international journals. Results. No standardized protocols for pain control in SWL exist, although it is crucial for treatment outcome. General and spinal anaesthesia show excellent pain control but are only recommended for selected cases. The newer opioids and nonsteroidal anti-inflammatory drugs are able to deliver good analgesia. Interest in inhalation anaesthesia with nitrous oxide, local anaesthesia with deep infiltration of the tissue, and dermal anaesthesia with EMLA or DMSO has recently rekindled, showing good results in terms of pain control and a favourable side effect profile. Tamsulosin and paracetamol are further well-known drugs being currently investigated. Conclusion. Apart from classically used drugs like opioids and NSARs, medicaments like nitrous oxide, paracetamol, DMSA, or refined administration techniques for infiltration anaesthesia show a good effectiveness in pain control for SWL. PMID:22135735

  5. Predictive value of low tube voltage and dual-energy CT for successful shock wave lithotripsy: an in vitro study.

    PubMed

    Largo, Remo; Stolzmann, Paul; Fankhauser, Christian D; Poyet, Cédric; Wolfsgruber, Pirmin; Sulser, Tullio; Alkadhi, Hatem; Winklhofer, Sebastian

    2016-06-01

    This study investigates the capabilities of low tube voltage computed tomography (CT) and dual-energy CT (DECT) for predicting successful shock wave lithotripsy (SWL) of urinary stones in vitro. A total of 33 urinary calculi (six different chemical compositions; mean size 6 ± 3 mm) were scanned using a dual-source CT machine with single- (120 kVp) and dual-energy settings (80/150, 100/150 Sn kVp) resulting in six different datasets. The attenuation (Hounsfield Units) of calculi was measured on single-energy CT images and the dual-energy indices (DEIs) were calculated from DECT acquisitions. Calculi underwent SWL and the number of shock waves for successful disintegration was recorded. The prediction of required shock waves regarding stone attenuation/DEI was calculated using regression analysis (adjusted for stone size and composition) and the correlation between CT attenuation/DEI and the number of shock waves was assessed for all datasets. The median number of shock waves for successful stone disintegration was 72 (interquartile range 30-361). CT attenuation/DEI of stones was a significant, independent predictor (P < 0.01) for the number of required shock waves with the best prediction at 80 kVp (β estimate 0.576) (P < 0.05). Correlation coefficients between attenuation/DEI and the number of required shock waves ranged between ρ = 0.31 and 0.68 showing the best correlation at 80 kVp (P < 0.001). The attenuation of urinary stones at low tube voltage CT is the best predictor for successful stone disintegration, being independent of stone composition and size. DECT shows no added value for predicting the success of SWL. PMID:26391614

  6. Diuresis and inversion therapy to improve clearance of lower caliceal stones after shock wave lithotripsy: A prospective, randomized, controlled, clinical study

    PubMed Central

    Ahmed, Abul-fotouh; Shalaby, Essam; Maarouf, Aref; Badran, Yasser; Eladl, Mahmoud; Ghobish, Ammar

    2015-01-01

    Objective: To improve the clearance of lower caliceal stones (LCSs) after shock wave lithotripsy (SWL) using a combination of intra-operative forced diuresis and inversion therapy. Materials and Methods: One hundred and fifty-seven consecutive patients with symptomatic, single LCSs of 5–20 mm size were prospectively randomized into two groups. The first (study group, SG) underwent SWL at the time of the maximum diuresis with the patient in the Trendelenburg position with an angle of 30 degree, while the second group (control group, CG) underwent standard SWL. After the last SWL session, patients were followed-up regularly using plain abdominal X-ray and renal ultrasound. The primary endpoint of the study was the stone-free rate (SFR) at 12 weeks. Results: A total of 141 patients completed the study treatment protocol and follow-up: 69 patients in SG and 72 patients in CG. Both groups were comparable in baseline data. SG showed significantly higher SFR at all follow-up time points. At week 12, 78.3% of SG were rendered stone free, whereas only 61.1% were stone free in CG (P = 0.030). Also, there was a significantly higher SFR for larger stones (>10 mm) and stones with higher attenuation value (>500 Hounsfield units) in SG than CG. Mild non-significant complications were reported in both groups. Conclusion: SWL with intraoperative forced diuresis and inversion seems to be an effective measure with minimal extra cost to improve LCS clearance post-SWL. PMID:25878414

  7. Perspective on Lithotripsy Adverse Effects

    NASA Astrophysics Data System (ADS)

    Knoll, Thomas; Wendt-Nordahl, Gunnar

    2008-09-01

    Shock wave lithotripsy (SWL) is an effective and without any doubt the least invasive procedure to treat upper urinary tract calculi. Acute complications are rarely reported and do not require specific treatment in most cases. However, one should be aware that energy levels sufficient for stone breakage are capable of damaging tissue as well, and significant hematoma—not only in the kidney but as well in surrounding organs—has been observed. Furthermore, only little is known about the long-term effects of SWL. Some authors have reported an increased incidence of hypertension and possibly also diabetes mellitus. Such chronic diseases—if indeed related to prior SWL—may be a late result of acute SWL-related trauma but the discussion on the underlying pathogenesis is controversial. Many factors have to be considered, such as the natural history of recurrent stone formers, technical principles of SWL, and differences in treatment protocols. Promising studies are currently underway to optimize stone breakage while limiting potential collateral damage. With this progress, SWL remains a safe treatment option for most urinary calculi.

  8. Optimization of pressure waveform, distribution and sequence in shock wave lithotripsy

    NASA Astrophysics Data System (ADS)

    Zhou, Yufeng

    This work aims to improve shock wave lithotripsy (SWL) technology by increasing stone comminution efficiency while reducing simultaneously the propensity of tissue injury. First, the mechanism of vascular injury in SWL was investigated. Based on in vitro vessel phantom experiment and theoretical calculation, it was found that SWL-induced large intraluminal bubble expansion may constitute a primary mechanism for the rupture of capillaries and small blood vessels. However, when the large intraluminal bubble expansion is suppressed by inversion of the pressure waveform of the lithotripter shock wave (LSW), rupture of a 200-mum cellulose hollow fiber vessel phantom can be avoided. Based on these experimental observations and theoretical assessment of bubble dynamics using the Gilmore model an in situ pulse superposition technique was developed to reduce tissue injury without compromising stone comminution in SWL. A thin shell ellipsoidal reflector insert was fabricated to fit snugly with the original HM-3 reflector. Using the Hamilton model, the effects of reflector geometry on the pulse profile and sequence of the shock waves were evaluated qualitatively. Guided by this analysis, the design of the reflector insert had been refined to suppress the intraluminal bubble expansion, which was confirmed by high-speed imaging of bubble dynamics both in free field and inside a vessel phantom. The pulse pressure, beam size and stone comminution efficiency of the upgraded reflector were all found to be comparable to those of the original reflector. However, the greatest difference lies in the propensity for tissue injury. At the lithotripter focus, about 30 shocks are needed to cause a rupture of the vessel phantom using the original reflector, but no rupture can be produced after 200 shocks by the upgraded reflector. Overall, the upgraded reflector could significantly reduce the propensity of vessel rupture while maintaining satisfactory stone comminution. Second, to improve

  9. Incidence and risk factors of renal hematoma: a prospective study of 1,300 SWL treatments.

    PubMed

    Schnabel, M J; Gierth, M; Chaussy, C G; Dötzer, K; Burger, M; Fritsche, H M

    2014-06-01

    Shock wave lithotripsy (SWL) is the gold standard for the treatment of upper urinary tract stones. Despite being relatively non-invasive, SWL can cause renal hematoma (RHT). The aim of this study was to determine incidence and risk factors for RHT following SWL. 857 patients were included in a prospectively maintained database. The observation period spans from 2007 to 2012. 1,324 procedures were performed due to kidney stones. Treatment protocol included power ramping and shock wave frequency of 60-90 per minute as well as an ultrasound check within 3 days of SWL for all patients. Patients with RHT were analyzed, and treatment characteristics were compared with the complete population in a non-statistical manner due to the low event count. RHTs after SWL, sized between 2.6 × 0.6 cm and 17 × 15 cm, were verified in seven patients (0.53%). In four patients, the RHT was asymptomatic. Three patients developed pain after SWL treatment due to a RHT. In one patient surgical intervention was necessary due to a symptomatic RHT, the kidney was preserved. The risk of RHT following SWL treatment of kidney stones is about 0.5%. Clinically relevant or symptomatic RHTs occur in 0.23%, RHTs requiring surgical intervention are extremely rare. Older age and vascular comorbidities appear to be risk factors for the development of RHT. The technical characteristics of SWL treatment and intake of low-dose acetylsalicylic acid due to an imperative cardiologic indication do not appear to influence the risk. Prospective studies are warranted. PMID:24419328

  10. Does ureteral stenting matter for stone size? A retrospectıve analyses of 1361 extracorporeal shock wave lithotripsy patients

    PubMed Central

    Dogan, Cagatay; Can, Gulce Ecem; Tansu, Nejat; Erozencı, Ahmet; Onal, Bulent

    2015-01-01

    Introduction The aim of our study was to determine the efficacy of ureteral stents for extracorporeal shock wave lithotripsy (SWL) treatment of pelvis renalis stones and to compare the results and complications in stented and non-stented patients. Material and methods Between 1995 and 2011, 1361 patients with pelvis renalis stones were treated with SWL. Patients were subdivided into three groups according to stone burden: ≤1 cm2 (group 1; n = 514), 1.1 to 2 cm2 (group 2; n = 530) and >2 cm2 (group 3; n = 317). Each group was divided into subgroups of patients who did and did not undergo ureteral stent implantation before SWL treatment. The efficacy of treatment was evaluated by determining the effectiveness quotient (EQ). Statistical analysis was performed by chi-square, Fisher's exact and Mann-Whitney U tests. Results Of the 514, 530 and 317 patients in groups 1, 2 and 3 respectively, 30 (6%), 44 (8%) and 104 (33%) patients underwent auxiliary stent implantation. Steinstrasse rates did not differ significantly between stented and non-stented patients in each group. The EQ was calculated as 62%, 33% and 70% respectively in non-stented, stented and totally for group 1. This ratio calculated as 58%, 25% and 63% for group 2 and 62%, 26% and 47% for group 3. Stone-free rates were significantly higher for non-stented than for stented patients in groups 2 and 3. Conclusions Stone free rates are significantly higher in non-stented than in stented patients with pelvis renalis stones >1 cm2, whereas steinstrasse rates are not affected. PMID:26568882

  11. Stone heterogeneity index as the standard deviation of Hounsfield units: A novel predictor for shock-wave lithotripsy outcomes in ureter calculi.

    PubMed

    Lee, Joo Yong; Kim, Jae Heon; Kang, Dong Hyuk; Chung, Doo Yong; Lee, Dae Hun; Do Jung, Hae; Kwon, Jong Kyou; Cho, Kang Su

    2016-01-01

    We investigated whether stone heterogeneity index (SHI), which a proxy of such variations, was defined as the standard deviation of a Hounsfield unit (HU) on non-contrast computed tomography (NCCT), can be a novel predictor for shock-wave lithotripsy (SWL) outcomes in patients with ureteral stones. Medical records were obtained from the consecutive database of 1,519 patients who underwent the first session of SWL for urinary stones between 2005 and 2013. Ultimately, 604 patients with radiopaque ureteral stones were eligible for this study. Stone related variables including stone size, mean stone density (MSD), skin-to-stone distance, and SHI were obtained on NCCT. Patients were classified into the low and high SHI groups using mean SHI and compared. One-session success rate in the high SHI group was better than in the low SHI group (74.3% vs. 63.9%, P = 0.008). Multivariate logistic regression analyses revealed that smaller stone size (OR 0.889, 95% CI: 0.841-0.937, P < 0.001), lower MSD (OR 0.995, 95% CI: 0.994-0.996, P < 0.001), and higher SHI (OR 1.011, 95% CI: 1.008-1.014, P < 0.001) were independent predictors of one-session success. The radiologic heterogeneity of urinary stones or SHI was an independent predictor for SWL success in patients with ureteral calculi and a useful clinical parameter for stone fragility. PMID:27035621

  12. Tracking kidney stones with sound during shock wave lithotripsy

    NASA Astrophysics Data System (ADS)

    Kracht, Jonathan M.

    The prevalence of kidney stones has increased significantly over the past decades. One of the primary treatments for kidney stones is shock wave lithotripsy which focuses acoustic shock waves onto the stone in order to fragment it into pieces that are small enough to pass naturally. This typically requires a few thousand shock waves delivered at a rate of about 2 Hz. Although lithotripsy is the only non-invasive treatment option for kidney stories, both acute and chronic complications have been identified which could be reduced if fewer shock waves were used. One factor that could be used to reduce the number of shock waves is accounting for the motion of the stone which causes a portion of the delivered shock waves to miss the stone, yielding no therapeutic benefit. Therefore identifying when the stone is not in focus would allow tissue to be spared without affecting fragmentation. The goal of this thesis is to investigate acoustic methods to track the stone in real-time during lithotripsy in order to minimize poorly-targeted shock waves. A relatively small number of low frequency ultrasound transducers were used in pulse-echo mode and a novel optimization routine based on time-of-flight triangulation is used to determine stone location. It was shown that the accuracy of the localization may be estimated without knowing the true stone location. This method performed well in preliminary experiments but the inclusion of tissue-like aberrating layers reduced the accuracy of the localization. Therefore a hybrid imaging technique employing DORT (Decomposition of the Time Reversal Operator) and the MUSIC (Multiple Signal Classification) algorithm was developed. This method was able to localize kidney stories to within a few millimeters even in the presence of an aberrating layer. This would be sufficient accuracy for targeting lithotripter shock waves. The conclusion of this work is that tracking kidney stones with low frequency ultrasound should be effective clinically.

  13. Evaluation of shock wave lithotripsy injury in the pig using a narrow focal zone lithotriptor

    PubMed Central

    Connors, Bret A.; McAteer, James A.; Evan, Andrew P.; Blomgren, Philip M.; Handa, Rajash K.; Johnson, Cynthia D.; Gao, Sujuan; Pishchalnikov, Yuri A.; Lingeman, James E.

    2012-01-01

    OBJECTIVE To assess renal injury in a pig model after treatment with a clinical dose of shock waves using a narrow focal zone (≈ 3 mm) lithotriptor (Modulith SLX, Karl Storz Lithotripsy). MATERIALS AND METHODS The left kidney of anaesthetized female pigs were treated with 2000 or 4000 shock waves (SWs) at 120 SWs/min, or 2000 SWs at 60 SWs/min using the Storz SLX. Measures of renal function (glomerular filtration rate and renal plasma flow) were collected before and 1 h after shock wave lithotripsy (SWL) and the kidneys were harvested for histological analysis and morphometric quantitation of haemorrhage in the renal parenchyma with lesion size expressed as a percentage of functional renal volume (FRV). A fibre-optic probe hydrophone was used to determine acoustic output and map the focal width of the lithotriptor. Data for the SLX were compared with data from a previously published study in which pigs of the same age (7–8 weeks) were treated (2000 SWs at 120 or 60 SWs/min) using an unmodified Dornier HM3 lithotriptor. RESULTS Treatment with the SLX produced a highly focused lesion running from cortex to medulla and often spanning the full thickness of the kidney. Unlike the diffuse interstitial haemorrhage observed with the HM3, the SLX lesion bore a blood-filled core of near-complete tissue disruption devoid of histologically recognizable kidney structure. Despite the intensity of tissue destruction at the core of the lesion, measures of lesion size based on macroscopic determination of haemorrhage in the parenchyma were not significantly different from kidneys treated using the HM3 (2000 SWs, 120 SWs/min: SLX, 1.86 ± 0.52% FRV; HM3, 3.93 ± 1.29% FRV). Doubling the SW dose of the SLX from 2000 to 4000 SWs did not significantly increase lesion size. In addition, slowing the firing rate of the SLX to 60 SWs/min did not reduce the size of the lesion (2.16 ± 0.96% FRV) compared with treatment at 120 SWs/min, as was the case with the HM3 (0.42 ± 0.23% FRV vs 3

  14. FRAGMENTATION OF URINARY CALCULI IN VITRO BY BURST WAVE LITHOTRIPSY

    PubMed Central

    Maxwell, Adam D.; Cunitz, Bryan W.; Kreider, Wayne; Sapozhnikov, Oleg A.; Hsi, Ryan S.; Harper, Jonathan D.; Bailey, Michael R.; Sorensen, Mathew D.

    2015-01-01

    Purpose We have developed a new method of lithotripsy that uses short, broadly focused bursts of ultrasound rather than shock waves to fragment stones. This study investigated the characteristics of stone comminution by burst wave lithotripsy in vitro. Materials and Methods Artificial and natural stones (mean 8.2±3.0 mm, range 5–15 mm) were treated with ultrasound bursts using a focused transducer in a water bath. Stones were exposed to bursts with focal pressure amplitude ≤6.5 MPa at 200 Hz burst repetition rate until completely fragmented. Ultrasound frequencies of 170 kHz, 285 kHz, and 800 kHz were applied using 3 different transducers. The time to achieve fragmentation for each stone type was recorded, and fragment size distribution was measured by sieving. Results Stones exposed to ultrasound bursts were fragmented at focal pressure amplitudes ≥2.8 MPa at 170 kHz. Fractures appeared along the stone surface, resulting in fragments separating at the surface nearest to the transducer until the stone was disintegrated. All natural and artificial stones were fragmented at the highest focal pressure of 6.5 MPa with treatment durations between a mean of 36 seconds for uric acid to 14.7 minutes for cystine stones. At a frequency of 170 kHz, the largest artificial stone fragments were <4 mm. Exposures at 285 kHz produced only fragments <2 mm, and 800 kHz produced only fragments <1 mm. Conclusions Stone comminution with burst wave lithotripsy is feasible as a potential noninvasive treatment method for nephrolithiasis. Adjusting the fundamental ultrasound frequency allows control of stone fragment size. PMID:25111910

  15. Adverse effects of shock waves and strategies for improved treatment in shock wave lithotripsy

    NASA Astrophysics Data System (ADS)

    McAteer, James A.; Evan, Andrew P.; Connors, Bret A.; Williams, James C.; Willis, Lynn R.

    2005-04-01

    Lithotripter SWs rupture blood vessels in the kidney. This acute trauma, accompanied by a fall in renal function, can lead to significant long-term effects such as profound scarring of the kidney cortex and renal papillaea permanent loss of functional renal mass. SWL has been linked to new-onset hypertension in some patients, and recent studies suggest that multiple lithotripsies can actually alter a patient's stone disease leading to formation of stones (brushite) that are harder to break. Cavitation and shear appear to play a role in stone breakage and tissue damage. Progress in understanding these mechanisms, and the renal response to SWs, has led to practical strategies to improve treatment. Slowing the SW-rate, or initiating treatment at low kV/power both improve stone breakage and reduce the number of potentially tissue-damaging SWs needed to achieve comminution. The observation that SWs cause transient vasoconstriction in the kidney has led to studies in pigs showing that a pre-conditioning dose of low-energy SWs significantly reduces trauma from subsequent high-energy SWs. Thus, SWs can induce adverse effects in the kidney, but what we have learned about the mechanisms of SW action suggests strategies that could make lithotripsy safer and more effective. [Work supported by NIH-DK43881, DK55674.

  16. Turbulent Water Coupling in Shock Wave Lithotripsy

    PubMed Central

    Lautz, Jaclyn; Sankin, Georgy; Zhong, Pei

    2013-01-01

    Previous studies have demonstrated that stone comminution decreases with increased pulse repetition frequency as a result of bubble proliferation in the cavitation field of a shock wave lithotripter (Pishchalnikov et al., 2011). If cavitation nuclei remain in the propagation path of successive lithotripter pulses, especially in the acoustic coupling cushion of the shock wave source, they will consume part of the incident wave energy, leading to reduced tensile pressure in the focal region and thus lower stone comminution efficiency. We introduce a method to remove cavitation nuclei from the coupling cushion between successive shock exposures using a jet of degassed water. As a result, pre-focal bubble nuclei lifetime quantified by B-mode ultrasound imaging was reduced from 7 s to 0.3 s by a jet with an exit velocity of 62 cm/s. Stone fragmentation (percent mass < 2 mm) after 250 shocks delivered at 1 Hz was enhanced from 22 ± 6% to 33 ± 5% (p = 0.007) in water without interposing tissue mimicking materials. Stone fragmentation after 500 shocks delivered at 2 Hz was increased from 18 ± 6% to 28 ± 8% (p = 0.04) with an interposing tissue phantom of 8 cm thick. These results demonstrate the critical influence of cavitation bubbles in the coupling cushion on stone comminution and suggest a potential strategy to improve the efficacy of contemporary shock wave lithotripters. PMID:23322027

  17. Effective radiation exposure evaluation during a one year follow-up of urolithiasis patients after extracorporeal shock wave lithotripsy

    PubMed Central

    Tekinarslan, Erdem; Keskin, Suat; Buldu, İbrahim; Sönmez, Mehmet Giray; Karatag, Tuna; Istanbulluoglu, Mustafa Okan

    2015-01-01

    Introduction To determine and evaluate the effective radiation exposure during a one year follow-up of urolithiasis patients following the SWL (extracorporeal shock wave lithotripsy) treatment. Material and methods Total Effective Radiation Exposure (ERE) doses for each of the 129 patients: 44 kidney stone patients, 41 ureter stone patients, and 44 multiple stone location patients were calculated by adding up the radiation doses of each ionizing radiation session including images (IVU, KUB, CT) throughout a one year follow-up period following the SWL. Results Total mean ERE values for the kidney stone group was calculated as 15, 91 mSv (5.10-27.60), for the ureter group as 13.32 mSv (5.10-24.70), and in the multiple stone location group as 27.02 mSv (9.41-54.85). There was no statistically significant differences between the kidney and ureter groups in terms of the ERE dose values (p = 0.221) (p >0.05). In the comparison of the kidney and ureter stone groups with the multiple stone location group; however, there was a statistically significant difference (p = 0.000) (p <0.05). Conclusions ERE doses should be a factor to be considered right at the initiation of any diagnostic and/or therapeutic procedure. Especially in the case of multiple stone locations, due to the high exposure to ionized radiation, different imaging modalities with low dose and/or totally without a dose should be employed in the diagnosis, treatment, and follow-up bearing the aim to optimize diagnosis while minimizing the radiation dose as much as possible. PMID:26568880

  18. Controlled Cavitation to Augment SWL Stone Comminution: Mechanistic Insights In-Vitro

    PubMed Central

    Duryea, Alexander P.; Roberts, William W.; Cain, Charles A.; Hall, Timothy L.

    2013-01-01

    Stone comminution in shock wave lithotripsy (SWL) has been documented to result from mechanical stresses conferred directly to the stone, as well as the activity of cavitational microbubbles. Studies have demonstrated that the presence of this cavitation activity is crucial for stone subdivision; however, its exact role in the comminution process remains somewhat weakly defined, in part due to the fact that it is difficult to isolate the cavitational component from the shock waves themselves. In this study, we further explored the importance of cavitation in SWL stone comminution through the use of histotripsy ultrasound therapy. Histotripsy was utilized to target model stones designed to mimic the mid-range tensile fracture strength of naturally occurring cystine calculi with controlled cavitation at strategic time points in the SWL comminution process. All SWL was applied at a peak-positive pressure (p+) of 34 MPa and a peak-negative pressure (p−) of 8 MPa; a shock rate of 1 Hz was used. Histotripsy pulses had a p− of 33 MPa and were applied at a pulse repetition frequency (PRF) of 100 Hz. Ten model stones were sonicated in-vitro with each of five different treatment schemes: A. 10 minutes SWL (600 shocks) with 0.7 seconds of histotripsy interleaved between successive shocks (totaling to 42,000 pulses); B. 10 minutes SWL (600 shocks) followed by 10 minutes histotripsy applied in 0.7 second bursts (1 burst per second, totaling to 42,000 pulses); C. 10 minutes histotripsy applied in 0.7 second bursts (42,000 pulses) followed by 10 minutes SWL (600 shocks); D. 10 minutes SWL-only (600 shocks); E. 10 minutes histotripsy-only applied in 0.7 second bursts (42,000 pulses). Following sonication, debris was collected and sieved through 8, 6, 4, and 2 mm filters. It was found that SWL-only generated a broad range of fragment sizes, with an average of 14.9 ± 24.1% of the original stone mass remaining >8 mm. Histotripsy-only eroded the surface of stones to tiny

  19. Management of lower pole renal calculi: shock wave lithotripsy versus percutaneous nephrolithotomy versus flexible ureteroscopy.

    PubMed

    Preminger, Glenn M

    2006-04-01

    Current ureteroscopic intracorporeal lithotripsy devices and stone retrieval technology allow for the treatment of calculi located throughout the intra-renal collecting system. Difficulty accessing lower pole calculi, especially when the holmium laser fiber is utilized, is often encountered. Herein we review our experience where lower pole renal calculi were ureteroscopically managed by holmium laser fragmentation, either in situ, or by first displacing the stone into a less dependent position with the aid of a nitinol stone retrieval device. Lower pole stones less than 20 mm can be primarily treated by ureteroscopic means in patients: that are obese; have a bleeding diathesis; with stones resistant to shockwave lithotripsy (SWL); with complicated intra-renal anatomy; or as a salvage procedure after failed SWL. Lower pole calculi are fragmented with a 200 microm holmium laser fiber via a 7.5 F flexible ureteroscope. For those patients where the laser fiber reduced ureteroscopic deflection, precluding re-entry into the lower pole calyx, a 1.9 F nitinol basket is used to displace the lower pole calculus into a more favorable position, thus allowing for easier fragmentation. A nitinol device passed into the lower pole, through the ureteroscope, for stone displacement cause only a minimal loss of deflection and no significant impact on irrigation. Eighty-five percent of patients were stone free by IVP or CT scan performed at 3 months. Ureteroscopic management of lower pole calculi is a reasonable alternative to SWL or percutaneous nephrolithotomy (PNL) in patients with low volume stone disease. If the stone cannot be fragmented in situ, nitinol basket or grasper retrieval, through a fully deflected ureteroscope, allows for repositioning of the stone into a less dependant position, thus facilitating stone fragmentation. PMID:16463145

  20. Tandem shock wave cavitation enhancement for extracorporeal lithotripsy.

    PubMed

    Loske, Achim M; Prieto, Fernando E; Fernandez, Francisco; van Cauwelaert, Javier

    2002-11-21

    Extracorporeal shock wave lithotripsy (ESWL) has been successful for more than twenty years in treating patients with kidney stones. Hundreds of underwater shock waves are generated outside the patient's body and focused on the kidney stone. Stones fracture mainly due to spalling, cavitation and layer separation. Cavitation bubbles are produced in the vicinity of the stone by the tensile phase of each shock wave. Bubbles expand, stabilize and finally collapse violently, creating stone-damaging secondary shock waves and microjets. Bubble collapse can be intensified by sending a second shock wave a few hundred microseconds after the first. A novel method of generating two piezoelectrically generated shock waves with an adjustable time delay between 50 and 950 micros is described and tested. The objective is to enhance cavitation-induced damage to kidney stones during ESWL in order to reduce treatment time. In vitro kidney stone model fragmentation efficiency and pressure measurements were compared with those for a standard ESWL system. Results indicate that fragmentation efficiency was significantly enhanced at a shock wave delay of about 400 and 250 micros using rectangular and spherical stone phantoms, respectively. The system presented here could be installed in clinical devices at relatively low cost, without the need for a second shock wave generator. PMID:12476975

  1. Dynamics of concerted bubble cluster collapse in shock wave lithotripsy

    NASA Astrophysics Data System (ADS)

    Pishchalnikov, Yuri A.; McAteer, James A.; Evan, Andrew P.; Sapozhnikov, Oleg A.; Cleveland, Robin O.; Colonius, Tim; Bailey, Michael R.; Crum, Lawrence A.

    2003-10-01

    Cavitation bubble cluster collapse at the surface of artificial kidney stones during shock wave lithotripsy was investigated in vitro by means of multiframe high-speed photography, passive cavitation detection (PCD), and pressure waveform measurements using a fiber-optic probe hydrophone (FOPH). It was observed that after the passage of the lithotripter shock pulse the stone was covered by numerous individual bubbles. During their growth phase the bubbles coalesced into bubble clusters, with the biggest cluster at the proximal face of the stone. High-speed camera images suggested that cluster collapse started at the periphery and ended with a violent collapse in a small region in the center of the surface of the stone. Shadowgraphy resolved numerous secondary shock waves emitted during this focused collapse. Shock wave emission during cluster collapse was confirmed by PCD. Measurement with the FOPH showed that these shock waves were typically of short duration (0.2 μs). The majority of the shock waves emanating from cluster collapse were low amplitude but some shock waves registered amplitudes on the order of the incident shock pulse (tens of MPa). [Work supported by NIH DK43881, DK55674.

  2. Abdominal Compartment Syndrome and Necrotizing Pancreatitis Following Extracorporeal Shock Wave Lithotripsy.

    PubMed

    Gupta, S; Scambia, J; Gandillon, C; Aversano, F; Batista, R

    2016-09-01

    Extracorporeal shock wave lithotripsy (ESWL) is a common procedure in the treatment of renal calculi. There have been major complications reported with ESWL such as acute pancreatitis, bower perforation, venous thrombosis, and biliary obstruction. There are few reports in the literature of necrotizing pancreatitis secondary to ESWL. We have a case report of a 29-year-old female that developed an abdominal compartment syndrome with an acute necrotizing pancreatitis hours after extracorporeal shock wave lithotripsy. PMID:27462545

  3. Stone heterogeneity index as the standard deviation of Hounsfield units: A novel predictor for shock-wave lithotripsy outcomes in ureter calculi

    PubMed Central

    Lee, Joo Yong; Kim, Jae Heon; Kang, Dong Hyuk; Chung, Doo Yong; Lee, Dae Hun; Do Jung, Hae; Kwon, Jong Kyou; Cho, Kang Su

    2016-01-01

    We investigated whether stone heterogeneity index (SHI), which a proxy of such variations, was defined as the standard deviation of a Hounsfield unit (HU) on non-contrast computed tomography (NCCT), can be a novel predictor for shock-wave lithotripsy (SWL) outcomes in patients with ureteral stones. Medical records were obtained from the consecutive database of 1,519 patients who underwent the first session of SWL for urinary stones between 2005 and 2013. Ultimately, 604 patients with radiopaque ureteral stones were eligible for this study. Stone related variables including stone size, mean stone density (MSD), skin-to-stone distance, and SHI were obtained on NCCT. Patients were classified into the low and high SHI groups using mean SHI and compared. One-session success rate in the high SHI group was better than in the low SHI group (74.3% vs. 63.9%, P = 0.008). Multivariate logistic regression analyses revealed that smaller stone size (OR 0.889, 95% CI: 0.841–0.937, P < 0.001), lower MSD (OR 0.995, 95% CI: 0.994–0.996, P < 0.001), and higher SHI (OR 1.011, 95% CI: 1.008–1.014, P < 0.001) were independent predictors of one-session success. The radiologic heterogeneity of urinary stones or SHI was an independent predictor for SWL success in patients with ureteral calculi and a useful clinical parameter for stone fragility. PMID:27035621

  4. Transient cavitation produced by extracorporeal shock wave lithotripsy

    NASA Astrophysics Data System (ADS)

    Cioanta, Iulian

    1998-12-01

    Two decades ago, a new medical procedure was introduced, allowing the fragmentation of kidney stones from outside the human body (noninvasively) using a shock wave device termed lithotripter ('stone crusher'). Considered as one of the most important medical inventions of this century, lithotripsy is currently used in more than 80% of urolithiasis cases. Experimental studies have shown that transient or inertial cavitation is generated by this procedure near the stones and in renal tissue. To find a correlation between the number of shocks delivered and the treatment efficiency, the acoustic emission (AE) generated by the oscillation of cavitation bubbles, and its relation with stone fragmentation and tissue damage during shock wave lithotripsy were studied. In vitro experiments were carried out to identify the correlation between the AE signals and the expansion and collapse of cavitation bubbles, which were captured by high-speed photography (20,000 frames per second). This correlation has been verified on four different electrohydraulic lithotripters, under multiple experimental conditions. The effects of tissue attenuation on AE and stone fragmentation were also studied. The in vitro results have further allowed the interpretation of AE signals from in vivo experiments with pigs. Although similar in general trend, in vivo AE signals are found to be shorter in expansion and longer in the total ringing times (including the rebound phenomenon) than for in vitro AE signals, indicating a tissue constraining effect on bubble oscillation. Based on this observation a new mechanism for renal vascular and tubular injury is proposed. In addition, changes in AE signals have been observed as the total number of shocks increases, and this dose dependence feature has allowed the determination of a threshold value for extended tissue injury at 20 kV. This result has been confirmed by histological analysis and by results of a theoretical model study of bubble oscillation in a

  5. Extracorporeal shock wave lithotripsy: a study of renal stone differences.

    PubMed

    Powers, C J; Tinterow, M M; Burpee, J F

    1989-01-01

    The extracorporeal shock wave lithotriptor (ESWL or lithotriptor) is a new, revolutionary, noninvasive method of treating renal calculi. It offers a safer, cheaper and more effective method of treatment compared to the traditional open surgery. Its history dates back only to 1980--and to 1985 at HCA Wesley Medical Center in Wichita, where research is just beginning. Initial research focused on ESWL versus traditional open surgery, but more recent research is investigating elements within the ESWL treatment. This article presents an investigation of renal stone size in relation to number of ESWL treatments needed per stone, number of shock waves per treatment, length of hospital stay post-lithotripsy, and hospital costs per length of stay during HCA Wesley's first year of operation. The subjects in this study consisted of approximately every third patient who received an ESWL treatment and were grouped according to stone sizes of less than 2 cm and those greater than 2 cm. A questionnaire was used, and after data were collected from the patient's charts and billing, a t-test for independent samples was used for analysis. PMID:2709649

  6. High-efficiency shock-wave generator for extracorporeal lithotripsy.

    PubMed

    Broyer, P; Cathignol, D; Theillère, Y; Mestas, J L

    1996-09-01

    In extracorporeal lithotripsy, the electro-acoustic efficiency of electrohydraulic generators is limited by the inductance of the electrical discharge circuit. A new shock-wave generator is described that uses a coaxial discharge line enabling electro-acoustic efficiency to be greatly increased. The line is built using a para-electric ceramic with a relative dielectric constant of 1700, manufactured for use in high-voltage impulse mode. A coaxial spark gap, with minimal inductance, has been developed to obtain the triggered breakdown of the discharge line. Shock waves are created with a coaxial electrode plugged directly into the spark gap and immersed in an electrolyte of degassed saline. Electrode gap and electrolyte resistivity are adjusted to match the resistivity of the electrolyte volume between the underwater electrodes to the characteristic impedance of the line. The discharge line generates in the medium a rectangular current pulse with an amplitude of about 6000 A and a rise time of 50 ns. Compared with conventional generators, measurements of the expansive peak pressure pulse show an increase of 105% at 10 kV, 86.5% at 12 kV and 34.5% at 14 kV charging voltage. Electro-acoustic efficiency is found to be 11% instead of 5.5% for a conventional discharge circuit. PMID:8945854

  7. Secondary shock wave emissions from cavitation in lithotripsy

    NASA Astrophysics Data System (ADS)

    Chitnis, Parag V.; Cleveland, Robin O.

