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  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. A Pilot Study to Evaluate Haemostatic Function, following Shock Wave Lithotripsy (SWL) for the Treatment of Solitary Kidney Stones

    PubMed Central

    Hughes, Stephen Fôn; Thomas-Wright, Samantha Jayne; Banwell, Joseph; Williams, Rachel; Moyes, Alyson Jayne; Mushtaq, Sohail; Abdulmajed, Mohamed; Shergill, Iqbal

    2015-01-01

    Purpose The number of patients undergoing shock wave lithotripsy (SWL) in the UK for solitary unilateral kidney stones is increasing annually. The development of postoperative complications such as haematuria and sepsis following SWL is likely to increase. Comparing a range of biological markers with the aim of monitoring or predicting postoperative complications following SWL has not been extensively researched. The main purpose of this pilot-study was to test the hypothesis that SWL results in changes to haemostatic function. Subsequently, this pilot-study would form a sound basis to undertake future investigations involving larger cohorts. Methods Twelve patients undergoing SWL for solitary unilateral kidney stones were recruited. From patients (8 male and 4 females) aged between 31–72 years (median—43 years), venous blood samples were collected pre-operatively (baseline), at 30, 120 and 240 minutes postoperatively. Specific haemostatic biomarkers [platelet counts, prothrombin time (PT), activated partial thromboplastin time (aPTT), fibrinogen, D-dimer, von Willebrand Factor (vWF), sE-selectin and plasma viscosity (PV)] were measured. Results Platelet counts and fibrinogen concentration were significantly decreased following SWL (p = 0.027 and p = 0.014 respectively), while D-dimer and vWF levels significantly increased following SWL (p = 0.019 and p = 0.001 respectively). PT, APTT, sE-selectin and PV parameters were not significantly changed following SWL (p>0.05). Conclusions Changes to specific biomarkers such as plasma fibrinogen and vWF suggest that these represent a more clinically relevant assessment of the extent of haemostatic involvement following SWL. Analysis of such markers, in the future, may potentially provide valuable data on “normal” response after lithotripsy, and could be expanded to identify or predict those patients at risk of coagulopathy following SWL. The validation and reliability will be assessed through the assessment of

  3. 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.

  4. 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.

  5. Complementary approaches to decreasing discomfort during shockwave lithotripsy (SWL).

    PubMed

    Ngee-Ming, Goh; Tamsin, Drake; Rai, B P; Somani, B K

    2014-06-01

    Shock wave lithotripsy (SWL) is an established treatment for renal stones. Although non-invasive, it can cause significant pain and anxiety during the procedure. Our purpose was to review the literature to look at the effect of complimentary therapy in patients undergoing SWL and whether it led to a reduction in the requirement of analgesics and anxiolytics. A systematic review was performed on the use of acupuncture, auricular acupressure, transcutaneous electrical nerve stimulation (TENS) and music during SWL. Only prospective randomized controlled trials were selected. Two reviewers independently extracted the data from each study. Outcomes relating to analgesia requirement, anxiety and stone-free rates (SFR) were compared. Seven papers were identified reporting on 591 patients (acupuncture-3, TENS-1 and music-3). Pain control/analgesia requirement was significantly better in four studies (music-2, acupuncture-1, TENS-1). Significantly lower anxiety was noted in one study with music and two using acupuncture. No difference in SFR was noted with the use of complementary therapy. No major or minor side effects were noted. Complementary therapy for SWL can help lower analgesia requirement and the anxiety associated with it. However, it does not have any effect on the SFR.

  6. Is the gravity effect of radiographic anatomic features enough to justify stone clearance or fragments retention following extracorporeal shock wave lithotripsy (SWL).

    PubMed

    Mustafa, Mahmoud

    2012-08-01

    We determined whether the gravity effect of radiographic anatomic features on the preoperative urography (IVP) are enough to predict fragments clearance after shock wave lithotripsy (SWL). A Total of 282 patients with mean age 45.8 ± 13.2 years (189 male, 93 female), who underwent SWL due to renal calculi between October 2005 and August 2009 were enrolled. The mean calculi load was 155.72 ± 127.66 mm². The patients were stratified into three groups: patients with pelvis calculi (group 1); patients with upper or middle pole calculi (group 2) and patients with lower pole calculi (group 3). Three angles on the pretreatment IVP were measured: the inner angle between the axis of the lower pole infundibular and ureteropelvic axis (angle I); the inner angle between the lower pole infundibular axis and main axis of pelvis-ureteropelvic (UP) junction point (angle II) and the inner angle between the lower pole infundibular axis and perpendicular line (angle III). Multivariate analysis was used to define the significant predictors of stone clearance. The overall success rate was 85.81%. All angles, sessions number, shock waves number and stone burden were significant predictors of success in patients in group 1. However, in group 2 only angle II and in group 3 angles I and II had significant effect on stone clearance. Radiographic anatomic features have significant role in determining the stone-free rate following satisfactory fragmentation of renal stones with SWL. The measurement of infundibulopelvic angle in different manner helps to predict the stone-free status in patients with renal calculi located not only in lower pole, but also in renal pelvis and upper or middle pole. Gravity effect is not enough to justify the significant influence of the radiographic anatomic features on the stone clearance and fragments retention after SWL.

  7. 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

  8. 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].

  9. Innovations in shock wave lithotripsy technology

    NASA Astrophysics Data System (ADS)

    Zhong, Pei; Zhou, Yufeng; Zhu, Songlin; Cocks, Franklin; Preminger, Glenn

    2003-10-01

    Since its introduction in early 1980s, shock wave lithotripsy (SWL) has been used widely in clinic for the treatment of kidney and upper urinary stones. Although a variety of methods have been developed for shock wave generation, coupling, and focusing, the core of SWL technology has not changed significantly. In this talk, we will present a summary of our research efforts, aiming to provide innovations in SWL technology. Our strategy is to first better understand the mechanisms by which stone comminution and tissue injury are produced in SWL using various experimental and theoretical techniques. Based on this knowledge, we then developed novel techniques that can optimize the effect of cavitation in SWL via modification of the waveform profile, pressure distribution, and pulse sequence of lithotripter-generated shock waves. These new techniques were upgraded on a Dornier HM-3 lithotripter, the gold standard in SWL. Both in vitro phantom and in vivo animal experiments were carried out which demonstrated that the performance and safety of the upgraded HM-3 lithotripter is superior to the original HM-3 lithotripter. Finally, strategies to improve stone comminution efficiency while reducing tissue injury in SWL will be presented. [Work supported by NIH DK52985 and DK58266.

  10. 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.

  11. Extracorporeal shock wave lithotripsy today.

    PubMed

    Tailly, Geert G

    2013-07-01

    Even 32 years after its first introduction shockwave lithotripsy (SWL) remains a matter of discussion and controversy. Since the first SWL in 1980, millions of treatments have been performed worldwide. To this day SWL remains the least invasive of all stone treatments and is considered the treatment modality of first choice for the majority of urinary stones. Despite the massive scale on which SWL is performed in a wide range of indications, complication rate has always remained very low and usually limited to minor side effects and complications. The introduction of affordable multifunctional lithotripters has made SWL available to more and more departments of urology worldwide. Still many centers are disappointed with the treatment results and concerned about the adverse tissue effects. In this SWL proves to be the victim of its uninvasiveness and its apparent ease of practice. Urologists need proper skill and experience; however, to adequately administer shockwaves in order to improve outcome. This aspect is too often minimized and neglected. Apart from this the power of shockwaves often is underestimated by operators of shockwave machines. Basic knowledge of the physics of shockwaves could further reduce the already minimal adverse tissue effects. Good training and coaching in the administration of shockwaves would no doubt lead to a renaissance of SWL with better treatment results and minimal adverse tissue effects.

  12. Extracorporeal shock wave lithotripsy today

    PubMed Central

    Tailly, Geert G

    2013-01-01

    Even 32 years after its first introduction shockwave lithotripsy (SWL) remains a matter of discussion and controversy. Since the first SWL in 1980, millions of treatments have been performed worldwide. To this day SWL remains the least invasive of all stone treatments and is considered the treatment modality of first choice for the majority of urinary stones. Despite the massive scale on which SWL is performed in a wide range of indications, complication rate has always remained very low and usually limited to minor side effects and complications. The introduction of affordable multifunctional lithotripters has made SWL available to more and more departments of urology worldwide. Still many centers are disappointed with the treatment results and concerned about the adverse tissue effects. In this SWL proves to be the victim of its uninvasiveness and its apparent ease of practice. Urologists need proper skill and experience; however, to adequately administer shockwaves in order to improve outcome. This aspect is too often minimized and neglected. Apart from this the power of shockwaves often is underestimated by operators of shockwave machines. Basic knowledge of the physics of shockwaves could further reduce the already minimal adverse tissue effects. Good training and coaching in the administration of shockwaves would no doubt lead to a renaissance of SWL with better treatment results and minimal adverse tissue effects. PMID:24082441

  13. Cavitation in shock wave lithotripsy

    NASA Astrophysics Data System (ADS)

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

    2003-10-01

    A case is presented for the important role of cavitation in stone comminution and tissue injury in shock wave lithotripsy (SWL). Confocal hydrophones and a coincidence algorithm were used to detect cavitation in kidney parenchyma. Elevated hydrostatic pressure dissolved cavitation nuclei and suppressed cell injury and stone comminution in vitro. A low-insertion-loss, thin, mylar film nearly eliminated stone erosion and crack formation only when in direct contact with the stone. This result indicates not only that cavitation is important in both cracking and erosion but also that bubbles act at the surface. Time inversion of the shock wave by use of a pressure-release reflector reduced the calculated pressure at bubble collapse and the measured depth of bubble-induced pits in aluminum. Correspondingly tissue injury in vivo was nearly eliminated. Cavitation was localized and intensified by the use of synchronously triggered, facing lithotripters. This dual pulse lithotripter enhanced comminution at its focus and reduced lysis in surrounding blood samples. The enhancement of comminution was lost when stones were placed in glycerol, which retarded bubble implosion. Thus, cavitation is important in comminution and injury and can be controlled to optimize efficacy and safety. [Work supported by NIH DK43381, DK55674, and FIRCA.

  14. 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.

  15. Extracorporeal shock wave lithotripsy: An opinion on its future

    PubMed Central

    Rassweiler, Jens; Rassweiler, Marie-Claire; Frede, Thomas; Alken, Peter

    2014-01-01

    The development of miniaturized nephroscopes which allow one-stage stone clearance with minimal morbidity has brought the role of shock wave lithotripsy (SWL) in stone management into question. Design innovations in SWL machines over the last decade have attempted to address this problem. We reviewed the recent literature on SWL using a MEDLINE/PUBMED research. For commenting on the future of SWL, we took the subjective opinion of two senior urologists, one mid-level expert, and an upcoming junior fellow. There have been a number of recent changes in lithotripter design and techniques. This includes the use of multiple focus machines and improved coupling designs. Additional changes involve better localization real-time monitoring. The main goal of stone treatment today seems to be to get rid of the stone in one session rather than being treated multiple times non-invasively. Stone treatment in the future will be individualized by genetic screening of stone formers, using improved SWL devices for small stones only. However, there is still no consensus about the design of the ideal lithotripter. Innovative concepts such as emergency SWL for ureteric stones may be implemented in clinical routine. PMID:24497687

  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. 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

  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. 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.

  20. 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.

  1. [Extracorporeal shock wave lithotripsy for ureteral stone in patient with implanted cardiac pacemaker: a case report].

    PubMed

    Kato, Yuji; Hou, Kyokushin; Hori, Junichi; Taniguchi, Narumi; Yamaguchi, Satoshi; Yachiku, Sunao; Azumi, Makoto; Osanai, Hiroaki

    2003-09-01

    We report a case of extracorporeal shock wave lithotripsy (SWL) for ureteral stone in patient with implanted cardiac pacemaker. A 68-year-old woman was admitted to our hospital for left back pain due to left single ureteral stone (13 x 7 mm) in 2002. A permanent cardiac pacemaker has been implanted for sick sinus syndrome in 1997. After evaluation for cardiac function and pacemaker function by a cardiologist and a pacemaker technician, SWL (MFL 5000, Dornier) was performed without changing pacemaker mode (DDD mode). Shock waves were incorrectly exposed a few time triggered by arterial pacing amplitude, but no cardiovascular event or malfunction of the pacemaker was occurred during or after SWL. The ureteral stone was successfully fragmented with 2,400 shock waves (24 kV) and the fragments were delivered immediately.

  2. 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

  3. Extracorporeal shock wave lithotripsy in infants less than 12-month old.

    PubMed

    Turna, Burak; Tekin, Ali; Yağmur, İsmail; Nazlı, Oktay

    2016-10-01

    There is a lack of literature on children compared to adults regarding the long-term effects of extracorporeal shock wave lithotripsy (SWL), specifically in infants. The aim of the present study was to analyze the efficacy and safety of SWL in infants and also evaluate its potential adverse effects in the mid-term. Between May 1999 and December 2013, 36 infants with 39 renal units underwent SWL treatment for kidney stones with an electrohydraulic lithotripter (Dornier MPL 9000/ELMED Multimed Classic). All children were less than 12-month old. The mid-term effects of SWL were examined at the last follow-up by measuring arterial blood pressure, random blood glucose level and ipsilateral kidney size. Evaluation of treatment and its consequences was based on clinical examination, blood tests and conventional imaging (plain abdominal radiography and ultrasound). Overall stone-free rate was 84.6 % after 3-month follow-up without any major complications. Mid-term follow-up was available in 20 of 36 children with a mean follow-up of 3.2 ± 2.8 years (range 0.5-15.3). None of the infants were found to develop new onset of hypertension or diabetes. All treated infant kidneys' sizes were in the normal percentile range. SWL for management of infant kidney stones is effective and safe in the mid-term.

  4. Poly(methyl methacrylate) particles for local drug delivery using shock wave lithotripsy: In vitro proof of concept experiment.

    PubMed

    Shaked, Eliav; Shani, Yoav; Zilberman, Meital; Scheinowitz, Mickey

    2015-08-01

    To leverage current local drug delivery systems methodology, there is vast use of polymeric particles serving as drug carriers to assure minimal invasive therapy with little systemic distribution of the released drug. There is an increasing interest in poly(methyl methacrylate) (PMMA) serving as carriers in drug delivery. The study aims to develop PMMA carriers for localized drug delivery and release system, combining innovative biomaterial technology and shock wave lithotripsy (SWL), and to study the effect of SWL on various concentrations of PMMA particles. We prepared PMMA particles that contain horseradish peroxidase (HRP) using a double emulsion technique, and investigated the mechanism of in vitro drug release from the carriers following exposure to SWL. We investigated the correlation between production method modifications, concentrations of the carriers subjected to SWL, and shock wave patterns. We successfully produced PMMA particles as drug carriers and stimulated the release of their contents by SWL; their polymeric shell can be shattered externally by SWL treatment, leading to release of the encapsulated drug. HRP enzyme activity was maintained following the encapsulation process and exposure to high dose of SWL pulses. Increased shock wave number results in increased shattering and greater fragmentation of PMMA particles. The results demonstrate a dose-response release of HRP; quantitation of the encapsulated HRP from the carriers rises with the number of SWL. Moreover, increased concentration of particles subjected to the same dose of SWL results in a significant increase of the total HRP release. Our research offers novel technique and insights into new, site-specific drug delivery and release systems.

  5. Elimination of cavitation-related attenuation in shock wave lithotripsy

    NASA Astrophysics Data System (ADS)

    Sankin, G. N.; Lautz, J. M.; Simmons, W. N.; Zhong, P.; Frank, S. T.; Szeri, A. J.