    2005-04-01

    We investigate the role of secondary shock waves (SSWs) generated by cavitation in lithotripsy. Acoustic pressure was measured with a fiber optic probe hydrophone and cavitation using a dual passive cavitation detector (PCD) consisting of two confocal transducers. An artificial stone (~7 mm diameter and ~9 mm length) was placed at the focus of an electrohydraulic lithotripter. The fiber was inserted through a hole drilled through the stone so that the tip was at the proximal surface. SSWs were identified by matching the time of arrival to that of the inertial collapse signature acquired by the PCD. Measurements of SSWs were obtained for 50% of SWs fired at 20 kV and 1 Hz. The peak positive pressure for the SSW was p+=33.7+/-14.8 MPa, which was comparable to the pressure induced by the incident SW (p+=42.6+/-6 MPa). The peak pressure in water was p+=23.2+/-4.4 MPa. The PCD also recorded acoustic emissions from forced collapse of pre-existing bubbles caused by the incident SW. We propose that both the reflection from the semi-rigid stone boundary and SSW from the forced collapse contribute to the observed increase in the peak pressure of the incident SW in presence of a stone. [Work supported by NIH.

  8. Pediatric extracorporeal shock wave lithotripsy: Predicting successful outcomes.

    PubMed

    McAdams, Sean; Shukla, Aseem R

    2010-10-01

    Extracorporeal shock wave lithotripsy (ESWL) is currently a first-line procedure of most upper urinary tract stones <2 cm of size because of established success rates, its minimal invasiveness and long-term safety with minimal complications. Given that alternative surgical and endourological options exist for the management of stone disease and that ESWL failure often results in the need for repeat ESWL or secondary procedures, it is highly desirable to identify variables predicting successful outcomes of ESWL in the pediatric population. Despite numerous reports and growing experience, few prospective studies and guidelines for pediatric ESWL have been completed. Variation in the methods by which study parameters are measured and reported can make it difficult to compare individual studies or make definitive recommendations. There is ongoing work and a need for continuing improvement of imaging protocols in children with renal colic, with a current focus on minimizing exposure to ionizing radiation, perhaps utilizing advancements in ultrasound and magnetic resonance imaging. This report provides a review of the current literature evaluating the patient attributes and stone factors that may be predictive of successful ESWL outcomes along with reviewing the role of pre-operative imaging and considerations for patient safety. PMID:21369388

  9. Impact of Colic Pain as a Significant Factor for Predicting the Stone Free Rate of One-Session Shock Wave Lithotripsy for Treating Ureter Stones: A Bayesian Logistic Regression Model Analysis

    PubMed Central

    Chung, Doo Yong; Cho, Kang Su; Lee, Dae Hun; Han, Jang Hee; Kang, Dong Hyuk; Jung, Hae Do; Kown, Jong Kyou; Ham, Won Sik; Choi, Young Deuk; Lee, Joo Yong

    2015-01-01

    Purpose This study was conducted to evaluate colic pain as a prognostic pretreatment factor that can influence ureter stone clearance and to estimate the probability of stone-free status in shock wave lithotripsy (SWL) patients with a ureter stone. Materials and Methods We retrospectively reviewed the medical records of 1,418 patients who underwent their first SWL between 2005 and 2013. Among these patients, 551 had a ureter stone measuring 4–20 mm and were thus eligible for our analyses. The colic pain as the chief complaint was defined as either subjective flank pain during history taking and physical examination. Propensity-scores for established for colic pain was calculated for each patient using multivariate logistic regression based upon the following covariates: age, maximal stone length (MSL), and mean stone density (MSD). Each factor was evaluated as predictor for stone-free status by Bayesian and non-Bayesian logistic regression model. Results After propensity-score matching, 217 patients were extracted in each group from the total patient cohort. There were no statistical differences in variables used in propensity- score matching. One-session success and stone-free rate were also higher in the painful group (73.7% and 71.0%, respectively) than in the painless group (63.6% and 60.4%, respectively). In multivariate non-Bayesian and Bayesian logistic regression models, a painful stone, shorter MSL, and lower MSD were significant factors for one-session stone-free status in patients who underwent SWL. Conclusions Colic pain in patients with ureter calculi was one of the significant predicting factors including MSL and MSD for one-session stone-free status of SWL. PMID:25902059

  10. Shifting the Split Reflectors to Enhance Stone Fragmentation of Shock Wave Lithotripsy.

    PubMed

    Wang, Jen-Chieh; Zhou, Yufeng

    2016-08-01

    Shock wave lithotripsy (SWL) has been used widely in urology for about three decades to treat kidney calculi. Technical development to improve performance (i.e., stone fragmentation efficiency) is continuous. Low-pressure wide-focus lithotripters have already achieved promising results. In this study, the lithotripter field and profile of lithotripter shock waves were changed simultaneously using a cost-effective and convenient design. An intact parabolic reflector was split into four pieces, and each part was moved individually. By shifting the split reflectors, the focused acoustic beams were separated. As a result, the beam width in the focal region could be increased. Both numerical models of wave propagation using a k-wave approach and hydrophone measurements showed similar pressure waveforms at the focus and the distributions along and transverse to the lithotripter axis. The increase of the shifting distance from 0 mm to 7 mm resulted in the increase of -6 dB beam width from 7.1 mm to 13.9 mm and location of tensile peak on axis moving from z = -14 mm to 1 mm. The Lithotripters at 10 kV (intact reflector) and at 12 kV with the split reflectors shifted by 5 mm were compared with each other because of their similar peak positive pressures at the focus (8.07 MPa ± 0.05 MPa vs. 7.90 MPa ± 0.11 MPa, respectively). However, there were significant differences in their positive beam width (8.7 mm vs. 10.2 mm), peak negative pressure (-6.34 MPa ± 0.04 MPa vs. -7.13 MPa ± 0.13 MPa), the maximum tensile stress (7.55 MPa vs. 8.95 MPa) and shear stress (6.1 MPa vs. 7.76 MPa) in a 10-mm diameter spherical stone and bubble collapse time (127.6 μs ± 5.4 μs vs. 212.7 μs ± 8.2 μs). As a result, stone fragmentation efficiency was enhanced about 1.8-fold (57.9% ± 4.6% vs. 32.2% ± 5.6%, p < 0.05) when shifting the split reflectors. These results suggest that this new reflector design could change the characteristics of

  11. Endoscopically-controlled electrohydraulic intracorporeal shock wave lithotripsy (EISL) of salivary stones.

    PubMed

    Königsberger, R; Feyh, J; Goetz, A; Kastenbauer, E

    1993-02-01

    Twenty-nine patients with salivary stones were treated with the endoscopically-controlled electrohydraulic shock wave lithotripsy (EISL). This new minimally invasive treatment of sialolithiasis is performed under local anesthesia on an outpatient basis with little inconvenience to the patient. For endoscopy, a flexible fibroscope with an additional probe to generate shock waves is placed into the submandibular duct and advanced until the stone is identified. For shock wave-induced stone disintegration, the probe electrode must be placed 1 mm in front of the concrement. The shock waves are generated by a sparkover at the tip of the probe. By means of the endoscopically-controlled shock wave lithotripsy it was possible to achieve complete stone fragmentation in 20 out of 29 patients without serious side effects. In three patients, only partial stone fragmentation could be achieved due to the stone quality. Endoscopically-controlled electrohydraulic intracorporeal shock wave lithotripsy represents a novel minimally invasive therapy for endoscopically accessible salivary gland stones. The advantage in comparison to the endoscopically-controlled laser lithotripsy will be discussed. PMID:8445694

  12. Dynamics of bubble oscillation in constrained media and mechanisms of vessel rupture in SWL.

    PubMed

    Zhong, P; Zhou, Y; Zhu, S

    2001-01-01

    Rupture of small blood vessels is a primary feature of the vascular injury associated with shock-wave lithotripsy (SWL) and cavitation has been implicated as a potential mechanism. To understand more precisely the underlying mechanical cause of the injury, the dynamics of SWL-induced bubble dynamics in constrained media were investigated. Silicone tubing and regenerated cellulose hollow fibers of various inner diameters (0.2 to 1.5 mm) were used to fabricate vessel phantoms, which were placed in a test chamber filled with castor oil so that cavitation outside the phantom could be suppressed. Degassed water seeded with 0.2% Albunex contrast agent was circulated inside the vessel phantom, and intraluminal bubble dynamics during SWL were examined by high-speed shadowgraph imaging and passive cavitation detection via a 20-MHz focused transducer. It was observed that, in contrast to the typical large and prolonged expansion and violent inertial collapse of SWL-induced bubbles in a free field, the expansion of the bubbles inside the vessel phantom was significantly constrained, leading to asymmetric elongation of the bubbles along the vessel axis and, presumably, much weakened collapse. The severity of the constraint is vessel-size dependent, and increases dramatically when the inner diameter of the vessel becomes smaller than 300 microm. Conversely, the rapid, large intraluminal expansion of the bubbles causes a significant dilation of the vessel wall, leading to consistent rupture of the hollow fibers (i.d. = 200 microm) after less than 20 pulses of shock wave exposure in a XL-1 lithotripter. The rupture is dose-dependent, and varies with the spatial location of the vessel phantom in the lithotripter field. Further, when the large intraluminal bubble expansion was suppressed by inversion of the lithotripter pressure waveform, rupture of the hollow fiber could be avoided even after 100 shocks. Theoretical calculation of SWL-induced bubble dynamics in blood confirms that

  13. Renovascular acute renal failure precipitated by extracorporeal shock wave lithotripsy for pancreatic stones

    PubMed Central

    Cecere, Nicolas; Goffette, Pierre; Deprez, Pierre; Jadoul, Michel; Morelle, Johann

    2015-01-01

    Extracorporeal shock wave lithotripsy (ESWL) for pancreatic stones is considered a safe and efficient method to facilitate fragmentation and stone removal. We describe the case of a 73-year-old woman with a solitary functioning kidney who presented an acute-onset anuria and renovascular renal failure the day after ESWL. We speculate that vascular calcifications in the area targeted by shock waves played a critical role in renal artery obstruction in the present case. PMID:26251710

  14. Long-term evaluation of extracorporeal shock wave lithotripsy in the treatment of salivary stones.

    PubMed

    Schmitz, S; Zengel, P; Alvir, I; Andratschke, M; Berghaus, A; Lang, S

    2008-01-01

    Extracorporeal shock wave lithotripsy is a rather new therapeutical method in the treatment of sialolithiasis. The objective was to evaluate retrospectively the results of the extracorporeal shock wave lithotripsy therapy performed with a Minilith SL 1 lithotripter on 167 out-patients with symptomatic stones (average size 5.94 mm) of the salivary glands over an observation period of seven years. A successful treatment with total stone disintegration was achieved in 51 (31 per cent) patients. In 92 (55 per cent) patients treatment was partially successful, with disappearance of the symptoms but a sonographically still identifiable stone. Treatment failure occurred in 24 (14 per cent) patients who then underwent surgery. The mean follow-up period was 35.6 months (minimum three, maximum 83), after which 83.2 per cent of the initially successfully treated patients were still free of symptoms.Therefore, extracorporeal shock wave lithotripsy, as a non-invasive treatment alternative with few side effects, is an efficient technique for the therapy of sialolithiasis in selected patients. PMID:17466089

  15. OPTIMIZING AN ESCALATING SHOCK WAVE AMPLITUDE TREATMENT STRATEGY TO PROTECT THE KIDNEY FROM INJURY DURING SHOCK WAVE LITHOTRIPSY

    PubMed Central

    Handa, Rajash K.; McAteer, James A.; Connors, Bret A.; Liu, Ziyue; Lingeman, James E.; Evan, Andrew P.

    2013-01-01

    OBJECTIVE To test the idea that a pause (~3-min) in the delivery of shock waves (SW) soon after the initiation of treatment is unnecessary for achieving a reduction in renal injury, if treatment is begun at a low power setting that generates low-amplitude SWs. MATERIALS AND METHODS Anesthetized female pigs were assigned to one of three SWL treatment protocols that did not involve a pause in SW delivery of more than 10 seconds (2000 SWs at 24 kV; 100 SWs at 12 kV + ~10-sec pause + 2000 SWs at 24 kV; 500 SWs at 12 kV + ~10-sec pause + 2000 SWs at 24 kV; all SWs delivered at 120 SWs/min using an unmodified Dornier HM3 lithotripter). Renal function was measured before and after SWL. The kidneys were then processed for quantification of the SWL-induced hemorrhagic lesion. Values for lesion size were compared to previous data collected from pigs in which treatment included a 3-min pause in SW delivery. RESULTS All SWL treatment protocols produced a similar degree of vasoconstriction (23–41% reduction in GFR and ERPF) in the SW-treated kidney. The mean renal lesion in pigs treated with 100 low-amplitude SWs delivered before the main dose of 2000 high-amplitude SWs (2.27% FRV) was statistically similar to that measured for pigs treated with 2000 SWs all at high-amplitude (3.29% FRV). However, pigs treated with 500 low-amplitude SWs before the main SW dose had a significantly smaller lesion (0.44% FRV) that was comparable to the lesion in pigs from a previous study in which there was a 3-min pause in treatment separating a smaller initial dose of 100 low-amplitude SWs from the main dose of 2000 high-amplitude SWs (0.46% FRV). Time between the initiation of the low- and high-amplitude SWs was ~4-min for these latter two groups compared to ~1-min when there was negligible pause after the initial 100 low-amplitude SWs in the protocol. CONCLUSIONS Pig kidneys treated by SWL using a 2-step low-to-high power ramping protocol were protected from injury with negligible pause

  16. Reduction of tissue injury in shock-wave lithotripsy by using an acoustic diode.

    PubMed

    Zhu, Songlin; Dreyer, Thomas; Liebler, Marko; Riedlinger, Rainer; Preminger, Glenn M; Zhong, Pei

    2004-05-01

    An acoustic diode (AD) was constructed of two acoustic transparent membranes with good initial contact to allow the transmission of the positive pressure of lithotripter shock wave at an almost unaltered level, yet attenuate significantly its negative pressure, was fabricated. It was evaluated systematically on a Dornier HM-3 lithotripter to assess its application potential to reduce vascular injury without compromising stone fragmentation efficiency during shock-wave lithotripsy. By inserting the AD, the maximum compressive pressure, maximum tensile pressure and tensile duration of the lithotripter shock wave were formed to drop from 49.7 to 47.8 MPa, -7.5 to -7.0 MPa and 6.0 to 5.1 micros, respectively. Damage of a 0.2-mm inner diameter vessel phantom (cellulose hollow fiber) was reduced from rupture after 31 +/- 11 shocks to no rupture after 100 shocks. Maximum bubble size in free-field, maximum dilation of the vessel phantom wall and bubble collapse time became smaller with the use of the AD. However, stone fragmentation showed similar results without a statistically significant difference between the case with and without the AD. All these evidences suggest that the use of an acoustic diode may be a feasible approach to reduce tissue injury without compromising stone comminution in shock-wave lithotripsy. PMID:15183234

  17. More efficient focusing for extracorporeal shock wave lithotripsy

    NASA Astrophysics Data System (ADS)

    Loske, Achim M.; Prieto, Fernando E.

    2001-10-01

    The purpose of this study was to generate alternative pressure waveforms in order to increase efficiency during non-invasive treatments of nephrolithiasis. Two new systems for electrohydraulic shock wave generators were tested. These devices generate two pressure pulses, instead of only one positive peak, followed by a trough, as in conventional systems. Pressure measurements and stone fragmentation efficiency were compared to that of conventional shock wave generators, using needle hydrophones and kidney-stone models.

  18. Detecting Fragmentation of Kidney Stones in Lithotripsy by Means of Shock Wave Scattering

    NASA Astrophysics Data System (ADS)

    Sapozhnikov, Oleg A.; Trusov, Leonid A.; Owen, Neil R.; Bailey, Michael R.; Cleveland, Robin O.

    2006-05-01

    Although extracorporeal shock wave lithotripsy (a procedure of kidney stone comminution using focused shock waves) has been used clinically for many years, a proper monitoring of the stone fragmentation is still undeveloped. A method considered here is based on recording shock wave scattering signals with a focused receiver placed far from the stone, outside the patient body. When a fracture occurs in the stone or the stone becomes smaller, the elastic waves in the stone will propagate differently (e.g. shear waves will not cross a fracture) which, in turn, will change the scattered acoustic wave in the surrounding medium. Theoretical studies of the scattering phenomenon are based on a linear elastic model to predict shock wave scattering by a stone, with and without crack present in it. The elastic waves in the stone and the nearby liquid were modeled using a finite difference time domain approach. The subsequent acoustic propagation of the scattered waves into the far-field was calculated using the Helmholtz-Kirchhoff integral. Experimental studies were conducted using a research electrohydraulic lithotripter that produced the same acoustic output as an unmodified Dornier HM3 clinical lithotripter. Artificial stones, made from Ultracal-30 gypsum and acrylic, were used as targets. The stones had cylindrical shape and were positioned co-axially with the lithotripter axis. The scattered wave was measured by focused broadband PVDF hydrophone. It was shown that the size of the stone noticeably changed the signature of the reflected wave.

  19. Laser-induced shock-wave lithotripsy of canine urocystoliths and nephroliths

    NASA Astrophysics Data System (ADS)

    Woods, J. P.; Bartels, Kenneth E.; Stair, Ernest L.; Schafer, Steven A.; Nordquist, Robert E.

    1997-05-01

    Urolithiasis is a common disease affecting dogs which can sometimes be treated with dietary and medical protocols. In many cases, however, medical management cannot be employed because the dietary restrictions are contraindicated, effective medical dissolution protocols for the calculi (uroliths) do not exist, or obstruction by the calculi may result in deterioration of renal function during the time required for medical dissolution. At present, the management of medically untreatable calculi has been surgical removal which may result in temporary but dramatic decrease in renal function, irreversible loss of damaged nephrons, and significant risk, particularly for bilateral or recurrent nephroliths. An innovative technique for the removal of these uroliths would involve laser lithotripsy which transforms light energy into acoustical energy generating a shock wave sufficient to fragment stones (photoacoustic ablation). The laser is transmitted via quartz fibers which are small and flexible and can be used under direct vision through endoscopes resulting in effective fragmentation with little surrounding tissue damage. Lasers are becoming increasingly more utilized in veterinary medicine, in contrast to the limited availability of other non-invasive methods of treatment of nephroliths (i.e. extracorporeal shock-wave lithotripsy).

  20. Scrotal hematoma resulting from extracorporeal shock wave lithotripsy for a renal calculus: a sign of retroperitoneal hemorrhage

    PubMed Central

    Katz, Darren J.; Dodds, Lachlan J.

    2011-01-01

    We report a rare case of a patient presenting with scrotal hematoma associated with retroperitoneal hemorrhage after extracorporeal shock wave lithotripsy (ESWL). We propose a mechanism for the formation of scrotal hematoma and its importance as a sign of retroperitoneal hemorrhage. PMID:24578909

  1. Stone Comminution Correlates with the Average Peak Pressure Incident on a Stone during Shock Wave Lithotripsy

    PubMed Central

    Smith, N.; Zhong, P.

    2012-01-01

    To investigate the roles of lithotripter shock wave (LSW) parameters and cavitation in stone comminution, a series of in vitro fragmentation experiments have been conducted in water and 1,3-butanediol (a cavitation-suppressive fluid) at a variety of acoustic field positions of an electromagnetic shock wave lithotripter. Using field mapping data and integrated parameters averaged over a circular stone holder area (Rh = 7 mm), close logarithmic correlations between the average peak pressure (P+(avg)) incident on the stone (D = 10 mm BegoStone) and comminution efficiency after 500 and 1,000 shocks have been identified. Moreover, the correlations have demonstrated distinctive thresholds in P+(avg) (5.3 MPa and 7.6 MPa for soft and hard stones, respectively), that are required to initiate stone fragmentation independent of surrounding fluid medium and LSW dose. These observations, should they be confirmed using other shock wave lithotripters, may provide an important field parameter (i.e., P+(avg)) to guide appropriate application of SWL in clinics, and facilitate device comparison and design improvements in future lithotripters. PMID:22935690

  2. Development of a new diagnostic sensor for extra-corporeal shock-wave lithotripsy

    NASA Astrophysics Data System (ADS)

    Fedele, F.; Coleman, A. J.; Leighton, T. G.; White, P. R.; Hurrell, A. M.

    2004-01-01

    Extracorporeal shock-wave lithotripsy is the leading technique used in urology for the non-invasive treatment of kidney and ureteric stones. The stone is comminuted by thousands of ultrasound shocks, into fragments small enough to be naturally passed. Since the technique was introduced in the 1980 different generations of lithotripters have been developed. Nevertheless the alignment systems (x-ray, ultrasound) still have some limitations (indeed, the tighter focusing of newer lithotripter reduces the tolerance for misalignment) and there is no capability for on-line monitoring of the degree of fragmentation of the stone. There is 50% incidence of re-treatments, possibly due to these deficiencies. The objective of this research is to design a new passive acoustic sensor, exploiting the secondary acoustic emission generated during the treatment, which could be used as a diagnostic device for lithotripsy. With a passive cylindrical cavitation detector, developed by the National Physical Laboratory, it was possible to detect these emissions in a laboratory lithotripter, and it was shown that they contain information on the degree of stone fragmentation and stone location. This information could be used to perform the desired monitoring and to improve the stone targeting. In collaboration with Precision Acoustic Ltd, some clinical prototypes were developed and tested to verify the relevance of these preliminary results. Clinical results are presented.

  3. The effect of extracorporeal shock wave lithotripsy on the prosthesis interface in cementless arthroplasty. Evaluation in a rabbit model.

    PubMed

    Stranne, S K; Callaghan, J J; Fyda, T M; Fulghum, C S; Glisson, R R; Weinerth, J L; Seaber, A V

    1992-06-01

    The effect of extracorporeal shock wave lithotripsy on interfacial strength between prosthesis and bone in cementless arthroplasty was examined using a rabbit model. Paired femora, each implanted with fiber mesh porous coated titanium implants, were harvested from rabbits 15 weeks after implantation. In group I, one femur from each pair was exposed to lithotripsy treatment consisting of 2,000 shocks at 20 kV. In group II, one femur from each pair was exposed to 2,000 shocks at 26 kV. Contralateral femora from each pair served as controls in both groups. Mechanical pushout tests were conducted on the implants using a 1321 Instron testing machine at a constant rate of 1 mm/minute. Shock waves generated at 20 kV were found to have no significant decrease on either the prosthesis/bone interfacial strength or energy to failure of cementless implants. Shock waves generated at 26 kV produced a mean 17.45% decrease in the prosthesis/bone interfacial strength, which approached statistical significance (P = .062), and a 7.84% mean decrease in the energy to failure (P = .268). However, in four of the seven group II specimens, cortical fractures occurred. These findings suggest that lithotripsy will not aid in the removal of uncemented porous coated devices and lithotripsy inadvertently focused at an uncemented device will not disrupt significantly the prosthesis-bone interface. PMID:1613525

  4. Bacteria Inactivation During Lithotripsy

    NASA Astrophysics Data System (ADS)

    del Sol Quintero, María; Mora, Ulises; Gutiérrez, Jorge; Mues, Enrique; Castaño, Eduardo; Fernández, Francisco; Loske, Achim M.

    2006-09-01

    The influence of extracorporeal and intracorporeal lithotripsy on the viability of bacteria contained inside artificial kidney stones was investigated in vitro. Two different bacteria were exposed to the action of one extracorporeal shock wave generator and four intracorporeal lithotripters.

  5. Clinical experience with shock-wave lithotripsy using the Siemens Modularis Vario lithotripter

    PubMed Central

    Hassouna, Mohamed E.; Oraby, Samir; Sameh, Wael; El-Abbady, Ahmed

    2011-01-01

    Purpose To assess the effectiveness of a lithotripter (Modularis Vario; Siemens, AG Healthcare, Munich, Germany) in the management of renal and ureteric stones. Patients and methods In all, 1146 adult patients with renal or ureteric stones were treated at one urological centre using the latest model of the Modularis Vario lithotripter. The effectiveness of lithotripsy and re-treatment rate were assessed. Data were obtained on stone location, stone size, shock wave usage, success rate, and complications. Results Between May 2007 and November 2009, 698 patients with renal stones and 448 with ureteric stones underwent extracorporeal shock-wave lithotripsy (ESWL). The mean (SD) renal stone size was 12.8 (3.8) mm; a mean of 1.36 sessions was required, with a mean (SD) number of 3744 (1961) shocks delivered per renal stone. After 3 months, the success rate defined as the patient being stone-free or with residual fragments of <4 mm; for renal stones the rate was 91.1%, with a 6.9% complication rate in the form of steinstrasse and severe renal colic. The mean (SD) ureteric stone size was 10.4 (2.7) mm. A mean of 1.37 sessions was required, with a mean (SD) of 4551 (2467) shocks delivered for each ureteric stone. The success rate for ureteric stones was 89.5%, with a 5.6% complication rate. The overall efficiency quotient was 0.66. Conclusion The Siemens Modularis Vario lithotripter is a safe and effective machine for treating renal and ureteric stones. PMID:26579276

  6. Kidney damage in extracorporeal shock wave lithotripsy: a numerical approach for different shock profiles.

    PubMed

    Weinberg, Kerstin; Ortiz, Michael

    2009-08-01

    In shock-wave lithotripsy--a medical procedure to fragment kidney stones--the patient is subjected to hypersonic waves focused at the kidney stone. Although this procedure is widely applied, the physics behind this medical treatment, in particular the question of how the injuries to the surrounding kidney tissue arise, is still under investigation. To contribute to the solution of this problem, two- and three-dimensional numerical simulations of a human kidney under shock-wave loading are presented. For this purpose a constitutive model of the bio-mechanical system kidney is introduced, which is able to map large visco-elastic deformations and, in particular, material damage. The specific phenomena of cavitation induced oscillating bubbles is modeled here as an evolution of spherical pores within the soft kidney tissue. By means of large scale finite element simulations, we study the shock-wave propagation into the kidney tissue, adapt unknown material parameters and analyze the resulting stress states. The simulations predict localized damage in the human kidney in the same regions as observed in animal experiments. Furthermore, the numerical results suggest that in first instance the pressure amplitude of the shock wave impulse (and not so much its exact time-pressure profile) is responsible for damaging the kidney tissue. PMID:18807077

  7. Effects of hydrochlorothiazide on kidney stone therapy with extracorporeal shock wave lithotripsy

    PubMed Central

    Tehranchi, Ali; Rezaei, Yousef; Mohammadi-Fallah, Mohammadreza; Mokhtari, Mohammadreza; Alizadeh, Mansour; Abedi, Farzad; Khalilzadeh, Masoud; Tehranchi, Parisa

    2014-01-01

    Objective: The aim of this investigation was to assess the efficacy of hydrochlorothiazide as a hypocalciuric diuretic on stone-free rate of renal pelvic calculi after extracorporeal shock wave lithotripsy (ESWL). Materials and Methods: A double-blind, placebo-controlled randomized clinical trial was conducted and 52 patients with renal pelvic calculi (diameter ≤2 cm) were enrolled from February 2010 to September 2010. ESWL protocol was performed by 2,500 shocks per session. The patients were randomized into two groups: (1) 26 patients who were given 25 mg hydrochlorothiazide twice daily; and (2) 26 patients who received placebo. The stone-free rate was defined as residual calculus size ≤4 mm in controlled ultrasound on 2nd week, 1 month and 3 months after ESWL. Results: 19 (78%) of the first group and 9 (42.9%) of the second group were stone-free after one session of ESWL (P = 0.02). 88% of the group 1 and 47.8% of the group 2 were stone-free on 1 month after ESWL (P = 0.003); however, this effect of hydrochlorothiazide was not related to the patients' body mass index, age and gender. The accessory treatment procedures were applied in 24% of the group 1 compared with 19% of the group 2 during 3 months (P = 0.68). All patients in both groups were stone-free on 3 months following lithotripsy. Conclusions: Hydrochlorothiazide did not impact on the stone-free rate and using accessory procedure within 3 months; however, it decreased duration of stone-free status and number of ESWL sessions. PMID:25125892

  8. New tip design and shock wave pattern of electrohydraulic probes for endoureteral lithotripsy.

    PubMed

    Vorreuther, R

    1993-02-01

    A new tip design of a 3.3F electrohydraulic probe for endoureteral lithotripsy was evaluated in comparison to a regular probe. The peak pressure, as well as the slope of the shock front, depend solely on the voltage. Increasing the capacity leads merely to broader pulses. A laser-like short high-pressure pulse has a greater impact on stone disintegration than a corresponding broader low-pressure pulse of the same energy. Using the regular probe, only positive pressures were obtained. Pressure distribution around the regular tip was approximately spherical, whereas the modified probe tip "beamed" the shock wave to a great extent. In addition, a negative-pressure half-cycle was added to the initial positive peak pressure, which resulted in a higher maximal pressure amplitude. The directed shock wave had a greater depth of penetration into a model stone. Thus, the ability of the new probe to destroy harder stones especially should be greater. The trauma to the ureter was reduced when touching the wall tangentially. No difference in the effect of the two probes was seen when placing the probe directly on the mucosa. PMID:8481720

  9. Evaluation of the shock-wave pattern for endoscopic electrohydraulic lithotripsy.

    PubMed

    Vorreuther, R; Engelmann, Y

    1995-01-01

    We evaluated the electrical events and the resulting shock waves of the spark discharge for electrohydraulic lithotripsy at the tip of a 3.3F probe. Spark generation was achieved by variable combinations of voltage and capacity. The effective electrical output was determined by means of a high-voltage probe, a current coil, and a digital oscilloscope. Peak pressures, rise times, and pulse width of the pressure profiles were recorded using a polyvinylidene difluoride needle hydrophone in 0.9% NaCl solution at a distance of 10 mm. The peak pressure and the slope of the shock front depend solely on the voltage, while the pulse width was correlated with the capacity. Pulses of less than 1-microsecond duration can be obtained when low capacity is applied and the inductivity of the cables and plugs is kept at a low level. Using chalk as a stone model it was proven that short pulses of high peak pressure provided by a low capacity and a high voltage have a greater impact on fragmentation than the corresponding broader shock waves of lower peak pressure carrying the same energy. PMID:7725212

  10. Reduction of tissue injury without compromising stone comminution in shock wave lithotripsy

    NASA Astrophysics Data System (ADS)

    Zhou, Yufeng; Auge, Brian; Preminger, Glenn M.; Zhong, Pei

    2002-05-01

    To ameliorate vascular injury without compromising stone comminution in shock wave lithotripsy, we have recently developed an in situ pulse superposition technique to suppress large intraluminal bubble expansion [Zhong and Zhou, J. Acoust. Soc. Am. 110, 3283-3291 (2001)]. This strategy was implemented using a simple modification of a HM-3 lithotripter reflector. In this work, further optimization of the reflector geometry was carried out based on theoretical analysis and in vitro pressure waveform measurements using a fiber optical hydrophone. Using the upgraded reflector, no rupture of a cellulose hollow fiber (i.d.=0.2 mm) vessel phantom could be observed around the lithotripter beam focus even after 200 shocks at 24 kV. In comparison, less than 50 shocks were needed to cause a rupture of the vessel phantom using the original reflector at 20 kV. At corresponding output settings, stone comminution is comparable between the two reflector configurations, although the size of the fragments produced by the upgraded reflector is slightly larger. In addition, preliminary results from animal studies have demonstrated a significant reduction in tissue injury using the upgraded reflector, which confirms the validity of this approach in vivo. [Work supported by NIH.

  11. Abruptly changing patterns of diffusion and use of extracorporeal shock-wave renal lithotripsy.

    PubMed

    Bloom, B S; Hillman, A L; Schwartz, J S

    1991-07-01

    Early diffusion and use of extracorporeal shock-wave lithotripsy (ESWL) was found by a 1986 survey of the first 84 operational renal lithotripters in the United States to be similar to that of other equipment-embodied technologies. Resurvey in 1988 of this cohort of units found that clinical indications for ESWL treatment--stone size and location--expanded greatly. Professional fees for ESWL services remained essentially constant, while technical component charges increased 21.0%. Volume of procedures declined by 19.8% among the most productive units, and by 34.4% among the least productive study units; the previously noted approximate fourfold difference remained unchanged between most and least productive units. ESWL patterns of diffusion were comparable to other equipment-embodied diagnostic technology (magnetic resonance imaging [MRI] and computed tomography [CT]) during the first few years of clinical availability. ESWL growth slowed sooner than that of CT and MRI following their introduction into clinical practice, declining in the fourth to fifth year of use following rapid expansion in the first 2 years of availability. While clinical indications for both ESWL and imaging technologies expanded over time, CT and MRI experienced continued growth beyond that of ESWL at the same points of their respective life cycles. In the market areas of the 84 study units, the use of ESWL declined even with expanded indications for treatment, perhaps due to faster expansion of number of units than growth of clinical indications for treatment. PMID:2063841

  12. Effects of extracorporeal shock-wave lithotripsy on referred hyperalgesia from renal/ureteral calculosis.

    PubMed

    Giamberardino, M A; de Bigontina, P; Martegiani, C; Vecchiet, L

    1994-01-01

    In patients suffering from colics due to calculosis of one upper urinary tract the evolution in time of referred parietal hyperalgesia after stone fragment elimination promoted by extracorporeal shock wave lithotripsy (ESWL) was studied. Before ESWL, all patients presented clinical evidence (positivity to dermographism and Head's procedure, pinch palpation, digital pressure and Giordano's manoeuver) and instrumental signs (significant lowering of pain threshold to electrical tissue stimulation) of cutaneous, subcutaneous and muscular tissue hyperalgesia in the lumbar region of the affected side. After ESWL, hyperalgesia decreased in the three tissues, as shown by progressive change in the clinical tests and an increase in pain threshold to electrical stimulation in relation to the extent of stone fragment expulsion. In the stone-free condition, hyperalgesia had disappeared in the skin but remained to a mild and moderate extent in the subcutaneous tissue and muscle respectively. It is concluded that the persistence in time of referred hyperalgesia is only in part linked to the continuing presence and activity of the stone in the urinary tract. To a certain extent, the phenomenon seems to become independent of the primary focus, possibly as a result of plastic neuronal changes in the central nervous system which, triggered by afferent visceral inputs, are maintained even after their removal. PMID:8159443

  13. Can a dual-energy computed tomography predict unsuitable stone components for extracorporeal shock wave lithotripsy?

    PubMed Central

    Ahn, Sung Hoon; Oh, Tae Hoon

    2015-01-01

    Purpose To assess the potential of dual-energy computed tomography (DECT) to identify urinary stone components, particularly uric acid and calcium oxalate monohydrate, which are unsuitable for extracorporeal shock wave lithotripsy (ESWL). Materials and Methods This clinical study included 246 patients who underwent removal of urinary stones and an analysis of stone components between November 2009 and August 2013. All patients received preoperative DECT using two energy values (80 kVp and 140 kVp). Hounsfield units (HU) were measured and matched to the stone component. Results Significant differences in HU values were observed between uric acid and nonuric acid stones at the 80 and 140 kVp energy values (p<0.001). All uric acid stones were red on color-coded DECT images, whereas 96.3% of the nonuric acid stones were blue. Patients with calcium oxalate stones were divided into two groups according to the amount of monohydrate (calcium oxalate monohydrate group: monohydrate≥90%, calcium oxalate dihydrate group: monohydrate<90%). Significant differences in HU values were detected between the two groups at both energy values (p<0.001). Conclusions DECT improved the characterization of urinary stone components and was a useful method for identifying uric acid and calcium oxalate monohydrate stones, which are unsuitable for ESWL. PMID:26366277

  14. A cumulative shear mechanism for tissue damage initiation in shock-wave lithotripsy

    PubMed Central

    Freund, Jonathan B.; Colonius, Tim; Evan, Andrew P.

    2007-01-01

    Evidence suggests that inertial cavitation plays an important role in the renal injury incurred during shock-wave lithotripsy. However, it is unclear how tissue damage is initiated, and significant injury typically occurs only after a sufficient dose of shock waves. While it has been suggested that shock-induced shearing might initiate injury, estimates indicate that individual shocks do not produce sufficient shear to do so. In this paper, we hypothesize that the cumulative shear of the many shocks is damaging. This mechanism depends upon whether there is sufficient time between shocks for tissue to relax to its unstrained state. We investigate the mechanism with a physics-based simulation model wherein the the basement membranes that define the tubules and vessels in the inner medulla are represented as elastic shells surrounded by viscous fluid. Material properties are estimated from in vitro tests of renal basement membranes and documented mechanical properties of cells and extracellular gels. Estimates for the net shear deformation from a typical lithotripter shock (~ 0.1%) are found from a separate dynamic shock simulation. The results suggest that the larger interstitial volume (~ 40%) near the papilla tip gives the tissue there a relaxation time comparable to clinical shock delivery rates (~ 1Hz), thus allowing shear to accumulate. Away from the papilla tip, where the interstitial volume is smaller (≲ 20%), the model tissue relaxes completely before the next shock would be delivered. Implications of the model are that slower delivery rates and broader focal zones should both decrease injury, consistent with some recent observations. PMID:17507147

  15. Impact of shock wave pattern and cavitation bubble size on tissue damage during ureteroscopic electrohydraulic lithotripsy.

    PubMed

    Vorreuther, R; Corleis, R; Klotz, T; Bernards, P; Engelmann, U

    1995-03-01

    It is known that electrohydraulic lithotripsy (EHL) during ureteroscopy may cause ureteral damage. To evaluate this trauma potential, find its mechanism and make it possible to avoid it, our research employed photographic evaluation, tissue studies, shock wave measurements and disintegration tests. The setup included a 3.3 F probe attached to an experimental generator with adjustable voltages and capacities providing energies from 25 mJ. to 1300 mJ. per pulse. In general, we distinguish between two traumatic mechanisms: (1) After placing the probe directly on the mucosa the rapid initial plasma penetrates the tissue resulting in a small, nonthermal, punched-like defect, whose depth depends on the energy applied. This trauma has minor clinical implications and is avoided by maintaining a minimum safety distance of 1 mm.; (2) According to physics, each plasma is followed by a cavitation bubble. The maximum size of this bubble depends on the energy applied and ranges from 3 mm. (25 mJ) to > 15 mm. (1300 mJ). In proportion to the bubble size, the ureteral wall may be distended or disrupted, even when the probe is not in direct contact with the mucosa. Therefore, the goal should be to obtain a low energy pressure pulse with high disintegration efficacy. Our evaluation of the pressure waves revealed that the selection of a high voltage and a low capacity leads to short and steep "laser-like" pulses. These pulses have a significant higher impact on stone disintegration than the broader pulses of the same energy provided by currently available generators. PMID:7861549

  16. Comparison of Tissue Injury from Focused Ultrasonic Propulsion of Kidney Stones Versus Extracorporeal Shock Wave Lithotripsy

    PubMed Central

    Connors, Bret A.; Evan, Andrew P.; Blomgren, Philip M.; Hsi, Ryan S.; Harper, Jonathan D.; Sorensen, Mathew D.; Wang, Yak-Nam; Simon, Julianna C.; Paun, Marla; Starr, Frank; Cunitz, Bryan W.; Bailey, Michael R.; Lingeman, James E.

    2013-01-01

    Purpose Focused ultrasonic propulsion is a new non-invasive technique designed to move kidney stones and stone fragments out of the urinary collecting system. However, the extent of tissue injury associated with this technique is not known. As such, we quantitated the amount of tissue injury produced by focused ultrasonic propulsion under simulated clinical treatment conditions, and under conditions of higher power or continuous duty cycles, and compared those results to SWL injury. Materials and Methods A human calcium oxalate monohydrate stone and/or nickel beads were implanted (with ureteroscopy) into 3 kidneys of live pigs (45–55 kg) and repositioned using focused ultrasonic propulsion. Additional pig kidneys were exposed to SWL level pulse intensities or continuous ultrasound exposure of 10 minutes duration (ultrasound probe either transcutaneous or on the kidney). These kidneys were compared to 6 kidneys treated with an unmodified Dornier HM3 Lithotripter (2400 shocks, 120 SWs/min and 24 kV). Histological analysis was performed to assess the volume of hemorrhagic tissue injury created by each technique (% functional renal volume, FRV). Results SWL produced a lesion of 1.56±0.45% FRV. Ultrasonic propulsion produced no detectable lesion with the simulated clinical treatment. A lesion of 0.46±0.37% FRV or 1.15±0.49% FRV could be produced if excessive treatment parameters were used while the ultrasound probe was placed on the kidney. Conclusions Focused ultrasonic propulsion produced no detectable morphological injury to the renal parenchyma when using clinical treatment parameters and produced injury comparable in size to SWL when using excessive treatment parameters. PMID:23917165

  17. Treatment Protocols to Reduce Injury and Improve Stone Breakage in SWL

    NASA Astrophysics Data System (ADS)

    McAteer, James A.; Evan, Andrew P.; Connors, Bret A.; Pishchalnikov, Yuri A.; Williams, James C.; Lingeman, James E.

    2008-09-01

    Here we provide a capsule summary of key observations showing that adverse effects can be reduced and stone breakage outcomes can be improved by the choice of the treatment protocol used in SWL. The take home message is—technique in lithotripsy can be used to significant advantage. SW-rate is key, and so is the sequence of SW delivery. Patient studies have shown that stone breakage is significantly improved at 60SW/min compared to a rate of 120SW/min, and laboratory experiments with pigs show that acute SWL injury to the kidney can be reduced dramatically by further slowing the SW firing rate to 30SW/min. The sequence of SW administration has a profound effect on the kidney, and renal injury is significantly reduced when the treatment protocol incorporates a priming dose of SW's followed by a brief pause before treatment is resumed. Continued developments in lithotripsy technology are welcome and will hopefully lead to improved SWL systems. Current experience suggests, however, that technology is not a substitute for expert technique, and attention to the fundamentals of SW delivery is essential to achieve the best possible outcomes regardless of the lithotripter at hand.

  18. Diagnostic and prognostic role of computed tomography in extracorporeal shock wave lithotripsy complications

    PubMed Central

    Telegrafo, Michele; Carluccio, Davide Antonio; Rella, Leonarda; Ianora, Amato Antonio Stabile; Angelelli, Giuseppe; Moschetta, Marco

    2016-01-01

    Purpose: To evaluate the role of multidetector computed tomography (MDCT) in recognizing the complications of extracorporeal shock wave lithotripsy (ESWL) and providing a prognostic grading system for the therapeutic approach. Materials and Methods: A total of 43 patients who underwent ESWL because of urinary stone disease were assessed by 320-row MDCT examination before and after ESWL. Pre-ESWL CT unenhanced scans were performed for diagnosing stone disease. Post-ESWL CT scans were acquired before and after intravenous injection of contrast medium searching for peri-renal fluid collection or hyper-density, pyelic or ureteral wall thickening, blood clots in the urinary tract, peri- or intra-renal hematoma or abscess, active bleeding. A severity grading system of ESWL complications was established. Results: Patients were affected by renal (n = 36) or ureteral (n = 7) lithiasis. Post-ESWL CT examination detected small fluid collections and hyper-density of peri-renal fat tissue in 35/43 patients (81%), pyelic or ureteral wall thickening in 2/43 (4%), blood clots in the urinary tract in 9/43 (21%), renal abscesses or hematomas with a diameter of <2 cm in 10/43 (23%), large retroperitoneal collections in 3/43 (7%), active bleeding from renal vessels in 1/43 (2%). Mild complications were found in 30 cases; moderate in 9; severe in 4. The therapeutic choice was represented by clinical follow-up (n = 20), clinical and CT follow-up (n = 10), ureteral stenting (n = 9), drainage of large retroperitoneal collections (n = 3), and arterial embolization (n = 1). Conclusion: MDCT plays a crucial role in the diagnosis of urolithiasis and follow-up of patients treated with ESWL recognizing its complications and providing therapeutic and prognostic indications. PMID:27141186

  19. Efficacy of Alfuzosin After Shock Wave Lithotripsy for the Treatment of Ureteral Calculi

    PubMed Central

    Cho, Hee Ju; Shin, Soon Cheol; Seo, Do Young; Min, Dong Suk; Cho, Jeong Man; Kang, Jung Yoon

    2013-01-01

    Purpose We evaluated the efficacy of alfuzosin for the treatment of ureteral calculi less than 10 mm in diameter after extracorporeal shock wave lithotripsy (ESWL). Materials and Methods A randomized, single-blind clinical trial was performed prospectively by one physician between June 2010 and August 2011. A total of 84 patients with ureteral calculi 5 to 10 mm in diameter were divided into two groups. Alfuzosin 10 mg (once daily) and loxoprofen sodium 68.1 mg (as needed) were prescribed to group 1 (n=41), and loxoprofen sodium 68.1 mg (as needed) only was prescribed to group 2 (n=44). The drug administration began immediately after ESWL and continued until stone expulsion was confirmed up to a maximum of 42 days after the procedure. Results Thirty-nine of 41 (95.1%) patients in group 1 and 40 of 43 (93.0%) patients in group 2 ultimately passed stones (p=0.96). The number of ESWL sessions was 1.34±0.65 and 1.41±0.85 in groups 1 and 2, respectively (p=0.33). The patients who required analgesics after ESWL were 8 (19.5%) in group 1 and 13 (30.2%) in group 2 (p=0.31). Visual analogue scale pain severity scores were 5.33±1.22 and 6.43±1.36 in groups 1 and 2, respectively (p=0.056). The time to stone expulsion in groups 1 and 2 was 9.5±4.8 days and 14.7±9.8 days, respectively (p=0.005). No significant adverse effects occurred. Conclusions The use of alfuzosin in combination with ESWL seems to facilitate stone passage and to reduce the time of stone expulsion but does not affect the stone-free rate. PMID:23550174

  20. A study of stone fragmentation in shock wave lithotripsy by customizing the acoustic field and waveform shape

    NASA Astrophysics Data System (ADS)

    Chitnis, Parag Vijay

    Shock wave lithotripsy is the preferred treatment modality for kidney stones in the United States. Despite clinical use for over twenty-five years, the mechanisms of stone fragmentation are still under debate. A piezoelectric array was employed to examine the effect of waveform shape and pressure distribution on stone fragmentation in lithotripsy. The array consisted of 170 elements placed on the inner surface of a 15 cm-radius spherical cap. Each element was driven independently using a 170 individual pulsers, each capable of generating 1.2 kV. The acoustic field was characterized using a fiber optic probe hydrophone with a bandwidth of 30 MHz and a spatial resolution of 100 mum. When all elements were driven simultaneously, the focal waveform was a shock wave with peak pressures p+ = 65 +/- 3 MPa and p- = -16 +/- 2 MPa and the -6 dB focal region was 13 mm long and 2 mm wide. The delay for each element was the only control parameter for customizing the acoustic field and waveform shape, which was done with the aim of investigating the hypothesized mechanisms of stone fragmentation such as spallation, shear, squeezing, and cavitation. The acoustic field customization was achieved by employing the angular spectrum approach for modeling the forward wave propagation and regression of least square errors to determine the optimal set of delays. Results from the acoustic field customization routine and its implications on stone fragmentation will be discussed.

  1. Suppression of large intraluminal bubble expansion in shock wave lithotripsy without compromising stone comminution: Refinement of reflector geometry

    NASA Astrophysics Data System (ADS)

    Zhou, Yufeng; Zhong, Pei

    2003-01-01

    Using the Hamilton model [Hamilton, J. Acoust. Soc. Am. 93, 1256-1266 (1993)], the effects of reflector geometry on the pulse profile and sequence of the shock waves produced by the original and upgraded reflector of an HM-3 lithotripter were evaluated qualitatively. Guided by this analysis, we have refined the geometry of the upgraded reflector to enhance its suppressive effect on intraluminal bubble expansion without compromising stone comminution in shock wave lithotripsy. Using the original HM-3 reflector at 20 kV, rupture of a standard vessel phantom made of cellulose hollow fiber (i.d.=0.2 mm), in which degassed water seeded with ultrasound contrast agents was circulated, was produced at the lithotripter focus after about 30 shocks. In contrast, using the upgraded reflector at 24 kV no rupture of the vessel phantom could be produced within a 20-mm diameter around the lithotripter focus even after 200 shocks. On the other hand, stone comminution was comparable between the two reflector configurations, although slightly larger fragments were produced by the upgraded reflector. After 2000 shocks, stone comminution efficiency produced by the original HM-3 reflector at 20 kV is 97.15+/-1.92% (mean+/-SD), compared to 90.35+/-1.96% produced by the upgraded reflector at 24 kV (p<0.02). All together, it was found that the upgraded reflector could significantly reduce the propensity for vessel rupture in shock wave lithotripsy while maintaining satisfactory stone comminution.

  2. The pulsed dye laser versus the Q-switched Nd:YAG laser in laser-induced shock-wave lithotripsy.

    PubMed

    Thomas, S; Pensel, J; Engelhardt, R; Meyer, W; Hofstetter, A G

    1988-01-01

    To date, there are two fairly well-established alternatives for laser-induced shock-wave lithotripsy in clinical practice. The Q-switched Nd:YAG laser is distinguished by the high-stone selectivity of its coupler systems. The necessity of a coupler system and its fairly small conversion rate of light energy into mechanical energy present serious drawbacks. Furthermore, the minimal outer diameter of the transmission system is 1.8 mm. The pulsed-dye laser can be used with a highly flexible and uncomplicated 200-micron fiber. However, the laser system itself is more complicated than the Q-switched Nd:YAG laser and requires a great deal of maintenance. Biological evaluation of damage caused by direct irradiation shows that both laser systems produce minor damage of different degrees. YAG laser lithotripsy with the optomechanical coupler was assessed in 31 patients with ureteral calculi. The instability and limited effectiveness of the fiber application system necessitated auxiliary lithotripsy methods in 14 cases. Dye-laser lithotripsy is currently being tested in clinical application. Further development, such as systems for blind application or electronic feedback mechanisms to limit adverse tissue effects, have yet to be optimized. Nevertheless, laser-induced shock-wave lithotripsy has the potential to become a standard procedure in the endourologic management of stone disease. PMID:2902500

  3. Dual pulses for cavitation control in lithotripsy: Shock wave-bubble interactions and bioeffects

    NASA Astrophysics Data System (ADS)

    Sokolov, Dahlia L.

    2002-08-01

    Cavitation, the growth and collapse of gas/vapor bubbles, appears to play an important role in both stone comminution and tissue injury during shock wave lithotripsy, the clinical treatment in which focused, high amplitude shock pulses are used to comminute kidney stones. The goal of this research was to characterize in vitro cavitation activity and stone and cell damage in a novel system that uses converging dual pulses, produced by two identical, confocal lithotripters, to modify the cavitation field. The cavitation bubble dynamics were numerically calculated, and experiments were performed in a research electrohydraulic shock wave lithotripter to determine bubble size, lifetime, and pit depth created in aluminum foils by cavitation collapse. Furthermore, damage to model stones and to red blood cells was measured for both single and dual-pulses. A single shock pulse creates a ˜15 x 100 mm cloud of bubbles in water. The greatest cavitation activity and stone damage from single-pulses was found to occur 2 cm proximal to the geometric focus, F2, where the stone is normally aligned. Therefore, a 2 cm shift in stone alignment may potentially improve stone comminution and reduce tissue injury in clinical treatment. The dual-pulse lithotripter, on the other hand, generates a localized and intensified cavitation field that increased stone comminution efficiency at F2 by at least three times the maximum values achieved by single-pulses. At F2, acoustic pressure approximately doubled, as did bubble size, collapse time, and pit depth on foils. A significant reduction in comminution of stones suspended in glycerol indicates that cavitation activity, not the doubling of acoustic pressure, explains the increased comminution. On either side of F2, the second delayed pulse mitigated bubble collapse, resulting in little or no pitting on foils and reduced hemolysis, even when compared with single pulses. Numerical calculations of radial dynamics agreed with experimental findings

  4. Extracorporeal Shock Wave Lithotripsy for Management of Residual Stones after Ureterolithotripsy versus Mini-Percutaneous Nephrolithotomy: A Retrospective Study

    PubMed Central

    Huang, Zhichao; Zhao, Xiaokun; Zhang, Lei; Zhong, Zhaohui; Xu, Ran; Zhang, Lianping

    2013-01-01

    Purpose To compare the efficacy of extracorporeal shock wave lithotripsy in managing residual stones after ureterolithotripsy and mini-percutaneous nephrolithotomy. Materials and Methods A retrospective study was carried out of 71 patients with proximal urinary tract stones (greater than 10 mm) who underwent ureterolithotripsy or mini-percutaneous nephrolithotomy at a single institution from 2009 to 2011. The 71 patients were divided into two groups: group I (n = 37) comprised patients who underwent ureterolithotripsy, and group II (n = 34) comprised patients who underwent mini-percutaneous nephrolithotomy. Clinical characteristics, stone-free rates, stone demographics, and complications were evaluated. Results The overall stone-free rate was 90.1%. The stone-free rates in groups I and II were 97.3% and 82.4%, respectively. There was a statistically significant difference in the stone-free rates between groups I and II (P = 0.035). Neither serious intraoperative nor postoperative complications were observed. No significant difference in complications was observed between the two groups (P = 0.472). Conclusions The results of our study suggest that extracorporeal shock wave lithotripsy is an effective and safe auxiliary procedure for managing residual stones after primary endoscopic surgery. This procedure is associated with a satisfactory stone-free rate and a low complication rate, particularly for residual stones after ureteroscopic procedures. PMID:23785516

  5. Part I. Mechanisms of injury associated with extracorporeal shock wave lithotripsy; Part II. Exsolution of volatiles

    NASA Astrophysics Data System (ADS)

    Howard, Danny Dwayne

    Part I - Shock waves are focused in extracorporeal shock wave lithotripsy (ESWL) machines to strengths sufficient to fracture kidney stones. Substantial side effects-most of them acute-have resulted from this procedure, including injury to soft tissue. The focusing of shock waves through various layers of tissue is a complex process which stimulates many bio-mechano-chemical responses.This thesis presents results of an in vitro study of the initial mechanical stimulus. Planar nitrocellulose membranes of order 10 um thick were used as models of thin tissue structures. Two modes of failure were recorded: Failure due to cavitation collapsing on or near the membranes, and failure induced by altering the structure of shock waves. Tests were done in water at and around F2 to characterize the extent of cavitation damage, and was found to be confined within the focal region, 1.2 cm along the axis of focus.Scattering media were used to simulate the effects of acoustic nonuniformity of tissue and to alter the structure of focusing shock waves. 40 um diameter (average) hollow glass spheres were added to ethylene glycol, glycerine and castor oil to vary the properties of the scattering media. Multiple layer samples of various types of phantom tissue were tested in degassed castor oil to gauge the validity of the scattering media. The scattering media and tissue samples increased the rise time decreased strain rate in a similar fashion. Membranes were damaged by the decreased strain rate and accumulated effects of the altered structure: After about 20 or so shocks immersed in the scattering media and after about 100 shocks behind the tissue samples. The mode of failure was tearing with multiple tears in some cases from about .1 cm to about 3 cm depending of the number of shocks and membrane thickness.Part II - This work examines the exsolution of volatiles-carbon dioxide from water-in a cylindrical test cell under different pressure conditions. Water was supersaturated with

  6. Shock wave-bubble interaction near soft and rigid boundaries during lithotripsy: numerical analysis by the improved ghost fluid method.

    PubMed

    Kobayashi, Kazumichi; Kodama, Tetsuya; Takahira, Hiroyuki

    2011-10-01

    In the case of extracorporeal shock wave lithotripsy (ESWL), a shock wave-bubble interaction inevitably occurs near the focusing point of stones, resulting in stone fragmentation and subsequent tissue damage. Because shock wave-bubble interactions are high-speed phenomena occurring in tissue consisting of various media with different acoustic impedance values, numerical analysis is an effective method for elucidating the mechanism of these interactions. However, the mechanism has not been examined in detail because, at present, numerical simulations capable of incorporating the acoustic impedance of various tissues do not exist. Here, we show that the improved ghost fluid method (IGFM) can treat shock wave-bubble interactions in various media. Nonspherical bubble collapse near a rigid or soft tissue boundary (stone, liver, gelatin and fat) was analyzed. The reflection wave of an incident shock wave at a tissue boundary was the primary cause for the acceleration or deceleration of bubble collapse. The impulse that was obtained from the temporal evolution of pressure created by the bubble collapse increased the downward velocity of the boundary and caused subsequent boundary deformation. Results of this study showed that the IGFM is a useful method for analyzing the shock wave-bubble interaction near various tissues with different acoustic impedance. PMID:21918295

  7. Suppression of large intraluminal bubble expansion in shock wave lithotripsy without compromising stone comminution: refinement of reflector geometry.

    PubMed

    Zhou, Yufeng; Zhong, Pei

    2003-01-01

    Using the Hamilton model [Hamilton, J. Acoust. Soc. Am. 93, 1256-1266 (1993)], the effects of reflector geometry on the pulse profile and sequence of the shock waves produced by the original and upgraded reflector of an HM-3 lithotripter were evaluated qualitatively. Guided by this analysis, we have refined the geometry of the upgraded reflector to enhance its suppressive effect on intraluminal bubble expansion without compromising stone comminution in shock wave lithotripsy. Using the original HM-3 reflector at 20 kV, rupture of a standard vessel phantom made of cellulose hollow fiber (i.d. = 0.2 mm), in which degassed water seeded with ultrasound contrast agents was circulated, was produced at the lithotripter focus after about 30 shocks. In contrast, using the upgraded reflector at 24 kV no rupture of the vessel phantom could be produced within a 20-mm diameter around the lithotripter focus even after 200 shocks. On the other hand, stone comminution was comparable between the two reflector configurations, although slightly larger fragments were produced by the upgraded reflector. After 2000 shocks, stone comminution efficiency produced by the original HM-3 reflector at 20 kV is 97.15 +/- 1.92% (mean +/- SD), compared to 90.35 +/- 1.96% produced by the upgraded reflector at 24 kV (p<0.02). All together, it was found that the upgraded reflector could significantly reduce the propensity for vessel rupture in shock wave lithotripsy while maintaining satisfactory stone comminution. PMID:12558294

  8. Treatment of renal uric acid stone by extracorporeal shock wave lithotripsy combined with sodium bicarbonate: 2 case reports

    PubMed Central

    Li, Hao-Yong; Lian, Pei-Yu; Zhou, Zhi-Yan; Song, Peng; Yan, Yi; Liu, Ji-Hong

    2015-01-01

    Uric acid stone is the most comment radiolucent renal stone with high recurrence rate, which would further cause acute upper urinary tract obstruction and kidney failure. Here we report two cases of renal uric acid stone from December 2012 to April 2013. One 43-year-old male patient suffered from chronic uric acid nephrolithiasis caused by the long-term indwelling of bilateral double-J stent. Another 69-year-old patient was also diagnosed with uric acid nephrolithiasis at the right kidney. Both patients were first treated with extracorporeal shock wave lithotripsy (ESWL), followed by 1.5% sodium bicarbonate dissolution therapy. After a week of the treatment, the uric acid stones in both patients were completely dissolved without retrograde infection. In summary, the use of ESWL and sodium bicarbonate dissolution therapy as a combined modality is a safe, effective, inexpensive treatment for uric acid nephrolithiasis. PMID:26550383

  9. EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY AND ENDOSCOPIC URETERAL STENT PLACEMENT IN AN ASIAN SMALL-CLAWED OTTER (AONYX CINEREA) WITH NEPHROLITHIASIS.

    PubMed

    Wojick, Kimberlee B; Berent, Allyson C; Weisse, Chick W; Gamble, Kathryn C

    2015-06-01

    Urolithiasis is a significant disease concern in Asian small-clawed otters (Aonyx cinerea), with over 60% of captive animals affected. Bilateral ureteral stent placement, using endoscopic and fluoroscopic guidance, and extracorporeal shock wave lithotripsy (ESWL) were performed as salvage procedures in a 13-yr-old intact female Asian small-clawed otter following a 7-yr history of nephrolithiasis and progressive renal insufficiency. Following the procedure, radiographs revealed a slight shifting of urolith position, although a decrease in urolith mass was not observed. As a result of declining quality of life related to severe osteoarthritis, the otter was euthanized 5 wk after the procedure. While this treatment approach was unsuccessful in this case, the technique was clinically feasible, so ESWL and ureteral stent placement may remain a consideration for other individuals of this species presented earlier in the course of this disease. PMID:26056891

  10. Aggressive extracorporeal shock wave lithotripsy of gall bladder stones within wider treatment criteria: fragmentation rate and early results.

    PubMed Central

    Meiser, G; Heinerman, M; Lexer, G; Boeckl, O

    1992-01-01

    Two hundred and twenty patients with a total of 412 gall bladder stones of between 8 and 38 mm in size were treated with extracorporeal shock wave lithotripsy, using the overhead module Lithostrar Plus. Fifty six per cent of stones were solitary (mean (SD) diameter 23 (5) mm) and 9.5% of the patients had more than three stones. Stones were successfully disintegrated in 218 patients (fragmentation size less than 5 mm in 80%, less than 10 mm in 19%). Some 65% of patients required one treatment and the rest two or three. A mean (SD) of 4100 (1800) shock waves with a pressure of 700 bar were applied. Twenty four to 48 hours after lithotripsy a transient but significant increase in serum transaminase activities (31%) and in bilirubin (29%), urinary amylase (27%), and blood leukocyte (62%) values was observed. In 29% of patients there was a transient microhaematuria, in 2% transient macrohaematuria, and in 25% painless petechiae of the skin. Ultrasound showed temporary gall bladder wall oedema in 13%, temporary distension of the gall bladder in 11%, and transient common bile duct distension in 8% after treatment. After discharge from hospital, 31% of patients complained of recurrent colic that responded to simple analgesics. Four to eight weeks after therapy, four patients developed biliary pancreatitis and 11 biliary obstruction that was managed by endoscopy. To date, 105 patients have been followed for over 12 months. Sixty one of these had a solitary stone, 17 had two, and 27 had three or more stones. A total of 59 patients, including 44 with a primary solitary stone, eight with two stones, and seven with three or more stones are completely stone free. Images Figure 1 Figure 2 Figure 3 PMID:1371761

  11. Shock-induced bubble jetting into a viscous fluid with application to tissue injury in shock-wave lithotripsy

    PubMed Central

    Freund, J. B.; Shukla, R. K.; Evan, A. P.

    2009-01-01

    Shock waves in liquids are known to cause spherical gas bubbles to rapidly collapse and form strong re-entrant jets in the direction of the propagating shock. The interaction of these jets with an adjacent viscous liquid is investigated using finite-volume simulation methods. This configuration serves as a model for tissue injury during shock-wave lithotripsy, a medical procedure to remove kidney stones. In this case, the viscous fluid provides a crude model for the tissue. It is found that for viscosities comparable to what might be expected in tissue, the jet that forms upon collapse of a small bubble fails to penetrate deeply into the viscous fluid “tissue.” A simple model reproduces the penetration distance versus viscosity observed in the simulations and leads to a phenomenological model for the spreading of injury with multiple shocks. For a reasonable selection of a single efficiency parameter, this model is able to reproduce in vivo observations of an apparent 1000-shock threshold before wide-spread tissue injury occurs in targeted kidneys and the approximate extent of this injury after a typical clinical dose of 2000 shock waves. PMID:19894850

  12. Simulation of shock-induced bubble collapse with application to vascular injury in shockwave lithotripsy

    NASA Astrophysics Data System (ADS)

    Coralic, Vedran

    Shockwave lithotripsy is a noninvasive medical procedure wherein shockwaves are repeatedly focused at the location of kidney stones in order to pulverize them. Stone comminution is thought to be the product of two mechanisms: the propagation of stress waves within the stone and cavitation erosion. However, the latter mechanism has also been implicated in vascular injury. In the present work, shock-induced bubble collapse is studied in order to understand the role that it might play in inducing vascular injury. A high-order accurate, shock- and interface-capturing numerical scheme is developed to simulate the three-dimensional collapse of the bubble in both the free-field and inside a vessel phantom. The primary contributions of the numerical study are the characterization of the shock-bubble and shock-bubble-vessel interactions across a large parameter space that includes clinical shockwave lithotripsy pressure amplitudes, problem geometry and tissue viscoelasticity, and the subsequent correlation of these interactions to vascular injury. Specifically, measurements of the vessel wall pressures and displacements, as well as the finite strains in the fluid surrounding the bubble, are utilized with available experiments in tissue to evaluate damage potential. Estimates are made of the smallest injurious bubbles in the microvasculature during both the collapse and jetting phases of the bubble's life cycle. The present results suggest that bubbles larger than one micrometer in diameter could rupture blood vessels under clinical SWL conditions.

  13. Combined short and long-delay tandem shock waves to improve shock wave lithotripsy according to the Gilmore-Akulichev theory.

    PubMed

    de Icaza-Herrera, Miguel; Fernández, Francisco; Loske, Achim M

    2015-04-01

    Extracorporeal shock wave lithotripsy is a common non-invasive treatment for urinary stones whose fragmentation is achieved mainly by acoustic cavitation and mechanical stress. A few years ago, in vitro and in vivo experimentation demonstrated that such fragmentation can be improved, without increasing tissue damage, by sending a second shock wave hundreds of microseconds after the previous wave. Later, numerical simulations revealed that if the second pulse had a longer full width at half maximum than a standard shock wave, cavitation could be enhanced significantly. On the other side, a theoretical study showed that stress inside the stone can be increased if two lithotripter shock waves hit the stone with a delay of only 20 μs. We used the Gilmore-Akulichev formulation to show that, in principle, both effects can be combined, that is, stress and cavitation could be increased using a pressure pulse with long full width at half maximum, which reaches the stone within hundreds of microseconds after two 20 μs-delayed initial shock waves. Implementing the suggested pressure profile into clinical devices could be feasible, especially with piezoelectric shock wave sources. PMID:25553714

  14. Extracorporeal shock-wave lithotripsy with MPL9000 for the treatment of urinary stones in pediatric patients.

    PubMed

    Zanetti, G; Montanari, E; Guarneri, A; Seveso, M; Trinchieri, A; Rovera, F; Austoni, E; Pisani, E

    1993-12-01

    Extracorporeal shock-wave lithotripsy (ESWL) is now applied as the treatment of choice in most cases of urinary stones. Its acceptance in pediatry, however has been only gradual despite numerous positive studies. We report on fourteen young patients (mean age: 9.7 years) who were all treated by ESWL with the MPL9000 lithotriptor for renal stones. Each patient received an average of 1440 shocks with generator energy set at 14.4 Kv. Six of these patients required either analgosedation or anesthesia. No observable complications of treatment occurred. At one-month follow up, the kidneys of twelve patients were found to be stone-free, while two still presented fragments that could pass spontaneously. At three-month follow-up, thirteen patients were stone-free and a single patient retained some fragments. From this data we infer that ESWL with the MPL9000 lithotriptor may be used safety and efficiently to treat urolithiasis in younger patients. PMID:8312950

  15. Suppression of large intraluminal bubble expansion in shock wave lithotripsy without compromising stone comminution: methodology and in vitro experiments.

    PubMed

    Zhong, P; Zhou, Y

    2001-12-01

    for vessel rupture in shock wave lithotripsy. PMID:11785829

  16. Suppression of large intraluminal bubble expansion in shock wave lithotripsy without compromising stone comminution: Methodology and in vitro experiments

    NASA Astrophysics Data System (ADS)

    Zhong, Pei; Zhou, Yufeng

    2001-12-01

    rupture in shock wave lithotripsy.

  17. The protective effects of the traditional Chinese herbs against renal damage induced by extracorporeal shock wave lithotripsy: a clinical study.

    PubMed

    Sheng, Binwu; He, Dalin; Zhao, Jun; Chen, Xingfa; Nan, Xunyi

    2011-04-01

    Extracorporeal shock wave lithotripsy (ESWL)-induced renal damage can occur as a result of multiple mechanisms. We have reported previously that Astragalus membranaceus, Salvia miltiorrhiza, a decoction of six drugs containing rhizoma Rehmanniae preparata and supplements of a few traditional Chinese medicinal herbs for invigorating the kidney and excreting calculus, have a protective effect on renal injury induced by high-energy shock waves (HESW) in rabbits. In this clinical study we further investigate the protective effects of these traditional Chinese herbs against renal damage induced by ESWL. Sixty consenting patients with renal calculus who underwent ESWL treatment were included and randomly assigned to the medication group or control group. Post-ESWL plasma nitric oxide (NO), endothelin-1 (ET-1), malondialdehyde (MDA), and serum tumor necrosis factor α (TNF-α) increased significantly in the controls (P < 0.05), while in the medication group, slightly but not significantly elevated levels of plasma ET-1, NO, and serum TNF-α were found. The difference between the groups was statistically significant (P < 0.05). The levels of superoxide dismutase (SOD) decreased gradually in the controls, reaching a trough 72 h after ESWL (P < 0.05), while in the treated group it was unchanged, and remained at a level higher versus the controls (P < 0.05). Plasma NO peaked twice by 72 h and at 1 week in the controls (P < 0.05). Urinary enzymes and β(2)-microglobulin increased significantly and peaked by 24 h and immediately after ESWL (P < 0.05). These values were greater in the controls, and the difference was statistically significant (P < 0.05). This study demonstrates that the preparations of traditional Chinese medicines for invigorating the kidney and excreting calculus can reduce renal tubular damage induced by ESWL, and can shorten the recovery time of renal tubules in human subjects. PMID:20607528

  18. A Case of Septic Shock caused by Achromobacter xylosoxidans in an Immunocompetent Female Patient after Extracorporeal Shock Wave Lithotripsy for a Ureteral Stone

    PubMed Central

    Lee, So Yon; Park, In Young; Park, So Yeon; Lee, Jin Seo; Kang, Goeun; Kim, Jae Seok

    2016-01-01

    Achromobacter xylosoxidans can cause various types of infections, but its infection in humans is rare. A. xylosoxidans has been reported as a rare etiological agent of infections including primary bacteremia, catheter-related bloodstream infection, endocarditis, otitis, and pneumonia, particularly in immunocompromised hosts. We encountered a case of septic shock caused by A. xylosoxidans in a 52-year-old, immunocompetent woman with no underlying disease, who received extracorporeal shock wave lithotripsy to remove a left upper ureteral stone. She was treated with antibiotics to which the organism was susceptible but died as a result of septic shock. PMID:27104016

  19. A Case of Septic Shock caused by Achromobacter xylosoxidans in an Immunocompetent Female Patient after Extracorporeal Shock Wave Lithotripsy for a Ureteral Stone.

    PubMed

    Lee, Jae Hyuk; Lee, So Yon; Park, In Young; Park, So Yeon; Lee, Jin Seo; Kang, Goeun; Kim, Jae Seok; Eom, Joong Sik

    2016-03-01

    Achromobacter xylosoxidans can cause various types of infections, but its infection in humans is rare. A. xylosoxidans has been reported as a rare etiological agent of infections including primary bacteremia, catheter-related bloodstream infection, endocarditis, otitis, and pneumonia, particularly in immunocompromised hosts. We encountered a case of septic shock caused by A. xylosoxidans in a 52-year-old, immunocompetent woman with no underlying disease, who received extracorporeal shock wave lithotripsy to remove a left upper ureteral stone. She was treated with antibiotics to which the organism was susceptible but died as a result of septic shock. PMID:27104016

  20. [The endoscopic treatment of large calculi in the choledochus. The preliminary results with intracorporeal electrohydraulic shock-wave lithotripsy].