    2017-03-01

    In shock wave lithotripsy (SWL), acoustic pulses with a leading compression wave followed by a tensile wave are delivered into the patient's body using a water-filled coupling cushion. Cavitation-related acoustic energy loss in the coupling unit depends critically on water conditions, e.g. dissolved gas concentration and exchange flow rate. We have systematically investigated the attenuation mechanism in the coupling water via pressure measurements and cavitation characterization. In non-degassed water the bubble cluster became progressively dense (i.e., proliferated because of gas diffusion into bubbles and splitting of bubbles into many daughter bubbles) in shock waves delivered at 1 Hz leading to reduction in the tensile wave duration from a nominal value of 4.6 to 1.8 µs. To reduce cavitation in the coupling water along the beam path, we have used a continuous jet flow to remove residual daughter bubbles between consecutive shocks. As a result, stone fragmentation efficiency was increased from 16±4% to 30±5% (p = 0.002) after 250 shocks. Such a hydrodynamic approach for tensile wave attenuation in the coupling water may be used to provide a flexible means for a novel treatment strategy with tissue protection.

  6. 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

  7. Comparison of two different running models for the shock wave lithotripsy machine in Taipei City Hospital: self-support versus outsourcing cooperation.

    PubMed

    Huang, Chi-Yi; Chen, Shiou-Sheng; Chen, Li-Kuei

    2009-10-01

    To compare two different running models including self-support and outsourcing cooperation for the extracorporeal shock wave lithotripsy (SWL) machine in Taipei City Hospital, we made a retrospective study. Self-support means that the hospital has to buy an SWL machine and get all the payment from SWL. In outsourcing cooperation, the cooperative company provides an SWL machine and shares the payment with the hospital. Between January 2002 and December 2006, we used self-support for the SWL machine, and from January 2007 to December 2008, we used outsourcing cooperation. We used the method of full costing to calculate the cost of SWL, and the break-even point was the lowest number of treatment sessions of SWL to make balance of payments every month. Quality parameters including stone-free rate, retreatment rate, additional procedures and complication rate were evaluated. When outsourcing cooperation was used, there were significantly more treatment sessions of SWL every month than when utilizing self-support (36.3 +/- 5.1 vs. 48.1 +/- 8.4, P = 0.03). The cost of SWL for every treatment session was significantly higher using self-support than with outsourcing cooperation (25027.5 +/- 1789.8 NT$ vs. 21367.4 +/- 201.0 NT$). The break-even point was 28.3 (treatment sessions) for self-support, and 28.4 for outsourcing cooperation, when the hospital got 40% of the payment, which would decrease if the percentage increased. No significant differences were noticed for stone-free rate, retreatment rate, additional procedures and complication rate of SWL between the two running models. Besides, outsourcing cooperation had lower cost (every treatment session), but a greater number of treatment sessions of SWL every month than self-support.

  8. Massive steinstrasse without lithotripsy: a rare case report

    PubMed Central

    Abdulmajed, Mohamed Ismat; Anandaram, Pallavoor Sudarsanam; Wyn Jones, Vaughan; Shergill, Iqbal Singh

    2013-01-01

    The accumulation of ureteric stone fragments causing ureteric blockage is known as ‘Steinstrasse’ or ‘Stone Street’ and is usually described as a complication of shock-wave lithotripsy (SWL). We herein present a rare case of massive Steinstrasse in a young male patient with no previous history of urolithiasis or lithotripsy. PMID:26328081

  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. Innovations in Lithotripsy Technology

    NASA Astrophysics Data System (ADS)

    Zhong, Pei

    2007-04-01

    The introduction of shock wave lithotripsy (SWL) in the early 1980's revolutionized the surgical management for kidney stone disease. Since then, although numerous 2nd- and 3rd-generation lithotripters have been developed using various means for shock wave generation, focusing, patient coupling and stone localization, the technical improvements in these devices were largely made based on practical concerns for user convenience and multifunctionality of the system rather than a clear understanding of the working principles of SWL. In this paper, the fundamental mechanisms of stone comminution and tissue injury in SWL revealed by basic studies in the past two decades are first reviewed. This is followed by a summary of the innovations in SWL technology developed in recent years that have been demonstrated to provide improved stone comminution with concomitantly reduced tissue injury both in vitro using phantom systems and in vivo in animal models. Furthermore, the role of treatment strategy in determining the overall outcome of clinical lithotripsy is emphasized, and future prospects for lithotripsy research and technological innovations are discussed.

  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. 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.

  13. Can we predict the need for intervention in steinstrasse following shock wave lithotripsy?

    PubMed Central

    Phukan, Chandan; Nirmal, T. J.; Wann, Cornerstone V.; Chandrasingh, J.; Kumar, Santosh; Kekre, Nitin S.; Devasia, Antony

    2017-01-01

    Introduction: Steinstrasse (SS) is a known complication of shock wave lithotripsy (SWL). Although the majority of SS clears spontaneously, about 6% require intervention. This study was carried out to identify the factors that determine the need for intervention in SS. Materials and Methods: This was a retrospective study of all patients who developed steinstrasse following SWL at our center. They were divided into two groups: a) Those cleared spontaneously and b) Those required intervention. The two groups were compared with regard to demographic profile, stone factors and factors related to steinstrasse. Results: Out of 2436 cases of SWL, 89 (3%) formed steinstrasse. The majority of the patients (35%) who required intervention had stone sizes of 10-14 mm. Coptcoat type III steinstrasse required significantly more interventions for clearance (P = 0.001). The site and the size of the SS was not a predictor of intervention for SS. Conclusions: Early intervention is warranted in patients with steinstrasse where the lead fragment is >5 mm (Coptcoat type III). PMID:28216930

  14. Bubble Proliferation in Shock Wave Lithotripsy Occurs during Inertial Collapse

    NASA Astrophysics Data System (ADS)

    Pishchalnikov, Yuri A.; McAteer, James A.; Pishchalnikova, Irina V.; Williams, James C.; Bailey, Michael R.; Sapozhnikov, Oleg A.

    2008-06-01

    In shock wave lithotripsy (SWL), firing shock pulses at slow pulse repetition frequency (0.5 Hz) is more effective at breaking kidney stones than firing shock waves (SWs) at fast rate (2 Hz). Since at fast rate the number of cavitation bubbles increases, it appears that bubble proliferation reduces the efficiency of SWL. The goal of this work was to determine the basis for bubble proliferation when SWs are delivered at fast rate. Bubbles were studied using a high-speed camera (Imacon 200). Experiments were conducted in a test tank filled with nondegassed tap water at room temperature. Acoustic pulses were generated with an electromagnetic lithotripter (DoLi-50). In the focus of the lithotripter the pulses consisted of a ˜60 MPa positive-pressure spike followed by up to -8 MPa negative-pressure tail, all with a total duration of about 7 μs. Nonlinear propagation steepened the shock front of the pulses to become sufficiently thin (˜0.03 μm) to impose differential pressure across even microscopic bubbles. High-speed camera movies showed that the SWs forced preexisting microbubbles to collapse, jet, and break up into daughter bubbles, which then grew rapidly under the negative-pressure phase of the pulse, but later coalesced to re-form a single bubble. Subsequent bubble growth was followed by inertial collapse and, usually, rebound. Most, if not all, cavitation bubbles emitted micro-jets during their first inertial collapse and re-growth. After jetting, these rebounding bubbles could regain a spherical shape before undergoing a second inertial collapse. However, either upon this second inertial collapse, or sometimes upon the first inertial collapse, the rebounding bubble emerged from the collapse as a cloud of smaller bubbles rather than a single bubble. These daughter bubbles could continue to rebound and collapse for a few cycles, but did not coalesce. These observations show that the positive-pressure phase of SWs fragments preexisting bubbles but this initial

  15. SHOCK WAVE LITHOTRIPSY TARGETING OF THE KIDNEY AND PANCREAS DOES NOT INCREASE THE SEVERITY OF METABOLIC SYNDROME IN A PORCINE MODEL

    PubMed Central

    Handa, Rajash K.; Evan, Andrew P.; Connors, Bret A.; Johnson, Cynthia D.; Liu, Ziyue; Alloosh, Mouhamad; Sturek, Michael; Evans-Molina, Carmella; Mandeville, Jessica A.; Gnessin, Ehud; Lingeman, James E.

    2014-01-01

    Purpose To determine whether shock wave lithotripsy (SWL) treatment of the kidney of metabolic syndrome (MetS) pigs worsens glucose tolerance or increases the risk of developing diabetes mellitus. Materials and Methods Nine-month-old female Ossabaw miniature pigs were fed a hypercaloric atherogenic diet to induce MetS. At 15 months of age, pigs were treated with 2000 SWs or 4000 SWs (24 kV at 120 SWs/min) using the unmodified Dornier HM3 lithotripter. SWs were targeted to the upper pole calyx of the left kidney so as to model treatment that would also expose the tail of the pancreas to SWs. Intravenous glucose tolerance tests (IVGTTs) were performed on conscious, fasting pigs before SWL and at 1 month and 2 months post-SWL with blood samples taken for glucose and insulin measurement. Results Pigs fed the hypercaloric atherogenic diet were obese, dyslipidemic, insulin resistant and glucose intolerant—consistent with the development of MetS. Assessment of insulin resistance, glucose tolerance and pancreatic beta cell function from fasting plasma glucose and insulin levels, and the glucose and insulin response profile to IVGTTs, were similar before and after SWL. Conclusions The MetS status of SWL treated pigs was unchanged 2 months following treatment of the kidney with 2000 high-amplitude SWs or overtreatment with 4000 high-amplitude SWs. These findings do not support a single SWL treatment of the kidney as a risk factor for the onset of diabetes mellitus. PMID:24657667

  16. Ureteral stenting can be a negative predictor for successful outcome following shock wave lithotripsy in patients with ureteral stones

    PubMed Central

    Kang, Dong Hyuk; Cho, Kang Su; Ham, Won Sik; Chung, Doo Yong; Kwon, Jong Kyou; Choi, Young Deuk

    2016-01-01

    Purpose To evaluate ureteral stenting as a negative predictive factor influencing ureteral stone clearance and to estimate the probability of one-session success in shock wave lithotripsy (SWL) patients with a ureteral stone. Materials and Methods We retrospectively reviewed the medical records of 1,651 patients who underwent their first SWL. Among these patients, 680 had a ureteral stone measuring 4–20 mm and were thus eligible for our study. The 57 patients who underwent ureteral stenting during SWL were identified. Maximal stone length (MSL), mean stone density (MSD), skin-to-stone distance (SSD), and stone heterogeneity index (SHI) were determined by pre-SWL noncontrast computed tomography. Results After propensity score matching, 399 patients were extracted from the total patient cohort. There were no significant differences between stenting and stentless groups after matching, except for a higher one-session success rate in the stentless group (78.6% vs. 49.1%, p=0.026). In multivariate analysis, shorter MSL, lower MSD, higher SHI, and absence of a stent were positive predictors for one-session success in patients who underwent SWL. Using cutoff values of MSL and MSD obtained from receiver operator curve analysis, in patients with a lower MSD (≤784 HU), the success rate was lower in those with a stent (61.1%) than in those without (83.5%) (p=0.001). However, in patients with a higher MSL (>10 mm), the success rate was lower in those with a stent (23.6%) than in those without (52.2%) (p=0.002). Conclusions Ureteral stenting during SWL was a negative predictor of one-session success in patients with a ureteral stone. PMID:27847914

  17. History of shock wave lithotripsy

    NASA Astrophysics Data System (ADS)

    Delius, Michael

    2000-07-01

    The first reports on the fragmentation of human calculi with ultrasound appeared in the fifties. Initial positive results with an extracorporeal approach with continuous wave ultrasound could, however, not be reproduced. A more promising result was found by generating the acoustic energy either in pulsed or continuous form directly at the stone surface. The method was applied clinically with success. Extracorporeal shock-wave generators unite the principle of using single ultrasonic pulses with the principle of generating the acoustic energy outside the body and focusing it through the skin and body wall onto the stone. Häusler and Kiefer reported the first successful contact-free kidney stone destruction by shock waves. They had put the stone in a water filled cylinder and generated a shock wave with a high speed water drop which was fired onto the water surface. To apply the new principle in medicine, both Häusler and Hoff's group at Dornier company constructed different shock wave generators for the stone destruction; the former used a torus-shaped reflector around an explosion wire, the latter the electrode-ellipsoid system. The former required open surgery to access the kidney stone, the latter did not. It was introduced into clinical practice after a series of experiments in Munich.

  18. Comparison of success rates and financial cost of extracorporeal shock-wave lithotripsy in situ and after manipulation for proximal ureteral stones.

    PubMed

    Varkarakis, J; Protogerou, V; Albanis, S; Sofras, F; Deliveliotis, C

    2003-08-01

    Our aim was to compare the stone free rate and the financial cost between in situ and after manipulation shock wave lithotripsy (SWL) for proximal ureteral stones. A total of 130 patients with proximal ureteral stones were prospectively randomized into two groups. Sixty-five patients (group 1) underwent SWL in situ and 65 patients (group 2) underwent SWL after an attempt was made to push back the stone into the kidney with the help of a ureteral catheter. The mean per person financial cost of both techniques was estimated after a follow up period of 3 months. The stone free rate 1 month post treatment was 83% (54/65 patients) for group 1 and 95% (62/65) for group 2. The higher success rate at 1 month for the pushback group was statistically significant ( P=0.04) but was correlated with a higher cost (euro 852 vs euro 1008.5). Fifteen additional sessions of SWL and follow up visits were needed in group 1, therefore making the final costs of the two therapeutic pathways almost equal (euro 1050.9 vs euro 1088.9), with no great difference in the overall fragmentation rates at 3 months between groups (94% and 97%, respectively). Stone manipulation offers higher stone free rates faster than in situ extracorporeal SWL, but is more expensive. This disparity in cost is diminished when costs are corrected for follow-ups and treatment of complications.

  19. 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

  20. Statistical Case Study of Extracorporeal Shock Wave Lithotripsy

    DTIC Science & Technology

    2007-11-02

    Shock Wave Lithotripsy (ESWL) is one of the recent, most common ways of treating patients with urinary (renal and ureteric) stones through non...Page 1 of 3 Statistical Case Study of Extracorporeal Shock Wave Lithotripsy Hani M. Amasha1 and Basel M. Al-Eideh2 1Department of...invasive destruction of stones [1]. Many reports and studies have shown its safety and success. It offers the patient less pain; much less discomfort and

  1. Treatment of small lower pole calculi--SWL vs. URS vs. PNL?

    PubMed

    Knoll, Thomas; Tasca, Andrea; Buchholz, Noor P

    2011-03-01

    According to current guideline recommendations extracorporeal shock wave lithotripsy (SWL) remains the first choice treatment for small and mid-sized renal calculi. However, the results of SWL treatment for lower pole stones can be disappointing whilst more invasive endoscopic modalities, such as flexible ureterorenoscopy (fURS) and percutaneous nephrolithotomy (PNL) are often considered more effective. This article summarizes a point-counterpoint discussion at the 9th eULIS symposium in Como, Italy, and discusses the potential advantages and disadvantages of the different therapeutic approaches.

  2. 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

  3. 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

  4. 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.

  5. Is unilateral transversus abdominis plane block an analgesic alternative for ureteric shock wave lithotripsy?

    PubMed Central

    Elnabtity, Ali Mohamed Ali; Tawfeek, Mohamed M.; Keera, Amr Ali; Badran, Yasser Ali

    2015-01-01

    Background: Various sedative and analgesic techniques have been used during shock wave lithotripsy (SWL). Aim: This study aimed at evaluating the efficacy of ultrasound-guided unilateral transversus abdominis plane (TAP) block as an analgesic technique alternative during ureteric SWL. Settings and Design: Prospective randomized comparative study. Materials and Methods: Fifty patients scheduled for ureteric SWL were randomly allocated into two equal groups: Group (F) received 1.5 mcg/kg fentanyl intravenous and group (T) received unilateral TAP block with injection of 25 ml of bupivacaine 0.25% (62.5 mg). Statistical Analysis: Statistical analysis was performed using SPSS program version 19 and EP16 program. Results: The visual analog scale was significantly less in group (T) than in group (F) both intra-operatively (at 10, 20, 30, and 40 min) and postoperatively (at 10 min intervals in the postanesthesia care unit [PACU]) (P < 0.001). Rescue analgesia with pethidine during the procedure and in the PACU was less (P < 0.001) in the group (T) than group (F) with a median of 20 mg versus 55 mg, respectively. The higher sedation scores observed in group (F) at 15, 25, and 35 min during the procedure, and at 20 min during the PACU time were statistically highly significant (P < 0.001), but only significant at 10 min (P = 0.03) and 30 min (P = 0.007) during the PACU time. There was also highly significant decrease (P < 0.001) in the time of PACU stay in group (T) (38.2 ± 6.6 min) compared with group (F) (89.2 ± 13.39 min). We recorded 6 patients in group (F) (24%) who have developed respiratory depression (respiratory rate < 10 breaths/min) compared to 0% in group (T) (P = 0.022). In addition, in group (F) nausea was noted in 8 patients (32%) and vomiting in 6 patients (24%), which was statistically significant when compared to group (T) (0%) (P = 0.01 and 0.022, respectively). Conclusion: Ultrasound-guided unilateral TAP block is an effective alternative analgesic

  6. Age-related delay in urinary stone clearance in elderly patients with solitary proximal ureteral calculi treated by extracorporeal shock wave lithotripsy.

    PubMed

    Ichiyanagi, Osamu; Nagaoka, Akira; Izumi, Takuji; Kawamura, Yuko; Kato, Tomoyuki

    2015-10-01

    We investigated the effects of aging on the stone-free rate (SFR) after shock wave lithotripsy (SWL) for the treatment of proximal ureteral calculi. A total of 247 consecutive patients were retrospectively selected, classified into seven groups set at 10 year increments (from 20 to 90 years), and examined for SFR after SWL. According to our final analysis, 185 male and 62 female patients with an average age of 54.1 years had stones with a diameter of 11.5 mm and a density of 893.1 Hounsfield units. On average, SFR was 74.9 % at 3 months after 1.7 SWL sessions. SFR gradually reached ≥ 90 % for each age-group after 1.5-2 years. Median durations to achieve 50 % SFR were estimated to be 21 and 86 days for those in their 20 and 80 s, respectively. However, the difference between the two estimates was not significant (p = 0.064). The durations to achieve 50 % SFR for the other groups lay between these two estimates. Aging does not affect long-term SFR, but patients aged ≥ 80 years might experience delayed stone clearance within the first 12 months after SWL.

  7. 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

  8. 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.

  9. Treatment of Renal Calculi with Extracorporeal Shock Wave Lithotripsy

    PubMed Central

    Eberwein, P. M.; Denstedt, J. D.

    1992-01-01

    In 12 years, extracorporeal shock wave lithotripsy has replaced other treatment techniques for most surgical calculi in the upper urinary tract. Worldwide clinical series have documented its efficacy. Technological advances and modifications have significantly expanded the clinical applications of this technique. Imagesp1673-aFigure 3 PMID:21221368

  10. Dimethyl sulfoxide with lignocaine versus eutectic mixture of local anesthetics: prospective randomized study to compare the efficacy of cutaneous anesthesia in shock wave lithotripsy.

    PubMed

    Kumar, Santosh; Kumar, Sunil; Ganesamoni, Raguram; Mandal, Arup K; Prasad, Seema; Singh, Shrawan K

    2011-06-01

    The objective of the study was to compare the efficacy of dimethyl sulfoxide (DMSO) mixed with lignocaine and eutectic mixture of local anesthetics (EMLA) cream as topically applied surface anesthetics in relieving pain during shock wave lithotripsy (SWL) in a prospective randomized study. Of the 160 patients, 80 patients received DMSO with lignocaine and 80 patients received EMLA cream, applied to the skin of the flank at the area of entry of shock waves. SWL was done with Seimens lithostar multiline lithotripter. The pain during the procedure was assessed using visual analog and verbal rating scores. The mean visual analog scale scores for the two groups were 3.03 for DMSO group and 4.43 for EMLA group. The difference of pain score on visual analog scale was statistically significant (p < 0.05). Similarly, the pain scores as rated on the verbal rating scale were also evaluated; the mean score on verbal rating scale were 2.34 for DMSO group and 3.00 for the EMLA group. The difference between the pain score on verbal rating scale was also found to be statistically significant (p < 0.05). Our study showed that DMSO with lignocaine is a better local anesthetic agent for SWL than EMLA cream. The stone fragmentation and clearance rates are also better in the DMSO group.

  11. Interactions of shock waves with material interfaces in lithotripsy and inertial confinement fusion

    NASA Astrophysics Data System (ADS)

    Iloreta, Jonathan Ian

    This dissertation focuses on the interaction of shock wave with material interfaces in shock wave lithotrispsy (SWL) and inertial confinement fusion (ICF). In the area of SWL, a method to characterize shock wave lithotripters by examining the potential for cavitation associated with the lithotripter shock wave (LSW) has been developed. The method uses the maximum radius achieved by a bubble subjected to a LSW as a representation of the cavitation potential for that region in the lithotripter. It is found that the maximum radius is determined by the work done on a bubble by the LSW. The method is used to characterize two reflectors: an ellipsoidal reflector and an ellipsoidal reflector with an insert. The results show that the use of an insert reduced the ---6 dB volume (with respect to peak positive pressure) from 1.6 cm3 to 0.4 cm3, the -6 dB volume (with respect to peak negative pressure) from 14.5 cm3 to 8.3 cm3, and reduced the volume characterized by high cavitation potential (i.e. regions characterized by bubbles with radii larger than 429 microm) from 103 cm3 to 26 cm3. Thus, the insert is an effective way to localize the potentially damaging effects of shock wave lithotripsy, and suggests an approach to optimize the shape of the reflector. Also in the area of SWL, the dynamics of bubbles near a kidney stone subjected to a lithotripter shock wave are considered to address the effect of kidney stone geometry and composition on the cavitation potential near the stone in a shock wave lithotripter. Results of the reflection of the LSW from cylindrical kidney stones with proximal surfaces of varying geometry show that the presence of the stone enhances bubble growth near the stone and decreases growth further away, due to constructive and destructive interference, respectively. These effects hold true regardless of the shape and curvature of the face, and are strongest for stones with concave faces and higher reflection coefficients. An interesting consequence of

  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. 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

  14. Successful extracorporeal shock wave lithotripsy for sibling pancreatic duct stones.

    PubMed

    Kitajima, Y; Ohiwa, T; Yamada, T; Sano, H; Ohara, H; Nakazawa, T; Ando, H; Hashimoto, T; Nakamura, S; Nomura, T; Joh, T; Yokoyama, Y; Itoh, M

    2001-01-01

    We present a case of 2 brothers with idiopathic chronic pancreatitis associated with pancreatic duct stones which could be successfully disintegrated by extracorporeal shock wave lithotripsy (ESWL). An obvious etiology for the pancreatolithiasis, like alcohol or biliary disease, was lacking and point mutations of the cationic trypsinogen gene exons 2 and 3 were not detected in the long arm of the 7th chromosome. However, a hereditary etiology could not be precluded since pancreatolithiasis occurred in the siblings. There has been no recurrence of pancreatic stones during 42 months of follow-up periods, for both. ESWL, the least invasive therapy, appeared applicable and effective for pancreatolithiasis in the present cases.

  15. [Extracorporeal shock-wave lithotripsy in horseshoe kidney].

    PubMed

    Blasco Casares, F J; Ibarz Servio, L; Ramón Dalmau, M; Ruiz Marcellán, F J

    1994-05-01

    Presentation of our experience in the use of extracorporeal shock wave lithotripsy (ESWL) for the treatment of lithiasis that occurred in 34 renal units from 28 patients with horseshoe kidneys. All patients but one were placed in supine decubitus with the calculus positioned in F2. A total of 47 sessions were performed for 34 treatments apart from 3 ureteroscopies for ureteral voiding. The results of the follow-up is absence of lithiasis in 13 renal units, debris of less than 3 mm in six, non-removable debris in 13 cases and relapse in two.

  16. 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.

  17. Turbulent water coupling in shock wave lithotripsy.

    PubMed

    Lautz, Jaclyn; Sankin, Georgy; Zhong, Pei

    2013-02-07

    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 J. Acoust. Soc. Am. 130 EL87-93). 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 to 0.3 s by a jet with an exit velocity of 62 cm s(-1). 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.

  18. In vitro comparison of shock wave lithotripsy machines

    NASA Astrophysics Data System (ADS)

    Teichman, Joel M.; Cecconi, Patricia P.; Pearle, Margaret S.; Clayman, Ralph V.

    2005-04-01

    We tested the hypothesis that shock wave lithotripsy machines vary in the ability to fragment stones to small size. Calcium oxalate monohydrate, calcium phosphate, cystine and struvite calculi were fragmented in vitro with the Dornier HM3, Storz Modulith SLX, Siemens Lithostar C, Medstone STS-T, HealthTronics LithoTron 160, Dornier Doli S and Medispec Econolith lithotriptors. Stones were given 2000 shocks or the FDA limit. Post-lithotripsy fragment size was compared. Struvite calculi were completely fragmented by all devices. The mean incidence of calcium phosphate dihydrate, calcium oxalate monohydrate, and cystine stones rendered into fragments greater than 2 mm was 0% for the HM3, Modulith SLX and Lithostar C, 10% for the STS-T, 3% for the LithoTron 160, 29% for the Doli and 18% for the Econolith (p=0.04); 0% for the HM3, Modulith SLX, Lithostar C, STS-T and LithoTron 160, 4% for the Doli and 9% for the Econolith (p=0.15); 1% for the HM3, 0% for the Modulith SLX, 1% for the Lithostar C, 10% for the STS-T, 14% for the LithoTron 160, 3% for the Doli and 9% for the Econolith (p=0.44), respectively. Shock wave lithotriptors vary in fragmentation ability.

  19. 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

  20. Evaluating the importance of mean stone density and skin-to-stone distance in predicting successful shock wave lithotripsy of renal and ureteric calculi.

    PubMed

    Wiesenthal, Joshua D; Ghiculete, Daniela; D'A Honey, R John; Pace, Kenneth T

    2010-08-01

    Shock wave lithotripsy (SWL) is considered the first line treatment for the majority of patients with renal and ureteric calculi, with success rates from contemporary series varying from 60 to 90%. Success is dependent on many patient and stone-related factors. We conducted a retrospective analysis of mean stone CT density (MSD) and skin-to-stone distance (SSD) to determine their influence on the success of SWL of renal and ureteric calculi. Data from all patients treated at the St. Michael's Hospital Lithotripsy Unit from May 2004 to June 2009 were reviewed. Analysis was restricted to those patients with a pre-treatment non-contrast CT scan conducted at our center demonstrating a solitary renal or ureteric calculus < or =20 mm in maximal diameter. Successful treatment of renal stones was defined as those patients who were stone free or had asymptomatic, clinically insignificant residual fragments < or =4 mm in diameter, as measured by KUB X-ray, 3 months after a single SWL treatment. Successful treatment of ureteric stones was defined as being stone free on KUB X-ray, 2-weeks post-SWL. Demographic, stone, patient, treatment and follow-up data were collected from a prospective database and review of CT and KUB imaging by two independent urologists and one radiologist. Data were analyzed with logistic regression, Chi square analysis and ANOVA where appropriate. 422 patients (69.7% male) with a mean age of 51.4 years (SD 12.9) and mean BMI 27.0 kg/m(2) (SD 4.9) were analyzed. Mean stone size was 78.9 mm(2) (SD 77.3) for ureteral stones and 66.1 mm(2) (SD 63.2) for renal stones, with 95 (43.6%) of the renal stones located in the lower pole. The single-treatment success rates for ureteral and renal stones were 62.3% and 68.8%, respectively. On univariate analysis, predictors of SWL success, regardless of stone location, were age (p = 0.01), BMI (p = 0.01), stone size (p < 0.01), MSD (p < 0.01) and SSD (p < 0.01). On multivariate analysis, MSD >900 HU (OR = 0.49, CI: 0

  1. Indomethacin as prophylaxis against ureteral colic following extracorporeal shock wave lithotripsy.

    PubMed

    Cole, R S; Palfrey, E L; Smith, S E; Shuttleworth, K E

    1989-01-01

    Ureteral colic occurs in 24 to 34 per cent of all patients following extracorporeal shock wave lithotripsy. Recent research has shown prostaglandin synthetase inhibitors to be effective in relieving the pain associated with ureteral colic. Our prospective, controlled, double-blind, randomized study was designed to test the efficacy of indomethacin in the prophylactic treatment of pain after extracorporeal shock wave lithotripsy. Patients undergoing extracorporeal shock wave lithotripsy were randomized into 2 groups. Group 1 received 100 mg. indomethacin suppositories twice daily and group 2 received placebo suppositories. After extracorporeal shock wave lithotripsy 2 analgesics were available to the patients: oral co-dydramol or intramuscular pethidine was offered in the normal manner by the nursing staff. The pre-extracorporeal shock wave lithotripsy x-ray was used to make a quantitative estimate of the total stone burden in each patient. The post-extracorporeal shock wave lithotripsy analgesic requirement was used to compare the 2 groups. Of 112 patients recruited to the study 55 received indomethacin and 57 received placebo. The request for analgesia in the 2 groups was not different (28 of 55 and 33 of 57, respectively). However, in the indomethacin group only 6 patients required pethidine (10 doses), compared to 18 (41 doses) in the placebo group. This difference is statistically significant (p less than 0.01). There was no difference between the 2 groups in the occurrence of ureteral steinstrasse. Indomethacin has been shown to be effective in the prophylactic treatment of ureteral colic after lithotripsy.

  2. Tandem shock wave cavitation enhancement for extracorporeal lithotripsy

    NASA Astrophysics Data System (ADS)

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

    2002-11-01

    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 µs 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 µs 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.

  3. 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.

  4. Patient information leaflets for extracorporeal shock wave lithotripsy: questionnaire survey

    PubMed Central

    Askari, A; Shergill, I

    2012-01-01

    Objectives To compare the level of information provided in extracorporeal shock wave lithotripsy (ESWL) patient information leaflets in the London and East of England Deaneries Design All trusts in the London and East of England Deanery who offer an ESWL service were contacted and leaflets were compared Setting London and East of England Deanery Participants Alan Askari, Iqbal Shergill Main outcome measures Examination of key information that was communicated to ESWL patients via leaflets Results 12 trusts responded across the two deaneries. There was significant variation in the amount of information provided in the leaflets with some leaflets not containing an adequate level of instruction or information to patients Conclusions The authors propose that a national standardised information leaflet should be incorporated with the British Association of Urological Surgeons (BAUS) procedure specific information leaflet for ESWL procedures PMID:22666532

  5. Principles and application of extracorporeal shock wave lithotripsy.

    PubMed

    Robinson, S N; Crane, V S; Jones, D G; Cochran, J S; Williams, O B

    1987-04-01

    The physics, instrumentation, and patient-care aspects of extracorporeal shock wave lithotripsy (ESWL) in the treatment of kidney stone disease are described. The kidney stone is located through the use of two integrated roentgenographic imaging systems. The x-ray tubes, fixed on either side of a tub of water in which the patient is partially immersed, are directed upward. The patient is maneuvered until the imaging systems indicate the kidney stone is within the second focus of the reflector and within the 1.5-cu cm target area. Once within this alignment, the stone is ready for shock wave treatment; general or regional anesthesia is used to immobilize the patient so that the position of the stone can be maintained within the focus of the shock wave. When the stone is repeatedly subjected to this high-energy force, it begins to disintegrate until fragments of less than 1 mm are left. ESWL can (1) disintegrate kidney stones of all types, (2) be efficiently transmitted over distances that allow the shock wave source to be outside the body, (3) safely pass through living tissue, and (4) be precisely controlled and focused into a small target area. ESWL is a safe, effective, and cost-saving treatment that can be used for 90% of all kidney stone disease that previously required surgery.

  6. Clinical comparison of extracorporeal shock wave lithotripsy and percutaneous nephrolithotomy in treating renal calculi.