    PubMed

    Vladimirov, B

    1990-01-01

    Results are reported of endoscopic treatment of: 236 patients with common bile duct calculi treated by endoscopic sphincterotomy with or without hydrostatic balloon extraction and extraction of the calculi, mechanical lithotripsy and endoprosthesis; preliminary results in 12 patients treated by intracorporeal electrohydraulic lithotripsy. Complete removal of calculi from the common bile duct was achieved in 171 of 236 sphincterotomized patients (72 per cent). Complications were observed in 11 per cent of the patients. Mechanical cracking of common bile duct calculi was realized in 60 of 65 patients (92 per cent) with complications observed in 3 per cent. Thus, with the use of mechanical lithotripsy the success of endoscopic treatment rose to 98 per cent, without increase in the incidence of complications. Seven patients had endoprostheses placed because of failure to extract the calculi. Intracorporeal electrohydraulic lithotripsy was performed in 12 patients with common bile duct lithiasis (4 with single and 8 with numerous stones with diameter 20-40 mm. In one patient transient acute pancreatitis was observed. A rise in serum amylase content was recorded in 9 patients. The stones in the common bile duct were effectively broken to pieces and removed in 8 patients. Lithotripsy was unsuccessful in 4 patients, two of whom had solid calcium depositions. In the common bile duct of the other two MTBE gas applied. The patients were subjected to repeated lithotripsy with positive effect. It is pointed out in conclusion that crushing stones in the common bile duct allows real improvement of the results of endoscopic sphincterotomy in common bile duct calculosis. Endoscopic treatment of larger calculi became also feasible which until a few years ago were contraindication for endoscopic treatment. PMID:2102523

  1. [Research on Energy Distribution During Osteoarthritis Treatment Using Shock Wave Lithotripsy].

    PubMed

    Zhang, Shinian; Wang, Xiaofeng; Zhang, Dong

    2015-04-01

    Extracorporeal shock wave treatment is capable of providing a non-surgical and effective treatment modality for patients suffering from osteoarthritis. The major objective of current works is to investigate how the shock wave (SW) field would change if a bony structure exists in the path of the acoustic wave. Firstly, a model of finite element method (FEM) was developed based on Comsol software in the present study. Then, high-speed photography experiments were performed to record cavitation bubbles with the presence of mimic bone. On the basis of comparing experimental with simulated results, the effectiveness of FEM model could be verified. Finally, the energy distribution during extracorporeal shock wave treatment was predicted. The results showed that the shock wave field was deflected with the presence of bony structure and varying deflection angles could be observed as the bone shifted up in the z-direction relative to shock wave geometric focus. Combining MRI/CT scans to FEM modeling is helpful for better standardizing the treatment dosage and optimizing treatment protocols in the clinic. PMID:26211244

  2. Effect of High Shock Number on Acute Complication Development After Extracorporeal Shockwave Lithotripsy

    PubMed Central

    Hadj-Moussa, Miriam

    2013-01-01

    Abstract Purpose We assessed whether high shock number is associated with higher rates of acute complication development after extracorporeal shockwave lithotripsy (SWL). Patients and Methods A retrospective chart review of 372 patients who underwent 436 SWL procedures at 24 kV using a Medstone STS-T lithotripter (Medstone International Inc., Aliso Viejo, CA) was conducted. Complications occurred within 4 weeks of SWL. Treatments were split into three cohorts based on shock number (<2400, 2401–4000, and >4000). Postoperative sequelae of patients who were stone free and those with residual stone were studied separately. Chi-square tests were used to evaluate the relationship between shock number cohort and postoperative complication development. Results SWL treatments recorded for each cohort were 158 (37.4%), 145 (34.4%), and 119 (28.2%), respectively. The short-term complication rate when SWL was successful was 8.3% overall. Complication rate for each cohort was 9.5% (11), 7.8% (5), and 7.2% (7), respectively. When SWL was successful, statistical analysis revealed no significant difference between complication rates and shock number cohort (P=0.63). Complications in patients with a residual stone occurred after 41.4% of treatments and trended upward with shock number cohort, but did not reach statistical significance (P=0.84). Conclusions At high voltage, high shock number was not shown to cause higher rates of short-term postoperative complications, as experienced by patients, when SWL was successful or resulted in a residual stone, yet complication rates associated with residual stone burden were approximately five times as common. Forgoing a higher shock number in the presence of a residual stone may therefore increase the risks of sequelae immediately after SWL. PMID:23537270

  3. Modeling and experimental analysis of acoustic cavitation bubbles for Burst Wave Lithotripsy

    PubMed Central

    Maeda, Kazuki; Colonius, Tim; Kreider, Wayne; Maxwell, Adam; Cunitz, Bryan; Bailey, Michael

    2016-01-01

    A combined modeling and experimental study of acoustic cavitation bubbles that are initiated by focused ultrasound waves is reported. Focused ultrasound waves of frequency 335 kHz and peak negative pressure 8 MPa are generated in a water tank by a piezoelectric transducer to initiate cavitation. The resulting pressure field is obtained by direct numerical simulation (DNS) and used to simulate single bubble oscillation. The characteristics of cavitation bubbles observed by high-speed photography qualitatively agree withs the simulation result. Finally, bubble clouds are captured using acoustic B-mode imaging that works in synchronization with high-speed photography. PMID:27087826

  4. Modeling and experimental analysis of acoustic cavitation bubbles for Burst Wave Lithotripsy

    NASA Astrophysics Data System (ADS)

    Maeda, Kazuki; Kreider, Wayne; Maxwell, Adam; Cunitz, Bryan; Colonius, Tim; Bailey, Michael

    2015-12-01

    Cavitation bubbles initiated by focused ultrasound waves are investigated through experiments and modeling. Pulses of focused ultrasound with a frequency of 335 kHz and a peak negative pressure of 8 MPa is generated in a water tank by a piezoelectric transducer to initiate cavitation. The pressure field is modeled by solving the Euler equations and used to simulate single bubble oscillation. The characteristics of cavitation bubbles observed by highspeed photography qualitatively agree with the simulation results. Finally, bubble clouds are captured using acoustic B-mode imaging that works synchronized with high-speed photography.

  5. Overview of shock waves in medicine

    NASA Astrophysics Data System (ADS)

    Cleveland, Robin O.

    2003-10-01

    A brief overview of three applications of shock waves is presented. Shock wave lithotripsy (SWL) has been in clinical use for more than 20 years. In the United States it is used to treat more than 80% of kidney stone cases and has wide acceptance with patients because it is a noninvasive procedure. Despite SWLs enormous success there is no agreement on how shock waves comminute stones. There is also a general acceptance that shock waves lead to trauma to the soft tissue of the kidney. Yet there has been little forward progress in developing lithotripters which provide comminution with less side-effects, indeed the original machine is still considered the gold standard. The last decade has seen the advent of new shock wave devices for treating principally musculoskeletal indications, such as plantar fasciitis, tennis elbow, and bone fractures that do not heal. This is referred to as shock wave therapy (SWT). The mechanisms by which SWT works are even less well understood than SWL and the consequences of bioeffects have also not been studied in detail. Shock waves have also been shown to be effective at enhancing drug delivery into cells and assisting with gene transfection. [Work partially supported by NIH.

  6. Proteus mirabilis viability after lithotripsy of struvite calculi

    NASA Astrophysics Data System (ADS)

    Prabakharan, Sabitha; Teichman, Joel M. H.; Spore, Scott S.; Sabanegh, Edmund; Glickman, Randolph D.; McLean, Robert J. C.

    2000-05-01

    Urinary calculi composed of struvite harbor urease-producing bacteria within the stone. The photothermal mechanism of holmium:YAG lithotripsy is uniquely different than other lithotripsy devices. We postulated that bacterial viability of struvite calculi would be less for calculi fragmented with holmium:YAG irradiation compared to other lithotripsy devices. Human calculi of known struvite composition (greater than 90% magnesium ammonium phosphate hexahydrate) were incubated with Proteus mirabilis. Calculi were fragmented with no lithotripsy (controls), or shock wave, intracorporeal ultrasonic, electrohydraulic, pneumatic, holmium:YAG or pulsed dye laser lithotripsy. After lithotripsy, stone fragments were sonicated and specimens were serially plated for 48 hours at 38 C. Bacterial counts and the rate of bacterial sterilization were compared. Median bacterial counts (colony forming units per ml) were 8 X 106 in controls and 3 X 106 in shock wave, 3 X 107 in ultrasonic, 4 X 105 in electrohydraulic, 8 X 106 in pneumatic, 5 X 104 in holmium:YAG and 1 X 106 in pulsed dye laser lithotripsy, p less than 0.001. The rate of bacterial sterilization was 50% for holmium:YAG lithotripsy treated stones versus 0% for each of the other cohorts, p less than 0.01. P. mirabilis viability is less after holmium:YAG irradiation compared to other lithotripsy devices.

  7. Impact of ureteric stent on outcome of extracorporeal shockwave lithotripsy: A propensity score analysis

    PubMed Central

    Gołąb, Adam; Słojewski, Marcin

    2016-01-01

    Introduction Extracorporeal shockwave lithotripsy (SWL) is one of the most frequently performed procedures in patients with urolithiasis. For ureter-localized stones, SWL is often preceded by a double J stent insertion. However, fear of serious complications, including sepsis associated with stents, is often expressed. The following study assessed the impact of stent insertions on the results of SWL in patients with ureteric stones. Material and methods The study group consisted of 411 ureteric stone patients who were treated with SWL from January 2010 to December 2014. In 60 cases, treatment was preceded by ureteric stent insertion. A propensity scoring system was used to pair non-stented patients with the stented group. Success rates were assessed and compared using the chi-squared test. Multivariate logistic regression analysis was used to evaluate the influence of particular variables on the stone-free rate. Results The overall success rate was 82.2%. After matching, the success rate of the stented group was not significantly different from the control group (85.0% vs. 83.3% respectively, p = 0.80). The mean number of sessions was higher in the stented group (1.88 per patient). Stones located in the lower part of the ureter have the greatest chance of being successfully treated. Conclusions The double J stent has no influence on the outcome of SWL treatment. In view of the greater likelihood of having additional sessions, this approach should be reserved for selected cases. PMID:27551556

  8. A comparative study to analyze the efficacy and safety of flexible ureteroscopy combined with holmium laser lithotripsy for residual calculi after percutaneous nephrolithotripsy

    PubMed Central

    Xu, Gang; Wen, Jiaming; Li, Zhongyi; Zhang, Zhewei; Gong, Xiuqing; Chen, Jimin; Du, Chuanjun

    2015-01-01

    A certain proportion of patients with initial Percutaneous nephrolithotripsy (PCNL) management require ancillary procedures to increase the stone-free rate. In this study, we aim to analyze the efficacy and safety of flexible ureteroscopy combined with holmium laser lithotripsy (F-UL) for treatment of residual calculi after PCNL by comparison with extracorporeal shockwave lithotripsy (SWL). Total of 96 patients with residual renal calculi (4 mm to 20 mm) after PCNL was enrolled from May 2010 to March 2013. They were randomly divided into two groups: US Group: patients were treated with F-UL; SWL Group: patients were treated with SWL. Follow-up was made one month and three months after treatment. The mean residual stone size after PCNL was 12.4 ± 4.3 mm in US group compared with 11.9 ± 4.5 in SWL group. The stone-free rate was 84.7% one month after surgical procedure in US group, this rate increased to 91.3% in the third months, while the stone-free rate in SWL group is 64.6% one month after treatment and 72.9% in the third month. For residual stone in lower calyx, the stone-free rate three month after treatment was 90.4% in US group compared to 65.2% in SWL group (P < 0.05). The overall complication rate was low in both groups, no severe complication was found. Both F-UL and SWL are safe and effective methods for residual calculi after PCNL, without severe complications. F-UL provided significantly higher stone-free rate compared with SWL, especially for low-pole calculi. PMID:26064375

  9. Study of the ureterovesical jet flow by means of dupplex Doppler ultrasonography in patients with residual ureteral stone after extracorporeal shock wave lithotripsy.

    PubMed

    Ciftci, Halil; Cece, Hasan; Dusak, Abdurrahim; Savas, Murat; Verit, Ayhan; Yeni, Ercan

    2010-02-01

    The aims of our study are to evaluate ureterovesical jet flow Doppler ultrasound (US) in patients with residual ureteral stone after extracorporeal shock wave lithotripsy (ESWL) and to compare with unobstructed contralateral ureter. Patients who have residual ureteral stone in intravenous pyelography (IVP) and/or computed tomography (CT) after ESWL and unobstructed contralateral ureter in 20 patients were prospectively evaluated with Doppler US. The mean peak velocity of the Doppler waveforms was obtained on the residual ureteral stone and contralateral non-obstructed ureter (17.10 +/- 20), (56.0 +/- 32), respectively (P < 0.05). In conclusion, due to the absence of contraindications and side-effects, Doppler US is sensitive and highly specific that can contribute significantly to the diagnosis of residual ureteral stone after ESWL. It can replace IVP and/or CT, in condition where IVP is undesirable and in addition Doppler US can supply a functional investigation of the obstructed ureter. PMID:19940988

  10. Cost-effectiveness of extracorporeal shock wave lithotripsy in a poor resource setting: The Okada, Nigeria experience

    PubMed Central

    Eze, Kenneth C.; Irekpita, E.; Salami, T. A.

    2016-01-01

    Background: The first extracorporeal shock wave lithotripsy (ESWL) used in Nigeria was at Igbinedion Hospital and Medical Research Centre (IHMRC), Okada in 1992 and it functioned for 6 consecutive years. The objectives of this study were to analyze the cost-effectiveness of the procedure and highlight the associated factors that led to its failure. Methods: A retrospective study of medical records and publications associated with the use of ESWL at IHMRC, Okada, for the period of 1992 to 1998. The study was conducted between January 2003 and November 2008. Unclassified authentic information relating to the use of ESWL and treatment of upper urinary tract stones was obtained from the IHMRC Okada and some government hospitals on hospital bills. Relevant documents in public domains related to the national and international wages and emoluments of medical workers and socioeconomic development of Nigeria within the time the ESWL functioned were studied. Result: A total of 32 patients were treated with 51 treatment sessions which is an average of nine patients per year and an average of two treatment sessions per patient were involved. The reasons for the low patronage were the extremely low stone formation rate of Nigerians, poverty, and out-of-pocket payment system. In addition, each treatment session of ESWL at Okada cost an average of $681.8 compared to $227.3 for open nephrolithotomy in a nearby high profile teaching hospital. The IHMRC, Okada, paid an average annual salary of ₦180,000 ($8,181.8) for each medical consultant compared to ₦120,000 ($5,454.5) paid by federal teaching hospitals in Nigeria within the period. Expatriate consultant doctors from Europe and USA who initially manned the lithotriptor at IHMRC, Okada, were paid much higher salaries. Average annual income of $5,909 for each of the 6 years amounting to a total of $34,771.7 for the six years was realized which could not maintain staff salaries in the hospital leading to staff emigration

  11. Shock Wave Lithotripsy

    MedlinePlus

    ... an organ donor. Professionals GFR CME/CE Primary Care Clinician Tools Guidelines Physicians Pharmacists Advanced Practitioners Nurses & Technicians Dietitians Social Workers Spring Clinical Meetings Local Chapters Journals Education & Research Kidney Career Center Featured Story GFR You can ...

  12. Focused Ultrasound and Lithotripsy.

    PubMed

    Ikeda, Teiichiro; Yoshizawa, Shin; Koizumi, Norihiro; Mitsuishi, Mamoru; Matsumoto, Yoichiro

    2016-01-01

    Shock wave lithotripsy has generally been a first choice for kidney stone removal. The shock wave lithotripter uses an order of microsecond pulse durations and up to a 100 MPa pressure spike triggered at approximately 0.5-2 Hz to fragment kidney stones through mechanical mechanisms. One important mechanism is cavitation. We proposed an alternative type of lithotripsy method that maximizes cavitation activity to disintegrate kidney stones using high-intensity focused ultrasound (HIFU). Here we outline the method according to the previously published literature (Matsumoto et al., Dynamics of bubble cloud in focused ultrasound. Proceedings of the second international symposium on therapeutic ultrasound, pp 290-299, 2002; Ikeda et al., Ultrasound Med Biol 32:1383-1397, 2006; Yoshizawa et al., Med Biol Eng Comput 47:851-860, 2009; Koizumi et al., A control framework for the non-invasive ultrasound the ragnostic system. Proceedings of 2009 IEEE/RSJ International Conference on Intelligent Robotics and Systems (IROS), pp 4511-4516, 2009; Koizumi et al., IEEE Trans Robot 25:522-538, 2009). Cavitation activity is highly unpredictable; thus, a precise control system is needed. The proposed method comprises three steps of control in kidney stone treatment. The first step is control of localized high pressure fluctuation on the stone. The second step is monitoring of cavitation activity and giving feedback on the optimized ultrasound conditions. The third step is stone tracking and precise ultrasound focusing on the stone. For the high pressure control we designed a two-frequency wave (cavitation control (C-C) waveform); a high frequency ultrasound pulse (1-4 MHz) to create a cavitation cloud, and a low frequency trailing pulse (0.5 MHz) following the high frequency pulse to force the cloud into collapse. High speed photography showed cavitation collapse on a kidney stone and shock wave emission from the cloud. We also conducted in-vitro erosion tests of model and natural

  13. Acoustic cavitation bubbles in the kidney induced by focused shock waves in extracorporeal shock wave lithotripsy (ESWL)

    NASA Astrophysics Data System (ADS)

    Kuwahara, M.; Ioritani, N.; Kambe, K.; Taguchi, K.; Saito, T.; Igarashi, M.; Shirai, S.; Orikasa, S.; Takayama, K.

    1990-07-01

    On an ultrasonic imaging system a hyperechoic region was observed in a focal area of fucused shock waves in the dog kidney. This study was performed to learn whether cavitation bubbles are responsible for this hyperechoic region. The ultrasonic images in water of varying temperatures were not markedly different. In the flowing stream of distilled water, the stream was demonstrated as a hyperechoic region only with a mixture of air bubbles. Streams of 5%-50% glucose solutions were also demonstrated as a hyperechoic region. However, such concentration changes in living tissue, as well as thermal changes, are hardly thought to be induced. The holographic interferometry showed that the cavitation bubbles remained for more than 500 msec. in the focal area in water. This finding indicate that the bubble can remain for longer period than previously supposed. These results support the contentions that cavitation bubbles are responsible for the hyperechoic region in the kidney in situ.

  14. Extracorporeal shock waves lithotripsy versus retrograde ureteroscopy: is radiation exposure a criterion when we choose which modern treatment to apply for ureteric stones?

    PubMed Central

    Pricop, Catalin; Maier, Adrian; Negru, Dragos; Malau, Ovidiu; Orsolya, Martha; Radavoi, Daniel; Serban, Dragomir R.

    2014-01-01

    The aim of this study is to compare two major urological procedures in terms of patient exposure to radiation. We evaluated 175 patients, that were subjected to retrograde ureteroscopy (URS) and extracorporeal shock waves lithotripsy (ESWL) for lumbar or pelvic ureteral lithiasis, at two urological departments. The C-arm Siemens (produced in 2010 by Siemens AG, Germany) was used for ureteroscopy. The radiological devices of the lithotripters used in this study in the two clinical centers had similar characteristics. We evaluated patient exposure to ionizing radiation by using a relevant parameter, the air kerma-area product (PKA; all values in cGy cm2), calculated from the radiation dose values recorded by the fluoroscopy device. PKA depends on technical parameters that change due to anatomical characteristics of each case examined, such as body mass index (BMI), waist circumference, and stone location. For the patients subjected to ESWL for lumbar ureteral lithiasis the mean of PKA(cGy cm2) was 509 (SD=180), while for those treated for pelvic ureteral lithiasis the mean of PKA was 342 (SD=201). In the URS group for lumbar ureteral lithiasis, the mean of PKA (cGy cm2) was 892 (SD=436), while for patients with pelvic ureteral lithiasis, the mean of PKA was 601 (SD=429). The patients treated by URS had higher exposure to ionizing radiation dose than patients treated by ESWL. The risk factors of higher radiation doses were obesity, exposure time, and localization of the stones. PMID:25428680

  15. Flexible Ureterorenoscopy Versus Extracorporeal Shock Wave Lithotripsy for the Treatment of Renal Pelvis Stones of 10–20 mm in Obese Patients

    PubMed Central

    Javanmard, Babak; Razaghi, Mohammad Reza; Ansari Jafari, Anahita; Mazloomfard, Mohammad Mohsen

    2015-01-01

    Introduction: To compare outcomes of retrograde intrarenal surgery (RIRS) with extracorporeal shock wave lithotripsy (ESWL) as treatment of choice. Methods: A total number of 46 patients with renal pelvic stones 10-20 mm and body mass index (BMI) >30 randomized in two groups underwent RIRS and ESWL from 2011 to 2014 and followed for 3 months. Results: The patients mean ± SD age was 36.1 ± 13.1 years in ESWL and 33.2 ± 11.4 years in RIRS groups (P = .1) with comparable BMI in both groups (36.2 vs 38.1). In ESWL and RIRS groups, the operation time was 72.2 ± 21 vs 66.5 ± 19 minutes (P = .061), respectively. Stone free rate (SFR) at 3 months was 68% in ESWL group vs 90.4% in RIRS group (P = .019). The complication rate was 20% in ESWL group vs 14.2% in RIRS group (P = .211) but all of them were minor and managed conservatively. Conclusion: According to our study, RIRS procedure in comparison with ESWL is a safe and successful option of treatment for renal pelvis stone of 10-20 mm in obese people. PMID:26705461

  16. Quantitative Assessment of Shockwave Lithotripsy Accuracy and the Effect of Respiratory Motion*

    PubMed Central

    Bailey, Michael R.; Shah, Anup R.; Hsi, Ryan S.; Paun, Marla; Harper, Jonathan D.

    2012-01-01

    Abstract Background and Purpose Effective stone comminution during shockwave lithotripsy (SWL) is dependent on precise three-dimensional targeting of the shockwave. Respiratory motion, imprecise targeting or shockwave alignment, and stone movement may compromise treatment efficacy. The purpose of this study was to evaluate the accuracy of shockwave targeting during SWL treatment and the effect of motion from respiration. Patients and Methods Ten patients underwent SWL for the treatment of 13 renal stones. Stones were targeted fluoroscopically using a Healthtronics Lithotron (five cases) or Dornier Compact Delta II (five cases) shockwave lithotripter. Shocks were delivered at a rate of 1 to 2 Hz with ramping shockwave energy settings of 14 to 26 kV or level 1 to 5. After the low energy pretreatment and protective pause, a commercial diagnostic ultrasound (US) imaging system was used to record images of the stone during active SWL treatment. Shockwave accuracy, defined as the proportion of shockwaves that resulted in stone motion with shockwave delivery, and respiratory stone motion were determined by two independent observers who reviewed the ultrasonographic videos. Results Mean age was 51±15 years with 60% men, and mean stone size was 10.5±3.7 mm (range 5–18 mm). A mean of 2675±303 shocks was delivered. Shockwave-induced stone motion was observed with every stone. Accurate targeting of the stone occurred in 60%±15% of shockwaves. Conclusions US imaging during SWL revealed that 40% of shockwaves miss the stone and contribute solely to tissue injury, primarily from movement with respiration. These data support the need for a device to deliver shockwaves only when the stone is in target. US imaging provides real-time assessment of stone targeting and accuracy of shockwave delivery. PMID:22471349

  17. Optimal Skin-to-Stone Distance Is a Positive Predictor for Successful Outcomes in Upper Ureter Calculi following Extracorporeal Shock Wave Lithotripsy: A Bayesian Model Averaging Approach

    PubMed Central

    Cho, Kang Su; Jung, Hae Do; Ham, Won Sik; Chung, Doo Yong; Kang, Yong Jin; Jang, Won Sik; Kwon, Jong Kyou; Choi, Young Deuk; Lee, Joo Yong

    2015-01-01

    Objectives To investigate whether skin-to-stone distance (SSD), which remains controversial in patients with ureter stones, can be a predicting factor for one session success following extracorporeal shock wave lithotripsy (ESWL) in patients with upper ureter stones. Patients and Methods We retrospectively reviewed the medical records of 1,519 patients who underwent their first ESWL between January 2005 and December 2013. Among these patients, 492 had upper ureter stones that measured 4–20 mm and were eligible for our analyses. Maximal stone length, mean stone density (HU), and SSD were determined on pretreatment non-contrast computed tomography (NCCT). For subgroup analyses, patients were divided into four groups. Group 1 consisted of patients with SSD<25th percentile, group 2 consisted of patients with SSD in the 25th to 50th percentile, group 3 patients had SSD in the 50th to 75th percentile, and group 4 patients had SSD≥75th percentile. Results In analyses of group 2 patients versus others, there were no statistical differences in mean age, stone length and density. However, the one session success rate in group 2 was higher than other groups (77.9% vs. 67.0%; P = 0.032). The multivariate logistic regression model revealed that shorter stone length, lower stone density, and the group 2 SSD were positive predictors for successful outcomes in ESWL. Using the Bayesian model-averaging approach, longer stone length, lower stone density, and group 2 SSD can be also positive predictors for successful outcomes following ESWL. Conclusions Our data indicate that a group 2 SSD of approximately 10 cm is a positive predictor for success following ESWL. PMID:26659086

  18. Extracorporeal shock wave lithotripsy versus retrograde intrarenal surgery for treatment for renal stones 1-2 cm: a meta-analysis.

    PubMed

    Zheng, Changjian; Yang, Hongmei; Luo, Jun; Xiong, Bo; Wang, Hongzhi; Jiang, Qing

    2015-11-01

    This study is to evaluate the efficacy and safety of extracorporeal shock wave lithotripsy (ESWL) versus retrograde intrarenal surgery (RIRS) for the treatment for renal calculi 1-2 cm. PubMed, Embase, the Cochrane Central Register of Controlled Trials, and the Chinese Biomedical Literature Database were researched and hand-searched for relevant congress abstracts and journals about RIRS and ESWL for the treatment for 1- to 2-cm renal stones. The retrieval time ended in September 2014. The related trials met the inclusion criteria were included in the meta-analysis. Two reviewers independently assessed the quality of all included studies, and meta-analysis was performed with RevMan 5.2. Seven literatures were retrieved, including 983 patients. The meta-analysis results showed that, compared to RIRS group, the patients in ESWL group had the following features:(1) the stone-free rate [relative risk (RR) 0.86; 95% confidence interval (CI) 0.77-0.95, P = 0.005] was significantly different between two groups; (2) The retreatment rate of RIRS group was lower (RR 8.12; 95% CI 4.77-13.83, P < 0.00); (3) The complications were not significantly different between two groups (Grade I RR 1.06; 95% CI 0.67-1.69, P = 0.80; Grade II RR 0.75; 95% CI 0.29-1.91, P = 0.54; Grade III RR 0.86; 95% CI 0.26-2.86, P = 0.80). Compared to ESWL, our results showed that RIRS provided significantly higher stone-free rate and lower retreatment rate and without increase in the incidence of complications. However, further randomized trials are needed to confirm these findings. PMID:26211003

  19. Pain control using pethidine in combination with diazepam compared to diclofenac in combination with hyoscine-n-butyl bromide: in patients undergoing extracorporeal shock wave lithotripsy

    PubMed Central

    Cecen, Kursat; Karadag, Mert Ali; Uslu, Mehmet; Arslan, Omer Erkam

    2015-01-01

    Introduction Extracorporeal Shock Wave Lithotripsy (ESWL) remains the preferred least invasive treatment for urinary tract stones. The main purpose of this study was to compare two treatment modalities for pain control during the ESWL procedure. Material and methods From 2013 to 2014, 220 patients received ESWL for kidney stones. Before the procedure, the weight and height were measured to determine the body mass index (BMI); in addition, oxygen saturation and the pulse of the patients, as well as pain level were determined. The pain control provided included two different methods: diclofenac sodium plus hyoscine-N-butyl bromide in the first group and pethidine plus diazepam in the second group. The pain level of the patients was determined using two different scales: the Wong-Baker and the Visual Analogue scales (VAS). At the end of three sessions, all patients were evaluated for the stone fragmentation rate by plain abdominal X-ray, and the findings were recorded and analyzed. Results A total of 220 patients were enrolled in this study. There were 91 patients in the first group (diclofenac sodium + hyoscine-N-butyl bromide) (male/female: 63/28) and 129 (male/female: 83/46) patients in the second group (pethidine HCL +diazepam). The mean age with SD according to each group was 42.03 (±16.43) and 42.56 (±14.23), respectively (p = 0.8). With regard to pain scores (using the Wong-Baker and VAS scales), the responses were significantly lower in the second group (p <0.001). Conclusions Pethidine in combination with diazepam was superior to diclofenac and Hyoscine-N-butyl bromide for pain in patients undergoing ESWL. PMID:26251744

  20. An Evaluation of Electroacupuncture at the Weizhong Acupoint (BL-40) as a Means of Relieving Pain Induced by Extracorporeal Shock Wave Lithotripsy.

    PubMed

    Chen, Wei-Ta; Chang, Fang-Chia; Chen, Yi-Hung; Lin, Jaung-Geng

    2014-01-01

    Background. Extracorporeal shock wave lithotripsy (ESWL) is the preferred option for urolithiasis treatment. However, intensities of pain may be induced and the sedative anesthetic or analgesics were usually needed. The aim of this study was to develop an improved acupuncture-assisted anesthesia approach in pain relief. Methods. We conducted a single-blind, randomized controlled study in China Medical University Hospital. Patients treated by ESWL due to upper urolithiasis were randomly divided into control group, sham-EA group, and 100 Hz EA group. The high frequency electroacupuncture (EA) was applied at the Weizhong acupoint (100 Hz EA group) for 20 minutes prior to the ESWL. In the sham-EA group, the same procedures were performed as those of 100 Hz EA group but no electric current was given to stimulate the acupoints. In the control group, no action was taken before operation. The information including the numbers and dosage of analgesic requirements, pain score, vital signs, and the satisfaction of procedure was collected. Results. A total of 74 subjects were recruited and we found that the interval to the first request analgesic, the number/total dosage of additional analgesic, recovery time from anesthesia, and the satisfaction were all better in both the 100 Hz EA and the sham-EA group. The 100 Hz EA also showed better relief of painful sensations by delaying the onset of pain. Conclusions. The 100 Hz EA and the sham-EA can effectively relieve pain due to ESWL as well as reducing the dosage of opium analgesic used. PMID:25152761

  1. Fragmentation methods in laser lithotripsy

    NASA Astrophysics Data System (ADS)

    Jiang, Zhi X.; Whitehurst, Colin; King, Terence A.

    1991-07-01

    Following a series of opto-acoustic-mechanical and spectroscopic studies into the basic mechanisms of laser lithotripsy, a plasma-mediated opto-mechanical energy transfer model is presented. Laser energy, first absorbed by the calculi material at the surface and couples into the initiated plasma following ionization of vaporized material, is finally transformed into destructive mechanical energy via a shock wave induced by the impulsive expansion of the resulting plasma. This leads to the fragmentation of the calculi. The laser-plasma energy coupling gives a new definition for the fluence threshold to laser induced breakdown, which agrees with shock wave detection and analysis. A laser pulse shape with initial low intensity and sufficient fluence to vaporize a required amount of target material (lasting a few microsecond(s) ) and terminating in a short, intense pulse of about 1microsecond(s) or less, to couple most of the laser energy into the dense young plasma and so create high pressures, is required to produce optimum effect for laser lithotripsy. An opto-mechanical coupler has been designed which transfers the maximum laser energy into mechanically destructive energy, and successfully fragments various types of urinary and biliary calculi even including those calculi with poor surface absorptance, like pure white cystine. A solid state laser, Ho:YAG (2.1 micrometers wavelength and 150 microsecond(s) pulse width), has also been tested as an alternative to the flashlamp-excited dye laser. The underwater shock wave induced by this laser has been measured and has successfully fragmented calculi with poor absorptance in the visible region.

  2. Flexible ureterorenoscopy (F-URS) with holmium laser versus extracorporeal shock wave lithotripsy (ESWL) for treatment of renal stone <2 cm: a meta-analysis.

    PubMed

    Mi, Yuanyuan; Ren, Kewei; Pan, Haiyan; Zhu, Lijie; Wu, Sheng; You, Xiaoming; Shao, Hongbao; Dai, Feng; Peng, Tao; Qin, Feng; Wang, Jian; Huang, Yi

    2016-08-01

    The objective of the study was to systematically review the efficacy and safety of flexible ureterorenoscopy (F-URS) with holmium laser versus extracorporeal shock wave lithotripsy (ESWL) for the treatment of renal stone <2 cm. A systematic literature review was performed in April 2015 using the PubMed, Embase, Web of Science and the Chinese Biomedical Literature (CNKI and Wanfang) databases to identify relevant studies. All clinical trials were retrieved and their included references investigated. Two reviewers independently assessed the quality of all included studies, and the eligible studies were included and analyzed using the RevMan 5.3 software. Six prospective randomized comparison trials and eight retrospective comparison trials were included, involving a total of 2348 patients. For renal stone 1-2 cm, F-URS technique provided a significantly higher stone-free rate (SFR) [weighted mean difference (WMD) = 2.35, 95 % confidence interval (CI) 1.65-3.34, P < 0.00001], lower auxiliary procedure rate (APR) [odds ratio (OR) 0.33, 95 % CI 0.22-0.50, P < 0.00001] and lower retreatment rate (RR) (OR 0.07, 95 % CI 0.01-0.37, P = 0.002). Similar results were found in the lower pole stone for 1-2 cm subgroup. For renal stone <1 cm, F-URS technique also showed a significantly higher SFR than ESWL (WMD = 2.13, 95 % CI 1.13-4.00, P = 0.02). F-URS is associated with higher SFR, lower APR and RR than ESWL. F-URS is a safe and effective procedure. It can successfully treat patients with stones for 1-2 cm, especially for lower pole stone, without increasing complications, operative time and hospital stay. F-URS can be used as an alternative treatment to ESWL in selected cases with larger renal stones. However, further randomized trials are needed to confirm these findings. PMID:26530230

  3. Laser-induced shock wave lithotripsy. Influence of laser pulse energy and irrigation solutions on stone disintegration.

    PubMed

    Hofmann, R; Hartung, R; Schmidt-Kloiber, H; Reichel, E

    1990-01-01

    With a high intensity Q-switched Nd-YAG laser shock waves can be generated in a liquid close to the calculus. Up to 80 mJ single pulse energy with 8 nsec pulse duration can be transmitted through flexible quartz fibers. Energy conversion and enhancement can be accomplished at the fiber tip with optical focussing of the light at the quartz tip, with irrigation solutions and with high pulse energies. Iron-III-dextran solutions (1 mg Fe3+/1) and magnesium chloride (50 mmol/l) increased the pressure in the laser induced breakdown up to ten times (8,000-10,000 bar). Smaller stone particles and higher efficacy in stone fragmentation could be achieved. PMID:1969188

  4. Improving the lens design and performance of a contemporary electromagnetic shock wave lithotripter

    PubMed Central

    Neisius, Andreas; Smith, Nathan B.; Sankin, Georgy; Kuntz, Nicholas John; Madden, John Francis; Fovargue, Daniel E.; Mitran, Sorin; Lipkin, Michael Eric; Simmons, Walter Neal; Preminger, Glenn M.; Zhong, Pei

    2014-01-01

    The efficiency of shock wave lithotripsy (SWL), a noninvasive first-line therapy for millions of nephrolithiasis patients, has not improved substantially in the past two decades, especially in regard to stone clearance. Here, we report a new acoustic lens design for a contemporary electromagnetic (EM) shock wave lithotripter, based on recently acquired knowledge of the key lithotripter field characteristics that correlate with efficient and safe SWL. The new lens design addresses concomitantly three fundamental drawbacks in EM lithotripters, namely, narrow focal width, nonidealized pulse profile, and significant misalignment in acoustic focus and cavitation activities with the target stone at high output settings. Key design features and performance of the new lens were evaluated using model calculations and experimental measurements against the original lens under comparable acoustic pulse energy (E+) of 40 mJ. The −6-dB focal width of the new lens was enhanced from 7.4 to 11 mm at this energy level, and peak pressure (41 MPa) and maximum cavitation activity were both realigned to be within 5 mm of the lithotripter focus. Stone comminution produced by the new lens was either statistically improved or similar to that of the original lens under various in vitro test conditions and was significantly improved in vivo in a swine model (89% vs. 54%, P = 0.01), and tissue injury was minimal using a clinical treatment protocol. The general principle and associated techniques described in this work can be applied to design improvement of all EM lithotripters. PMID:24639497

  5. Music does not reduce alfentanil requirement during patient-controlled analgesia (PCA) use in extracorporeal shock wave lithotripsy for renal stones.