    PubMed Central

    Mays, N.; Challah, S.; Patel, S.; Palfrey, E.; Creeser, R.; Vadera, P.; Burney, P.

    1988-01-01

    STUDY OBJECTIVE: To compare extracorporeal shock wave lithotripsy and percutaneous nephrolithotomy for efficacy in treating renal calculi. DESIGN: Non-randomised multicentre cohort study with 3 month follow up and 13 month data collection period. SETTING: Lithotripter centre in London, tertiary referral hospital, and urological clinics in several secondary and tertiary care centres. PATIENTS: 933 of 1001 patients treated by lithotripsy at the lithotripter centre were compared with 195 treated by nephrolithotomy. Missing patients were due to incomplete collection of data. Age and sex distributions and characteristics of the stones were similar in the two treatment groups. Two patients died in the lithotripsy group. Three month follow up was achieved in about 84% of both groups (783/933 for lithotripsy; 163/195 for nephrolithotomy). INTERVENTIONS: The nephrolithotomy group had surgical nephrolithotomy alone. In the lithotripsy group 83% (774/933) had lithotripsy alone, 11% (103/933) had combined lithotripsy and nephrolithotomy, and 6% (56/933) had lithotripsy plus ureteroscopy. Single and combined lithotripter treatments were analysed as one group and compared with nephrolithotomy. END POINT: Presence of stones three months after treatment. MEASUREMENTS AND MAIN RESULTS: Presence of residual stones was assessed by plain radiography, ultrasonography, or intravenous urography. After adjustment for age and size and position of stone for patients with single stones the likelihood of being free of stones three months after treatment was significantly greater in the nephrolithotomy group than the lithotripsy group (odds ratio 6.6; 95% confidence interval 3.0 to 14.6) and the response was particularly pronounced with staghorn calculi (62% (8/13) v 15% (141/96) patients free of stones after nephrolithotomy and lithotripsy, respectively). OTHER FINDINGS: 19%(146/775) of patients who had had lithotripsy had to be readmitted within three months after treatment compared with 14

  7. Shock wave lithotripsy at 60 or 120 shocks per minute: A randomized, double-blinded trial

    NASA Astrophysics Data System (ADS)

    Pace, Kenneth; Ghiculete, Daniela; Harju, Melanie; Honey, R. John

    2005-04-01

    Rate of shock wave administration is a factor in the per-shock efficiency of SWL. Decreasing shock wave frequency from 120 shocks per minute (s/m) may improve stone fragmentation. This study is the first to test this hypothesis in vivo. Patients with previously untreated radio-opaque kidney stones were randomized to SWL at 60 or 120 s/m and followed at 2 weeks and 3 months. Primary outcome was success rate, defined as stone-free or asymptomatic fragments 5 mm in size 3 months post-treatment. 111 patients were randomized to 60 s/m and 109 to 120 s/m. The groups were comparable on age, gender, BMI, stent status, and initial stone area. Success rate was higher for 60 s/m (75% versus 61%, p=0.027). Patients with stone area 100 mm2 experienced the greatest benefit: success rates were 71% for 60 s/m versus 32% (p=0.002), and stone-free rates were 60% versus 28% (p=0.015). Repeat SWL treatment was required in 32% treated at 120 s/m versus 18% (p=0.018). Fewer shocks were required (2423 versus 2906, p=0.001), but treatment time was longer (40.6 versus 24.2 minutes, p=0.001). SWL treatment at 60 s/m yields better outcomes than 120 s/m, particularly for stones 100 mm2.

  8. 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

  9. Ureteral wall thickness at the impacted ureteral stone site: a critical predictor for success rates after SWL.

    PubMed

    Sarica, Kemal; Kafkasli, Alper; Yazici, Özgür; Çetinel, Ali Cihangir; Demirkol, Mehmet Kutlu; Tuncer, Murat; Şahin, Cahit; Eryildirim, Bilal

    2015-02-01

    The aim of the study was to determine the possible predictive value of certain patient- and stone-related factors on the stone-free rates and auxiliary procedures after extracorporeal shock wave lithotripsy in patients with impacted proximal ureteral calculi. A total of 111 patients (86 male, 25 females M/F: 3.44/1) with impacted proximal ureteral stones treated with shock wave lithotripsy were evaluated. Cases were retrieved from a departmental shock wave lithotripsy database. Variables analyzed included BMI of the case, diameter of proximal ureter and renal pelvis, stone size and Hounsfield unit, ureteral wall thickness at the impacted stone site. Stone-free status on follow-up imaging at 3 months was considered a successful outcome. All patients had a single impacted proximal ureteral stone. While the mean age of the cases was 46 ± 13 years (range 26-79 years), mean stone size was 8.95 mm (5.3-15.1 mm). Following shock wave lithotripsy although 87 patients (78.4%) were completely stone-free at 3-month follow-up visit, 24 (21.6%) cases had residual fragments requiring further repeat procedures. Prediction of the final outcome of SWL in patients with impacted proximal ureteral stones is a challenging issue and our data did clearly indicate a highly significant relationship between ureteral wall thickness and the success rates of shock wave lithotripsy particularly in cases requiring additional procedures. Of all the evaluated stone- and patient-related factors, only ureteral wall thickness at the impacted stone site independently predicted shock wave lithotripsy success.

  10. [Medical and Economic Aspects of Extracorporeal Shock Wave Lithotripsy].

    PubMed

    Knoll, T; Fritsche, H-M; Rassweiler, J

    2011-11-01

    Extracorporeal shock wave lithotripsy (ESWL) is the method of choice for most renal and ureteral calculi. However, endoscopic procedures such as ureteroscopy or percutaneous nephrolithotomy are being more and more performed as primary treatment alternatives in clinical routine. This development may result from the sometimes unsatisfying results of ESWL. While this is often explained by a lower efficacy of last-generation machines, an often unrecognized explanation is the impact of a less well trained urologist. To achieve best results it is mandatory that fundamental knowledge about shock wave physics and disintegration mechanisms are available. In Germany, the reimbursement system between outpatient and inpatient departments is totally separate. This leads to difficulties in clinical practice. We believe that patients at risk for complications, such as ureteral stones, urinary tract infections or high age, benefit from inpatient treatment, while uncomplicated renal stones can safely be treated on an outpatient basis. Regular application and training of ESWL will aid an optimization of its results and acceptance.

  11. 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.

  12. 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.

  13. Management of upper ureteral stones exceeding 15 mm in diameter: Shock wave lithotripsy versus semirigid ureteroscopy with holmium:yttrium–aluminum–garnet laser lithotripsy

    PubMed Central

    Aboutaleb, Hamdy; Omar, Mohamed; Salem, Shady; Elshazly, Mohamed

    2016-01-01

    Objectives: We conducted a retrospective study to evaluate the efficacy and outcome of shock wave lithotripsy versus semirigid ureteroscopy in the management of the proximal ureteral stones of diameter exceeding 15 mm. Methods: During the 2009−2014 study period, 147 patients presenting with the proximal ureteral stones exceeding 15 mm in diameter were treated. Both shock wave lithotripsy and ureteroscopy with laser lithotripsy were offered for our patients. A 6/8.9 Fr semirigid ureteroscope was used in conjunction with a holmium:yttrium–aluminum–garnet laser. The stone-free rate was assessed at 2 weeks and 3 months post-treatment. All patients were evaluated for stone-free status, operation time, hospital stay, perioperative complications, and auxiliary procedures. Results: Of the 147 patients who took part in this study, 66 (45%) had undergone shock wave lithotripsy and 81 (55%) underwent ureteroscopy. At the 3-month follow-up, the overall stone-free rate in the shock wave lithotripsy group was 39/66 (59%) compared to 70/81 (86.4%) in the ureteroscopic laser lithotripsy group. Ureteroscopic laser lithotripsy achieved a highly significant stone-free rate (p = 0.0002), and the mean operative time, auxiliary procedures, and postoperative complication rates were comparable between the two groups. Conclusion: In terms of the management of proximal ureteral stones exceeding 15 mm in diameter, ureteroscopy achieved a greater stone-free rate and is considered the first-line of management. Shock wave lithotripsy achieved lower stone-free rate, and it could be used in selected cases. PMID:28348743

  14. 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.

  15. Pediatric extracorporeal shock wave lithotripsy: Predicting successful outcomes

    PubMed Central

    McAdams, Sean; Shukla, Aseem R.

    2010-01-01

    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

  16. 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.

  17. Intraluminal bubble dynamics induced by lithotripsy shock wave

    NASA Astrophysics Data System (ADS)

    Song, Jie; Bai, Jiaming; Zhou, Yufeng

    2016-12-01

    Extracorporeal shock wave lithotripsy (ESWL) has been the first option in the treatment of calculi in the upper urinary tract since its introduction. ESWL-induced renal injury is also found after treatment and is assumed to associate with intraluminal bubble dynamics. To further understand the interaction of bubble expansion and collapse with the vessel wall, the finite element method (FEM) was used to simulate intraluminal bubble dynamics and calculate the distribution of stress in the vessel wall and surrounding soft tissue during cavitation. The effects of peak pressure, vessel size, and stiffness of soft tissue were investigated. Significant dilation on the vessel wall occurs after contacting with rapid and large bubble expansion, and then vessel deformation propagates in the axial direction. During bubble collapse, large shear stress is found to be applied to the vessel wall at a clinical lithotripter setting (i.e. 40 MPa peak pressure), which may be the mechanism of ESWL-induced vessel rupture. The decrease of vessel size and viscosity of soft tissue would enhance vessel deformation and, consequently, increase the generated shear stress and normal stresses. Meanwhile, a significantly asymmetric bubble boundary is also found due to faster axial bubble expansion and shrinkage than in radial direction, and deformation of the vessel wall may result in the formation of microjets in the axial direction. Therefore, this numerical work would illustrate the mechanism of ESWL-induced tissue injury in order to develop appropriate counteractive strategies for reduced adverse effects.

  18. 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

  19. Modeling elastic wave propagation in kidney stones with application to shock wave lithotripsy

    NASA Astrophysics Data System (ADS)

    Cleveland, Robin O.; Sapozhnikov, Oleg A.

    2005-10-01

    A time-domain finite-difference solution to the equations of linear elasticity was used to model the propagation of lithotripsy waves in kidney stones. The model was used to determine the loading on the stone (principal stresses and strains and maximum shear stresses and strains) due to the impact of lithotripsy shock waves. The simulations show that the peak loading induced in kidney stones is generated by constructive interference from shear waves launched from the outer edge of the stone with other waves in the stone. Notably the shear wave induced loads were significantly larger than the loads generated by the classic Hopkinson or spall effect. For simulations where the diameter of the focal spot of the lithotripter was smaller than that of the stone the loading decreased by more than 50%. The constructive interference was also sensitive to shock rise time and it was found that the peak tensile stress reduced by 30% as rise time increased from 25 to 150 ns. These results demonstrate that shear waves likely play a critical role in stone comminution and that lithotripters with large focal widths and short rise times should be effective at generating high stresses inside kidney stones.

  20. [Shock wave lithotripsy, retrograde intrarenal surgery or percutaneous nephrolithotomy for lower pole renal stones?].

    PubMed

    Rojas, Alejandro; Gallegos, Héctor; Salvadó, José A

    2015-09-09

    Among the therapeutic alternatives available for the treatment of lower pole renal calculi are extracorporeal lithotripsy, percutaneous nephrolithotomy and retrograde intrarenal surgery. There is controversy about which of these techniques is more effective, especially for stones smaller than 20 mm. Searching in Epistemonikos database, which is maintained by screening 30 databases, we identified four systematic reviews including 11 pertinent randomized controlled trials overall. We combined the evidence and generated a summary of findings following the GRADE approach. We concluded percutaneous nephrolithotomy probably increases success rate, but it is not clear if it decreases the need of retreatment compared to extracorporeal shock wave lithotripsy. In comparison to retrograde intrarenal surgery, it may increase success rate, but it is not clear if it decreases the need of retreatment. Retrograde intrarenal surgery may increase success rate, and probably decreases need of retreatment compared to extracorporeal shock wave lithotripsy.

  1. [Effects of shock-wave lithotripsy (ESWL) on electrolytic and hormonal balance in nephrolithiasis patients].

    PubMed

    Dzhavad-Zade, S M; Abdullaev, S Sh

    1998-01-01

    Blood concentrations of parathyroid hormone, aldosterone, hydrocortisone, Na+, K+, Ca2+, 24-h urine concentration of Ca2+, blood pressure were measured on day 3 and 7 after extracorporeal shock-wave lithotripsy. A total of 54 patients with nephrolithiasis (NL) were examined. In NL patients with hypertension the above lithotripsy led to a fall in pressure by 15-20%, to correction of initial hormonal and electrolytic unbalance. There were marked changes in the levels of parathyroid hormone, total Ca2+ in the blood and 24-h urine.

  2. Evaluation of long-term side effects after shock-wave lithotripsy for renal calculi using a third generation electromagnetic lithotripter.

    PubMed

    Pirola, Giacomo Maria; Micali, Salvatore; Sighinolfi, Maria Chiara; Martorana, Eugenio; Territo, Angelo; Puliatti, Stefano; Bianchi, Giampaolo

    2016-10-01

    To assess the incidence of long-term side effects after shock-wave lithotripsy treatment performed with an electromagnetic Dornier Lithotripter S device. A specific follow-up was undertaken on a cohort of 100 selected patients that underwent SWL for a single renal stone in our center from 2002 to 2004. Previous and current data were compared using the Student t test. Factors associated with the incidence of hypertension and diabetes mellitus were determined. Ten years after treatment, mean serum creatinine level and glomerular filtration rate remained similar to previous values (serum creatinine level: 0.96 ± 0.22 vs. 0.92 ± 0.19 mg/dL; glomerular filtration rate: 92.8 ± 17.8 vs. 88.1 ± 21.7 mL/min). There were marked increases in blood cholesterol, blood pressure, and blood glucose levels, while smoking decreased. Age, glomerular filtration rate, body mass index, blood glucose and blood pressure at the time of treatment were significantly associated with the presence of hypertension and diabetes mellitus at follow-up; blood cholesterol was associated with diabetes mellitus development. After 10 years, overall renal function appeared to have been unaffected by shock-wave lithotripsy treatment. The increased rate of hypertension and diabetes mellitus were consistent with the incidence in the global population. This is the first report on the long-term safety of a third generation electromagnetic lithotripter, and indicates that there are no long-term sequelae.

  3. Numerical simulation of shock wave generation and focusing in shock wave lithotripsy

    NASA Astrophysics Data System (ADS)

    Krimmel, Jeff; Colonius, Tim

    2007-11-01

    Shock wave lithotripsy is a procedure where focused shock waves are fired at kidney stones in order to pulverize them. Many lithotripters with different source mechanisms and reflector shapes (or lenses) are in clinical use, but accurate prediction of focal region pressure is made difficult by nonlinearity and cavitation. We report on development of a numerical simulation framework aimed at accurate prediction of focal region flow physics. Shock wave generation and beam focusing are simulated via the Euler equations with MUSCL-type shock capturing scheme and adaptive mesh-refinement (Berger and Oliger, 1984). In future work, a bubbly cavitating flow model will be added. Electrohydraulic, electromagnetic, and piezoelectric lithotripters are modeled with axisymmetric and three-dimensional geometries. In the electrohydraulic case, a simple expanding bubble model simulates spark firing. In the piezoelectric case, a boundary condition prescribing the motion of individual elements is used. Amplitudes and durations of calculated focal region waveforms are in reasonable agreement with experimental data.

  4. 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

  5. Holographic interferometric observation of shock wave focusing to extracorporeal shock wave lithotripsy

    NASA Astrophysics Data System (ADS)

    Takayama, Kazuyoshi; Obara, Tetsuro; Onodera, Osamu

    1991-04-01

    Underwater shock wave focusing is successfully applied to disintegrate and remove kidney stones or gallbladder stones without using surgical operations. This treatment is one of the most peaceful applications ofshock waves and is named as the Extracorporeal Shock Wave Lithotripsy. Ajoint research project is going on between the Institute ofFluid Science, Tohoku University and the School ofMedicine, Tohoku University. The paper describes a result of the fundamental research on the underwater shock wave focusing applied to the ESWL. Quantitatively to visualize the underwater shock waves, various optical flow visualization techniques were successfully used such as holographic interferometry, and shadowgraphs combined with Ima-Con high speed camera. Double exposure holographic interferometric observation revealed the mechanism of generation, propagation and focusing of underwater shock waves. The result of the present research was already used to manufacture a prototype machine and it has already been applied successfully to ESWL crinical treatments. However, despite of success in the clinical treatments, important fundamental questions still remain unsolved, i.e., effects of underwater shock wave focusing on tissue damage during the treatment. Model experiments were conducted to clarify mechanism of the tissue damage associated with the ESWL. Shock-bubble interactions were found responsible to the tissue damage during the ESWL treatment. In order to interprete experimental findings and to predict shock wave behavior and high pressures, a numerical simulation was carried. The numerical results agreed with the experiments.

  6. How to improve lithotripsy and chemolitholysis of brushite-stones: an in vitro study.

    PubMed

    Heimbach, D; Jacobs, D; Hesse, A; Müller, S C; Zhong, P; Preminger, G M

    1999-08-01

    Because of their resistance to fragmentation, treatment of brushite stones is a big problem. This study was performed to look for an improvement in therapeutic strategies by using artificial stones made of brushite (Bon(n)-stones), which are comparable to their natural counterparts. Using an ultrasound transmission technique, longitudinal wave propagation speeds were measured at different time intervals during treatment with hemiacidrin. From these and density measurements, transverse wave speed, wave impedance and dynamic mechanical properties of the artificial stones were calculated. Moreover, the microhardness of artificial stones was measured and investigations on shock wave lithotripsy (SWL) combined with initial chemolytic treatment of the stones were performed. The suggestion was confirmed that stone fragility and thus SWL can be improved by varying the physical properties of brushite stones through treatment with hemiacidrin. Additionally, we demonstrated the efficacy of Suby G in dissolving artificial brushite stones using an experimental arrangement simulating the physiological conditions in the upper urinary tract. Moreover, the efficacy of four different intracorporeal lithotripsy devices (electrohydraulic, pneumatic, laser and ultrasound) was tested and it was shown that electrohydraulic lithotripsy seems to be the best system for comminution of brushite stones.

  7. Radiation dose to patient and personnel during extracorporeal shock wave lithotripsy

    SciTech Connect

    Bush, W.H.; Jones, D.; Gibbons, R.P.

    1987-10-01

    Radiation dose to the patient and personnel was determined during extracorporeal shock wave lithotripsy treatment of 60 patients. Surface radiation dose to the patient's back from the fluoroscopy unit on the side with the kidney stone averaged 10 rem (100 mSv.) per case, although the range was wide (1 to 30 rem). The surface dose from the opposing biplane x-ray unit was less, averaging 5.5 rem (55 mSv.) per case but again with a wide range (0.1 to 21 rem). Exit dose at the lower abdomen averaged 13 mrem. (0.13 mSv.) per case and estimated female gonad dose averaged 100 mrem. (1.2 mSv.). Radiation dose to personnel working in the extracorporeal shock wave lithotripsy suite averaged less than 2 mrem. (0.02 mSv.) per case, making it a procedure that is safe in regard to radiation exposure.

  8. Renal Vasoconstriction Occurs Early During Shockwave Lithotripsy in Humans

    PubMed Central

    Hsi, Ryan S.; Sorensen, Mathew D.; Paun, Marla; Dunmire, Barbrina; Liu, Ziyue; Bailey, Michael; Harper, Jonathan D.

    2015-01-01

    Abstract Introduction: In animal models, pretreatment with low-energy shock waves and a pause decreased renal injury from shockwave lithotripsy (SWL). This is associated with an increase in perioperative renal resistive index (RI). A perioperative rise is not seen without the protective protocol, which suggests that renal vasoconstriction during SWL plays a role in protecting the kidney from injury. The purpose of our study was to investigate whether there is an increase in renal RI during SWL in humans. Materials and Methods: Subjects were prospectively recruited from two hospitals. All subjects received an initial 250 shocks at low setting, followed by a 2-minute pause. Treatment power was then increased. Measurements of the renal RI were taken before start of procedure, at 250, after 750, after 1500 shocks, and at the end of the procedure. A linear mixed-effects model was used to compare RIs at the different time points. Results: Fifteen patients were enrolled. Average treatment time was 46 ± 8 minutes. Average RI at pretreatment, after 250, after 750, after 1500 shocks, and post-treatment was 0.67 ± 0.06, 0.69 ± 0.08, 0.71 ± 0.07, 0.73 ± 0.07, and 0.74 ± 0.06, respectively. In adjusted analyses, RI was significantly increased after 750 shocks compared with pretreatment (p = 0.05). Conclusion: Renal RI increases early during SWL in humans with the protective protocol. Monitoring for a rise in RI during SWL is feasible and may provide real-time feedback as to when the kidney is protected. PMID:26239232

  9. Comparing non contrast computerized tomography criteria versus dual X-ray absorptiometry as predictors of radio-opaque upper urinary tract stone fragmentation after electromagnetic shockwave lithotripsy.

    PubMed

    Hameed, Diaa A; Elgammal, Mohammed A; ElGanainy, Ehab O; Hageb, Adel; Mohammed, Khaled; El-Taher, Ahmed Mohamed; Mostafa, Mostafa Mohamed; Ahmed, Abdelfatah Ibrahim

    2013-11-01

    The objective of this study was to assess the value of dual X-ray absorptiometry (DXA) in comparison to non contrast computed tomography (NCCT) density as possible predictors of upper urinary tract stone disintegration by shock wave lithotripsy (SWL). This study included 100 consecutive patients, with solitary renal stone 0.5-2 cm or upper ureteral stone up to 1 cm. DXA to calculate stone mineral density (SMD) and stone mineral content (SMC) was done. NCCT was performed to measure Hounsfield units (HU). SWL was performed with an electromagnetic lithotripsy, plain X-ray documented disintegration after SWL. Successful treatment was defined as stone free or complete fragmentation after 1 or 2 sessions of SWL. The impact of patients age, sex, body mass index, stone laterality, location, volume, length, mean SMC and SMD, HU and Hounsfield density (HD), skin to stone distance (SSD) and number of shock waves were evaluated by univariate and multivariate analysis. Only 76 patients were available for follow-up. Success of disintegration was observed in 50 out of 76 patients (65.8 %). On multivariate analysis, SMC and number of shock wave were the significant independent factors affecting SWL outcome (p = 0.04 and p = 0.000, respectively). SMC as detected by DXA is a significant predictor of success of stone disintegration by SWL. SMC measured by DXA is more accurate than HU measured by CT. Patients with high stone mineral content (SMC greater than 0.65 g) should be directly offered another treatment option.

  10. The management of sialolithiasis in 2 children through use of extracorporeal shock wave lithotripsy.

    PubMed

    Escudier, M P; Drage, N A

    1999-07-01

    The management of salivary calculi in children may prove difficult for a number of reasons. Traditional investigations require ionizing radiation and in cases of sialography may be poorly tolerated. Similarly, any surgical treatment is likely to require general anesthesia and, in a number of cases, removal of the affected gland, which is associated with attendant risks. As an alternative, ultrasound and extracorporeal shock wave lithotripsy therapy offers low morbidity and outpatient procedures that are well tolerated, as illustrated by these 2 cases.

  11. [EFFECTIVENESS OF EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY IN PATIENTS WITH UROLITHIASIS OF A SOLITARY KIDNEY].

    PubMed

    Parshenkova, I G; Dutov, V V; Rumjancev, A A; Mamedov, E A

    2015-01-01

    The article presents results of extracorporeal shock wave lithotripsy (ESWL) in 62 patients with urolithiasis of a solitary kidney. In 50 (80.6%) patients calculi were located in the kidney and in 12 (19.4%) patients in the ureter. Effectiveness of ESWL at 3 month follow-up was 85.5%, which is somewhat lower than in patients with two healthy kidneys due to the choice of sparing low-energy modes of lithotripsy. The effectiveness of ESWL depended on the size of the original calculi (p<0.0001), and the baseline urodynamics of the upper urinary tract (p<0.0001). The rates of complications (32.3%) and auxiliary procedures (16.1%) were relatively low, due to the usage of pre-drainage of the kidney before a session of ESWL in patients with large and multiple calculi. There was no correlation between the occurrence of complications during treatment and the clinical form of a solitary kidney (p>0.05). In patients with stones larger than 1 cm and a moderate baseline abnormalities of the upper urinary tract urodynamics ESWL was less effective (p<0.0001), they had increased time of lithotripsy (p=0.013), more sessions (p<0.0001), complications (19.4%, p=0.043) and auxiliary manipulation (9.7%). Nevertheless, the duration of stay in hospital in the postoperative period did not correlate with the size of calculus (p=0.504). Extracorporeal shock wave lithotripsy is a highly effective and safe treatment of stones of a solitary kidney. Rational choice of indications and contraindications for the use of ESWL in a specific clinical situation is of great importance.

  12. [The morphologic and functional state of the kidneys exposed to focused waves during remote nephro-lithotripsy].

    PubMed

    Gavrilevich, B A; Sergienko, N F; Kudriavtsev, Iu V; Olefir, Iu V

    2006-06-01

    Clinical and experimental research has shown that complications connected with negative influence of focused waves in distant lithotripsy in litotripters with an electrohydravlic system of focused waves generation depend on many factors, including the regime of wave generator work, an electrode interval, defocusing the wave as a result of an electrode interval center displacement, the amplitude of pressure and the length of a wave impulse in positive and negative phases. The wave impulse is distorted, which leads to kidney tissue damage.

  13. Assessing the risk of incident hypertension and chronic kidney disease after exposure to shockwave lithotripsy and ureteroscopy

    PubMed Central

    Denburg, Michelle R.; Jemielita, Thomas; Tasian, Gregory; Haynes, Kevin; Mucksavage, Phillip; Shults, Justine; Copelovitch, Lawrence

    2015-01-01

    In this study we sought to determine if among individuals with urolithiasis, extracorporeal shock wave lithotripsy (SWL) and ureteroscopy are associated with a higher risk of incident arterial hypertension (HTN) and/or chronic kidney disease (CKD). This was measured in a population-based retrospective study of 11,570 participants with incident urolithiasis and 127,464 without urolithiasis in The Health Improvement Network. Patients with pre-existing HTN and CKD were excluded. The study included 1319 and 919 urolithiasis patients with at least one SWL or URS procedure, respectively. Multivariable Cox regression was used to estimate the hazard ratio for incident CKD stage 3–5 and HTN in separate analyses. Over a median of 3.7 and 4.1 years, 1423 and 595 of urolithiasis participants developed HTN and CKD, respectively. Urolithiasis was associated with a significant hazard ratio each for HTN of 1.42 (95% CI: 1.35, 1.51) and for CKD of 1.82 (1.67, 1.98). SWL was associated with a significant increased risk of HTN 1.34 (1.15, 1.57), while ureteroscopy was not. When further stratified as SWL to the kidney or ureter, only SWL to the kidney was significantly and independently associated with HTN 1.40 (1.19, 1.66). Neither SWL nor ureteroscopy was associated with incident CKD. Since urolithiasis itself was associated with a hazard ratio of 1.42 for HTN, an individual who undergoes SWL to the kidney can be expected to have a significantly increased hazard ratio for HTN of 1.96 (1.67, 2.29) compared to an individual without urolithiasis. PMID:26509587

  14. Use of internal polyethylene ureteral stents in extracorporeal shock-wave lithotripsy of staghorn calculi.

    PubMed

    Pode, D; Shapiro, A; Verstandig, A; Pfau, A

    1987-01-01

    Ureteral stenting during extracorporeal shock-wave lithotripsy (ESWL) of complete staghorn calculi, using an internal polyethylene pigtail catheter, was found to be an efficient prophylactic measure against the high rate of complications in these cases. In the presence of a ureteral stent the stone fragments passed more easily into the bladder, accumulation of obstructing stone streets was prevented, and internal drainage of the urine was guaranteed. The need for auxiliary measures such as percutaneous nephrostomy, ureteroscopy or ureteral meatotomy was prevented in most cases. This prophylactic measure may turn ESWL to become the primary treatment of large staghorn calculi.

  15. Acute pancreatitis due to extracorporeal shock wave lithotripsy: a rare complication.

    PubMed

    Limon, Onder; Kantar, Funda Ugur; Sahin, Erkan; Arslan, Murat; Ugurhan, Aslı Aydınoglu

    2014-11-01

    Extracorporeal shock wave lithotripsy (ESWL) is considered the treatment of choice for most renal and upper ureteral stones. Although extensive data have documented its safety, serious complications have been reported in 1% of patients, including acute pancreatitis, perirenal hematoma, urosepsis, venous thrombosis, biliary obstruction, bowel perforation, lung injury, and rupture of aortic aneurysms. Here, we report a 41-year-old woman who underwent ESWL for a calculus at the right renal pelvis and immediately developed acute pancreatitis after the procedure. Although the possibility of post-ESWL acute pancreatitisis extremely low, physicians must be aware of this complication in emergency departments.

  16. 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.

  17. Lithotripsy procedure (image)

    MedlinePlus

    Extracorporeal shock wave lithotripsy (ESWL) is a procedure used to shatter simple stones in the kidney or upper urinary tract. Ultrasonic waves are passed through the body until they strike the dense stones. Pulses of ...

  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. Shock wave lithotripsy is effective and safe for distal ureteral calculi in children.

    PubMed

    Ozbey, Isa; Aksoy, Yilmaz; Ziypak, Tevfik; Yapanoglu, Turgut; Polat, Ozkan; Aksoy, Mehmet

    2007-10-01

    We evaluated the effectiveness of the Siemens Lithostar Modularis lithotriptor for the management of distal ureteric calculi in children. Between 2004 and 2006, 29 children with distal ureteric calculi were treated in our stone center with the Siemens Lithostar Modularis (Siemens Medical Solutions, Inc.) Effectiveness of lithotripsy, retreatment and efficacy quotient rates, and complications were assessed. The series consisted of 18 (62%) boys and 11 (38%) girls with an age range of 1-13 years (average age 7.0 +/- 3.5). Under fluoroscopic guidance, children were treated with a maximum 3,000 shocks at an average of 2.2 +/- 0.3 kV. Mean stone size was 8.2 +/- 3.2 mm (range 4-18). Success was defined as the lack of any visible stone fragments on posttreatment radiological evaluation. The mean number of sessions required was 1.5 +/- 0.8/patient (range 1-4). Complete clearance rate at 3 months was 86.2%. Re-treatment and efficacy quotient rates for distal ureteral stones were 41.4 and 55.6%, respectively. Complications such as urinary tract infection or steinstrasse occurred in 2 (6.9%) patients. Minor complications included petechial skin hemorrhage at the site of entry of shock waves in all patients. Our results show that shock wave lithotripsy for distal ureteral calculi with the Siemens Lithostar Modularis lithotriptor has a high success rate (86.2%) and efficacy quotient (55.6%) with negligible complications in children.

  20. 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).

  1. Disseminated tuberculosis after extracorporeal shock-wave lithotripsy in an AIDS patient presenting with urosepsis.

    PubMed

    Tourchi, Ali; Ebadi, Maryam; Hosseinzadeh, Alireza; Shabaninia, Mahsa

    2014-03-01

    Haematogenous dissemination of undiagnosed urinary tuberculosis after performing extracorporeal shock-wave lithotripsy (ESWL) is extremely rare. Herein, we report a 41-year-old male who presented with urosepsis to the emergency room; catheterization was performed and retention resolved. He had a tattoo on his left arm and a five-year history of intravenous drug use. Blood tests indicated anaemia, leukocytosis, elevated CRP and ESR and mild hyponatraemia; haematuria, moderate bacteriuria and 2+ proteinuria on urinanalysis were observed. Chest X-ray revealed lesions suggestive of miliary tuberculosis, which was confirmed by chest CT scan. Brain CT and MRI suggested brain involvement in the setting of tuberculosis. On further investigations, HIV infection and hepatitis C seropositivity were detected and the patient remained in a coma for five days with a Glasgow Coma Scale of 6/15. Finally, the diagnosis of haematogenous dissemination of tuberculosis following lithotripsy was established. Anti-tuberculosis and anti-retroviral therapy were prescribed and monthly follow-up visits were scheduled. In conclusion, in a patient diagnosed with ureterolithiasis, a thorough history and physical examination, with specific attention to HIV and tuberculosis predisposing factors, should be carried out and preoperative screening tests considering the possibility of urinary tuberculosis are required. Finally, if urinary tuberculosis is detected, ESWL must be postponed until after appropriate treatment of tuberculosis.