    PubMed

    Cepeda, M S; Diaz, J E; Hernandez, V; Daza, E; Carr, D B

    1998-12-01

    To evaluate the impact of music on opioid requirements and pain levels during renal lithotripsy using alfentanil patient-controlled analgesia (PCA), we conducted a prospective, blinded, randomized controlled trial. Patients undergoing lithotripsy were instructed in PCA use and asked to rate their anxiety and select their preferred type of music. They were then premedicated with morphine and ketorolac and randomly allocated into two groups. Group 1 (n = 97) had music started 10 min before the procedure and maintained until 10 min after its conclusion. Group 2 (n = 96) had music begun at the conclusion of lithotripsy and continued for 10 min. Pain intensity, alfentanil requirement, side effects, quality of analgesia, patient satisfaction, and acceptance of the technique were evaluated. Demographics, alfentanil requirement, pain levels, side effects, quality of analgesia, and patient satisfaction were similar in both groups. The addition of music did not provide any benefit. This result raises the possibility that some nonpharmacologic therapies have minimal impact in settings where the painful stimulus is moderate to severe and adequate pharmacotherapy is available. PMID:9879163

  6. Thulium Fiber Laser lithotripsy

    NASA Astrophysics Data System (ADS)

    Blackmon, Richard Leious, Jr.

    The Thulium Fiber Laser (TFL) has been studied as a potential alternative to the conventional Holmium:YAG laser (Ho:YAG) for the treatment of kidney stones. The TFL is more ideally suited for laser lithotripsy because of the higher absorption coefficient of the emitted wavelength in water, the superior Gaussian profile of the laser beam, and the ability to operate at arbitrary temporal pulse profiles. The higher absorption of the TFL by water helps translate into higher ablation of urinary stones using less energy. The Gaussian spatial beam profile allows the TFL to couple into fibers much smaller than those currently being used for Ho:YAG lithotripsy. Lastly, the ability of arbitrary pulse operation by the TFL allows energy to be delivered to the stone efficiently so as to avoid negative effects (such as burning or bouncing of the stone) while maximizing ablation. Along with these improvements, the unique properties of the TFL have led to more novel techniques that have currently not been used in the clinic, such as the ability to control the movement of stones based on the manner in which the laser energy is delivered. Lastly, the TFL has led to the development of novel fibers, such as the tapered fiber and removable tip fiber, to be used for lithotripsy which can lead to safer and less expensive treatment of urinary stones. Overall, the TFL has been demonstrated as a viable alternative to the conventional Ho:YAG laser and has the potential to advance methods and tools for treatment of kidney stones.

  7. [beta 2-Adrenomimetics before and after extracorporeal lithotripsy].

    PubMed

    Pytel', Iu A; Rapoport, D M; Rudenko, V I; Chaban, A V

    1998-01-01

    Successful disintegration of the calculus in nephrolithiasis patients is impossible without normalization of the upper urinary tracts urodynamics in dyskinesia. We employ combined treatment with high-selective beta-2-adrenomimetic hexoprenalin (hinipral) to improve migration of the concrement fragments and therefore to prevent ureteral occlusion, acute pyelonephritis and renal colic. Hexoprenalin (hinipral) is taken 6 tablets a day or intravenously in drops (5 ml per 100 ml of saline) 3-5 days before and for 10-12 days after extracorporeal shock-wave lithotripsy. Adjuvant use of hexoprenalin in combined treatment of nephrolithiasis complicated by ureteropelvic dysfunction allows effective conduction of lithotripsy. PMID:9820034

  8. Kidney Stone Treatment with Lithotripsy

    MedlinePlus Videos and Cool Tools

    Kidney Stone Treatment with Lithotripsy Broward Health Medical Center Fort Lauderdale, FL November 11, 2011 I'm ... got at least three stones in his left kidney. He's been having pain and blood in his ...

  9. Femtosecond laser lithotripsy: feasibility and ablation mechanism

    NASA Astrophysics Data System (ADS)

    Qiu, Jinze; Teichman, Joel M. H.; Wang, Tianyi; Neev, Joseph; Glickman, Randolph D.; Chan, Kin Foong; Milner, Thomas E.

    2010-03-01

    Light emitted from a femtosecond laser is capable of plasma-induced ablation of various materials. We tested the feasibility of utilizing femtosecond-pulsed laser radiation (λ=800 nm, 140 fs, 0.9 mJ/pulse) for ablation of urinary calculi. Ablation craters were observed in human calculi of greater than 90% calcium oxalate monohydrate (COM), cystine (CYST), or magnesium ammonium phosphate hexahydrate (MAPH). Largest crater volumes were achieved on CYST stones, among the most difficult stones to fragment using Holmium:YAG (Ho:YAG) lithotripsy. Diameter of debris was characterized using optical microscopy and found to be less than 20 μm, substantially smaller than that produced by long-pulsed Ho:YAG ablation. Stone retropulsion, monitored by a high-speed camera system with a spatial resolution of 15 μm, was negligible for stones with mass as small as 0.06 g. Peak shock wave pressures were less than 2 bars, measured by a polyvinylidene fluoride (PVDF) needle hydrophone. Ablation dynamics were visualized and characterized with pump-probe imaging and fast flash photography and correlated to shock wave pressures. Because femtosecond-pulsed laser ablates urinary calculi of soft and hard compositions, with micron-sized debris, negligible stone retropulsion, and small shock wave pressures, we conclude that the approach is a promising candidate technique for lithotripsy.

  10. Comparison of a pulsed dye laser and electrohydraulic lithotripsy on porcine gallbladder and common bile duct in vitro.

    PubMed

    Birkett, D H; Lamont, J S; O'Keane, J C; Babayan, R K

    1992-01-01

    With the advent of minimal access biliary procedures there is a need for a safe intracorporal lithotripsy technique that can be used through small flexible endoscopes. Currently, the two techniques available are electrohydraulic lithotripsy and laser induced shock wave lithotripsy. In this study we compare the effect of a 504 nm coumarin pulsed dye laser and electrohydraulic lithotripsy on in vitro porcine gallbladder and common bile duct. Electrohydraulic lithotripsy at the lowest energy the generator would deliver caused perforation of both tissues in only a few pulses when a 1.9-F probe was placed in direct contact with the tissue. Energy from a 504 nm coumarin pulsed dye laser delivered through a 320-microns fiber placed in light contact with the tissue caused an energy-dependent perforation after 50 pulses in from none to 44% of tissues. It was also found that there was a higher incidence of perforation in more vascular than non-vascular tissue. When the EHL probe and the laser fiber were held 1-2 mm from the tissue surface, discharge of each resulted in no perforation. On histological examination of the tissues, the perforations were found to be very small with laser lithotripsy and considerably larger with the electrohydraulic lithotripsy. It was felt that laser lithotripsy in the clinical situation was likely to be much safer than electrohydraulic lithotripsy. PMID:1349415

  11. Holmium laser lithotripsy of bladder calculi

    NASA Astrophysics Data System (ADS)

    Beaghler, Marc A.; Poon, Michael W.

    1998-07-01

    Although the overall incidence of bladder calculi has been decreasing, it is still a significant disease affecting adults and children. Prior treatment options have included open cystolitholapaxy, blind lithotripsy, extracorporeal shock wave lithotripsy, and visual lithotripsy with ultrasonic or electrohydraulic probes. The holmium laser has been found to be extremely effective in the treatment of upper tract calculi. This technology has also been applied to the treatment of bladder calculi. We report our experience with the holmium laser in the treatment of bladder calculi. Twenty- five patients over a year and a half had their bladder calculi treated with the Holmium laser. This study was retrospective in nature. Patient demographics, stone burden, and intraoperative and post-operative complications were noted. The mean stone burden was 31 mm with a range of 10 to 60 mm. Preoperative diagnosis was made with either an ultrasound, plain film of the abdomen or intravenous pyelogram. Cystoscopy was then performed to confirm the presence and determine the size of the stone. The patients were then taken to the operating room and given a regional or general anesthetic. A rigid cystoscope was placed into the bladder and the bladder stone was then vaporized using the holmium laser. Remaining fragments were washed out. Adjunctive procedures were performed on 10 patients. These included transurethral resection of the prostate, transurethral incision of the prostate, optic internal urethrotomy, and incision of ureteroceles. No major complications occurred and all patients were rendered stone free. We conclude that the Holmium laser is an effective and safe modality for the treatment of bladder calculi. It was able to vaporize all bladder calculi and provides a single modality of treating other associated genitourinary pathology.

  12. Laser lithotripsy: a review of 20 years of research and clinical applications.

    PubMed

    Dretler, S P

    1988-01-01

    Four new technologies have transformed the treatment of urinary calculi: electrohydraulic lithotripsy, ultrasonic lithotripsy, extracorporeal shock wave lithotripsy, and laser lithotripsy. Initial attempts to ablate urinary calculi by continuous wave CO2, ruby, and Nd-YAG lasers failed because of excess thermal injury and inability to pass the laser energy via a flexible fiber. Basic laboratory studies then demonstrated that short pulsed laser energy absorbed by the calculus resulted in fragmentation. The parameters that produced optimal urinary calculus fragmentation were found using the flashlamp pumped tunable dye laser, with the following parameters: wavelength: 504 nm; pulse duration: 1 microsec; fiber: 250 micro silica-coated quartz; repetition: 5-20 Hz. Use of pulsed dye laser caused no tissue damage. The mechanism of fragmentation is light absorption, plasma development, and repetitive acoustic shock wave action with resultant fragmentation. The techniques for application of laser to calculi have been successful, and new, miniature instruments have been developed. Laser lithotripsy is a successful method for fragmenting ureteral calculi. The small caliber of the laser fiber makes this method useful for treating calculi in narrow, tortuous ureters; impacted calculi; distal calculi in ureters that cannot be dilated, via the percutaneous route for stones in calyces or impacted in the upper ureter. Investigations are continuing to optimize fragmentation of harder calculi and to use laser fragmentation within the kidney. Laser lithotripsy may also be used to fragment biliary calculi. PMID:2902498

  13. Patient and personnel exposure during extracorporeal lithotripsy.

    PubMed

    Glaze, S; LeBlanc, A D; Bushong, S C; Griffith, D P

    1987-12-01

    Extracorporeal shock wave lithotripsy (ESWL) has provided a nonsurgical approach to treatment of renal stones. The Dornier lithotripter uses dual image intensified x-ray systems to center the stone before treatment. Three imaging modes are offered: a fluoroscopic mode and two video spot filming modes. The average entrance exposure to the stone side of the typical patient at our facility is 2.6 X 10(-3) C kg-1 (10 R) [range: 0.5-7.7 X 10(-3) C kg-1 (2-30 R)] which is comparable and often much less than that reported for percutaneous lithotripsy. Recommendations are made for minimizing patient exposure. Scattered radiation levels in the lithotripter room are presented. We have determined that Pb protective apparel is not required during this procedure provided x-ray operation is temporarily halted should personnel be required to lean directly over the tub to attend to the patient. If the walls of the ESWL room are greater than 1.83 m (6 feet) from the tub, shielding in addition to conventional construction is not required. PMID:3679826

  14. Fragmentation process induced by microsecond laser pulses during lithotripsy

    NASA Astrophysics Data System (ADS)

    Rink, K.; Delacrétaz, G.; Salathé, R. P.

    1992-07-01

    A fiber optic stress sensing technique is applied to evaluate the fragmentation mechanism for pulsed dye-laser lithotripsy. We demonstrate for the first time that the fragmentation process with microsecond laser pulses originates from the shock wave induced by the cavitation bubble collapse. This shock occurs some hundreds of microseconds after the laser pulse. The shock induced by the plasma expansion, which occurs during laser irradiation, has a minor effect.

  15. Optically triggered solid state driver for shock wave therapy

    NASA Astrophysics Data System (ADS)

    Duryea, Alexander P.; Roberts, William W.; Cain, Charles A.; Hall, Timothy L.

    2012-10-01

    Shock wave lithotripsy (SWL) represents one of several first-line therapies for the treatment of stones located in the kidneys and ureters. Additional applications for shock wave therapy are also under exploration, including non-urinary calculi, orthopedics, and neovascularization. Except for the elimination of a large water bath in which the treatment is performed, current procedures remain largely unchanged, with one of the original commercial devices (the Dornier HM3) still considered a gold standard for comparison. To accelerate research in this area, Coleman, et al. published an experimental electrohydraulic shock wave generator capable of simulating the acoustic field generated by the HM3. We propose a further update of this system, replacing the triggered spark gap with an optically triggered solid state switch. The new system has better reliability, a wider operating range, and reduced timing jitter allowing synchronization with additional acoustic sources under exploration for improving efficacy and reducing injury. Originally designed for exciting electrohydraulic spark electrodes, the system can also be adapted for driving piezoelectric and electromagnetic sources.

  16. [Adjustable electrohydraulic lithotripsy for minimally invasive ureteroscopic stone treatment].

    PubMed

    Vorreuther, R; Engelking, R

    1992-03-01

    We report on 82 ureteroscopies and electrohydraulic lithotripsies performed with small semirigid ureteroscopes with a minimum outer diameter of 6.5 F and probes of 2.4 F and 3.3 F. Prototypes of new lithotripters were employed, which incorporate infinitely variable energy within a range of 265-1382 mJ per pulse. Increased energy was provided by a rise in voltage, thus modifying the peak pressure and the initial slope of the shock wave. One third of the stones were situated in the upper ureter, 15% in the middle and 46% in the lower ureter. In 54% of these cases previous ESWL (Dornier MFL 5000) had been performed without success. Over 85% of the manipulations were performed under local anesthesia and i.v. sedation. Stone contact was achieved in 99%. Lithotripsy was fully successful in over 90%. The average energy per pulse was 450 mJ. In 7% partial disintegration was achieved and the residual stone was flushed back into the renal pelvis followed by further effective ESWL treatment. One stone had to be removed by open surgery. There were no major complications, such as perforations, due to the electrohydraulic lithotripsy itself. One perforation was caused when the endoscope was advanced into the ureter. No strictures were seen at the 6-month follow-up examination. An indwelling stent was placed in 48% of cases, as the stone burden or an inflamed stone bed suggested this was necessary. We conclude that electrohydraulic lithotripsy with adjustable energy resulting in various peak pressures of the shock wave is a safe and effective method of endoureteral stone treatment. PMID:1561730

  17. Spectroscopic feedback in laser lithotripsy and laser angioplasty

    NASA Astrophysics Data System (ADS)

    Jiang, Zhi X.; King, Terence A.; Shah, T.; Watson, Graham M.

    1992-08-01

    The feasibility of new forms of monitoring the fragmentation and ablation process through the plasma feedback signals in laser lithotripsy and laser angioplasty has been investigated. In laser lithotripsy it has been found that shock wave feedback monitoring is not as reliable as the plasma emission feedback monitoring. The plasma emission spectra indicate clearly plasma formation on calculi or calcified plaque, while an audible signal can be observed on targets such as dark tissue, catheter, and blood. This technique was successful in ex-vivo experiments in which calculi were inserted into pigs' ureter and then fragmented. Spectra were obtained in vivo indicating calcium abundance in calculi and the feasibility of real-time stone composition analysis. Ex-vivo gallstone fragmentation was also performed successfully under plasma spectra feedback monitoring. In laser angioplasty, in vitro experiments have shown a discriminative effect at laser pulse energies of 40 mJ or greater. Strong plasma spectra can only be observed from calcified plaque and not from normal artery tissue or fibrous plaque. The threshold for plasma formation on calcified plaque increases in blood compared to that in saline while the spectral structure becomes more specific. This study shows promising prospects for the technique in both laser lithotripsy and laser angioplasty.

  18. Renal milk of calcium: contraindication to extracorporeal shockwave lithotripsy.

    PubMed

    Heidenreich, A; Vorreuther, R; Krug, B; Moul, J W; Engelmann, U H

    1996-01-01

    Renal milk-of-calcium (MOC) cysts are rare findings, with only approximately 60 cases reported in the literature. The diagnosis depends on the demonstration of the typical "half-moon" configuration on horizontal beam radiography; classical ultrasound finding is a gravity-dependent, echogenic shadowy material in a renal cyst. The importance of the MOC syndrome lies in its recognition and differentiation from a renal stone in order to avoid unwarranted surgery or extracorporeal shock-wave lithotripsy (ESWL). We have encountered five patients with renal MOC and present the typical clinical and radiological features in order to facilitate differential diagnosis. PMID:9118405

  19. Laser lithotripsy using double pulse technique

    NASA Astrophysics Data System (ADS)

    Helfmann, Juergen; Doerschel, Klaus; Mueller, Gerhard J.

    1990-07-01

    There are currntly several methods in the field of laser lithotripsy which operate not only at different wavelengths and pulse lengths but also with various types of optical front ends and various irrigation fluids'6. The methods can be divided into two main groups: First, those which utilize stone absorption and plasma formation on the stone surface to initiate stone fragmentation, such as dye lasers. Second, those which generate shock waves and caviatation in the surrounding fluid and which require additional means to produce aplasma (e.g. irrigation, focussing fiber end or metal surfaces). The pulsed Nd:YAG laser belongs to this group. The method presented here is the double pulse technique which is a combination of both methods. It uses two laser pulses with a short time delay transmitted by means of a fiber to destroy body concrements. The first pulse is the first harmonic of the Nd:YAG laser (532nm) which improves the coupling efficiency of the laser radiation with the stone. The second pulse is in the fundamental mode of the laser (1064 nm) delivering the high energy for the stone disruption.

  20. Endoscopically controlled laser lithotripsy of sialoliths

    NASA Astrophysics Data System (ADS)

    Gundlach, Peter; Hopf, Juergen U. G.; Linnarz, Marietta; Leege, Nils; Scherer, Hans H.; Tschepe, Johannes; Mueller, Gerhard J.

    1992-08-01

    Among the diseases of the major salivary glands, sialolithiasis is a frequent clinical picture. Until now the condition has nearly always had to be treated surgically. In rare cases, discharge can be achieved by acid stimulation of secretion. If located distally in the excretory duct, concrements may be removed by enoral lancing. If it is close to glands, e.g., in the knee of Wharton's duct or in the ductal part of the submandibular gland, extirpation of the gland including the stone is unavoidable. Besides wound healing problems and the occurrence of salivary fistulas, the main risk of surgery is injury to the nerves around the major salivary glands, e.g., the n. facialis or one of its branches, the n. hypoglossus, or the n. lingualis with consecutive paresis. Based on the clinical results of lithotripsy by laser-induced shock waves (LIL) applied to renal stones and ureteroliths as well as bilary duct and pancreas stones, we investigated the suitability of endoscopically controlled laser therapy for sialolithiasis.

  1. [Color processing of ultrasonographic images in extracorporeal lithotripsy].

    PubMed

    Lardennois, B; Ziade, A; Walter, K

    1991-02-01

    A number of technical difficulties are encountered in the ultrasonographic detection of renal stones which unfortunately limit its performance. The margin of error of firing in extracorporeal shock-wave lithotripsy (ESWL) must be reduced to a minimum. The role of the ultrasonographic monitoring during lithotripsy is also essential: continuous control of the focussing of the short-wave beamand assessment if the quality of fragmentation. The authors propose to improve ultrasonographic imaging in ESWL by means of intraoperative colour processing of the stone. Each shot must be directed to its target with an economy of vision avoiding excessive fatigue. The principle of the technique consists of digitalization of the ultrasound video images using a Macintosh Mac 2 computer. The Graphis Paint II program is interfaced directly with the Quick Capture card and recovers the images on its work surface in real time. The program is then able to attribute to each of these 256 shades of grey any one of the 16.6 million colours of the Macintosh universe with specific intensity and saturation. During fragmentation, using the principle of a palette, the stone changes colour from green to red indicating complete fragmentation. A Color Space card converts the digital image obtained into a video analogue source which is visualized on the monitor. It can be superimposed and/or juxtaposed with the source image by means of a multi-standard mixing table. Colour processing of ultrasonographic images in extracoporeal shockwave lithotripsy allows better visualization of the stones and better follow-up of fragmentation and allows the shockwave treatment to be stopped earlier. It increases the stone-free performance at 6 months. This configuration will eventually be able to integrate into the ultrasound apparatus itself. PMID:1364639

  2. Acceleration of lithotripsy using cavitation bubbles induced by second-harmonic superimposition

    NASA Astrophysics Data System (ADS)

    Osuga, Masamizu; Yasuda, Jun; Jimbo, Hayato; Yoshizawa, Shin; Umemura, Shin-ichiro

    2016-07-01

    Shock wave lithotripsy potentially produces residual stone fragments too large to pass through ureters and significant injury to the normal tissue surrounding the stone. Previous works have shown that the collapse of cavitation bubbles induced by high-intensity focused ultrasound can produce small stone fragments via cavitation erosion. However, the erosion rate is hypothesized to be reduced by ultrasound attenuation by excessively generated bubble clouds. If so, it is important to generate the bubbles only on the stone surface. The effects of peak-negative-enhanced (PNE) and peak-positive-enhanced (PPE) waves obtained by second-harmonic superimposition were investigated to control cavitation bubbles. With the PNE waves, the bubbles were generated only on the stone surface and the maximum erosion rate was 232 ± 32 mg/min. All the fragments were smaller than 2 mm, which makes them pass through ureters naturally. The proposed method shows the potential to significantly improve the speed of lithotripsy.

  3. [Case of renal subcapsular hematoma caused by flexible transurethral lithotripsy].

    PubMed

    Watanabe, Ryuta; Inada, Kouji; Azuma, Kouji; Yamashita, Yokihiko; Oka, Akihiro

    2013-09-01

    A 39-year-old man with macroscopic hematuria was admitted to our hospital. A stone, 5 mm in diameter was detected in the right ureteropelvic junction after abdominal computed tomography and plain abdominal radiography. We performed flexible transurethral lithotripsy (f-TUL) and crushed the stone and extracted almost all stone fragments without any complications. However, almost immediately after the operation, the patient began to complain about pain in the right back. In the results of abdominal plain computed tomography right renal subcapsular hematoma was detected. Because active bleeding was not observed in the results of enhanced computed tomography, only conservative treatment was performed. The patient was discharged from the hospital on day 11 of hospitalization. One month after the operation, plain computed tomography was performed and diminished subcapsular hematoma was detected. Renal subcapsular hematoma is assumed to be a unique complication of extracorporeal shock wave lithotripsy. This is the first report of a case of renal subcapsular hematoma caused by f-TUL. The onset of renal subcapsular hematoma following f-TUL could have been caused either because the laser fiber thrust into the renal lithiasis unintentionally or because the internal pressure of the renal pelvis increased substantially during the operation. PMID:24113753

  4. Visualizing mechanical stress and liquid flow during laser lithotripsy

    NASA Astrophysics Data System (ADS)

    Reinten, Ilja; Verdaasdonk, Rudolf; van der Veen, Albert; Klaessens, John

    2014-03-01

    The mechanism of action of the holmium laser lithotripsy is attributed to explosive expanding and imploding vapor bubbles in association with high-speed water jets creating high mechanical stress and cracking the stone surface. A good understanding of this mechanism will contribute to the improvement and the safety of clinical treatments. A new method has been developed to visualize the dynamics of mechanical effects and fluid flow induced by Holmium laser pulses around the fiber tip and the stone surface. The fiber tip was positioned near the surface of a stone on a slab of polyacrylamide gel submerged in water. The effects were captured with high speed imaging at 2000-10000 f/s. The dynamics of the pressure wave after the pulse could be visualized by observing the optical deformation of a fine line pattern in the background of the water container using digital subtraction software. This imaging technique provides a good understanding of the mechanical effects contributing to the effectiveness and safety of lithotripsy and can be used to study the optimal fiber shape and position towards the stone surface.

  5. A mechanistic analysis of stone fracture in lithotripsy.

    PubMed

    Sapozhnikov, Oleg A; Maxwell, Adam D; MacConaghy, Brian; Bailey, Michael R

    2007-02-01

    In vitro experiments and an elastic wave model were used to analyze how stress is induced in kidney stones by lithotripsy and to test the roles of individual mechanisms-spallation, squeezing, and cavitation. Cylindrical U30 cement stones were treated in an HM-3-style lithotripter. Baffles were used to block specific waves responsible for spallation or squeezing. Stones with and without surface cracks added to simulate cavitation damage were tested in glycerol (a cavitation suppressive medium). Each case was simulated using the elasticity equations for an isotropic medium. The calculated location of maximum stress compared well with the experimental observations of where stones fractured in two pieces. Higher calculated maximum tensile stress correlated with fewer shock waves required for fracture. The highest calculated tensile stresses resulted from shear waves initiated at the proximal corners and strengthened along the side surfaces of the stone by the liquid-borne lithotripter shock wave. Peak tensile stress was in the distal end of the stone where fracture occurred. Reflection of the longitudinal wave from the distal face of the stone--spallation-produced lower stresses. Surface cracks accelerated fragmentation when created near the location where the maximum stress was predicted. PMID:17348540

  6. Lithotripsy with the alexandrite laser: our initial 100 clinical cases.

    PubMed

    Pertusa, C; Albisu, A; Acha, M; Blasco, M; Llarena, R; Arregui, P

    1991-01-01

    The alexandrite laser system has proven to be an effective and safe method of treating ureteral stones. When the electromagnetic energy of a laser light pulse is selectively absorbed by the stone, a plasma forms at the surface. This plasma, which is composed of ions and electrons, continues to absorb laser energy, reaching very high pressure and generating a shock wave that fragments the stone. The degree of stone fragmentation is directly related to the composition and crystal lattice structure of the calculus. 112 calculi have been treated, and laser lithotripsy was successful in 87.5%. 6% of the stones were inadvertently flushed back into the kidney. No patient required an open ureterolithotomy. Guidance of the laser fiber onto the stone was performed by rigid ureteroscopy. There were no troublesome complications, and in a 3-month follow-up, no sequelae were reported. PMID:1687678

  7. Retrograde flexible ureterorenoscopic holmium-YAG laser lithotripsy: the new gold standard.

    PubMed

    Gould, D L

    1998-03-01

    To demonstrate the efficacy of flexible retrograde ureterorenoscopic holmium-YAG intracorporeal laser lithotripsy for the treatment of renal calculi, a total of 86 patients presenting to our hospital with renal calculi underwent flexible retrograde ureterorenoscopic holmium-YAG intracorporeal laser lithotripsy of their stones, and the data were collected prospectively. As extracorporeal shock wave lithotripsy is not available at our institution, all patients with renal calculi in this study were treated in a retrograde fashion using the Richard Wolf 6.0F semirigid ureteroscope, the 7.5F flexible ureterorenoscope, and the holmium-YAG laser by Coherent Inc. Except for inhospital consults or patients requiring admission secondary to infection, all cases were performed on an ambulatory basis. All renal calculi 3 cm or smaller were approached in a retrograde fashion. Where possible, the stones were initially debulked using the semirigid ureteroscope and the 550-microm fiber followed by the flexible ureterorenoscope in combination with the 360- or 200-microm laser fiber depending on stone position. Stones were fragmented until they were small enough to be removed by hydrocleansing. Using this technique, stone-free success rates for calculi 2.5 cm or smaller after a single treatment, regardless of stone composition or location, are superior to those of extracorporeal shock wave lithotripsy. For calculi between 2.5 and 3 cm, the results also are noted to be superior. We conclude that for calculi larger than 3 cm or for partial staghorn calculi, the treatment of choice appears to be a percutaneous approach. PMID:9568772

  8. Can stone density on plain radiography predict the outcome of extracorporeal shockwave lithotripsy for ureteral stones?

    PubMed Central

    Lim, Ki Hong; Jung, Jin-Hee; Kwon, Jae Hyun; Lee, Yong Seok; Bae, Jungbum; Cho, Min Chul; Lee, Kwang Soo

    2015-01-01

    Purpose The objective was to determine whether stone density on plain radiography (kidney-ureter-bladder, KUB) could predict the outcome of extracorporeal shockwave lithotripsy (ESWL) for ureteral stones. Materials and Methods A total of 223 patients treated by ESWL for radio-opaque ureteral stones of 5 to 20 mm were included in this retrospective study. All patients underwent routine blood and urine analyses, plain radiography (KUB), and noncontrast computed tomography (NCCT) before ESWL. Demographic, stone, and radiological characteristics on KUB and NCCT were analyzed. The patients were categorized into two groups: lower-density (LD) group (radiodensity less than or equal to that of the 12th rib, n=163) and higher-density (HD) group (radiodensity greater than that of the 12th rib, n=60). Stone-free status was assessed by KUB every week after ESWL. A successful outcome was defined as stone free within 1 month after ESWL. Results Mean stone size in the LD group was significantly smaller than that in the HD group (7.5±1.4 mm compared with 9.9±2.9 mm, p=0.002). The overall success rates in the LD and HD groups were 82.1% and 60.0%, respectively (p=0.007). The mean duration of stone-free status and average number of SWL sessions required for success in the two groups were 21.7 compared with 39.2 days and 1.8 compared with 2.3, respectively (p<0.05). On multivariate logistic analysis, stone size and time to ESWL since colic and radiodensity of the stone on KUB were independent predictors of successful ESWL. Conclusions Our data suggest that larger stone size, longer time to ESWL, and ureteral stones with a radiodensity greater than that of the 12th rib may be at a relatively higher risk of ESWL failure 1 month after the procedure. PMID:25598937

  9. Computed tomographic evaluation of gallstone calcification for biliary lithotripsy.

    PubMed

    Caslowitz, P L; Fishman, E K; Kafonek, D R; Lillemoe, K D; Mitchell, S; Widlus, D M; Saba, G P

    1991-04-01

    As the Food and Drug Administration trials for biliary lithotripsy in the United States near completion, future criteria for patient eligibility remain to be defined. Gallstone calcification greater than 3-mm partial rim on plain film (KUB) or oral cholecystogram (OCG) has excluded patients thus far, since early results of gallstone clearance (lithotripsy plus chemodissolution) were suboptimal with calcified stones. To evaluate the usefulness of these criteria for gallstone fragmentation, computed tomographic (CT) scans were performed on 20 patients immediately prior to lithotripsy to evaluate gallstone density and 24 hours after lithotripsy to observe the CT appearance of fragmentation. The adequacy of fragmentation was determined by pre- and post-lithotripsy sonography. This report constitutes the results of these investigations. PMID:10149158

  10. The problem of coupling in dry-head lithotripsy

    NASA Astrophysics Data System (ADS)

    Pishchalnikov, Yuri A.; McAteer, James A.; Neucks, Joshua S.; Pishchalnikova, Irina V.; Williams, James C.

    2007-04-01

    Recent in vitro studies have shown that air pockets can get trapped at the coupling interface of the treatment head in dry-head lithotripsy, and this can pose a significant barrier to transmission of shock wave energy to the focal zone. Breakage of model stones is very sensitive to the presence of air pockets at the coupling interface. The quality of routine coupling is highly variable, and it seems quite feasible that the way in which the coupling gel is applied may have a significant effect on the quality of coupling. Therefore, attempts to find the best coupling regime may be valuable to perform, and preliminary results of in vitro tests are presented in this report. Experiments were conducted using gel or castor oil as coupling agents. The test tank was coupled through a transparent Mylar membrane to the water-filled cushion of the treatment head, so that pockets of air trapped between the two coupling surfaces could be observed and photographed. It is shown that the quality of coupling can be improved by applying an excessive amount of gel to just the water cushion of the lithotripter, while applying gel to both the water cushion and the Mylar membrane typically gives poor coupling. Repeat decoupling and re-coupling substantially degraded the quality of coupling, reducing shock wave energy density at the target by ˜80%. It was also observed that using castor oil as a coupling medium does not guarantee air-free coupling.

  11. The use of laser lithotripsy status post cholecystostomy tube placement without interval cholecystectomy for calculous cholecystitis in a patient unfit for general anesthesia.

    PubMed

    Polite, Nathan M; Brown, Roy; Braveman, Joshua

    2013-12-01

    Acute cholecystitis in patients unfit for general anesthesia often initially requires cholecystectomy tube placement without cholecystectomy. The best way to definitively manage those patients with irreversible medical conditions, leaving them unable to undergo cholecystectomy, has yet to be defined. Laser lithotripsy is currently used in the management of stones of the genitourinary system. Extracorporeal shock wave cholelithotripsy has been extensively evaluated in Munich, Germany and since then, has been abandoned as an alternative treatment of cholelithiasis. This report discusses a novel approach using established cholecystocutaneous fistula tracts and laser lithotripsy to definitively treat this group of patients. PMID:24300938

  12. Pulse-stretched Alexandrite laser for improved optical fiber reliability for laser lithotripsy

    NASA Astrophysics Data System (ADS)

    Simons, David; Koschmann, Eric C.

    1992-06-01

    Clinical data shows that short pulse duration lasers used in laser induced shock wave lithotripsy severely damage optical fibers on both the proximal and distal ends which is unsuitable for clinical use. An Alexandrite laser system has been developed that uses dynamic pulse stretching of the Q-switched laser pulse and improved optical fiber coupling to eliminate the fiber damage. The method of pulse stretching presented controls the laser output pulse energy from 50 to 150 millijoules and temporal shape from 0.5 to 1.5 microseconds. This yields effective fragmentation of calculi without damage to the optical fiber.

  13. Laser lithotripsy with a Q-switched alexandrite laser system

    NASA Astrophysics Data System (ADS)

    Uebelacker, Walter

    1992-06-01

    The laser lithotripsy of ureter stones with the Alexan Triptor was introduced into urology in 1989. Pulsenergy, pulsewidth, wavelength, fiber performance, and endoscope performance are important parameters for effective stone disintegration.

  14. [TRANSURETHRAL CONTACT URETERAL LITHOTRIPSY IN A GASEOUS (CO2) MEDIUM].

    PubMed

    Glybochko, P V; Aljaev, Ju G; Rapoport, L M; Carichenko, D G; Arzumanjan, E G

    2015-01-01

    The paper describes for the first time the method of contact ureteral lithotripsy in gaseous (CO2) medium. It presents the results of a comparative study of urolithiasis patients treated with this treatment modality (study group, n=30) and with traditional contact ureteral lithotripsy in liquid medium (control group, n=30). The incidence of retrograde migration of calculus in the kidney in the study group was 0%, while it was 16.6% in the control group. Acute or exacerbation of chronic pyelonephritis was diagnosed in only 3 (10%) patients in the control group. The suggested method of contact ureteral lithotripsy is safe and provides several advantages over traditional contact ureteral lithotripsy in a fluid medium, such as: physiologic validity, absence of calculus hypermobility (increased mobility), improved visualization during surgery and high cost effectiveness. PMID:26237808

  15. Management of lower pole renal stones: the devil is in the details

    PubMed Central

    Issi, Yasar; Onem, Kadir; Germiyanoglu, Cankon

    2016-01-01

    Shock wave lithotripsy (SWL), retrograde intrarenal surgery (RIRS) and minimally invasive percutaneous nephrolithotomy (MIP) are highly effective treatment options for lower pole stones up to 2 cm. Selecting the best treatment modality represents a controversial area in urology, because each treatment methods have their own advantages and disadvantages. Donaldson and co-workers have recently published a very comprehensive review and meta-analysis to compare the benefits and harms of SWL, RIRS and PNL techniques. PMID:27047957

  16. Management of lower pole renal stones: the devil is in the details.

    PubMed

    Resorlu, Berkan; Issi, Yasar; Onem, Kadir; Germiyanoglu, Cankon

    2016-03-01

    Shock wave lithotripsy (SWL), retrograde intrarenal surgery (RIRS) and minimally invasive percutaneous nephrolithotomy (MIP) are highly effective treatment options for lower pole stones up to 2 cm. Selecting the best treatment modality represents a controversial area in urology, because each treatment methods have their own advantages and disadvantages. Donaldson and co-workers have recently published a very comprehensive review and meta-analysis to compare the benefits and harms of SWL, RIRS and PNL techniques. PMID:27047957

  17. Measurements of acoustic pressure at high amplitudes and intensities

    NASA Astrophysics Data System (ADS)

    Crum, L. A.; Bailey, M. R.; Kaczkowski, P.; McAteer, J. A.; Pishchalnikov, Y. A.; Sapozhnikov, O. A.