  2. Renal and hypertensive complications of extracorporeal shock wave lithotripsy: who is at risk?

    PubMed

    Bataille, P; Cardon, G; Bouzernidj, M; El Esper, N; Pruna, A; Ghazali, A; Westeel, P F; Achard, J M; Fournier, A

    1999-01-01

    Extracorporeal shock wave lithotripsy (ESWL) is now used in the treatment of about 90% of renal and ureteral stones. Because of the non-punctual delivery of energy to the stone, a small volume of renal parenchyma is injured giving place to a fibrous scar which can be shown by highly resolutive imaging techniques like magnetic nuclear resonance. Isotopic clearances point to a reduction of 15% in the renal plasma flow on the side of the lithotripsy, but this alteration appears to be transient in nature. In a few cases an abrupt onset of transient hypertension has been reported in clear relation to a compressive perirenal hematoma. The responsibility of ESWL in the late occurrence of permanent hypertension is, however, still uncertain, probably because of the difficulty in showing that this occurrence is not only related to the older age of the patient. The American Food and Drug Administration-sponsored multicentric study begun in 1992 should solve this issue in the future. Recent articles suggest that altered renal function prior to ESWL would predict the late occurrence of hypertension and worsening of renal failure. Furthermore, age and the resistance index of arcuate or interlobar renal arteries (measured by Doppler) could help to screen patients at risk of developing hypertension. In practice in patients over 60 years of age and/or with a plasma creatinine of >to 300 micromol/l, ESWL should be performed with caution, and renal function and blood pressure should be carefully monitored.

  3. 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.

  4. Current state of clinical lithotripsy

    NASA Astrophysics Data System (ADS)

    Lingeman, James E.

    2003-10-01

    Extracorporeal shock wave lithotripsy (ESWL) has revolutionized the treatment of urolithiasis. Because of the clinical success of the original lithotriptor, the Dornier HM3, numerous manufacturers introduced different approaches to lithotripsy based on empiricism rather than an understanding of the fundamental mechanisms of this new technology. Our understanding of shock wave physics and the physiologic effects of shock waves has progressed greatly over the last decade resulting in insights that hopefully will be reflected favorably in future lithotriptor designs and lithotripsy techniques.

  5. In vitro study of the mechanical effects of shock-wave lithotripsy.

    PubMed

    Howard, D; Sturtevant, B

    1997-01-01

    Impulsive stress in repeated shock waves administered during extracorporeal shock-wave lithotripsy (ESWL) causes injury to kidney tissue. In a study of the mechanical input of ESWL, the effects of focused shock waves on thin planar polymeric membranes immersed in a variety of tissue-mimicking fluids have been examined. A direct mechanism of failure by shock compression and an indirect mechanism by bubble collapse have been observed. Thin membranes are easily damaged by bubble collapse. After propagating through cavitation-free acoustically heterogeneous media (liquids mixed with hollow glass spheres, and tissue) shock waves cause membranes to fail in fatigue by a shearing mechanism. As is characteristic of dynamic fatigue, the failure stress increases with strain rate, determined by the amplitude and rise time of the attenuated shock wave. Shocks with large amplitude and short rise time (i.e., in uniform media) cause no damage. Thus the inhomogeneity of tissue is likely to contribute to injury in ESWL. A definition of dose is proposed which yields a criterion for damage based on measurable shock wave properties.

  6. 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.

  7. Kidney stones and lithotripters: critical analysis of the introduction of extracorporeal shock wave lithotripsy into Canada.

    PubMed Central

    Wiser, L C; Plain, R H; Dossetor, J B

    1990-01-01

    It is possible for a nonpharmaceutical medical innovation to enter the mainstream of the health care system without its efficacy and effectiveness having first been established by means of a randomized controlled trial (RCT). The result of this omission may be the discreditation and abandonment of the technology or procedure but not before precious resources that could have been better used elsewhere in the health care system are absorbed. A possible example of such a misallocation of resources is the introduction into Canada of extracorporeal shock wave lithotripsy (ESWL) for the treatment of urolithiasis. We review the development and diffusion of ESWL and recommend ways in which the deficiencies in regulating the introduction of new medical technologies can be corrected. PMID:2123736

  8. Radionuclide evaluation pre- and postextracorporeal shock wave lithotripsy for renal calculi.

    PubMed

    Bomanji, J; Boddy, S A; Britton, K E; Nimmon, C C; Whitfield, H N

    1987-08-01

    Forty-two patients were evaluated pre- and postextracorporeal shock wave lithotripsy (ESWL) using [99mTc]DTPA renography. A quantitative evaluation showed that the relative renal function decreased 2-3 days post-ESWL on the treated side, and the parenchymal transit time index (PTTI) increased 2-3 days post-ESWL (p less than 0.001) on the treated side and returned to the pretreatment level by 3 wk post-ESWL. The untreated side showed an increase in PTTI 2-3 days post-ESWL (p less than 0.01), which returned to normal by 3 wk post-ESWL. A significantly greater increase in PTTI was seen in patients who received greater than 1,000 shocks as compared with those who received less than 1,000 shocks. Five patients developed obstructing uropathy post-ESWL, when stone fragments caused ureteric obstruction.

  9. 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

  10. An FDTD-based computer simulation platform for shock wave propagation in electrohydraulic lithotripsy.

    PubMed

    Yılmaz, Bülent; Çiftçi, Emre

    2013-06-01

    Extracorporeal Shock Wave Lithotripsy (ESWL) is based on disintegration of the kidney stone by delivering high-energy shock waves that are created outside the body and transmitted through the skin and body tissues. Nowadays high-energy shock waves are also used in orthopedic operations and investigated to be used in the treatment of myocardial infarction and cancer. Because of these new application areas novel lithotriptor designs are needed for different kinds of treatment strategies. In this study our aim was to develop a versatile computer simulation environment which would give the device designers working on various medical applications that use shock wave principle a substantial amount of flexibility while testing the effects of new parameters such as reflector size, material properties of the medium, water temperature, and different clinical scenarios. For this purpose, we created a finite-difference time-domain (FDTD)-based computational model in which most of the physical system parameters were defined as an input and/or as a variable in the simulations. We constructed a realistic computational model of a commercial electrohydraulic lithotriptor and optimized our simulation program using the results that were obtained by the manufacturer in an experimental setup. We, then, compared the simulation results with the results from an experimental setup in which oxygen level in water was varied. Finally, we studied the effects of changing the input parameters like ellipsoid size and material, temperature change in the wave propagation media, and shock wave source point misalignment. The simulation results were consistent with the experimental results and expected effects of variation in physical parameters of the system. The results of this study encourage further investigation and provide adequate evidence that the numerical modeling of a shock wave therapy system is feasible and can provide a practical means to test novel ideas in new device design procedures.

  11. Tissue damage in kidney, adrenal glands and diaphragm following extracorporeal shock wave lithotripsy.

    PubMed

    Gecit, Ilhan; Kavak, Servet; Oguz, Elif Kaval; Pirincci, Necip; Günes, Mustafa; Kara, Mikail; Ceylan, Kadir; Kaba, Mehmet; Tanık, Serhat

    2014-10-01

    This study was designed to investigate whether exposure to short-term extracorporeal shock wave lithotripsy (ESWL) produces histologic changes or induces apoptosis in the kidney, adrenal glands or diaphragm muscle in rats. The effect of shock waves on the kidney of male Wistar rats (n = 12) was investigated in an experimental setting using a special ESWL device. Animals were killed at 72 h after the last ESWL, and the tissues were stained with an in situ Cell Death Detection Kit, Fluorescein. Microscopic examination was performed by fluorescent microscopy. Apoptotic cell deaths in the renal tissue were not observed in the control group under fluorescent microscopy. In the ESWL group, local apoptotic changes were observed in the kidney in the area where the shock wave was focused. The apoptotic cell deaths observed in the adrenal gland of the control group were similar to those observed in the ESWL groups, and apoptosis was occasionally observed around the capsular structure. Apoptotic cell deaths in the diaphragm muscle were infrequently observed in the control group. Apoptosis in the ESWL group was limited to the mesothelial cells. This study demonstrated that serious kidney, adrenal gland and diaphragm muscles damage occurred following ESWL, which necessitated the removal of the organ in the rat model. It is recognized that the ESWL complications related to the kidney, adrenal gland and diaphragm muscles are rare and may be managed conservatively.

  12. 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.

  13. Quantitative evaluation of stone fragments in extracorporeal shock wave lithotripsy using a time reversal operator

    NASA Astrophysics Data System (ADS)

    Wang, Jen-Chieh; Zhou, Yufeng

    2017-03-01

    Extracorporeal shock wave lithotripsy (ESWL) has been used widely in the noninvasive treatment of kidney calculi. The fine fragments less than 2 mm in size can be discharged by urination, which determines the success of ESWL. Although ultrasonic and fluorescent imaging are used to localize the calculi, it's challenging to monitor the stone comminution progress, especially at the late stage of ESWL when fragments spread out as a cloud. The lack of real-time and quantitative evaluation makes this procedure semi-blind, resulting in either under- or over-treatment after the legal number of pulses required by FDA. The time reversal operator (TRO) method has the ability to detect point-like scatterers, and the number of non-zero eigenvalues of TRO is equal to that of the scatterers. In this study, the validation of TRO method to identify stones was illustrated from both numerical and experimental results for one to two stones with various sizes and locations. Furthermore, the parameters affecting the performance of TRO method has also been investigated. Overall, TRO method is effective in identifying the fragments in a stone cluster in real-time. Further development of a detection system and evaluation of its performance both in vitro and in vivo during ESWL is necessary for application.

  14. Prediction of outcome of extracorporeal shock wave lithotripsy in the management of ureteric calculi.

    PubMed

    Wang, Mingqing; Shi, Qiduo; Wang, Xuguang; Yang, Kun; Yang, Rui

    2011-02-01

    The present study was designed to evaluate the clinical outcome of using extracorporeal shock wave lithotripsy (ESWL) in the treatment of ureteric calculi and to establish a predictive model for the stone-free rate in patients receiving the treatment. A total of 831 patients with ureteric calculi were accepted in this study. Several parameters, including stone site, stone number, stone size, history of urolithiasis, renal colic, hydronephrosis, and double-J ureteric stent, were analyzed using univariate and multivariate analyses. A prediction model was established based on the logistic regression analysis of the significant factors, and the goodness-of-fit of the model was evaluated by employing the Hosmer-Lemeshow test. At a 3-month follow-up after ESWL treatment, the overall stone-free rate was 96.8% (804/831) with no serious complications being found, while the treatment failed in 3.2% (27/831) of the patients. Five factors, including stone number, stone size, history of urolithiasis, renal colic, and double-J ureteric stent contributed significantly to the clinical outcome of the ESWL treatment. The prediction model had a sensitivity and overall accuracy of 99.8 and 96.9%, respectively. The results show that ESWL remains an effective method for treating ureteric calculi. The prediction model established in this study could be used as a method for estimating prognosis in patients following ESWL treatment.

  15. Renal morphology and function immediately after extracorporeal shock-wave lithotripsy

    SciTech Connect

    Kaude, J.V.; Williams, C.M.; Millner, M.R.; Scott, K.N.; Finlayson, B.

    1985-08-01

    The acute effects of extracorporeal shock-wave lithotripsy (ESWL) on morphology and function of the kidney were evaluated by excretory urography, quantitative radionuclide renography (QRR), and magnetic resonance imaging (MRI) in 33 consecutive patients. Excretory urograms demonstrated an enlarged kidney in seven (18%) of 41 treatments and partial or complete obstruction of the ureter by stone fragments after 15 (37%) of 41 treatments. Total effective renal plasma flow (ERPF) was not changed after ESWL, but the percentage ERPF of the treated kidney was decreased by more than 5% in 10 (30%) of 33 cases. QRR images showed partial parenchymal obstruction in 10 (25%) of 41 teated kidneys and total parenchymal obstruction in 9 (22%). MRI disclosed one or more abnormalities in 24 (63%) of 38 treated kidneys. Treated kidneys were normal by all three imaging methods in 26% and abnormal by one or more tests in 74% of cases. The morphologic and functional changes are attributed to renal contusion resulting in edema and extravasation of urine and blood into the interstitial, subcapsular, and perirenal spaces.

  16. Extracorporeal shock wave lithotripsy in the primary treatment of encrusted ureteral stents.

    PubMed

    Irkilata, Lokman; Ozgur, Berat Cem; Sancaktutar, Ahmet Ali; Akdeniz, Ekrem; Aydin, Mustafa; Demirel, Huseyin Cihan; Aydin, Hasan Riza; Doluoglu, Omer Gokhan; Resorlu, Berkan; Atilla, Mustafa Kemal

    2015-08-01

    Double pigtail (JJ) ureteral stents, are the most commonly used method of urinary diversion in the ureteral obstructions. Encrustations may occur as a result of prolonged exposure due to forgetting these stents in the body. Removing these materials might be an annoyance. Forty-four patients from three tertiary referral centres with forgotten JJ stents left in them between the years 2007 and 2014 were included in the study. Stents could not be removed by attempted cystoscopy. As an alternative approach, extracorporeal shock wave lithotripsy (ESWL) was the first choice since it is minimally invasive. The results of that treatment are presented along with the relevant demographic data. JJ stenting for urolithiasis was performed in 36 patients, after open surgery in five patients, and for oncological reasons in three patients. ESWL was applied to stents or to any suspicious region adjacent to the stent. In 29 of 44 patients, the stents were easily removed under cystoscopic procedures while in one patient the fragmented residual stent was spontaneously excreted. In eight patients, ureteroscopy was required; in five patients, percutaneous nephrolithotripsy was required; and in one patient, open surgery was required in order to remove stents. ESWL can be considered as a first-line treatment when a forgotten JJ stent is detected despite all precautions after any kind of urological intervention involving insertion of ureteral stents.

  17. 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.

  18. Extracorporeal shock wave lithotripsy with the Storz Modulith SL20: the first 500 patients.

    PubMed

    Liston, T G; Montgomery, B S; Bultitude, M I; Tiptaft, R C

    1992-05-01

    Our initial experience of extracorporeal shock wave lithotripsy (ESWL) with the Storz Modulith SL20 is reported. A total of 500 patients with 551 renal and 120 ureteric stones, mean diameter 11.9 mm, underwent 746 treatments; 68.2% of patients required a single treatment. The mean treatment rate for renal calculi was 1.4 and for ureteric calculi it was 1.5, rising to 4.2 for staghorns; 62.2% of treatments were performed on an out-patient basis. Analgesia (intravenous fentanyl) was required in 60.9% of treatments for renal calculi but in only 38.2% of those for ureteric calculi. The overall stone-free rate at 3 months was 77.6%, with a further 14.7% of patients having fragments less than 3 mm in diameter that required no further treatment. The stone-free rate was dependent on the site of the stone, with the majority of residual fragments lying in a lower pole calix. There were few complications. The Modulith is an efficient and safe lithotripter capable of treating stones in the kidney and throughout the ureter.

  19. 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

  20. Use of radionuclide renal imaging for clinical followup after extracorporeal shock wave lithotripsy of renal stones.

    PubMed

    Michaels, E K; Pavel, D G; Orellana, P; Montes, A; Olea, E

    1992-09-01

    Patients treated by extracorporeal shock wave lithotripsy (ESWL) are usually evaluated by excretory urography within 1 month after treatment to determine the clearance of stone debris and rule out asymptomatic obstruction. In an attempt to obtain more precise functional information, we used 99mtechnetium-diethylenetriaminepentaacetic acid and 131iodine-hippurate radionuclide renal imaging studies, and a plain abdominal radiograph as the initial followup study after ESWL of 64 kidneys in 55 patients. Of 53 kidneys studied within 60 days after ESWL 42 had abnormal radionuclide renal imaging studies demonstrating pelviocaliceal stasis, excretory delay or poor function, 8 of which required subsequent interventions for obstructing stone debris. Five patients had excretory delay after ESWL that was unexpected based on a pre-ESWL excretory urogram showing normal function without dilation. A subset of 23 patients with large stone burden or anatomical deformity from a prior operation had baseline radionuclide renal imaging studies before ESWL; function improved in 4 and worsened in 5 by radionuclide renal imaging studies after completion of treatment. A total of 19 patients had radionuclide renal imaging studies earlier (within 17 days) after ESWL because of poor function and/or large stone burden, and as expected they had evidence of obstruction from stone debris, which necessitated further followup. Our experience suggests that followup of ESWL by radionuclide renal imaging studies provides specific functional information that is of particular value in the management of patients with obstructing stone debris and/or diminished renal function. Radionuclide renal imaging studies may also reveal unsuspected obstruction or functional impairment after ESWL of uncomplicated stones, and is recommended as routine followup after ESWL.

  1. 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.

  2. 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.

  3. Advantage of a Broad Focal Zone in SWL: Synergism Between Squeezing and Shear

    NASA Astrophysics Data System (ADS)

    Sapozhnikov, Oleg A.; Bailey, Michael R.; Maxwell, Adam D.; MacConaghy, Brian; Cleveland, Robin O.; McAteer, James A.; Crum, Lawrence A.

    2007-04-01

    Objective: The focal zone width appears to be a critical factor in lithotripsy. Narrow focus machines have a higher occurrence of adverse effects, and arguably no greater comminution efficiency. Manufacturers have introduced new machines and upgrades to broaden the focus. Still, little data exists on how focal width plays a role in stone fracture. Thus, our aim was to determine if focal width interacts with established mechanisms known to contribute to stone fracture. Method: A series of experiments were undertaken with changes made to the stone in an effort to determine which is most important, the shock wave (SW) reflected from the back end of the stone (spallation), the SW ringing the stone (squeezing), the shear wave generated at surface of the stone and concentrated in the bulk of it (shear), or SWs generated from bubble collapse (cavitation). Shock waves were generated by a Dornier HM3-style lithotripter, and stones were made from U30 cement. Baffles were used to block specific waves that contribute to spallation, shear, or squeezing, and glycerol was used to suppress cavitation. Numerical simulation and high-speed imaging allowed for visualization of specific waves as they traveled within the stone. Results: For brevity, one result is explained. A reflective baffle was placed around the front edge of a cylindrical stone. The proximal baffle prevented squeezing by preventing the SW from traveling over the stone, but permitted the SW entering the stone through the proximal face and did not affect the other mechanisms. The distal baffle behaved the same as no baffle. The proximal baffle dramatically reduced the stress, and the stone did not break (stone broke after 45±10 SWs without the baffle and did not break after 400 SWs when the experiment stopped). The result implies that since removing squeezing halted comminution, squeezing is dominant. However, there is much more to the story. For example, if the cylindrical stone was pointed, it broke with the point

  4. 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

  5. Evaluation of Hounsfield Units as a predictive factor for the outcome of extracorporeal shock wave lithotripsy and stone composition.

    PubMed

    Nakasato, Takehiko; Morita, Jun; Ogawa, Yoshio

    2015-02-01

    The objective of this study was to evaluate the utility of the Hounsfield Unit (HU) values as a predictive factor of extracorporeal shock wave lithotripsy outcome for ureteral and renal stones. We also assessed the possibility that HU values could be used to predict stone composition. A retrospective study was performed to measure stone HU values in 260 patients who underwent extracorporeal shock wave lithotripsy (ESWL) for solitary renal and ureteral stones from July 2007 to January 2012. Stone volume, location, skin-to-stone distance, stone HU values, and stone composition were assessed. Success of ESWL was defined as: (1) being stone-free or (2) residual stone fragments <4 mm after 3 months by radiography. Of the 260 assessed patients, 141 (54.2%) were stone-free, 32 (12.3%) had residual stone fragments <4 mm (clinically insignificant stone fragments), and 87 (33.5%) had residual stone fragments ≥4 mm after one round of ESWL. Multivariate analysis revealed that stone location and mean HU were significant predictors of ESWL success. Receiver operating characteristic curves defined cutoff values for predicting treatment outcome. Treatment success rates were significantly higher for stones <815 HU than with stones >815 HU (P < 0.0265). HU of calcium oxalate and calcium phosphate stones were higher than those of uric acid stones, but we could not differentiate between calcium oxalate monohydrate and calcium oxalate dihydrate stones. Evaluation of stone HU values prior to ESWL can predict treatment outcome and aid in the development of treatment strategies.

  6. 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

  7. High frequency jet ventilation through a supraglottic airway device: a case series of patients undergoing extra-corporeal shock wave lithotripsy.

    PubMed

    Canty, D J; Dhara, S S

    2009-12-01

    High frequency jet ventilation has been shown to be beneficial during extra-corporeal shock wave lithotripsy as it reduces urinary calculus movement which increases lithotripsy efficiency with better utilisation of shockwave energy and less patient exposure to tissue trauma. In all reports, sub-glottic high frequency jet ventilation was delivered through a tracheal tube or a jet catheter requiring paralysis and direct laryngoscopy. In this study, a simple method using supraglottic jet ventilation through a laryngeal mask attached to a circle absorber anaesthetic breathing system is described. The technique avoids the need for dense neuromuscular blockade for laryngoscopy and the potential complications associated with sub-glottic instrumentation and sub-glottic jet ventilation. The technique was successfully employed in a series of patients undergoing lithotripsy under general anaesthesia as an outpatient procedure.

  8. Comparison of Extracorporeal Shock Wave Lithotripsy for Urolithiasis Between Children and Adults: A Single Centre Study

    PubMed Central

    Assad, Salman; Rahat Aleman Bhatti, Joshua; Hasan, Aisha; Shabbir, Muhammad Usman; Akhter, Saeed

    2016-01-01

    Objective To retrospectively evaluate the effectiveness of extracorporeal shock wave lithotripsy (ESWL) for urolithiasis and compare the results between children and adults. Materials and methods From January 2011 to January 2015 (four years), ESWL was performed in 104 children and 300 adults for urolithiasis. MODULITH® SLX-F2 lithotripter (Storz Medical AG, Tägerwilen, Switzerland) equipment was used for ESWL. The stone-free rates, the number of ESWL sessions required, complication rates and ancillary procedures used were evaluated in a comparative manner. Results The mean age ± standard deviation (SD) of children was 7.84±4.22 years and of adults was a 40.22±1.57 years. Mean ± SD of the stone size was 1.28±61 cm in the adults while 1.08 ± 0.59 cm in the children. In adults, the complications included steinstrasse in six (1.98%) patients, fever in 15 (4.95%), hematuria in 19 (6.28%) and sepsis in six (1.98%) patients. In children, steinstrasse was observed in two (1.9%), mild fever in two (1.9%), hematuria in six (5.7%) and sepsis was seen in four (3.8%) patients. The overall complication rate in the adults and in the children, it was found to be 46/300 (15%) and in the children, it was seen to be 14/104 (13%). No statistical difference was found in post-ESWL complications between children and adults (P>0.05). Ancillary procedures including double J (DJ) stent were used in 13 (12.5%) children and 87 (29%) adults. There was a better stone clearance rate in children i.e. 79% as compared to 68% in adults (X2: P=0.036). Conclusion Children can achieve high stone-free rates after ESWL with a lower need for repeat ancillary procedures as compared to adults. However, there is a difference in the post-ESWL complications between these groups. PMID:27800291

  9. 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

    2011-10-07

    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.

  10. Extracorporeal shockwave lithotripsy in pediatrics.

    PubMed

    D'Addessi, Alessandro; Bongiovanni, Luca; Sasso, Francesco; Gulino, Gaetano; Falabella, Roberto; Bassi, Pierfrancesco

    2008-01-01

    Since its introduction in 1980, extracorporeal shockwave lithotripsy (SWL) has become the first therapeutic option in most cases of upper-tract urolithiasis, and the technique has been used for pediatric renal stones since the first report of success in 1986. Lithotripter effectiveness depends on the power expressed at the focal point. Closely correlated with the power is the pain produced by the shockwaves. By reducing the dimensions of the focus, it becomes possible to treat the patient without anesthesia or analgesia but at the cost of a higher re-treatment rate. Older children often tolerate SWL under intravenous sedation, and minimal anesthesia is applicable for most patients treated with second- and third-generation lithotripters. Ureteral stenting before SWL has been controversial. Current data suggest that preoperative stent placement should be reserved for a few specific cases. Stone-free rates in pediatric SWL exceed 70% at 3 months, with the rate reaching 100% in many series. Even the low-birth-weight infant can be treated with a stone-free as high as 100%. How can one explain the good results? Possible explanations include the lesser length of the child's ureter, which partially compensates for the narrower lumen. Moreover, the pediatric ureter is more elastic and distensible, which facilitates passage of stone fragments and prevents impaction. Another factor is shockwave reproduction in the body: there is a 10% to 20% damping of shockwave energy as it travels through 6 cm of body tissue, so the small body volume of the child allows the shockwaves to be transmitted with little loss of energy. There are several concerns regarding the possible detrimental effect of shockwaves on growing kidneys. Various renal injures have been documented with all type of lithotripters. On the other hand, several studies have not shown adverse effects. In general, SWL is considered to be the method of choice for managing the majority of urinary stones in children of all

  11. 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.

  12. 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

  13. Shockwave lithotripsy with renoprotective pause is associated with renovascular vasoconstriction in humans.

    PubMed

    Bailey, Michael; Lee, Franklin; Hsi, Ryan; Paun, Marla; Dunmire, Barbrina; Liu, Ziyue; Sorensen, Mathew; Harper, Jonathan

    2014-09-03

    Animal studies have shown that shock wave lithotripsy (SWL) delivered with an initial course of low-energy shocks followed by a pause reduces renal injury. The pause correlates with increased arterial resistive index (RI) during SWL as measured by ultrasound. This suggests that renal vasoconstriction is associated with protecting the kidney from injury. This study explored whether a similar increase in RI is observed in humans. Patients were prospectively recruited from two hospitals. All received an initial dose of 250 lowest energy shocks followed by a two-minute pause. Shock power was then ramped up at the discretion of the physician; shock rate was maintained at 1 Hz. Spectral Doppler velocity measurements were taken from an interlobar artery at baseline after induction, during the pause at 250 shocks, after 750 shocks, after 1500 shocks, and at the end of the procedure. RI was calculated from the peak systolic and end diastolic velocities and a linear mixed-effects model was used to compare RIs. The statistical model accounted for age, gender, laterality, and body mass index (BMI). Measurements were taken from 15 patients. Average RI ± standard deviation pretreatment, after 250 shocks, after 750 shocks, after 1500 shocks, and post treatment was 0.68 ± 0.06, 0.71 ± 0.07, 0.73 ± 0.06, 0.75 ± 0.07 and 0.75 ± 0.06, respectively. RI was found to be significantly higher after 250 shocks compared to pretreatment (p = 0.04). RI did not correlate with age, gender, BMI, or treatment side. This is suggestive that allowing a pause for renal vascular vasoconstriction to develop may be beneficial, and can be monitored for during SWL, providing real-time feedback as to when the kidney is protected.

  14. Shockwave lithotripsy with renoprotective pause is associated with renovascular vasoconstriction in humans

    PubMed Central

    Bailey, Michael; Lee, Franklin; Hsi, Ryan; Paun, Marla; Dunmire, Barbrina; Liu, Ziyue; Sorensen, Mathew; Harper, Jonathan

    2015-01-01

    Animal studies have shown that shock wave lithotripsy (SWL) delivered with an initial course of low-energy shocks followed by a pause reduces renal injury. The pause correlates with increased arterial resistive index (RI) during SWL as measured by ultrasound. This suggests that renal vasoconstriction is associated with protecting the kidney from injury. This study explored whether a similar increase in RI is observed in humans. Patients were prospectively recruited from two hospitals. All received an initial dose of 250 lowest energy shocks followed by a two-minute pause. Shock power was then ramped up at the discretion of the physician; shock rate was maintained at 1 Hz. Spectral Doppler velocity measurements were taken from an interlobar artery at baseline after induction, during the pause at 250 shocks, after 750 shocks, after 1500 shocks, and at the end of the procedure. RI was calculated from the peak systolic and end diastolic velocities and a linear mixed-effects model was used to compare RIs. The statistical model accounted for age, gender, laterality, and body mass index (BMI). Measurements were taken from 15 patients. Average RI ± standard deviation pretreatment, after 250 shocks, after 750 shocks, after 1500 shocks, and post treatment was 0.68 ± 0.06, 0.71 ± 0.07, 0.73 ± 0.06, 0.75 ± 0.07 and 0.75 ± 0.06, respectively. RI was found to be significantly higher after 250 shocks compared to pretreatment (p = 0.04). RI did not correlate with age, gender, BMI, or treatment side. This is suggestive that allowing a pause for renal vascular vasoconstriction to develop may be beneficial, and can be monitored for during SWL, providing real-time feedback as to when the kidney is protected. PMID:26203348

  15. 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

  16. 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.

  17. Plain radiography, renography, and 99mTc-DMSA renal scintigraphy before and after extracorporeal shock wave lithotripsy for urolithiasis.

    PubMed

    Munck, O; Gerquari, I; Møller, J T; Jensen, L I; Thomsen, H S

    1992-11-01

    Eighteen patients were evaluated before and 5 weeks after the first treatment with extracorporeal shock wave lithotripsy (ESWL) using abdominal plain radiography, 131I-hippuran probe renography, and 99mTc-dimercaptosuccinic acid scintigraphy. In 6 patients no urolithiasis was present on the post ESWL plain radiograph, in 7 the size had decreased, and in 5 the stone mass was unchanged. The renograms were within normal range in the 6 patients who were cured by ESWL, whereas this was the case for only 4 of the 12 who still had renal calculi. In 2 patients pelvic stones had descended into the ureter after ESWL, and the renograms indicated obstruction. Another 3 patients had ureteral stones, whereas in the remaining 7 patients only pelvic stones were found on the plain radiographs. In no patient did the scintigrams reveal scars. It is concluded that abdominal plain radiography of the urinary tract and probe renography are complementary and sufficient in the monitoring of patients with urolithiasis post ESWL.

  18. 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.

  19. Hypovolemic Shock Caused by Massive Renal Hematoma After a Third Consecutive Extracorporeal Shockwave Lithotripsy Session: A Case Report.

    PubMed

    Sermeus, Loic; Vander Eeckt, Kathy; Ost, Dieter; Van Den Branden, Marcel

    2016-01-01

    Extracorporeal shockwave lithotripsy (SWL) is a commonly used technique for treating urinary calculi. Although noninvasive, highly effective, and widely accepted, SWL is not without complications. Next to fragmenting the calculi, the surrounding tissue is damaged, which can result in renal hematoma, a well-described complication. In most cases, the collateral tissue damage is mild and resolves with conservative treatment. However, rarely, severe complications may arise. Here we present a case of a 46-year-old male who developed a massive hematoma, both subcapsular and retroperitoneal, after a third consecutive SWL session, resulting in hypovolemic shock. Different probable causes are proposed, of which one cause, the length of the interval between SWL sessions, is not yet studied properly. Probably, short intervals keep the damaged tissue from healing sufficiently, as proposed in our case. Possibly, life-threatening situations can be avoided if more evidence-based guidelines are available.