    2004-01-01

    In our research group, we desire measurements of the large pressure amplitudes generated by the shock waves used in shock wave lithotripsy (SWL) and the large acoustic intensities used in High Intensity Focused Ultrasound (HIFU). Conventional piezoelectric or PVDF hydrophones can not be used for such measurements as they are damaged either by cavitation, in SWL applications, or heat, in HIFU applications. In order to circumvent these difficulties, we have utilized optical fiber hydrophones in SWL that do not cavitate, and small glass probes and a scattering technique for measurements of large HIFU intensities. Descriptions of these techniques will be given as well as some typical data.

  18. Effect of alpha1-blockers on stentless ureteroscopic lithotripsy

    PubMed Central

    Zhu, Jianguo; Liang, Yuxiang; Chen, Weihong; Xu, Shuxiong; Wang, Yuanlin; Hu, Jianxing; He, Hui-chan; Zhong, Wei-de; Sun, Zhaolin

    2016-01-01

    ABSTRACT Objective To evaluate the clinical efficiency of alpha1-adrenergic antagonists on stentless ureteroscopic lithotripsy treating uncomplicated lower ureteral stones. Materials and Methods From January 2007 to January 2013, 84 patients who have uncomplicated lower ureteral stones treated by ureteroscopic intracorporeal lithotripsy with the holmium laser were analyzed. The patients were divided into two groups, group A (44 patients received indwelled double-J stents) and group B (40 patients were treated by alpha1-adrenergic antagonists without stents). All cases of group B were treated with alpha1 blocker for 1 week. Results The mean operative time of group A was significantly longer than group B. The incidences of hematuria, flank/abdominal pain, frequency/urgency after surgery were statistically different between both groups. The stone-free rate of each group was 100%. Conclusions The effect of alpha1-adrenergic antagonists is more significant than indwelling stent after ureteroscopic lithotripsy in treating uncomplicated lower ureteral stones. PMID:27136474

  19. Massive Pulmonary Calculi Embolism: A Novel Complication of Pneumatic Lithotripsy

    PubMed Central

    Zhang, Lin; Zhou, Yiwu

    2015-01-01

    Abstract Pneumatic lithotripsy is a minimally invasive technique mainly for the treatment of urinary staghorn stones. Previous literatures have reported some therapeutic complications during or after this procedure, but calculi embolism has not been mentioned before. We report here a fatal case of calculi-induced pulmonary embolism in an adult woman who underwent pneumatic lithotripsy. An autopsy did not reveal any evidence of pulmonary embolism. However, light microscopy revealed noticeable presence of calculi in pulmonary arterioles and capillaries, as evidenced by environmental scanning electron microscope and energy dispersive X-ray analysis. The primary determinants of calculi embolism include intrarenal pressure, and volume and viscosity of the calculi fragments formation. Vascular intravasation of smashed calculi might increase pulmonary vascular resistance and hypoxemia and decrease cardiac output. This case report intends to provide information for clinicians to consider the probability of intraoperative calculi embolism during lithotripsies when patients develop typical symptoms of acute pulmonary embolism. PMID:26222867

  20. Observations of the collapses and rebounds of millimeter-sized lithotripsy bubbles

    PubMed Central

    Kreider, Wayne; Crum, Lawrence A.; Bailey, Michael R.; Sapozhnikov, Oleg A.

    2011-01-01

    Bubbles excited by lithotripter shock waves undergo a prolonged growth followed by an inertial collapse and rebounds. In addition to the relevance for clinical lithotripsy treatments, such bubbles can be used to study the mechanics of inertial collapses. In particular, both phase change and diffusion among vapor and noncondensable gas molecules inside the bubble are known to alter the collapse dynamics of individual bubbles. Accordingly, the role of heat and mass transport during inertial collapses is explored by experimentally observing the collapses and rebounds of lithotripsy bubbles for water temperatures ranging from 20 to 60 °C and dissolved gas concentrations from 10 to 85% of saturation. Bubble responses were characterized through high-speed photography and acoustic measurements that identified the timing of individual bubble collapses. Maximum bubble diameters before and after collapse were estimated and the corresponding ratio of volumes was used to estimate the fraction of energy retained by the bubble through collapse. The rebounds demonstrated statistically significant dependencies on both dissolved gas concentration and temperature. In many observations, liquid jets indicating asymmetric bubble collapses were visible. Bubble rebounds were sensitive to these asymmetries primarily for water conditions corresponding to the most dissipative collapses. PMID:22088027

  1. Report from the 29th World Congress of Endourology and SWL (November 30-December 3, 2011 - Kyoto, Japan).

    PubMed

    Rabasseda, X

    2012-02-01

    Kyoto is a city of surprises: from the most beautiful castles and temples known far and wide across the world, to the humblest temples, as beautiful as those appearing in all tourist guides, just hidden away in small lanes among busy traffic of bicycles and pedestrians shopping in markets or attending to their daily business. Add the innumerable tourists busily exploring the city's attractions, although this was not the reason for visiting Kyoto, which was the site of this year's World Congress of Endourology and SWL. Nevertheless, maybe as a compensation, the meeting was held in Kokusaikaikan, literally the International Conference Centre, which is a modern facility in the city outskirts, actually adjoining the Takaragaike park, with a beautiful lake and the mountains, brightly led by the trees' red leaves, just visible through the main hall windows. PMID:22384455

  2. Adaptable Design Improvements for Electromagnetic Shock Wave Lithotripters and Techniques for Controlling Cavitation

    NASA Astrophysics Data System (ADS)

    Smith, Nathan Birchard

    In this dissertation work, the aim was to garner better mechanistic understanding of how shock wave lithotripsy (SWL) breaks stones in order to guide design improvements to modern electromagnetic (EM) shock wave lithotripters. To accomplish this goal, experimental studies were carefully designed to isolate mechanisms of fragmentation, and models for wave propagation, fragmentation, and stone motion were developed. In the initial study, a representative EM lithotripter was characterized and tested for in vitro stone comminution efficiency at a variety of field positions and doses using phantom kidney stones of variable physical properties, and in different fluid mediums to isolate the contribution of cavitation. Through parametric analysis of the acoustic field measurements alongside comminution results, a logarithmic correlation was determined between average peak pressure incident on the stone surface and comminution efficiency. It was also noted that for a given stone type, the correlations converged to an average peak pressure threshold for fragmentation, independent of fluid medium in use. The correlation of average peak pressure to efficacy supports the rationale for the acoustic lens modifications, which were pursued to simultaneously enhance beam width and optimize the pulse profile of the lithotripter shock wave (LSW) via in situ pulse superposition for improved stone fragmentation by stress waves and cavitation, respectively. In parallel, a numerical model for wave propagation was used to investigate the variations of critical parameters with changes in lens geometry. A consensus was reached on a new lens design based on high-speed imaging and stone comminution experiments against the original lens at a fixed acoustic energy setting. The results have demonstrated that the new lens has improved efficacy away from the focus, where stones may move due to respiration, fragmentation, acoustic radiation forces, or voluntary

  3. [Extracorporeal shockwave lithotripsy in the treatment of distal ureteral stones larger than 10 mm in diameter].

    PubMed

    Ishii, Nobuyuki; Yoshinaga, Atsushi; Ohno, Rena; Chiba, Koji; Hayashi, Tetsuo; Kamata, Shigeyoshi; Watanabe, Toru; Yamada, Takumi

    2004-06-01

    Optimal treatment for distal ureteral stones remains controversial. During a period of 10 years, from December 1992 to December 2002, 103 distal ureteral stones larger than 10 mm in diameter were treated at our institution with extracorporeal shock wave lithotripsy (ESWL) using the Siemens Lithostar. Only 2 patients had a ureteral stent in place at the time of treatment. The overall stone-free rate was 98% with 1-12 session and 3-month stone-free rate was 95.1%. These data reveal that a high success rate was achieved in multisession ESWL. Therefore, ESWL is considered to be acceptable as first-line therapy for fragmentation of distal ureteral stones larger than 10 mm in diameter. PMID:15293734

  4. New tunable flashlamp-pumped solid state Ti:sapphire laser for laser lithotripsy

    NASA Astrophysics Data System (ADS)

    Jiang, Zhi X.; Giannetas, V.; Charlton, Andrew; King, Terence A.

    1993-05-01

    Laser pulses from a flashlamp pumped, solid state Ti:sapphire laser (Vuman, free running untuned wavelength 792 nm, 2 microseconds pulse width and up to 240 mJ pulse energy) have been successfully and efficiently coupled into thin optical fibers. The coupling efficiency can be up to 67% for 300 micron and 43% for 200 micron core diameter optical fibers. With these two optical fibers in vitro laser lithotripsy has been performed successfully on various human calculi including gall bladder, kidney, ureter and salivary duct stones. The bright white flash of the induced plasma emission, strong shock waves, fiber recoil and stone propulsion and the splattering of the stone chips have been observed during the calculi fragmentation.

  5. Study of cavitation bubble dynamics during Ho:YAG laser lithotripsy by high-speed camera

    NASA Astrophysics Data System (ADS)

    Zhang, Jian J.; Xuan, Jason R.; Yu, Honggang; Devincentis, Dennis

    2016-02-01

    Although laser lithotripsy is now the preferred treatment option for urolithiasis, the mechanism of laser pulse induced calculus damage is still not fully understood. This is because the process of laser pulse induced calculus damage involves quite a few physical and chemical processes and their time-scales are very short (down to sub micro second level). For laser lithotripsy, the laser pulse induced impact by energy flow can be summarized as: Photon energy in the laser pulse --> photon absorption generated heat in the water liquid and vapor (super heat water or plasma effect) --> shock wave (Bow shock, acoustic wave) --> cavitation bubble dynamics (oscillation, and center of bubble movement , super heat water at collapse, sonoluminscence) --> calculus damage and motion (calculus heat up, spallation/melt of stone, breaking of mechanical/chemical bond, debris ejection, and retropulsion of remaining calculus body). Cavitation bubble dynamics is the center piece of the physical processes that links the whole energy flow chain from laser pulse to calculus damage. In this study, cavitation bubble dynamics was investigated by a high-speed camera and a needle hydrophone. A commercialized, pulsed Ho:YAG laser at 2.1 mu;m, StoneLightTM 30, with pulse energy from 0.5J up to 3.0 J, and pulse width from 150 mu;s up to 800 μs, was used as laser pulse source. The fiber used in the investigation is SureFlexTM fiber, Model S-LLF365, a 365 um core diameter fiber. A high-speed camera with frame rate up to 1 million fps was used in this study. The results revealed the cavitation bubble dynamics (oscillation and center of bubble movement) by laser pulse at different energy level and pulse width. More detailed investigation on bubble dynamics by different type of laser, the relationship between cavitation bubble dynamics and calculus damage (fragmentation/dusting) will be conducted as a future study.

  6. Hazardous sound levels produced by extracorporeal shock wave lithotripsy

    SciTech Connect

    Lusk, R.P.; Tyler, R.S.

    1987-06-01

    Sound emitted from the Dornier system GmbH lithotriptor was found to be of sufficient intensity to warrant concern about noise-induced sensorineural hearing loss. The patients were exposed to impulses of 112 dB. peak sound pressure level. Operating room personnel were exposed to sounds of less intensity, although the number of impulses they were exposed to was much greater, thereby increasing the risk of hearing loss. Hearing protection is recommended for patients and operating room personnel.

  7. Salivary Stone Pneumatic Lithotripsy in a Live Porcine Model.

    PubMed

    Walvekar, Rohan R; Hoffman, Henry T; Kolenda, Jack; Hernandez, Stephen

    2016-06-01

    The purpose of this study is to evaluate the efficacy of endoscopic fragmentation and removal of artificial calculi in a live porcine model employing intracorporeal pneumatic lithotripsy. In this experimental study, 7 submandibular ducts were accessed and artificial calculi placed. A salivary pneumatic lithotripter probe was inserted through an interventional sialendoscope to fragment the calculi. A salivary duct catheter was then used to flush stone fragments, followed by endoscopy to assess complete fragmentation and ductal trauma. Ultimately, 7 artificial stones (3-10 mm, 4F/5F) were successfully fragmented without causing significant endoluminal trauma. Number of pulses for adequate stone fragmentation averaged 20 (range, 5-31). In all cases, stone fragments were successfully flushed out with the salivary duct catheter. Postprocedure endoscopy confirmed ductal integrity in all 7 ducts. While more studies are needed, this preliminary animal model demonstrates efficacy of endoscopic pneumatic lithotripsy for the management of sialolithiasis. PMID:27048662

  8. Nonvisualized gallbladder on oral cholecystography: implications for lithotripsy.

    PubMed

    Wong, K; Ekberg, O; Laufer, I; Malet, P F; Arger, P

    1990-01-01

    Currently, most protocols evaluating the efficacy of gallstone lithotripsy require a visualized gallbladder on oral cholecystography (OCG). The primary purpose of the OCG is to establish that the cystic duct is patent. When the gallbladder is visualized on OCG, it can also be used to number and size gallstones accurately. Patients with non-visualization of the gallbladder on OCG are excluded from consideration for lithotripsy. The purpose of this study was to evaluate retrospectively the ultrasonographic findings (i.e., number and sizes of stones in 32 patients with nonvisualization on the OCG). In 11 patients (34%) ultrasound (US) did not detect any stone, and it is presumed that the gallbladder failed to visualize for other reasons. Six patients (19%) had one or two stones and 15 (47%) patients had more than three stones. This suggests that 20% of patients with nonvisualization of the gallbladder on OCG would otherwise be eligible for lithotripsy provided that patency of the cystic duct can be demonstrated by other means, such as computed tomographic (CT) examination with oral biliary contrast or cholescintigraphy. PMID:2180774

  9. Laser and acoustic lens for lithotripsy

    DOEpatents

    Visuri, Steven R.; Makarewicz, Anthony J.; London, Richard A.; Benett, William J.; Krulevitch, Peter; Da Silva, Luiz B.

    2002-01-01

    An acoustic focusing device whose acoustic waves are generated by laser radiation through an optical fiber. The acoustic energy is capable of efficient destruction of renal and biliary calculi and deliverable to the site of the calculi via an endoscopic procedure. The device includes a transducer tip attached to the distal end of an optical fiber through which laser energy is directed. The transducer tip encapsulates an exogenous absorbing dye. Under proper irradiation conditions (high absorbed energy density, short pulse duration) a stress wave is produced via thermoelastic expansion of the absorber for the destruction of the calculi. The transducer tip can be configured into an acoustic lens such that the transmitted acoustic wave is shaped or focused. Also, compressive stress waves can be reflected off a high density/low density interface to invert the compressive wave into a tensile stress wave, and tensile stresses may be more effective in some instances in disrupting material as most materials are weaker in tension than compression. Estimations indicate that stress amplitudes provided by this device can be magnified more than 100 times, greatly improving the efficiency of optical energy for targeted material destruction.

  10. Comparison of ultrasonography and oral cholecystography in lithotripsy. II. Determining retreatment.

    PubMed

    Baumgartner, B R; Jones, M T; Torres, W E; Nelson, R C; Peterson, J E

    1991-07-01

    Both ultrasonography (US) and oral cholecystography (OCG) are being used to evaluate patients after extracorporeal shock wave lithotripsy (ESWL) for gallstones. Criteria for retreatment after the initial ESWL are usually related to the size of the residual fragments. This study examines the efficacy of ultrasound and OCG for determining both the size and number of stone fragments in the gallbladder in an in vitro model and in patients. Ultrasonography and OCG examinations using an in vitro ESWL phantom with ten groups of stones, and on 39 patients, were reviewed independently by three radiologists to determine both the size and number of stone fragments. For the in vitro study, the three readers estimated the correct number of fragments, or the next closest range, in 87% of observations by OCG and in 43% by US. The size of the largest fragment was measured within 1 mm of its actual size in 87% of observations by OCG and 20% by US. Correlation coefficients for the mean measurements of the three readers versus the actual fragment size and number were greater for OCG than for US. For the in vivo study, the three readers agreed in 47% of the OCG versus 32% of US examinations with respect to the number of fragments, and in 65% of OCG compared to 40% of US studies with respect to size of the largest fragment. Multiple statistical analyses demonstrate that these differences are statistically significant. A discrepancy among the readers concerning whether a patient was eligible for retreatment occurred in 15% of OCG as compared to 45% of US studies. Both the in vivo and in vitro studies indicate that there is more interobserver reproducibility for OCG than for US, and that OCG is more reliable in making the decision concerning patient eligibility for retreatment following lithotripsy. PMID:1885269

  11. Influence of Saline on Temperature Profile of Laser Lithotripsy Activation

    PubMed Central

    Silva, Igor N.; Donalisio da Silva, Rodrigo; Gustafson, Diedra; Sehrt, David; Kim, Fernando J.

    2015-01-01

    Abstract Purpose: We established an ex vivo model to evaluate the temperature profile of the ureter during laser lithotripsy, the influence of irrigation on temperature, and thermal spread during lithotripsy with the holmium:yttrium-aluminum-garnet (Ho:YAG) laser. Materials and Methods: Two ex vivo models of Ovis aries urinary tract and human calcium oxalate calculi were used. The Open Ureteral Model was opened longitudinally to measure the thermal profile of the urothelium. On the Clinical Model, anterograde ureteroscopy was performed in an intact urinary system. Temperatures were measured on the external portion of the ureter and the urothelium during lithotripsy and intentional perforation. The lithotripsy group (n=20) was divided into irrigated (n=10) and nonirrigated (n=10), which were compared for thermal spread length and values during laser activation. The intentional perforation group (n=10) was evaluated under saline flow. The Ho:YAG laser with a 365 μm laser fiber and power at 10W was used (1J/Pulse at 10 Hz). Infrared Fluke Ti55 Thermal Imager was used for evaluation. Maximum temperature values were recorded and compared. Results: On the Clinical Model, the external ureteral wall obtained a temperature of 37.4°C±2.5° and 49.5°C±2.3° (P=0.003) and in the Open Ureteral Model, 49.7°C and 112.4°C with and without irrigation, respectively (P<0.05). The thermal spread along the external ureter wall was not statically significant with or without irrigation (P=0.065). During intentional perforation, differences in temperatures were found between groups (opened with and without irrigation): 81.8°±8.8° and 145.0°±15.0°, respectively (P<0.005). Conclusion: There is an increase in the external ureteral temperature during laser activation, but ureteral thermal values decreased when saline flow was applied. Ureter thermal spread showed no difference between irrigated and nonirrigated subgroups. This is the first laser lithotripsy thermography study

  12. Minimally invasive percutaneous cystostomy with ureteroscopic pneumatic lithotripsy for calculus in bladder diverticula

    PubMed Central

    GU, SI-PING; YOU, ZHI-YUAN; HUANG, YUNTENG; LU, YI-JIN; HE, CAOHUI; CAI, XIAO-DONG; ZHOU, XIAO-MING

    2013-01-01

    The aim of this study was to investigate the effectiveness of minimally invasive percutaneous cystostomy with ureteroscopic pneumatic lithotripsy for treating calculus in bladder diverticula. Percutaneous cystostomy with ureteroscopic pneumatic lithotripsy was performed on six elderly male patients with calculi in bladder diverticula, who could not be treated with transurethral ureteroscopic lithotripsy. The stones were successfully removed from all patients, with no complications such as bladder perforation, rupture, urethritis or cystitis. The surgery time was 15–60 min, with an average time of 32 min. Postoperative ultrasound or X-ray examination showed no stone residues and the bladder stoma healed well. No recurrent stones were detected in the follow-up of 3–24 months (average, 16 months). Minimally invasive percutaneous cystostomy with ureteroscopic pneumatic lithotripsy is a safe, efficient and easy treatment for calculus in bladder diverticula. This method provides a new clinical approach for lithotripsy and we suggest that it is worthy of wider use. PMID:23837044

  13. Application systems for the intracorporal laser-induced shockwave lithotripsy using the Nd:YAG Q-switched laser

    NASA Astrophysics Data System (ADS)

    Frank, Klaus H.; Eichenlaub, M.; Hessel, Stefan F. F.; Wondrazek, Fritz

    1990-06-01

    For the laser-induced shockwave lithotripsy the electromagnetic energy of a laser light pulse is converted intracorporally into the acoustic energy of a shock wave. The lithotriptor is based on a specially developed, Q-switched Nd:YAG laser whose high power light pulses (70 mJ, 25 ns) are coupled into a flexible quartz fiber of 600 pim core diameter. Using focussing elements energy densities higher than 6 1O J m2 can be achieved resulting in an optical breakdown in water followed by a shock wave. As a result of different absorption mechanisms the breakdown threshold can be decreased by placing a metallic target into the laser beam. The different shockwave formations of such optomechanical transducers have been measured. First clinical applications have been performed.

  14. Quantification of the Range of Motion of Kidney and Ureteral Stones During Shockwave Lithotripsy in Conscious Patients.

    PubMed

    Harrogate, Suzanne R; Yick, L M Shirley; Williams, James C; Cleveland, Robin O; Turney, Benjamin W

    2016-04-01

    Effective shockwave lithotripsy requires accurate targeting of the stone throughout the course of treatment. Stone movement secondary to respiratory movement can make this more difficult. In vitro work has shown that stone motion outside the focal region reduces the efficacy of stone fragmentation; however, there are few clinical data on the degree of stone movement in patients during treatment. To investigate this, X-ray fluoroscopic images of the kidney and ureteral stones at the upper and lower limits of the normal respiratory cycle were acquired during shock wave lithotripsy of 58 conscious patients, and stone excursion was calculated from these images. In addition, the respiration rate and patient perceived pain were recorded during the course of the treatment. It was found that stone motion secondary to respiration was 7.7 ± 2.9 mm for kidney stones and 3.6 ± 2.1 mm for ureteral stones-less than has been reported in studies with anesthetized patients. There was no significant change of motion over the course of treatment although pain was found to increase. These data suggest that stone motion in conscious patients is less than in anesthetized patients. Furthermore, it suggests that lithotripters with focal regions of 8 mm or greater should not suffer from a marked drop in fragmentation efficiency due to stone motion. PMID:26756226

  15. Clinical factors associated with postoperative hydronephrosis after ureteroscopic lithotripsy

    PubMed Central

    Kim, Sun Woo; Ahn, Ji Hoon; Yim, Sang Un; Cho, Yang Hyun; Shin, Bo Sung; Chung, Ho Seok; Yu, Ho Song; Oh, Kyung Jin; Kim, Sun-Ouck; Jung, Seung Il; Kang, Taek Won; Kwon, Dong Deuk; Park, Kwangsung

    2016-01-01

    Purpose This study aimed to determine the predictors of ipsilateral hydronephrosis after ureteroscopic lithotripsy for ureteral calculi. Materials and Methods From January 2010 to December 2014, a total of 204 patients with ureteral calculi who underwent ureteroscopic lithotripsy were reviewed. Patients with lack of clinical data, presence of ureteral rupture, and who underwent simultaneous percutaneous nephrolithotomy (PNL) were excluded. Postoperative hydronephrosis was determined via computed tomographic scan or renal ultrasonography, at 6 months after ureteroscopic lithotripsy. Multivariable analysis was performed to determine clinical factors associated with ipsilateral hydronephrosis. Results A total of 137 patients were enrolled in this study. The mean age of the patients was 58.8±14.2 years and the mean stone size was 10.0±4.6 mm. The stone-free rate was 85.4%. Overall, 44 of the 137 patients (32.1%) had postoperative hydronephrosis. Significant differences between the hydronephrosis and nonhydronephrosis groups were noted in terms of stone location, preoperative hydronephrosis, impacted stone, operation time, and ureteral stent duration (all, p<0.05). On multivariable analysis, increasing preoperative diameter of the hydronephrotic kidney (adjusted odds ratio [OR], 1.21; 95% confidence interval [CI], 1.12–1.31; p=0.001) and impacted stone (adjusted OR, 3.01; 95% CI, 1.15–7.61; p=0.031) independently predicted the occurrence of postoperative hydronpehrosis. Conclusions Large preoperative diameter of the hydronephrotic kidney and presence of impacted stones were associated with hydronephrosis after ureteroscopic stone removal. Therefore, patients with these predictive factors undergo more intensive imaging follow-up in order to prevent renal deterioration due to postoperative hydronephrosis. PMID:27617316

  16. Intracorporeal lithotripsy with the holmium:YAG laser

    NASA Astrophysics Data System (ADS)

    Denstedt, John D.; Razvi, Hassan A.; Chun, Samuel S.; Sales, Jack L.

    1995-05-01

    A variety of devices are currently available for intracorporeal stone fragmentation. Recently a new wavelength of laser, the Holmium:YAG, has demonstrated a variety of potential urologic applications including ablation of soft tissue lesions as well as stone fragmentation. This laser has a wavelength of 2100 nm and operates in a pulsed mode. Energy is delivered through a 400 um quartz end-firing fiber. In this presentation we review our clinical experience with the Holmium:YAG laser for the treatment of renal and ureteral calculi. Over a 23 month period, 63 patients underwent 67 procedures. Seven procedures consisted of percutaneous nephrolithotripsy for large or staghorn renal calculi. Sixty procedures were performed for ureteral stones. Procedures for proximal ureteral stones (6) employed a retrograde approach using flexible ureteroscopes (8.5 or 9.8). Stones in the mid ureter (12) and distal ureter (42) were approached transurethrally using a 6.9 rigid ureteroscope. Complete stone fragmentation without the need for additional procedures was achieved in 82% of cases. Treatment failures included 1 stone migration into the renal pelvis during laser activation, 6 patients who had incomplete fragmentation and 3 patients in which laser malfunction precluded complete fragmentation. Stone analysis available in 23 patients revealed calcium oxalate monohydrate (15), calcium oxalate dihydrate (2), cystine (2), uric acid (3) and calcium phosphate (1). A single complication of ureteral perforation occurred when the laser was fired without direct visual guidance. Radiographic follow-up at an average of 16 weeks is available in 22 patients and has identified 2 patients with ureteral strictures that are not believed to be related to laser lithotripsy. In summary, we have found the Holmium:YAG laser to be a reliable and versatile device for intracorporeal lithotripsy. Its safety and efficacy make it a suitable alternative for performing intracorporeal lithotripsy of urinary

  17. Holmium laser lithotripsy for ureteral calculi: an outpatient procedure.

    PubMed

    Yip, K H; Lee, C W; Tam, P C

    1998-06-01

    A retrospective review was conducted to evaluate the efficacy of ureteroscopic lithotripsy using the holmium laser with a semirigid endoscope in a newly established day surgery center. In 1996, 69 consecutive patients (40 male and 29 female) with a mean age of 46.7 (range 21-73) years and ASA status I or II underwent ureteroscopic lithotripsy for their ureteral calculi using the holmium laser (365-micron fiber; power setting 0.5-1.4 J/5 Hz) and 8.5F semirigid ureteroscope in a day surgery setting. Stone features, postoperative pain scores, readmissions, and complications were evaluated. Eighteen upper, 17 middle, and 34 lower ureteral stones were treated, with a mean size measuring 12.1 (5-45) mm. The mean operative time was 61 minutes including the anesthetic time (range 15-150 minutes), and the success rate was 91% (63/69). The complication rate was 10% (7/69) including four unscheduled readmissions (6%). Telephone follow-up on postoperative Day 1 and Day 3 revealed mean pain scores of 2 and 1, respectively (on a 0-10 scale) and an analgesic requirement of 1 tablet of Dologesic (containing 32.5 mg of dextropropoxyphene + 320 mg of paracetamol) four times a day on both days. Ureteroscopic lithotripsy using the holmium laser and a semirigid endoscope is highly successful and well tolerated and carries a low complication rate. It is indicated as an ambulatory and minimally invasive treatment modality in low-risk patients with ureteral stones. PMID:9658294

  18. [Extracorporeal lithotripsy in the treatment of renal colic].

    PubMed

    Derevianko, I M; Naumenko, A A

    1996-01-01

    Renal colic arises in acute ureteral obstruction and indicates a sharp rise in intrapelvic pressure (up to 150 mm Hg). The diagnosis of renal colic is made basing on direct and indirect measurements of intrapelvic pressure. Ultrasound in renal colic detects dilatation of the calices and pelvis on the colic side, ureterolith can be also revealed by ultrasound. The authors used extracorporeal lithotripsy for fragmentation of the stone and colic relief in 68 patients. The colic stopped in all the cases. This method is extremely valuable in cases when spasmolytic and analgetic drugs, other conservative modalities fail. PMID:8928326

  19. Impact of voltage and capacity on the electrical and acoustic output of intracorporeal electrohydraulic lithotripsy.

    PubMed

    Vorreuther, R; Engelking, R

    1992-01-01

    The electrical and acoustic output created by the spark discharge for electrohydraulic lithotripsy at the tip of a 3.3-F probe was evaluated. Spark generation was achieved by variable combinations of voltage and capacity. The effective electrical output was determined by means of a high-voltage probe, a current coil and a digital oscilloscope. Peak pressures, rise times and pulse width of the shock waves were recorded using a polyvinylidene difluoride needle hydrophone in 0.9% NaCl solution at a distance of 10 mm. The effective electrical output is lower than the calculated output, due to inductivities, capacities and resistances of the cables and plugs. The life of the probes is markedly shorter when a combination of high voltage and low capacity is used than with low voltage and high capacity corresponding to the same energy. The peak pressure and the slope of the shock front depend solely on the voltage, while the pulse width is correlated with the capacity. The pulse intensity integral of the shock wave is likely to be the best equivalent to the applied energy. PMID:1455568

  20. Laser lithotripsy of a urethral calculus via ischial urethrotomy in a steer.

    PubMed

    Streeter, R N; Washburn, K E; Higbee, R G; Bartels, K E

    2001-09-01

    A steer examined because of obstructive urolithiasis and urethral rupture underwent laser lithotripsy, using a chromium-thulium-holmium:yttrium-aluminum-garnet (Ho:YAG) laser inserted through an ischial urethrotomy. Procedures were performed with caudal epidural anesthesia. Six months after surgery, the urethra was patent with no clinical evidence of urethral stricture or fistula. Ischial urethrotomy provided rapid access to the bladder for catheterization and to the obstructive urolith for lithotripsy. Laser lithotripsy was a rapid and effective means of urolith removal in this steer. PMID:11549094

  1. A fruitful demonstration in sensors based on upconversion luminescence of Yb3+/Er3+codoped Sb2O3-WO3-Li2O (SWL) glass-ceramic

    NASA Astrophysics Data System (ADS)

    Prasad Sukul, Prasenjit; Kumar, Kaushal

    2016-07-01

    In this article, erbium and ytterbium doped lithium tungsten antimonate (Yb3+/Er3+:Sb2O3-WO3-Li2O) glass-ceramics (GC) is synthesized and its novel applications in temperature sensing and detection of latent fingerprints is studied. It is also estimated that this material could be useful as a solar cell concentrator. The upconversion emission studies on Yb3+/Er3+:SWL glass-ceramics have shown intense green emission at 525 nm (2H11/2 → 4I15/2) & 545 nm (4s3/2 → 4I15/2). The variation of UC intensities with external temperature have shown a well-fashioned pattern, which suggests that the 2H11/2 and 4S3/2 levels of Er3+ ion are thermally coupled and can act as a temperature sensor in the 300–500 K temperature range. Dry powder of Yb3+/Er3+:SWL glass-ceramic is used to develop latent fingerprint with high contrast in green color on glass slide.

  2. Acoustic field distribution of sawtooth wave with nonlinear SBE model

    SciTech Connect

    Liu, Xiaozhou Zhang, Lue; Wang, Xiangda; Gong, Xiufen

    2015-10-28

    For precise prediction of the acoustic field distribution of extracorporeal shock wave lithotripsy with an ellipsoid transducer, the nonlinear spheroidal beam equations (SBE) are employed to model acoustic wave propagation in medium. To solve the SBE model with frequency domain algorithm, boundary conditions are obtained for monochromatic and sawtooth waves based on the phase compensation. In numerical analysis, the influence of sinusoidal wave and sawtooth wave on axial pressure distributions are investigated.

  3. Thulium fiber laser lithotripsy in an in vitro ureter model

    NASA Astrophysics Data System (ADS)

    Hardy, Luke A.; Wilson, Christopher R.; Irby, Pierce B.; Fried, Nathaniel M.

    2014-12-01

    Using a validated in vitro ureter model for laser lithotripsy, the performance of an experimental thulium fiber laser (TFL) was studied and compared to the clinical gold standard holmium:YAG laser. The holmium laser (λ=2120 nm) was operated with standard parameters of 600 mJ, 350 μs, 6 Hz, and 270-μm-core optical fiber. The TFL (λ=1908 nm) was operated with 35 mJ, 500 μs, 150 to 500 Hz, and a 100-μm-core fiber. Urinary stones (60% calcium oxalate monohydrate/40% calcium phosphate) of uniform mass and diameter (4 to 5 mm) were laser ablated with fibers through a flexible video-ureteroscope under saline irrigation with flow rates of 22.7 and 13.7 ml/min for the TFL and holmium laser, respectively. The temperature 3 mm from the tube's center and 1 mm above the mesh sieve was measured by a thermocouple and recorded throughout each experiment for both lasers. Total laser and operation times were recorded once all stone fragments passed through a 1.5-mm sieve. The holmium laser time measured 167±41 s (n=12). TFL times measured 111±49, 39±11, and 23±4 s, for pulse rates of 150, 300, and 500 Hz, respectively (n=12 each). Mean peak saline irrigation temperatures reached 24±1°C for holmium, and 33±3°C, 33±7°C, and 39±6°C, for TFL at pulse rates of 150, 300, and 500 Hz, respectively. To avoid thermal buildup and provide a sufficient safety margin, TFL lithotripsy should be performed with pulse rates below 500 Hz and/or increased saline irrigation rates. The TFL rapidly fragmented kidney stones due in part to its high pulse rate, high power density, high average power, and observation of reduced stone retropulsion and may provide a clinical alternative to the conventional holmium laser for lithotripsy.

  4. Pneumatic v electrokinetic lithotripsy in treatment of ureteral stones.

    PubMed

    Vorreuther, R; Klotz, T; Heidenreich, A; Nayal, W; Engelmann, U

    1998-06-01

    Recently, a new device (Combilith) for electrokinetic lithotripsy (EKL) has become available which is very similar to the well-known device for pneumatic (ballistic) lithotripsy (Swiss Lithoclast). The Lithoclast uses air pressure to push a projectile within the handpiece against the end of a metal probe, which is thereby accelerated and thrown like a jackhammer against the stone. In principle, the same stroking movement of a small metal probe is provided by EKL; the difference is that instead of a projectile, a magnetic core within the handpiece is accelerated by the electromagnetic principle. This paper compares the clinical efficacy and the features of the two devices. Testing the devices on a stone model, taking into account stone propulsion, the systems turned out to equally effective regarding stone disintegration. However, stone displacement was more pronounced with the Lithoclast applied on easily breaking stones. In a second experiment, an optoelectronic movement-measuring apparatus (Zimmer camera) was employed to measure the range and velocity of the movement of the probe tip without any contact. The linear acceleration velocity ranged from 5 to a maximum of 12.5 m/sec with both systems, but the maximum height of the stroke was 2.5 mm with the Lithoclast and 1 mm with EKL. After the initial break-up of soft stones, further impact of the probe tip against the stone resulted merely in propulsion; thus, the greater probe stroke height is the cause of the stone displacement. In a clinical trial, 22 ureteral stones were treated with the Lithoclast and 35 with the EKL. The two devices were equally effective in terms of stone disintegration and safety margin. Fixation using a Dormia basket was necessary in 12 cases (8 Lithoclast, 4 EKL). Although a difference in probe stroke height was noted when comparing pneumatic and electrokinetic lithotripsy, there were no clinically significant differences in the efficacy of stone fragmentation or stone-free rates. At the

  5. Thulium fiber laser lithotripsy in an in vitro ureter model.

    PubMed

    Hardy, Luke A; Wilson, Christopher R; Irby, Pierce B; Fried, Nathaniel M

    2014-12-01

    Using a validated in vitro ureter model for laser lithotripsy, the performance of an experimental thulium fiber laser (TFL) was studied and compared to the clinical gold standard holmium:YAG laser. The holmium laser (λ = 2120 nm) was operated with standard parameters of 600 mJ, 350 μs, 6 Hz, and 270-μm-core optical fiber. The TFL (λ=1908 nm) was operated with 35 mJ, 500 μs, 150 to 500 Hz, and a 100-μm-core fiber. Urinary stones (60% calcium oxalate monohydrate/40% calcium phosphate) of uniform mass and diameter (4 to 5 mm) were laser ablated with fibers through a flexible video-ureteroscope under saline irrigation with flow rates of 22.7 and 13.7 ml/ min for the TFL and holmium laser, respectively. The temperature 3 mm from the tube's center and 1 mm above the mesh sieve was measured by a thermocouple and recorded throughout each experiment for both lasers. Total laser and operation times were recorded once all stone fragments passed through a 1.5-mm sieve. The holmium laser time measured 167±41 s (n=12). TFL times measured 111±49, 39±11, and 23±4 s, for pulse rates of 150, 300, and 500 Hz, respectively (n=12 each). Mean peak saline irrigation temperatures reached 24±1°C for holmium, and 33±3°C, 33±7°C, and 39±6°C, for TFL at pulse rates of 150, 300, and 500 Hz, respectively. To avoid thermal buildup and provide a sufficient safety margin, TFL lithotripsy should be performed with pulse rates below 500 Hz and/or increased saline irrigation rates. The TFL rapidly fragmented kidney stones due in part to its high pulse rate, high power density, high average power, and observation of reduced stone retropulsion and may provide a clinical alternative to the conventional holmium laser for lithotripsy. PMID:25518001

  6. Safety and efficacy of holmium:YAG laser lithotripsy in patients with bleeding diatheses

    NASA Astrophysics Data System (ADS)

    Watterson, James D.; Girvan, Andrew R.; Cook, Anthony J.; Beiko, Darren T.; Nott, Linda; Auge, Brian K.; Preminger, Glenn M.; Denstedt, John D.

    2003-06-01

    Purpose: To assess the safety and efficacy of ureteroscopy and holmium:YAG (yttrium-aluminum-garnet) laser lithotripsy in the treatment of upper urinary tract calculi in patients with known and uncorrected bleeding diatheses. Materials and Methods: A retrospective chart review from 2 tertiary stone centers was performed to identify patients with known bleeding diatheses who were treated with holmium:YAG laser lithotripsy for upper urinary tract calculi. Twenty-five patients with 29 upper urinary tract calculi were treated with ureteroscopic holmium laser lithotripsy. Bleeding diatheses identified were coumadin administration for various conditions (17), liver dysfunction (3), thrombocytopenia (4), and von Willebrand's disease (1). Mean international normalized ratio (INR), platelet count and bleeding time were 2.3, 50 x 109/L, and > 16 minutes, for patients receiving coumadin or with liver dysfunction, thrombocytopenia, or von Willebrand's disease, respectively. Results: Overall, the stone-free rate was 96% (27/28) and 29 of 30 procedures were completed successfully without significant complication. One patient who was treated concomitantly with electrohydraulic lithotripsy (EHL) had a significant retroperitoneal hemorrhage that required blood transfusion. Conclusions: Treatment of upper tract urinary calculi in patients with uncorrected bleeding diatheses can be safely performed using contemporary small caliber ureteroscopes and holmium laser as the sole modality of lithotripsy. Ureteroscopic holmium laser lithotripsy without preoperative correction of hemostatic parameters limits the risk of thromboembolic complications and costs associated with an extended hospital stay. Avoidance of the use of EHL is crucial in reducing bleeding complications in this cohort of patients.

  7. Extracorporeal shockwave lithotripsy of gallstones. Possibilities and limitations.

    PubMed Central

    Vergunst, H; Terpstra, O T; Brakel, K; Laméris, J S; van Blankenstein, M; Schröder, F H

    1989-01-01

    Recently extracorporeal shockwave lithotripsy (ESWL) has been introduced as a nonoperative treatment for gallstone disease. Except for lung damage, no significant adverse effects of ESWL of gallbladder stones have been observed in animals. In clinical use ESWL of gallbladder stones is now confined to 15% to 30% of symptomatic patients. To achieve complete stone clearance, ESWL of gallbladder stones must be supplemented by an adjuvant therapy. ESWL of bile duct stones is highly effective and can be considered in patients in whom primary endoscopic or surgical stone removal fails. Second generation lithotriptors allow anesthesia-free (outpatient) treatments, but the clinical experience with most of these ESWL devices is still limited. The likelihood of gallbladder stone recurrence is a major disadvantage of ESWL treatment, which raises the issue of cost-effectiveness. ESWL for cholelithiasis is a promising treatment modality with good short-term and unknown long-term results. PMID:2684058

  8. Laser lithotripsy for removal of uroliths in dogs

    NASA Astrophysics Data System (ADS)

    Adams, Larry G.; Lulich, Jody P.

    2006-02-01

    Introduction: This study evaluated the ability to fragment and remove naturally occurring uroliths in dogs using a holmium: YAG laser. Methods: Twenty four dogs with naturally occurring uroliths including 10 spayed females and 14 neutered males. The dogs were 8.7 +/- 2.8 years old and weighed 13.7 +/- 8.0 kg. All dogs had bladder stones and 5 male dogs also had urethral stones. In female dogs, cystoscopy was performed using a rigid cystoscope with sheath diameter of 14 to 19 french. Cystoscopy was performed in males dogs using a 7.5 french diameter pediatric ureteroscope. Uroliths were fragmented using a 20 watt Holmium: YAG laser and the fragments were removed by basket extraction and voiding urohydropropulsion. Results: Average laser parameters for urolith fragmentation were 0.7 Joules at 8 Hertz (range: 0.5 to 1.3 Joules at 5 to 13 Hertz). All urolith fragments were successfully removed in all 10 female dogs and 11 of 14 male dogs. In one male dog, the urethra was too small to allow passage of the ureteroscope. In one of the male dogs, the urethral stones were successfully removed by laser lithotripsy, but removal of the bladder stones was performed by cystotomy. There was one complication of urethral perforation during attempts to pass an access sheath transurethrally in a dog with extensive proliferative urethritis. Conclusions: Laser lithotripsy is a safe and effective method of removing bladder and urethral stones in dogs provided the dog is large enough to permit transurethral passage of a cystoscope or ureteroscope.

  9. Cavitation bubble dynamics during thulium fiber laser lithotripsy

    NASA Astrophysics Data System (ADS)

    Hardy, Luke A.; Kennedy, Joshua D.; Wilson, Christopher R.; Irby, Pierce B.; Fried, Nathaniel M.

    2016-02-01

    The Thulium fiber laser (TFL) is being explored for lithotripsy. TFL parameters differ from standard Holmium:YAG laser in several ways, including smaller fiber delivery, more strongly absorbed wavelength, low pulse energy/high pulse rate operation, and more uniform temporal pulse structure. High speed imaging of cavitation bubbles was performed at 105,000 fps and 10 μm spatial resolution to determine influence of these laser parameters on bubble formation. TFL was operated at 1908 nm with pulse energies of 5-75 mJ, and pulse durations of 200-1000 μs, delivered through 100-μm-core fiber. Cavitation bubble dynamics using Holmium laser at 2100 nm with pulse energies of 200-1000 mJ and pulse duration of 350 μs was studied, for comparison. A single, 500 μs TFL pulse produced a bubble stream extending 1090 +/- 110 μm from fiber tip, and maximum bubble diameters averaged 590 +/- 20 μm (n=4). These observations are consistent with previous studies which reported TFL ablation stallout at working distances < 1.0 mm. TFL bubble dimensions were five times smaller than for Holmium laser due to lower pulse energy, higher water absorption coefficient, and smaller fiber diameter used.

  10. Stress wave focusing transducers

    SciTech Connect

    Visuri, S.R., LLNL

    1998-05-15

    Conversion of laser radiation to mechanical energy is the fundamental process behind many medical laser procedures, particularly those involving tissue destruction and removal. Stress waves can be generated with laser radiation in several ways: creation of a plasma and subsequent launch of a shock wave, thermoelastic expansion of the target tissue, vapor bubble collapse, and ablation recoil. Thermoelastic generation of stress waves generally requires short laser pulse durations and high energy density. Thermoelastic stress waves can be formed when the laser pulse duration is shorter than the acoustic transit time of the material: {tau}{sub c} = d/c{sub s} where d = absorption depth or spot diameter, whichever is smaller, and c{sub s} = sound speed in the material. The stress wave due to thermoelastic expansion travels at the sound speed (approximately 1500 m/s in tissue) and leaves the site of irradiation well before subsequent thermal events can be initiated. These stress waves, often evolving into shock waves, can be used to disrupt tissue. Shock waves are used in ophthalmology to perform intraocular microsurgery and photodisruptive procedures as well as in lithotripsy to fragment stones. We have explored a variety of transducers that can efficiently convert optical to mechanical energy. One such class of transducers allows a shock wave to be focused within a material such that the stress magnitude can be greatly increased compared to conventional geometries. Some transducer tips could be made to operate regardless of the absorption properties of the ambient media. The size and nature of the devices enable easy delivery, potentially minimally-invasive procedures, and precise tissue- targeting while limiting thermal loading. The transducer tips may have applications in lithotripsy, ophthalmology, drug delivery, and cardiology.

  11. Thulium fiber laser lithotripsy using small spherical distal fiber tips

    NASA Astrophysics Data System (ADS)

    Wilson, Christopher R.; Hardy, Luke A.; Kennedy, Joshua D.; Irby, Pierce B.; Fried, Nathaniel M.

    2016-02-01

    This study tests a 100-μm-core fiber with 300-μm-diameter ball tip during Thulium fiber laser (TFL) lithotripsy. The TFL was operated at 1908 nm wavelength with 35-mJ pulse energy, 500-μs pulse duration, and 300-Hz pulse rate. Calcium oxalate/phosphate stone samples were weighed, laser procedure times measured, and ablation rates calculated for ball tip fibers, with comparison to bare tip fibers. Photographs of ball tips were taken before and after each procedure to observe ball tip degradation and determine number of procedures completed before need to replace fiber. Saline irrigation rates and ureteroscope deflection were measured with and without TFL fiber present. There was no statistical difference (P > 0.05) between stone ablation rates for single-use ball tip fiber (1.3 +/- 0.4 mg/s) (n=10), multiple-use ball tip fiber (1.3 +/- 0.5 mg/s) (n=44), and conventional single-use bare tip fibers (1.3 +/- 0.2 mg/s) (n=10). Ball tip durability varied widely, but fibers averaged > 4 stone procedures before decline in stone ablation rates due to mechanical damage at front surface of ball tip. The small fiber diameter did not impact ureteroscope deflection or saline flow rates. The miniature ball tip fiber may provide a cost-effective design for safe fiber insertion through the ureteroscope working channel and the ureter without risk of scope damage or tissue perforation, and without compromising stone ablation efficiency during TFL ablation of kidney stones.

  12. Effectiveness and Safety of Ureteroscopic Holmium Laser Lithotripsy for Upper Urinary Tract Calculi in Elderly Patients.

    PubMed

    Yoshioka, Takashi; Otsuki, Hideo; Uehara, Shinya; Shimizu, Toshihiro; Murao, Wataru; Fujio, Koji; Fujio, Kei; Wada, Koichiro; Araki, Motoo; Nasu, Yasutomo

    2016-06-01

    Upper urinary tract calculi are common; however, there is no recommended treatment selection for elderly patients. Ureteroscopic holmium laser lithotripsy (URS lithotripsy) is minimally invasive, and it provides a high stone-free rate (SFR) treatment for upper urinary tract calculi. Here, we retrospectively evaluated the surgical outcomes of URS lithotripsy after dividing the 189 cases into 3 groups by patient age: the '<65 group' (<65 years old, n=108), the '65-74 group' (65-74 years old, n=42), and the ' 75 group' ( 75 years old, n=39). The patients' characteristics, stone status, and perioperative outcomes were assessed. The 65-74 group and the 75 group had a significantly higher prevalence of hypertension compared to the<65 group. Compared to the<65 group, the 65-74 group had a significantly higher prevalence of hyperlipidemia, and the 75 group had significantly higher the American Society of Anesthesiologists (ASA) scores. Despite these preoperative risk factors, SFR and postoperative pyelonephritis in the 65-74 group and the 75 group were similar to those of the<65 group. In conclusion, URS lithotripsy is the preferred treatment for upper urinary tract calculi, even for elderly patients who have multiple preoperative risk factors. PMID:27339204

  13. Ureteropyeloscopy and homium: YAG laser lithotripsy for treatment of ureteral calculi (report of 356 cases)

    NASA Astrophysics Data System (ADS)

    Wu, Zhong; Din, Qiang; Jiang, Hao-wen; Zen, Jing-cun; Yu, Jiang; Zhang, Yuanfang

    2005-07-01

    Objective: To evaluate the efficacy and safety of holmium YAG laser lithotripsy for the treatment of ureteral calculi. Methods: A total of 356 patients underwent ureteropyeloscopic lithotripsy using holmium YAG laser with a semirigid uretesopyeloscope, 93 upper, 135 middle, and 128 lower ureteral stones were treated. Results: The overall successful fragmentation rate for all ureteral stones in a single session achieved 98% (349/356). The successful fragmentation rate stratified by stone location was 95% 88/93 in the upper ureter, 99% (134/135) in the mid ureter , and 99%(127/128) in the distal ureter. 12 cases with bilateral ureteral stones which caused acute renal failure and anuria were treated rapidly and effectively by the holmium YAG laser lithotripsy. No complications such as perforation and severe trauma were encountered during the operations. 2 weeks 17months (with an average of 6.8 month ) follow up postoperatively revealed that the overall stone-free rate was 98%(343/349) and no ureteral stenosis was found. Conclusions Holmium YAG laser lithotripsy is a highly effective, minimally invasive and safe therapy for ureteral calculi. It is indicated as a first choice of treatment for patients with ureteral calculi, especially for the ones with mid- lower levels of ureteral calculi.

  14. Comparison of fluoride and sapphire optical fibers for Er: YAG laser lithotripsy.

    PubMed

    Qiu, Jinze; Teichman, Joel; Wang, Tianyi; Elmaanaoui, Badr; Gamez, David; Milner, Thomas E

    2010-06-01

    The long-pulse (200-350 micros) Holmium: YAG (Ho: YAG) laser (lambda = 2.12 microm) is used extensively in urology for laser lithotripsy. The long-pulse Erbium: YAG (Er: YAG) laser (lambda = 2.94 microm) fragments urinary calculi up to 5 times more efficiently than the Ho: YAG laser, however, no optical fibers are available to transmit efficiently 2.94 microm laser light for laser lithotripsy. We report results of a study evaluating a fluoride glass fiber to transmit Er: YAG laser light for laser lithotripsy and compare to a sapphire fiber that provides good transmission of Er: YAG light at low irradiance. The fluoride fiber provides superior light transmission efficiency over the sapphire fiber at an Er: YAG wavelength (2.94 microm). The sapphire fiber provides a more durable and robust delivery waveguide than the fluoride fiber when ablating urinary calculi in contact mode. Results of our study suggest that further development to improve performance of fluoride fibers for laser lithotripsy is warranted. PMID:20414904

  15. Laser lithotripsy of difficult bile duct stones under direct visual control.

    PubMed Central

    Neuhaus, H; Hoffmann, W; Zillinger, C; Classen, M

    1993-01-01

    Biliary laser lithotripsy was performed under direct visual control in 35 consecutive patients not amenable to routine endoscopy. The patients had 1-50 (median 1) bile duct stones with the greatest diameter of the largest stone being 9-42 mm (median 20 mm). Conventional endoscopic treatment had failed because of an inaccessible papilla (16 patients), biliary strictures (seven patients), and impaction or large size of calculi (12 patients). Twelve patients, depending on their anatomical condition, underwent peroral cholangioscopy by means of a mother-babyscope system. Percutaneous cholangioscopy was initially carried out in 23 patients, 7-20 days (median 10 days) after creation of a transhepatic fistula. Pulsed dye laser (32 patients) or alexandrite laser (three patients) lithotripsy was applied under an appropriate direct visual control in all cases. Complete stone disintegration succeeded in 33 of 35 patients. All resultant fragments passed the papilla within a mean number of 1.3 treatment sessions. Peroral cholangioscopic lithotripsy failed in two cases. One patient successfully underwent percutaneous laser treatment and the other patient was referred to surgery. Fever, temporary haemobilia, or a subcapsular liver haematoma were seen in a total of eight patients during establishment of the cutaneobiliary fistula. A 95 year old patient who had been admitted with septic cholangitis died because of cardiorespiratory failure 5 days after bile duct clearance. It is concluded that laser lithotripsy performed under a direct visual control is an effective and safe procedure for the non-surgical treatment of difficult bile duct stones. Ductal clearance can usually be achieved in a single treatment session when the papilla and the stones are accessible by the peroral route. Percutaneous cholangioscopic lithotripsy is more time consuming but highly effective even in patients with a difficult anatomy, bile duct strictures, or intrahepatic calculi. This approach should be

  16. Pulsed dye laser lithotripsy for treatment of urolithiasis in two geldings.

    PubMed

    Howard, R D; Pleasant, R S; May, K A

    1998-05-15

    Transendoscopic pulsed dye laser lithotripsy was effective in the treatment of calcium carbonate urothlithiasis in 2 adult geldings. Perineal urethrotomy provided convenient access for standing transendoscopic lithotripsy and evacuation of a large cystic calculus in one gelding. In the second horse, an obstructive urethral calculus was fragmented and removed by a transurethroscopic approach. Pulsed dye laser lithotriptor is effective in fragmentation of the most common form (calcium carbonate) of uroliths in horses and may be performed in standing horses with reduced surgical invasiveness and trauma to the urinary tract, compared with conventional approaches. The principle disadvantages include cost of the procedure, which is comparable to laparocystotomy, and the time delay required to make arrangements for use of the pulsed dye laser lithotriptor. PMID:9604033

  17. Application of holographic interferometric studies of underwater shock-wave focusing to medicine

    NASA Astrophysics Data System (ADS)

    Takayama, Kazuyoshi; Nagoya, H.; Obara, Tetsuro; Kuwahara, M.

    1993-01-01

    Holographic interferometric flow visualization was successfully applied to underwater shock wave focusing and its application to extracorporeal shock wave lithotripsy (ESWL). Real time diffuse holograms revealed the shock wave focusing process in an ellipsoidal reflector made from PMMA and double exposure holographic interferometry also clarified quantitatively the shock focusing process. Disintegration of urinary tract stones and gallbladder stones was observed by high speed photogrammetry. Tissue damage associated with the ESWL treatment is discussed in some detail.

  18. Laser lithotripsy with the Ho:YAG laser: fragmentation process revealed by time-resolved imaging

    NASA Astrophysics Data System (ADS)

    Schmidlin, Franz R.; Beghuin, Didier; Delacretaz, Guy P.; Venzi, Giordano; Jichlinski, Patrice; Rink, Klaus; Leisinger, Hans-Juerg; Graber, Peter

    1998-07-01

    Improvements of endoscopic techniques have renewed the interest of urologists in laser lithotripsy in recent years. Laser energy can be easily transmitted through flexible fibers thereby enabling different surgical procedures such as cutting, coagulating and lithotripsy. The Ho:YAG laser offers multiple medical applications in Urology, among them stone fragmentation. However, the present knowledge of its fragmentation mechanism is incomplete. The objective was therefore to analyze the fragmentation process and to discuss the clinical implications related to the underlying fragmentation mechanism. The stone fragmentation process during Ho:YAG laser lithotripsy was observed by time resolved flash video imaging. Possible acoustic transient occurrence was simultaneously monitored with a PVDF-needle hydrophone. Fragmentation was performed on artificial and cystine kidney stones in water. We observed that though the fragmentation process is accompanied with the formation of a cavitation bubble, cavitation has only a minimal effect on stone fragmentation. Fragment ejection is mainly due to direct laser stone heating leading to vaporization of organic stone constituents and interstitial water. The minimal effect of the cavitation bubble is confirmed by acoustic transients measurements, which reveal weak pressure transients. Stone fragmentation with the Holmium laser is the result of vaporization of interstitial (stone) water and organic stone constituents. It is not due to the acoustic effects of a cavitation bubble or plasma formation. The fragmentation process is strongly related with heat production thereby harboring the risk of undesired thermal damage. Therefore, a solid comprehension of the fragmentation process is needed when using the different clinically available laser types of lithotripsy.

  19. Comparison of different pulsed and Q-switched solid state laser systems for endoscopic laser-induced shockwave lithotripsy: performance and laser/stone interactions

    NASA Astrophysics Data System (ADS)

    Steiger, Erwin

    1990-06-01

    At present the laser induced shock wave lithotripsy (LISL) of urinary and biliary stones via fiber optic beam delivery is governed by two competing' laser systems: The flashlamp-pumped pulsed dye laser and the Q-switched Nd:YAG laser. The pulsed radiation of the dye system with pulse durations in the 1-2 .tsec region can be easily transmitted through extremely flexible fused silica fibers with core diameters of only 200 im whilst the Q-switched Nd:YAG laser with pulselengths of 5-25 nsec needs fibers with more than 400 tm core diameter. The dye laser releases acoustic shock waves for fragmentation simply by stone contact, the Q-switched Nd:YAG produces these waves in the surrounding aqueous medium by laser induced optical breakdown (LIB) when refocused by optical means or through additional metal absorbers, i.e. opto - mechanical couplers. We report on the system performances and laser/stone interactions of two alternative solid-state laser systems with variable pulselengths in the range of 1.7 - 30 sec and 30 - 1000 nsec, respectively: The pulsed psec-Nd:YAG laser and the Q-switched alexandrite laser. Regarding the endoscopic laser lithotripsy of urinary and biliary stones in the ureter or common bile duct, respectively, the laser energy delivery system, i.e. the optical fiber; is the most stressed part. Therefore we used long-pulse solid-state laser systems like the pulsed Nd:YAG laser with a pulse-slicing unit and a pulselength-tunable Q-switched alexandrite laser and studied fragmentation of synthetic plaster samples as well as urinary and biliary stones. The radiation of both laser systems can be effectively transmitted via standard 200 im core diameter optical quartz fibers what is absolutely necessary when used in conjunction with small caliber rigid or flexible endoscopes. As a compact and reliable solid-state system the alexandrite laser lithotripter is much less expensive than an extracorporeal shock wave lithotripter with the same fragmentation results

  20. Shock wave sensors: I. Requirements and design.

    PubMed

    Lewin, P A; Schafer, M E

    1991-01-01

    In the last 9 years, extracorporeal shock wave lithotripsy has become one of the preferred procedures for the treatment of urinary and gallbladder calculi. While there is still uncertainty as to the mechanisms of stone fragmentation, current hypotheses suggest that acoustical shock wave parameters such as rise time, peak compressional and rarefactional pressure, and frequency content may all influence the treatment's efficiency. Thus, optimization of lithotripsy treatment needs pressure sensors that can adequately characterize the shock wave field. This article presents and discusses the design of reliable, wideband, quantitative shock wave sensors made of piezoelectric material. The development, design, and performance characteristics of the sensors are presented. Sensor construction details are described, as are the methods used to characterize the sensor's acoustical performance. The key acoustical parameters of the sensor, its frequency response, and directivity pattern are presented; theory indicates that the probes feature uniform sensitivity over the frequency range up to 100 MHz. Preliminary experimental results indicate that piezoelectric polymer sensors made of polyvinylidene fluoride (PVDF) with a low acoustical impedance backing are suitable for lithotripter field measurements. The applicability of sensors based on fiber optics to shock wave measurements is also briefly discussed. In a companion article, shock wave measurement techniques are outlined and selected lithotripter test data are presented. PMID:10149140

  1. Gallbladder stone inspection and identification for laser lithotripsy

    NASA Astrophysics Data System (ADS)

    Makdisi, Yacob; Kokaj, Jahja O.

    1999-03-01

    Using high speed imaging techniques, the gall bladder stone immersed in liquid is detected and identified. The detection of the shock waves induced by laser power is reached by using interferometry technique. Using gall bladder and tissue images obtained by ultra-fast photography and time resolved laser fluorescence the correlation of correlation is performed. The tissue image is used to perform the correlation filter. Hence lower correlation output is used for firing of the laser power.

  2. Treatment of Kidney Stone in a Kidney-Transplanted Patient with Mini-Percutaneous Laser Lithotripsy: A Case Report

    PubMed Central

    Markić, Dean; Krpina, Kristian; Ahel, Juraj; Gršković, Antun; Španjol, Josip; Rubinić, Nino; Materljan, Mauro; Mikolašević, Ivana; Orlić, Lidija; Rački, Sanjin

    2016-01-01

    We report a case of a kidney-transplanted patient with urolithiasis treated with mini-percutaneous laser lithotripsy. The patient presented with renal dysfunction and graft hydronephrosis. Diagnostic procedures revealed ureterolithiasis as a cause of obstruction, and percutaneous nephrostomy was inserted as a temporary solution. Before surgery, the stone migrated to the renal pelvis. Mini-percutaneous laser lithotripsy was successfully performed, and during surgery, all stone fragments were removed. Six months after successful treatment, the patient has good functioning and stone-free graft. PMID:27066492

  3. Percutaneous Endoscopic Holmium Laser Lithotripsy for Management of Complicated Biliary Calculi

    PubMed Central

    Healy, Kelly; Chamsuddin, Abbas; Spivey, James; Martin, Louis; Nieh, Peter

    2009-01-01

    Background and Objectives: Advances in endoscopic techniques have transformed the management of urolithiasis. We sought to evaluate the role of such urological interventions for the treatment of complex biliary calculi. Methods: We conducted a retrospective review of all patients (n=9) undergoing percutaneous holmium laser lithotripsy for complicated biliary calculi over a 4-year period (12/2003 to 12/2007). All previously failed standard techniques include ERCP with sphincterotomy (n=6), PTHC (n=7), or both of these. Access to the biliary system was obtained via an existing percutaneous transhepatic catheter or T-tube tracts. Endoscopic holmium laser lithotripsy was performed via a flexible cystoscope or ureteroscope. Stone clearance was confirmed intra- and postoperatively. A percutaneous transhepatic drain was left indwelling for follow-up imaging. Results: Mean patient age was 65.6 years (range, 38 to 92). Total stone burden ranged from 1.7 cm to 5 cm. All 9 patients had stones located in the CBD, with 2 patients also having additional stones within the hepatic ducts. All 9 patients (100%) were visually stone-free after one endoscopic procedure. No major perioperative complications occurred. Mean length of stay was 2.4 days. At a mean radiological follow-up of 5.4 months (range, 0.5 to 21), no stone recurrence was noted. Conclusions: Percutaneous endoscopic holmium laser lithotripsy is a minimally invasive alternative to open salvage surgery for complex biliary calculi refractory to standard approaches. This treatment is both safe and efficacious. Success depends on a multidisciplinary approach. PMID:19660213

  4. Definitive ureteroscopy and intracorporeal lithotripsy in treatment of ureteral calculi during pregnancy

    PubMed Central

    Teleb, Mohamed; Ragab, Ahmed; Dawod, Tamer; Elgalaly, Hazem; Elsayed, Ehab; Sakr, Ahmed; Abdelhameed, Ahmed; Maarouf, Arif; Khalil, Salem

    2014-01-01

    Objective To evaluate the outcome of using semi-rigid ureteroscopy with or without intracorporeal pneumatic lithotripsy vs. temporary ureteric JJ stenting in the management of obstructing ureteric calculi in pregnant women. Patients and methods This prospective comparative study comprised 43 pregnant women with obstructing ureteric calculi. The diagnosis was based on the acute flank pain as the main symptom, microscopic haematuria, and unilateral hydronephrosis on abdominal ultrasonography (US). The patients were randomly divided into two groups; those in group 1 (22 patients) were treated by temporary ureteric JJ stenting until after delivery, and those in group 2 (21) were treated definitively by ureteroscopic stone extraction with intracorporeal pneumatic lithotripsy. Postoperative complications and the degree of patient satisfaction were reported. Results An obstructing ureteric stone was identified by US in 68% and 76% of groups 1 and 2, respectively. In group 1, nine patients had mid-ureteric stones and 13 had stones in the lower ureter. In group 2, seven patients had mid-ureteric stones, whilst the stones were in the distal ureter in 14. No perioperative foetal complications were detected in any group and all patients completed the full term of pregnancy. In group 1, four patients had a postoperative urinary tract infection (UTI), and the JJ stent was exchanged in seven. Two patients in group 2 had a postoperative UTI. Conclusions Definitive ureteroscopy, even with intracorporeal pneumatic lithotripsy, is an effective and safe treatment for pregnant women with obstructing ureteric calculi. It has a better outcome and is more satisfactory for the patients than a temporary JJ stent. PMID:26019966

  5. Emergency ureteroscopic lithotripsy in acute renal colic caused by ureteral calculi: a retrospective study.

    PubMed

    Al-Ghazo, Mohammed A; Ghalayini, Ibrahim Fathi; Al-Azab, Rami S; Bani Hani, Osamah; Bani-Hani, Ibrahim; Abuharfil, Mohammad; Haddad, Yazan

    2011-12-01

    This work was conducted to evaluate the safety and efficacy of emergency ureteroscopic lithotripsy in patients with ureteral stones. From May 2003 to December 2010, 244 patients (184 men and 60 women, mean age 45.6 ± 12.7 years (range 22-73 years) were treated with emergency ureteroscopic lithotripsy for ureteral calculi. All patients were divided into three groups according to the stone location in the ureter. Intracorporeal lithotripsy when necessary was performed with the Swiss lithoclast. The overall stone-free status was defined as the complete absence of stone fragments at 4 weeks, postoperatively. A double J stent was inserted in selected patients if there was significant ureteral wall trauma, edema at the stone impaction site, suspected or proved ureteral perforation, and if the stone migrated to the kidney. The overall success rate was 90.6%. The success rates were different according to the stone site. The success rate of groups A, B and C was 69.4, 94.8 and 96.6%, respectively. The overall rate of ureteral stent insertion at the end of the procedure was 177/244 (72.5%). The rate of stent insertion was 41/49 (83.7%), 32/46 (69.6%) and 104/149 (69.8%) in groups A, B and C, respectively. The overall complication, failure, and stricture rate was 32/244 (13.1%), 23/244 (9.4%) and 0.8%, respectively. With the recent advances in ureteroscopic technology, intracorporeal probes and stone extraction devices, emergency ureteroscopy is found to be a safe and effective procedure with immediate relief from ureteral colic and ureteral stone fragmentation. PMID:21499919

  6. Evaluation of Extracorporeal Shock Wave Lithotripsy (ESWL): Efficacy in Treatment of Urinary System Stones

    PubMed Central

    Junuzovic, Dzelaludin; Prstojevic, Jelena Kovacevic; Hasanbegovic, Munira; Lepara, Zahid

    2014-01-01

    ABSTRACT Introduction: Elimination of stone is determined by size and its localization. Stone from the ureter in 80% of cases can be eliminated spontaneously. If the stone by its characteristics is not spontaneously eliminated, taken are further steps and therapeutic protocols to solve this problem. Material and methods: The study was prospective, open and comparative. It was conducted at the Urology Clinic Clinical Center of Sarajevo University in the period from 2007 to 2013. The study included 404 patients with urinary tract lithiasis treated by ESWL. ESWL treatment is performed on the machine Siemens Model Lithostar Multiline, which has a combined ultrasonographic and fluoroscopic display, large energy density in order to obtain optimum focus (without damaging surrounding tissue) and minimal pain that on rare occasions requires for mild sedation-sedation. Results: From a total of 404 patients included in the study there were 234 (57.92%) male and 170 (42.08%) female patients. The most common type of stone both in female and male patients was calcium type. From a total of 262 calcium stones, 105 of them (40.07%) was present in female patients and 157 (59.92%) in male. Share of infectious type of stone in female patients was 63 (49.60%) and 64 among males (50.39%). Other stones were less abundant in both the gender groups and their total number was only 17. In women their frequency was 2 (13.33%) and 13 among males (86.67%). There was a significant difference in the frequency of different types of stones by gender (x2 = 11.47, p = 0.009). Conclusion: There was no statistically significant correlation between the number of treatments and localization of stones in the ureter, as well as a statistically significant correlation between the size of the stone and the localization of calculus in the ureter. PMID:25568579

  7. Holmium:YAG laser lithotripsy for the management of urolithiasis in small ruminants and pot-bellied pigs

    NASA Astrophysics Data System (ADS)

    Halland, Spring K.; House, John K.; George, Lisle

    2001-05-01

    Obstructive urolithiasis is a common problem in small ruminants and pot-bellied pigs. The most common site of urinary tract obstruction in these species is the urethra. Surgical procedures developed to relieve obstructions, in our experience have been effective in approximately 75% of cases. Urethral stricture is a common complication if the mucosa of the urethra is disrupted. The objective of this project was to evaluate endoscopy guided laser lithotripsy as a therapeutic modality to relieve urethral obstructions in small ruminants and pot-bellied pigs. The study population consisted of patients presented to the Veterinary Medical Teaching Hospital at the University of California Davis with obstructive urolithiasis. Lithotripsy was performed using a Holmium:YAG laser via a 200-micron low water quartz fiber passed through a flexible mini-endoscope. Two types of urinary calculi were managed with this technique, calcium carbonate and calcium hydroxyphosphate. Laser lithotripsy was effective at relieving obstructions caused by both types of calculi when conventional methods had failed. Laser lithotripsy performed via urethral endoscopy is a safe and effective therapeutic modality for management of obstructive urolithiasis in small ruminants and pot-bellied pigs and reduces the risk of post procedural urethral stricture.

  8. Ureteroscopy and holmium:YAG laser lithotripsy: an emerging definitive management strategy for symptomatic ureteral calculi in pregnancy

    NASA Astrophysics Data System (ADS)

    Watterson, James D.; Girvan, Andrew R.; Beiko, Darren T.; Nott, Linda; Wollin, Timothy A.; Razvi, Hassan A.; Denstedt, John D.

    2003-06-01

    Objectives: Symptomatic urolithiasis in pregnancy that does not respond to conservative measures has traditionally been managed with ureteral stent insertion or percutaneous nephrostomy (PCN). Holmium:yttrium-aluminum-garnet (YAG) laser lithotripsy using state-of-the-art ureteroscopes represents an emerging strategy for definitive stone management in pregnancy. The purpose of this study was to review the results of holmium laser lithotripsy in a cohort of patients who presented with symptomatic urolithiasis in pregnancy. Methods: A retrospective analysis was conducted at 2 tertiary stone centers from January 1996 to August 2001 to identify pregnant patients who were treated with ureteroscopic holmium laser lithotripsy for symptomatic urolithiasis or encrusted stents. Eight patients with a total of 10 symptomatic ureteral calculi and 2 encrusted ureteral stents were treated. Mean gestational age at presentation was 22 weeks. Mean stone size was 8.1 mm. Stones were located in the proximal ureter/ureteropelvic junction (UPJ) (3), mid ureter (1), and distal ureter (6). Results: Complete stone fragmentation and/or removal of encrusted ureteral stents were achieved in all patients using the holmium:YAG laser. The overall procedural success rate was 91%. The overall stone-free rate was 89%. No obstetrical or urological complications were encountered. Conclusions: Ureteroscopy and holmium laser lithotripsy can be performed safely in all stages of pregnancy providing definitive management of symptomatic ureteral calculi. The procedure can be done with minimal or no fluoroscopy and avoids the undesirable features of stents or nephrostomy tubes.

  9. Shock Wave Technology and Application: An Update☆

    PubMed Central

    Rassweiler, Jens J.; Knoll, Thomas; Köhrmann, Kai-Uwe; McAteer, James A.; Lingeman, James E.; Cleveland, Robin O.; Bailey, Michael R.; Chaussy, Christian

    2012-01-01

    Context The introduction of new lithotripters has increased problems associated with shock wave application. Recent studies concerning mechanisms of stone disintegration, shock wave focusing, coupling, and application have appeared that may address some of these problems. Objective To present a consensus with respect to the physics and techniques used by urologists, physicists, and representatives of European lithotripter companies. Evidence acquisition We reviewed recent literature (PubMed, Embase, Medline) that focused on the physics of shock waves, theories of stone disintegration, and studies on optimising shock wave application. In addition, we used relevant information from a consensus meeting of the German Society of Shock Wave Lithotripsy. Evidence synthesis Besides established mechanisms describing initial fragmentation (tear and shear forces, spallation, cavitation, quasi-static squeezing), the model of dynamic squeezing offers new insight in stone comminution. Manufacturers have modified sources to either enlarge the focal zone or offer different focal sizes. The efficacy of extracorporeal shock wave lithotripsy (ESWL) can be increased by lowering the pulse rate to 60–80 shock waves/min and by ramping the shock wave energy. With the water cushion, the quality of coupling has become a critical factor that depends on the amount, viscosity, and temperature of the gel. Fluoroscopy time can be reduced by automated localisation or the use of optical and acoustic tracking systems. There is a trend towards larger focal zones and lower shock wave pressures. Conclusions New theories for stone disintegration favour the use of shock wave sources with larger focal zones. Use of slower pulse rates, ramping strategies, and adequate coupling of the shock wave head can significantly increase the efficacy and safety of ESWL. PMID:21354696

  10. Comparison of urinary calculus fragmentation during Ho:YAG and Er:YAG lithotripsy

    NASA Astrophysics Data System (ADS)

    Kang, Hyun Wook; Lee, Ho; Teichman, Joel H.; Welch, A. J.

    2005-04-01

    We compared urinary calculus fragmentation with long pulsed Ho:YAG (λ= 2.12 μm) versus Er:YAG (λ = 2.94 μm) lasers. We measured the ablation width, depth, volume and efficiency as a function of pulse energy from calculus threshold energy to clinical energy typically used for Ho:YAG laser lithotripsy. Ablation effects were evaluated for three types of urinary calculi (calcium oxalate monohydrate, cystine, and uric acid), for single and multiple pulses applied at various optical energy levels. By means of comparing laser-induced crater topography and ablation volume for each stone type, the feasibility of Er:YAG laser lithotripsy was appraised. The Er:YAG laser pulse energy generated deeper and narrower crater shapes with relatively smooth contours whereas the Ho:YAG laser produced shallower and wider craters with irregular shapes. In terms of multiple pulses ablation, the Er:YAG produced larger ablation volume than Ho:YAG. The deeper crater induced by the Er:YAG was attributed to the higher absorption coefficient of stones at the 2.94 μm wavelength, and widening of crater by Ho:YAG was perhaps caused by lateral expansion of ablated material. Comparing the ablation efficiency, Er:YAG was superior to Ho:YAG for both single and five-pulses.

  11. Detachable fiber optic tips for use in thulium fiber laser lithotripsy

    NASA Astrophysics Data System (ADS)

    Hutchens, Thomas C.; Blackmon, Richard L.; Irby, Pierce B.; Fried, Nathaniel M.

    2013-03-01

    The thulium fiber laser (TFL) has recently been proposed as an alternative to the Holmium:YAG (Ho:YAG) laser for lithotripsy. The TFL's Gaussian spatial beam profile provides higher power transmission through smaller optical fibers with reduced proximal fiber tip damage, and improved saline irrigation and flexibility through the ureteroscope. However, distal fiber tip damage may still occur during stone fragmentation, resulting in disposal of the entire fiber after the procedure. A novel design for a short, detachable, distal fiber tip that can fit into an ureteroscope's working channel is proposed. A prototype, twist-lock, spring-loaded mechanism was constructed using micromachining methods, mating a 150-μm-core trunk fiber to 300-μm-core fiber tip. Optical transmission measuring 80% was observed using a 30-mJ pulse energy and 500-μs pulse duration. Ex vivo human calcium oxalate monohydrate urinary stones were vaporized at an average rate of 187 μg/s using 20-Hz modulated, 50% duty cycle 5 pulse packets. The highest stone ablation rates corresponded to the highest fiber tip degradation, thus providing motivation for use of detachable and disposable distal fiber tips during lithotripsy. The 1-mm outer-diameter prototype also functioned comparable to previously tested tapered fiber tips.

  12. Percutaneous yttrium aluminum garnet-laser lithotripsy of intrahepatic stones and casts after liver transplantation.

    PubMed

    Schlesinger, Nis Hallundbaek; Svenningsen, Peter; Frevert, Susanne; Wettergren, André; Hillingsø, Jens

    2015-06-01

    Bile duct stones and casts (BDSs) contribute importantly to morbidity after liver transplantation (LT). The purpose of this study was to estimate the clinical efficacy, safety, and long-term results of percutaneous transhepatic cholangioscopic lithotripsy (PTCSL) in transplant recipients and to discuss underlying factors affecting the outcome. A retrospective chart review revealed 18 recipients with BDSs treated by PTCSL laser lithotripsy with a holmium-yttrium aluminum garnet laser probe at 365 to 550 µm. They were analyzed in a median follow-up time of 55 months. In all but 1 patient (17/18 or 94%), it was technically feasible to clear all BDSs with a mean of 1.3 sessions. PTCSL was unsuccessful in 1 patient because of multiple stones impacting the bile ducts bilaterally; 17% had early complications (Clavien II). All biliary casts were successfully cleared; 39% had total remission; 61% needed additional interventions in the form of percutaneous transhepatic cholangiography and dilation (17%), re-PTCSL (11%), self-expandable metallic stents (22%), or hepaticojejunostomy (6%); and 22% eventually underwent retransplantation. The overall liver graft survival rate was 78%. Two patients died during follow-up for reasons not related to their BDS. Nonanastomotic strictures (NASs) were significantly associated with treatment failure. We conclude that PTCSL in LT patients is safe and feasible. NASs significantly increased the risk of relapse. Repeated minimally invasive treatments, however, prevented graft failure in 78% of the cases. PMID:25821134

  13. Dual-head lithotripsy in synchronous mode: Acute effect on renal function and morphology in the pig

    PubMed Central

    Handa, Rajash K.; McAteer, James A.; Willis, Lynn R.; Pishchalnikov, Yuri A.; Connors, Bret A.; Ying, Jun; Lingeman, James E.; Evan, Andrew P.

    2008-01-01

    Objective Lithotripters with two shock heads are now available for use in treating patients. However, little information is available by which to judge the safety of treatment with dual pulses. A study was conducted to assess the effect of dual-head lithotripsy on renal function and morphology in a pig model of shock wave (SW) injury. Methods A dual-head electrohydraulic lithotripter (Direx Duet) was used to treat the lower renal pole of anesthetized pigs with a clinical dose of SWs (2400 dual SWs; n=10) delivered in synchronous mode (i.e. both heads fired simultaneously). For comparison, pigs were treated with either 2400 SWs (n=12) or 4800 SWs (n=8) with a conventional electrohydraulic lithotripter (Dornier HM3). Results Dual SW treatment with the Duet lithotripter caused a decline in glomerular filtration rate (GFR, 4.1 ± 1.9 ml/min) with a trend for effective renal plasma flow (RPF, 31 ± 19 ml/min) to also fall. These changes in renal hemodynamics were comparable to decreases in GFR and RPF in response to treatment with 2400 SWs (4.8 ± 0.8 ml/min and 32 ± 10 ml/min, respectively) or 4800 SWs (5.4 ± 1.0 ml/min and 68 ± 14 ml/min, respectively) with the HM3 lithotripter. Linear association analysis showed that the functional response to dual-pulse SWs was less predictable than with conventional SWs. Morphological quantitation of kidney damage expressed as percentage of functional renal volume (FRV), showed that tissue injury with 2400 paired SWs with the Duet (0.96± 0.39% FRV, n=8) was comparable to injury produced by either 2400 single SWs (1.08±0.38% FRV, n=6), or 4800 single SWs (2.71±1.02% FRV, n=6) with the HM3. However, morphological damage appeared less consistent with the Duet (measurable in only 5 of 8 kidneys) than that observed with the HM3 (measurable in all 12 kidneys). Acoustic output and the timing of dual SWs in synchronous mode increased in variability as the electrodes aged, affecting the amplitude and targeting of focal pressures

  14. First temporal and spatial quantification of single-shot electrohydraulic lithotripsy in vitro.

    PubMed

    Corleis, R; Vorreuther, R; Engelmann, U; Schaarschmidt, U; Morgenstern, B

    1996-01-01

    Single electrohydraulic lithotripsy (EHL) discharges from a human ureter were analyzed with a mechanical high-speed motion analysis camera. We found a cavitation bubble, at 650 mJ, 4-11 mm in size, with a lifetime of 400-500 microseconds. Varying sizes and lifetimes were found using single-shot analysis, as well as in different shot-sequences. This supports similar observations by recent investigations of cavitation bubble size with high-shutter-speed videofilm, which have depicted events at shutter speeds of 4000/s, i.e., an approximate exposure time of 250 microseconds. Due to the occurrence of high-voltage interference from the EHL high-voltage generator, no other technical electronic event timing equipment has so far been available capable of mechanical high-speed film motion analysis, while at the same time avoiding high-voltage interference. PMID:8839484

  15. Comparison of holmium:YAG and thulium fiber lasers for lithotripsy

    NASA Astrophysics Data System (ADS)

    Blackmon, Richard L.; Irby, Pierce B.; Fried, Nathaniel M.

    2010-02-01

    The Holmium:YAG laser is currently the most common laser lithotripter. However, recent experimental studies have demonstrated that the Thulium fiber laser is also capable of vaporizing urinary stones. The high-temperature water absorption coefficient for the Thulium wavelength (μa = 160 cm-1 at λ = 1908 nm) is significantly greater than for the Holmium wavelength (μa = 28 cm-1 at λ = 2120 nm). We hypothesize that this should translate into more efficient laser lithotripsy using the Thulium fiber laser. This study directly compares stone vaporization rates for Holmium and Thulium fiber lasers. Holmium laser radiation pulsed at 3 Hz with 70 mJ pulse energy and 220 μs pulse duration was delivered through a 100-μm-core silica fiber to human uric acid (UA) and calcium oxalate monohydrate (COM) stones, ex vivo (n = 10 each). Thulium fiber laser radiation pulsed at 10 Hz with 70 mJ pulse energy and 1 ms pulse duration was also delivered through a 100-μm fiber for the same sets of 10 stones. For same number of pulses and total energy (126 J) delivered to each stone, mass loss averaged 2.4 +/- 0.6 mg (UA) and 0.7 +/- 0.2 mg (COM) for Holmium laser and 12.6 +/- 2.5 mg (UA) and 6.8 +/- 1.7 (COM) for Thulium fiber laser. UA and COM stone vaporization rates for Thulium fiber laser averaged 5-10 times higher than for Holmium laser at 70 mJ pulse energies. With further development, the Thulium fiber laser may represent an alternative to the conventional Holmium laser for more efficient laser lithotripsy.

  16. The economic burden of gallstone lithotripsy. Will cost determine its fate?

    PubMed

    Nealon, W H; Urrutia, F; Fleming, D; Thompson, J C

    1991-06-01

    Gallstone lithotripsy (LITHO) was performed on 52 patients who underwent 107 procedures. Two hundred sixty-seven gallstone patients were screened and 215 (81%) were excluded. Excessive stone burden and nonvisualization by oral cholecystogram (OCG) were the most common reasons for exclusion. The hospital course of 100 excluded patients who later underwent elective cholecystectomy was evaluated for length of hospital stay (2.3 days) and total cost of treatment ($3685.00). Successful fragmentation to less than 5 mm was achieved in 43 LITHO patients (83%). Five LITHO patients (10%) required conversion to operative management. Complications of LITHO included acute cholecystitis (1 of 52 patients) and biliary colic (17 of 52 patients, or 33%). Multiple procedures in one patient were common. Costs for LITHO were calculated in two ways: first the individual cost for each of the 52 candidates; second the cost for successful LITHO was calculated by excluding five patients who required operation as well as five patients (10%) who are predicted failures of LITHO. Including the preoperative evaluation, treatment, recovery room, and follow-up, the individual LITHO cost for 52 patients was $8275.00. If the same total expenditure is calculated after excluding patients who required operation and those predicted to fail, the cost per 'successful' LITHO procedure was $10,245. The cost of 1 year of bile acid therapy is $1949.00 or $2413.00 per 'successful' procedure. Follow-up costs were $1232.00 per patient or $1525.00 per 'successful' procedure. The added LITHO cost incurred by screening eventual noncandidates was $904.00 per successful procedure. The sum of these individual costs was $15,087.00 per success, as compared to $3685.00 for cholecystectomy. No allowance was made for cost of stone recurrence. Lithotripsy costs appear to be sufficiently high to render the procedure unlikely to emerge as the treatment of choice. PMID:2039296

  17. Comparison of ultrasonography and oral cholecystography in biliary lithotripsy. I. Screening patients.

    PubMed

    Torres, W E; Baumgartner, B R; Jones, M T; Steinberg, H V; Peterson, J E

    1991-07-01

    Ultrasound and oral cholecystography (OCG) are both used to evaluate candidates for biliary lithotripsy. Some investigators have suggested abandoning the OCG, believing that sufficient screening information can be obtained from ultrasound. This study compares ultrasound and OCG in assessing the size and number of gallstones, both in vitro and in vivo. In the in vitro model, 35 gallstones, divided into 20 groups, were separately suspended in dilute contrast media in a phantom, and examined by ultrasound and simulated OCG by each of three gastrointestinal radiologists. In the in vivo study, the ultrasound and OCG examinations from 53 patients were independently reviewed by three radiologists. The number and size of the stones were recorded in both studies. In the in vitro study, the stone size was measured within 2 mm of the actual size by OCG in 23/35 stones (66%) and by ultrasound in 4/35 stones (11%). The correct number of stones was determined by OCG in 19/20 groups (95%), and by ultrasound in 14/20 (70%). In the in vivo study, all readers saw the same number of stones in 40/50 (80%) patients by OCG and 33/49 (67%) patients by ultrasound. Statistical analyses revealed correlation coefficients for OCG greater than those for ultrasound in each comparison. The size of the largest stone was within 2 mm by all readers in 26/51 (51%) of patients by OCG and 20/47 (43%) patients by ultrasound. Oral cholecystography is more reliable than ultrasound for the determination of size and number of stones in patients being screened for biliary lithotripsy. PMID:1885268

  18. A comparison of efficacies of holmium YAG laser, and pneumatic lithotripsy in the endoscopic treatment of ureteral stones

    PubMed Central

    Akdeniz, Ekrem; İrkılata, Lokman; Demirel, Hüseyin Cihan; Saylık, Acun; Bolat, Mustafa Suat; Şahinkaya, Necmettin; Zengin, Mehmet; Atilla, Mustafa Kemal

    2014-01-01

    Objective: We aimed to compare the effectiveness of holmium YAG laser and pneumatic lithotripsy in the treatment of ureteral stones. Material and methods: A total of 216 patients who had established indications of ureteroscopy between November 2011 and June 2012 were included in this study. Patients’ files were retrospectively reviewed by dividing cases as groups that underwent pneumatic (PL) or laser lithotripsy (LL) procedures. Age, sex, stone burden and localization, duration of follow-up, operative times were evaluated. Stone-free rates were evaluated by ureteroscopical examination, postoperative scout films and ultrasonography. Results: Group PL consisted of 109 and group LL of 107 patients. Median age was 43.93±15.94 years in Group PL and 46.15±14.54 years in Group LL. Male to female ratio, stone burden and localization were similar for both groups. Overall success rate was 89.9% in Group PL and 87.9% in Group LL, respectively (p<0.791). With the aid of additional procedures, success rate was 100% for both groups at the end of the first month. Groups were not different as for operative time, rate of insertion of an ureteral catheter and its removal time. Hospitalization period was apparently somewhat shorter in Group LL (p=0.00). Conclusion: Pneumatic lithotripsy can be as efficacious as laser lithotripsy and be used safely in the endoscopic management of ureteral stone. In comparison of both methods, we detected no differences as to operative time, success of operation and the time to removal of the catheter, however, hospitalization period was shorter in Group LL. PMID:26328167

  19. Safety and efficacy of using the stone cone and an entrapment and extraction device in ureteroscopic lithotripsy for ureteric stones

    PubMed Central

    Shabana, Waleed; Teleb, Mohamed; Dawod, Tamer

    2015-01-01

    Objective To assess the safety and efficacy of using a stone cone and an entrapment and extraction device (N-Trap®, Cook Urological, Bloomington, IN, USA) to avoid stone retropulsion during ureteroscopic lithotripsy for ureteric stones. Patients and methods This retrospective comparative study included 436 patients treated with ureteroscopic lithotripsy for a single ureteric stone from February 2011 to January 2014. The diagnosis of a stone was confirmed by plain spiral computed tomography in all cases. Patients were divided according to the ureteric occlusion device applied to avoid stone retropulsion during pneumatic lithotripsy into three groups; group 1 (156) had no instruments used, group 2 (140) in whom the stone cone was applied, and group 3 (140) in whom the N-Trap was used. Patient demographics, stone criteria, operative duration and complications, and success rates (complete stone disintegration with no upward migration) were reported and analysed statistically. Results The stone was in the lower ureter in >55% of patients in all groups. The mean (SD) of maximum stone length was 9.8 (2.5), 10.4 (2.8) and 9.7 (2.9) in groups 1–3, respectively. The use of the stone cone or N-Trap did not significantly increase the operative duration (P = 0.13) or complication rates (P = 0.67). There was a statistically significant difference (P < 0.001) favouring groups 2 and 3 for retropulsion and success rates, being 83.3% in group 1, 97.1% in group 2 and 95.7% in group 3. Conclusion The stone cone and N-Trap gave high success rates in preventing stone retropulsion during ureteric pneumatic lithotripsy. Both devices caused no increase in operative duration or complications when used cautiously. PMID:26413324

  20. Characterization of a 50-μm-core optical fiber for potential use in Thulium fiber laser lithotripsy

    NASA Astrophysics Data System (ADS)

    Blackmon, Richard L.; Hutchens, Thomas C.; Hardy, Luke A.; Irby, Pierce B.; Fried, Nathaniel M.

    2014-03-01

    Our laboratory is currently studying the Thulium fiber laser (TFL) as a potential alternative laser lithotripter to the standard clinical Holmium:YAG laser. We have previously demonstrated efficient coupling of TFL energy into fibers as small as 100-μm-core-diameter without damage to the proximal end. Although smaller fibers have greater tendency to degrade at the distal tip during lithotripsy, fiber diameters (<= 200 μm) have been shown to increase saline irrigation rates through the working channel of a flexible ureteroscope, maximize ureteroscope deflection, and reduce stone retropulsion during laser lithotripsy. In this study, a 50-μm-core-diameter, 85-μm-outer-diameter fiber is characterized for TFL ablation of human calcium oxalate monohydrate urinary stones, ex vivo. The stone ablation rate was measured to be 70 +/- 22 μg/s for 35-mJ-pulse-energy, 500-μs-pulse-duration, and 50-Hz-pulse-rate. The ureteroscope working channel flow rate including the 50-μm fiber decreased by only 10% with no impairment of ureteroscope deflection. The fiber delivered up to 15.4 +/- 5.9 W under extreme bending (5-mm-radius) conditions. Stone retropulsion and fiber burn-back averaged 201 +/- 336 and 3000 +/- 2600 μm, respectively, after 2 minutes. With further development, Thulium fiber laser lithotripsy using ultra-small, 50-μm-core fibers may introduce new integration and miniaturization possibilities and potentially provide an alternatiμe to conventional Holmium:YAG laser lithotripsy using larger fibers.

  1. Ureteroscopic Lithotripsy

    PubMed Central

    Bagley, Demetrius H.

    1997-01-01

    There is a wide array of endoscopic lithotriptors presently available. Each of these has its own advantages and disadvantages. No single lithotriptor is suitable for all applications and none can meet the goal of fragmenting all calculi while remaining harmless to tissue. PMID:18493444

  2. Large subcapsular hematoma following ureteroscopic laser lithotripsy of renal calculi in a spina bifida patient: lessons we learn

    PubMed Central

    Vaidyanathan, Subramanian; Samsudin, Azi; Singh, Gurpreet; Hughes, Peter L; Soni, Bakul M; Selmi, Fahed

    2016-01-01

    Introduction Paraplegic patients are at greater risk of developing complications following ureteroscopic lithotripsy because of urine infection associated with neuropathic bladder, difficulties in access due to altered anatomy of urinary bladder and urethra, spinal curvature, spasticity, and contractures. We report the occurrence of large subcapsular hematoma following ureteroscopy and discuss lessons we learn from this case. Case report A 48-year-old male patient with spina bifida underwent ureteroscopy with laser lithotripsy and ureteric stenting for left ureteric stone and staghorn calculus with hydronephrosis; laser lithotripsy was repeated after 3 months; both procedures were performed by a senior urologist and did not result in any complications. Ureteroscopic laser lithotripsy was performed 5 months later by a urological trainee; it was difficult to negotiate the scope as vision became poor because of bleeding (as a result of the procedure). Postoperatively, hematuria persisted; temperature was 39°C. Cefuroxime was given intravenously followed by gentamicin for 5 days; hematuria subsided gradually; he was discharged home. Ten days later, this patient developed temperature, the urine culture grew Pseudomonas aeruginosa, and ciprofloxacin was given orally. Computed tomography (CT) of the urinary tract, performed 4 weeks after ureteroscopy, revealed a 9×7 cm subcapsular collection on the left kidney compressing underlying parenchyma. Percutaneous drainage was not feasible because of severe curvature of spine. Isotope renogram revealed deterioration in left renal function from 30% to 17%. Follow-up CT revealed reduction in the size of subcapsular hematoma, no hydronephrosis, and several residual calculi. Conclusion Risk of subcapsular hematoma following ureteroscopic lithotripsy can be reduced by avoiding prolonged endoscopy and performing ureteroscopy under low pressure. When a paraplegic patient develops features of infection after ureteroscopy, renal

  3. Shock-induced bubble collapse in a vessel: Implications for vascular injury in shockwave lithotripsy

    NASA Astrophysics Data System (ADS)

    Coralic, Vedran; Colonius, Tim

    2014-11-01

    In shockwave lithotripsy, shocks are repeatedly focused on kidney stones so to break them. The process leads to cavitation in tissue, which leads to hemorrhage. We hypothesize that shock-induced collapse (SIC) of preexisting bubbles is a potential mechanism for vascular injury. We study it numerically with an idealized problem consisting of the three-dimensional SIC of an air bubble immersed in a cylindrical water column embedded in gelatin. The gelatin is a tissue simulant and can be treated as a fluid due to fast time scales and small spatial scales of collapse. We thus model the problem as a compressible multicomponent flow and simulate it with a shock- and interface-capturing numerical method. The method is high-order, conservative and non-oscillatory. Fifth-order WENO is used for spatial reconstruction and an HLLC Riemann solver upwinds the fluxes. A third-order TVD-RK scheme evolves the solution. We evaluate the potential for injury in SIC for a range of pressures, bubble and vessel sizes, and tissue properties. We assess the potential for injury by comparing the finite strains in tissue, obtained by particle tracking, to ultimate strains from experiments. We conclude that SIC may contribute to vascular rupture and discuss the smallest bubble sizes needed for injury. This research was supported by NIH Grant No. 2PO1DK043881 and utilized XSEDE, which is supported by NSF Grant No. OCI-1053575.

  4. Moderate high power 1 to 20μs and kHz Ho:YAG thin disk laser pulses for laser lithotripsy

    NASA Astrophysics Data System (ADS)

    Renz, Günther

    2015-02-01

    An acousto-optically or self-oscillation pulsed thin disk Ho:YAG laser system at 2.1 μm with an average power in the 10 W range will be presented for laser lithotripsy. In the case of cw operation the thin disk Ho:YAG is either pumped with InP diode stacks or with a thulium fiber laser which leads to a laser output power of 20 W at an optical-to-optical efficiency of 30%. For the gain switched mode of operation a modulated Tm-fiber laser is used to produce self-oscillation pulses. A favored pulse lengths for uric acid stone ablation is known to be at a few μs pulse duration which can be delivered by the thin disk laser technology. In the state of the art laser lithotripter, stone material is typically ablated with 250 to 750 μs pulses at 5 to 10 Hz and with pulse energies up to a few Joule. The ablation mechanism is performed in this case by vaporization into stone dust and fragmentation. With the thin disk laser technology, 1 to 20 μs-laser pulses with a repetition rate of a few kHz and with pulse energies in the mJ-range are available. The ablation mechanism is in this case due to a local heating of the stone material with a decomposition of the crystalline structure into calcium carbonate powder which can be handled by the human body. As a joint process to this thermal effect, imploding water vapor bubbles between the fiber end and the stone material produce sporadic shock waves which help clear out the stone dust and biological material.

  5. Efficacy and safety of Ho:YAG Laser Lithotripsy for ureteroscopic removal of proximal and distal ureteral calculi

    PubMed Central

    2014-01-01

    Background Laser lithotripsy is an established endourological modality. Ho:YAG laser have broadened the indications for ureteroscopic stone managements to include larger stone sizes throughout the whole upper urinary tract. Aim of current work is to assess efficacy and safety of Ho:YAG laser lithotripsy during retrograde ureteroscopic management of ureteral calculi in different locations. Methods 88 patients were treated with ureteroscopic Ho:YAG laser lithotripsy in our institute. Study endpoint was the number of treatments until the patient was stone-free. Patients were classified according to the location of their stones as Group I (distal ureteric stones, 51 patients) and group II (proximal ureteral stones, 37). Group I patients have larger stones as Group II (10.70 mm vs. 8.24 mm, respectively, P = 0.020). Results Overall stone free rate for both groups was 95.8%. The mean number of procedures for proximal calculi was 1.1 ± 0.1 (1–3) and for distal calculi was 1.0 ± 0.0. The initial treatment was more successful in patients with distal ureteral calculi (100% vs. 82.40%, respectively, P = 0.008). No significant difference in the stone free rate was noticed after the second laser procedure for stones smaller versus larger than 10 mm (100% versus 94.1%, P = 0.13). Overall complication rate was 7.9% (Clavien II und IIIb). Overall and grade-adjusted complication rates were not dependant on the stone location. No laser induced complications were noticed. Conclusions The use of the Ho:YAG laser appears to be an adequate tool to disintegrate ureteral calculi independent of primary location. Combination of the semirigid and flexible ureteroscopes as well as the appropriate endourologic tools could likely improve the stone clearance rates for proximal calculi regardless of stone-size. PMID:25107528

  6. Microscopic analysis of laser-induced proximal fiber tip damage during holmium:YAG and thulium fiber laser lithotripsy

    NASA Astrophysics Data System (ADS)

    Wilson, Christopher R.; Hardy, Luke A.; Irby, Pierce B.; Fried, Nathaniel M.

    2016-04-01

    The thulium fiber laser (TFL) is being studied as an alternative to the standard holmium:YAG laser for lithotripsy. The TFL beam originates within an 18-μm-core thulium-doped silica fiber, and its near single mode, Gaussian beam profile enables transmission of higher laser power through smaller (e.g., 50- to 150-μm core) fibers than possible during holmium laser lithotripsy. This study examines whether the more uniform TFL beam profile also reduces proximal fiber tip damage compared with the holmium laser multimodal beam. Light and confocal microscopy images were taken of the proximal surface of each fiber to inspect for possible laser-induced damage. A TFL beam at a wavelength of 1908 nm was coupled into 105-μm-core silica fibers, with 35-mJ energy, and 500-μs pulse duration, and 100,000 pulses were delivered at each pulse rate setting of 50, 100, 200, 300, and 400 Hz. For comparison, single use, 270-μm-core fibers were collected after clinical holmium laser lithotripsy procedures performed with standard settings (600 mJ, 350 μs, 6 Hz). Total laser energy, number of laser pulses, and laser irradiation time were recorded, and fibers were rated for damage. For TFL studies, output pulse energy and average power were stable, and no proximal fiber damage was observed at settings up to 35 mJ, 400 Hz, and 14 W average power (n=5). In contrast, confocal microscopy images of fiber tips after holmium lithotripsy showed proximal fiber tip degradation, indicated by small ablation craters on the scale of several micrometers in all fibers (n=20). In summary, the proximal fiber tip of a 105-μm-core fiber transmitted up to 14 W of TFL power without degradation, compared to degradation of 270-μm-core fibers after transmission of 3.6 W of holmium laser power. The smaller and more uniform TFL beam profile may improve fiber lifetime, and potentially translate into lower costs for the surgical disposables as well.

  7. Incidence of cavitation in the fragmentation process of extracorporeal shock wave lithotriptors

    NASA Astrophysics Data System (ADS)

    Rink, K.; Delacrétaz, G.; Pittomvils, G.; Boving, R.; Lafaut, J. P.

    1994-05-01

    The fragmentation mechanism occurring in extracorporeal shock wave lithotripsy (ESWL) is investigated using a fiber optic stress sensing technique. With our technique, we demonstrate that cavitation is a major cause of fragmentation in ESWL procedures. When a target is placed in the operating area of the lithotriptor, two shock waves are detected. The first detected shock wave corresponds to the incoming shock wave generated by the lithotriptor. The second shock wave, detected some hundreds of microseconds later, is generated in situ. It results from the collapse of a cavitation bubble, formed by the reflection of the incoming shock wave at the target boundary. This cavitation induced shock wave generates the largest stress in the target area according to our stress sensing measurements.

  8. Percutaneous Transhepatic Endoscopic Holmium Laser Lithotripsy for Intrahepatic and Choledochal Biliary Stones

    SciTech Connect

    Rimon, Uri; Kleinmann, Nir; Bensaid, Paul; Golan, Gil; Garniek, Alexander; Khaitovich, Boris; Winkler, Harry

    2011-12-15

    Purpose: To report our approach for treating complicated biliary calculi by percutaneous transhepatic endoscopic biliary holmium laser lithotripsy (PTBL). Patients and Methods: Twenty-two symptomatic patients (11 men and 11 women, age range 51 to 88 years) with intrahepatic or common bile duct calculi underwent PTBL. Nine patients had undergone previous gastrectomy and small-bowel anastomosis, thus precluding endoscopic retrograde cholangiopancreatography. In the other 13 patients, stone removal attempts by ERCP failed due to failed access or very large calculi. We used a 7.5F flexible ureteroscope and a 200-{mu}m holmium laser fiber by way of a percutaneous transhepatic tract, with graded fluoroscopy, to fragment the calculi with direct vision. Balloon dilatation was added when a stricture was seen. The procedure was performed with the patient under general anaesthesia. A biliary drainage tube was left at the end of the procedure. Results: All stones were completely fragmented and flushed into the small bowel under direct vision except for one patient in whom the procedure was aborted. In 18 patients, 1 session sufficed, and in 3 patients, 2 sessions were needed. In 7 patients, balloon dilatation was performed for benign stricture after Whipple operation (n = 3), for choledochalenteric anastomosis (n = 3), and for recurrent cholangitis (n = 1). Adjunctive 'balloon push' (n = 4) and 'rendezvous' (n = 1) procedures were needed to completely clean the biliary tree. None of these patients needed surgery. Conclusion: Complicated or large biliary calculi can be treated successfully using PTBL. We suggest that this approach should become the first choice of treatment before laparoscopic or open surgery is considered.

  9. Differentiation of tissue and kidney stones for laser lithotripsy using different spectroscopic approaches

    NASA Astrophysics Data System (ADS)

    Lange, Birgit; Cordes, Jens; Brinkmann, Ralf

    2015-07-01

    Holmium lasers are nowadays the gold standard for endoscopic laser lithotripsy. However, there is a risk of damaging or perforating the ureter or kidney tissue when the vision is poor. An automatic tissue/stone differentiation would improve the handling and safety of the procedure. To achieve this objective, an easy and robust real-time discrimination method has to be found which can be used to realize a feedback loop to control the laser system. Two possible approaches have been evaluated: White light reflectance and fluorescence spectroscopy. In both cases, we use the treatment fiber for detection and evaluate the possibility to decide whether the fiber is placed in front of tissue or calculus by the signal that is delivered by the surface in front of it. White light reflectance spectroscopy uses the standard light source for endourologic surgeries: Radiation of a Xenon light source is coupled to the ureteroscope via a liquid light guide. The part of the white light that is reflected back into the fiber is spectroscopically analyzed. In a clinical proof of concept study reflection signals were measured in vivo in 8 patients. For differentiation of stone and tissue via autofluorescence, excitation as well as detection was done via the treatment fiber. A suitable excitation wavelength was chosen with in vitro measurements (UV / visible) on several human renal calculi and porcine tissues. For verification of the positive results with green excitation in a clinical proof of concept study, a measurement set-up was realized which allows the recording of fluorescence signals during an endourological intervention.

  10. Treatment of ureteral calculus obstruction with laser lithotripsy in an Atlantic bottlenose dolphin (Tursiops truncatus).

    PubMed

    Schmitt, Todd L; Sur, Roger L

    2012-03-01

    An adult female bottlenose dolphin (Tursiops truncatus) presented with acute anorexia secondary to progressive azotemia (blood urea nitrogen = 213 mg/dl, creatinine [Cr] = 9.5 mg/dl) and electrolyte abnormalities (K = 7.4 mEq/L). It was later diagnosed with postrenal obstruction secondary to bilaterally obstructing ureteral calculi seen on ultrasound. Treatment of the obstruction required two endoscopic procedures, cystoscopy for ureteral stent placement and ureteroscopy to perform intracorporeal lithotripsy on the obstructing calculi. Before the first procedure, the dolphin's azotemia was stabilized with aggressive fluid therapy, peritoneal dialysis, and treatment for acidosis. Diuresis subsequent to the fluid therapy enabled passage of the right obstructing urolith. For both endoscopic procedures, the dolphin was placed in left lateral recumbency due to the peritoneal dialysis catheter in the right retroperitoneal region. For the first procedure, a 12-French (Fr) flexible cystoscope was inserted retrograde into the bladder via the urethra, whereupon a calculus was seen obstructing the left ureteral orifice. A 4.8-Fr, 26-cm double-pigtail ureteral stent was placed up the left ureter to relieve the postrenal obstruction. Inadvertent proximal migration of the left ureteral stent occurred during the procedure. However, renal parameters (serum Cr = 5.8, K = 5.4) improved significantly by the next day. For the second procedure, 28 hr later, ureteroscopy was performed to treat the calculus and replace the existing stent with a longer stent. The left ureteral calculus was pulverized into tiny fragments by using a holmium:yttrium-aluminum-garnet laser inserted through a 6.9-Fr semirigid ureteroscope. The migrated stent was visualized in the distal left ureter and replaced with a 90-cm single-pigtail ureteral stent that was sutured exterior to the urogenital slit and removed 3 days later. Renal function normalized over the next several days, and the dolphin recovered over