  20. Hypovolemic Shock Caused by Massive Renal Hematoma After a Third Consecutive Extracorporeal Shockwave Lithotripsy Session: A Case Report

    PubMed Central

    Vander Eeckt, Kathy; Ost, Dieter; Van Den Branden, Marcel

    2016-01-01

    Abstract Extracorporeal shockwave lithotripsy (SWL) is a commonly used technique for treating urinary calculi. Although noninvasive, highly effective, and widely accepted, SWL is not without complications. Next to fragmenting the calculi, the surrounding tissue is damaged, which can result in renal hematoma, a well-described complication. In most cases, the collateral tissue damage is mild and resolves with conservative treatment. However, rarely, severe complications may arise. Here we present a case of a 46-year-old male who developed a massive hematoma, both subcapsular and retroperitoneal, after a third consecutive SWL session, resulting in hypovolemic shock. Different probable causes are proposed, of which one cause, the length of the interval between SWL sessions, is not yet studied properly. Probably, short intervals keep the damaged tissue from healing sufficiently, as proposed in our case. Possibly, life-threatening situations can be avoided if more evidence-based guidelines are available. PMID:28078329

  1. Effect of extracorporeal shock-wave lithotripsy on gallbladder emptying in patients with solitary and multiple gallbladder stones.

    PubMed

    Kratzer, W; Mason, R A; Haag, U; Maier, C; Janowitz, P; Beckh, K; Adler, G

    1995-06-01

    In a prospective study, we investigated the effect of extracorporeal shock-wave lithotripsy (ESWL) on gallbladder contractility and on fasting and residual gallbladder volume in patients with solitary and multiple gallbladder stones with stone densities < 100 Hounsfield units (HU) and adequate gallbladder function. Twenty-five patients (seven males and 18 females, mean age 48.5 +/- 11.7 years) treated with ESWL were assigned to either group I, consisting of 13 patients with solitary stones < 20 mm diameter, or group II, including patients with two to three stones and maximum stone diameter of 30 mm. ESWL was performed with the MPL 9000 lithotripter. Gallbladder ejection fraction was determined using the method of Dodds after a 12-hr fast and following application of a standard stimulative meal. Gallbladder volume was measured by ultrasound over 90 min at 10-min intervals before ESWL, then at 1, 30, 120, and 210 days after ESWL. At 24 hr after ESWL, residual gallbladder volume increased in group I from 7.4 ml to 13.9 ml (P = 0.0567) and in group II from 6.5 ml to 20.2 ml (P = 0.0076). Thereafter, residual volumes returned to pre-ESWL levels. In group II, post-ESWL fasting volumes were significantly increased over initial values at all time intervals. Correspondingly, only at 24 hr after ESWL, ejection fractions decreased from 73.1% to 64.9% in group I and from 76.5% to 62.7% in group II. No statistically significant differences in gallbladder contractility between the two groups were observed at any point of the follow-up period.(ABSTRACT TRUNCATED AT 250 WORDS)

  2. [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.

  3. 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.

  4. A cumulative shear mechanism for tissue injury initiation in shock-wave lithotripsy

    NASA Astrophysics Data System (ADS)

    Freund, Jonathan

    2007-11-01

    Considerable injury to renal tissue often accompanies treatment when shocks waves are delivered to break up kidney stones. The most severe injuries seem to involve cavitation damage, driven by the expansive portion of the lithotripor's wave. However, data from animal studies indicate that inverted shock waves, which should preclude cavitation, still cause local injury near the tip of the renal papilla, which seems particularly susceptible to injury in general. We develop a model of papilla tissue, which consists mostly of parallel fluid filled elastic 10 to 30μm diameter tubules, to assess whether or not the shear of repeated shocks can accumulate to cause injury. Material properties are estimated from reported measurements of renal basement membranes. A Stokes-flow boundary integral algorithm is used to estimate the net viscoelastic properties of the tissue. It is predicted that the particular microstructure of the tissue near the tip of the papilla is indeed susceptible to shear accumulation as consistent with several observations.

  5. 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

  6. The clinical efficacy of extracorporeal shock wave lithotripsy in pediatric urolithiasis: a systematic review and meta-analysis.

    PubMed

    Lu, Pei; Wang, Zijie; Song, Rijin; Wang, Xiaolan; Qi, Kai; Dai, Qiying; Zhang, Wei; Gu, Min

    2015-06-01

    The aim was to investigate the clinical efficacy and safety of extracorporeal shock wave lithotripsy (ESWL) in pediatric urolithiasis. A comprehensive systematic review and meta-analysis were performed. PubMed, Embase, and the Cochrane central register of controlled trials (CENTRAL) were searched, and the stone-free rates (SFRs) of various stone sizes and stone positions were extracted from the eligible articles. The quality of the original articles was assessed according to the McHarm Scale. The risk ratios (RRs) and 95% confidential intervals (CIs) were pooled, and the sensitive analysis was performed to evaluate the heterogeneity among all eligible studies. In total, 14 studies with 1842 patients were identified. The pooled RR for the SFR of stones less than 10 mm and greater than 10 mm was 1.14 (95% CI: 1.07, 1.21, P < 0.001); the RR for the SFR of stones in the renal pole calix (PC) and the renal pelvis was 0.95 (95% CI: 0.893, 1.009, P < 0.01); the RR for the SFR of stones in the upper/middle PC and the lower PC was 1.07 (95% CI: 0.997, 1.156, P < 0.061); and the RR for the SFR of stones in the proximal ureter and middle/distal ureter was 1.077 (95% CI: 1.005, 1.154, P = 0.036). Heterogeneity was low in all the analyses. Major complications in ESWL of pediatric urolithiasis were steinstrasse and abdominal colic, the incidences of which were 6.00 and 6.29 %, respectively. The SFR of stones <10 mm was significantly higher than stones >10 mm, and the SFR of stones located in proximal ureter was statistically greater than stones in middle or distal ureter in pediatric urolithiasis, leaving no significant between stones in renal PC and renal pelvis, or between upper/middle PC and lower PC. The use of ESWL in children is highly efficient, with negligible complications; ESWL therapy could be considered the first-line treatment for pediatric urolithiasis.

  7. Laser induced shock wave lithotripsy--biologic effects of nanosecond pulses

    SciTech Connect

    Hofmann, R.; Hartung, R.; Geissdoerfer, K.A.; Ascherl, R.; Erhardt, W.; Schmidt-Kloiber, H.; Reichel, E.

    1988-05-01

    Laser energy of a Nd-YAG laser (1064 nm. wave length, 8 nsec pulse duration) was directed against various tissue cultures and the urothelium of the ureter, bladder and kidney parenchyma in pigs. Single pulse energy was 50 to 120 mJ with a repetition rate of 20 Hz. Urothelium and kidney parenchyma were irradiated in seven pigs. Tissue samples were examined histologically and electron microscopically directly, two, four, eight and 12 days after irradiation. No macroscopic lesion could be found. Maximum energy caused a small rupture cone of 40 micron. depth. No thermic effects or necrosis resulted, so that no harm is to be expected with unintentional irradiation during laser stone disintegration.

  8. Extracorporeal shock wave lithotripsy for cystine urolithiasis in children: outcome and complications.

    PubMed

    Slavković, Andjelka; Radovanović, Miladin; Sirić, Zlatko; Vlajković, Marina; Stefanović, Vladisav

    The Siemens Lithostar Litotriptor was used to treat 6 children with cystine nephrolithiasis, previously treated by open surgery. Five children had renal calculi (3 multiple caliceal, 2 pelvis) and one had ureteral calculus. Stone size ranged from 0.2-2.5 cm in diameter, and stone burden was from 0.24 to 10.81 cm3 per kidney. From one to 4 ESWL sessions per unit were applied, with a total of 1,800 to 12,000 shock waves. The stone free rate at 3 months was 50%. A complete elimination was obtained with cystine stones in renal pelvis and ureter, however, up to 4 ESWL treatments failed in caliceal stones. Rather location of cystine calculi than previous surgery was associated with ESWL success rate. Two patients with positive urine cultures were successfully treated with appropriate antibiotics before ESWL was attempted. Perirenal hematoma was major complication demonstrated by radionuclide scintigraphy in one patient, and resolved spontaneously by 3 months. In the combined treatment of cystine urolithiasis in children ESWL, as auxillary procedure, was safe and effective in pelvis stone but failed in caliceal stones. Medical dissolution for retained fragments was found effective.

  9. 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.

  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. 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.

  12. Effect of MPL 9000 extracorporeal shock wave lithotripsy on renal hemodynamics and urine flow: assessment by 99mTc-DTPA renal scintigraphy.

    PubMed

    Naito, S; Yoshida, T; Ogata, N; Ichiya, Y; Koga, H; Kotoh, S; Masuda, K; Kumazawa, J

    1995-01-01

    The effect of extracorporeal shock wave lithotripsy (ESWL) with an MPL9000 lithotriptor on renal hemodynamics and urine flow was investigated by 99mTc-DTPA renal scintigraphy. In the first-pass scintigrams obtained within 1 min after injection of 99mTc-DTPA, there was no significant change in the time to the maximum radioactivity level and the maximum radioactivity ratio at 1 day before ESWL and 1 day or 1 month after ESWL. However, analysis of 30-min scintigrams showed that urinary clearance of radioactivity was delayed in the treated kidney 1 day after ESWL, particularly in the region targeted by shock waves, despite the absence of overt urinary tract obstruction by residual stone fragments. This change was reversible and was no longer noted 1 month after ESWL. These results suggest that ESWL with the MPL9000 lithotriptor induces a focal and temporary decrease in urine flow in the treated kidney, but has little or no effect on renal hemodynamics.

  13. Is quantitative diffusion-weighted MRI a valuable technique for the detection of changes in kidneys after extracorporeal shock wave lithotripsy?

    PubMed Central

    Hocaoglu, Elif; Inci, Ercan; Aydin, Sibel; Cesme, Dilek Hacer; Kalfazade, Nadir

    2015-01-01

    Objective The aim of this study was to evaluate the capability and the reliability of diffusion-weighted imaging (DWI) in the changes of kidneys occurring after extracorporeal shock wave lithotripsy (ESWL) treatment for renal stones. Materials and Methods A total of 32 patients who underwent ESWL treatment for renal stone disease between June and December 2011 were enrolled in this prospective study. Color Doppler ultrasonography (CDUS) and DWI were performed before and within 24 hours after ESWL. DWI was obtained with b factors of 0, 500 and 1000 s/mm2 at 1.5 T MRI. Each of Resistive index (RI) and ADC values were calculated from the three regions of renal upper, middle and lower zones for both of the affected and contralateral kidneys. Paired sample t test was used for statistical analyses. Results After ESWL, the treated kidneys had statistically significant lower ADC values in all different regions compared with previous renal images. The best discriminative parameter was signal intensity with a b value of 1000 s/mm2. The changes of DWI after ESWL were noteworthy in the middle of the treated kidney (p<0.01). There were no significant difference between RI values in all regions of treated and contralateral kidneys before and after treatment with ESWL (p>0.05). Conclusion DWI is a valuable technique enables the detection of changes in DWI after ESWL treatment that may provide useful information in prediction of renal damage by shock waves, even CDUS is normal. PMID:25928520

  14. Long-term incidence and risk factors for recurrent stones following percutaneous nephrostolithotomy or percutaneous nephrostolithotomy/extracorporeal shock wave lithotripsy for infection related calculi.

    PubMed

    Streem, S B

    1995-03-01

    A study was done to determine the long-term incidence and cause of recurrent stones following percutaneous nephrostolithotomy alone (13 patients) or combined with extracorporeal shock wave lithotripsy (31) for management of documented infection related struvite renal calculi. The patients were followed for 12 to 111 months (mean 41.7) to censorship or time of new stone formation. Of these patients 12 (27%) had recurrent stones at 12 to 61 months (mean 32.3) after treatment. As determined by a Kaplan-Meier estimate, the risk of new stone formation 5 years after treatment was 36.8%. Potential risk factors for recurrence, including history of stones, associated anatomical abnormalities, procedure used, radiographic status at completion of treatment and recurrent infection during followup, were analyzed with Cox's proportional hazards model. Of these potential risk factors, only an associated anatomical abnormality was found to influence significantly the rate of recurrent stone formation (p = 0.005). We conclude that continued surveillance for recurrent stones is mandatory even for patients initially rendered stone-free and those who maintain sterile urine. In addition, because the presence of a significant anatomical or functional urinary tract abnormality places a patient at much higher risk for recurrence, we suggest that subsequent studies be stratified as to the presence or absence of these abnormalities.

  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. Evaluation of renal function following treatment with extracorporeal shock wave lithotripsy (ESWL): the use of whole-kidney, parenchymal and pelvic transit times.

    PubMed

    Ilgin, N; Iftehar, S A; Vural, G; Bozkirli, I; Gokcora, N

    1998-02-01

    The aim of this prospective study was to assess the efficacy of using whole-kidney, mean parenchymal and pelvic transit times to evaluate renal function following treatment with extracorporeal shock wave lithotripsy (ESWL). Fifteen patients were evaluated 24-48 h before and after ESWL therapy using 99Tcm-DTPA renal scintigraphy. Using deconvolution analysis, whole-kidney, mean parenchymal and pelvic transit times were calculated and the pre-ESWL values were compared with the post-ESWL values. In both kidneys, there were no significant changes in the glomerular filtration rate or relative renal uptake when compared with the pre-ESWL values. The mean whole-kidney transit time of the tracer did not change significantly during the post-ESWL period. In the treated kidney, the mean post-ESWL parenchymal transit time was significantly increased (P < 0.05), while the mean pelvic transit time was significantly decreased (P < 0.05). In the untreated kidney, there were no significant changes in any of these parameters. We conclude that the dual use of parenchymal and pelvic transit times is more sensitive than the mean whole-kidney transit time and other measures, such as glomerular filtration rate and relative renal uptake, for the assessment of outcome of therapy and other related post-ESWL changes.

  17. Cloud cavitation effects in shockwave lithotripsy

    NASA Astrophysics Data System (ADS)

    Colonius, Tim; Tanguay, Michel

    2003-10-01

    Cavitation has already been identified as an important damage mechanism in the comminution of kidney stones in shockwave lithotripsy (SWL). However, the precise conditions that maximize the damage caused by the collapsing bubbles are still unknown. Numerical simulations are used to investigate shock propagation and the consequent growth and collapse of a bubble cloud in the focal region of a lithotripter. In the simulations, a continuum two-phase flow model for the ensemble-averaged macroscale is coupled to a Gilmore model for individual spherical bubble dynamics at the microscale. The simulations show agreement with experimental pressure measurements and high-speed photography of the bubble cloud. At void fractions commensurate with experiments, it is found that the collective collapse of the bubble cloud provides a significant increase to the energy available for comminution (beyond what a single bubble would produce). Relatively small increases in the pressure at the center of the cloud in advance of collapse (two orders of magnitude smaller than the initial shock) can more than double the energy of the collapsing bubble.

  18. 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

  19. A Possible Cumulative Shear Mechanism For Tissue Damage Initiation In SWL

    NASA Astrophysics Data System (ADS)

    Freund, Jonathan B.

    2007-04-01

    In shock-wave lithotripsy, inertial cavitation is observed in kidney tissue after hundreds of shocks are delivered, which seems to correspond with the onset of wide-spread injury. However, it is unclear what initiates the process. It is possible, and has been suggested before, that hemorrhage is a prelude to cavitation damage. We investigate the possibility that the net shear of multiple shocks can accumulate to cause this initial hemorrhage. A mathematical model is used to show that the larger interstitial volume fraction in the medulla toward the papilla tip would make it particularly sensitive there to this mechanism. This is consistent with observations.

  20. [Ureterorenoscopy combined with extracorporeal shockwave lithotripsy].

    PubMed

    González Cabrera, L A; Oro Ortiz, J

    1989-01-01

    In May 1986, extracorporeal shock wave lithotripsy and endourologic procedures became available in the treatment of lithiasis at the "Hermanos Ameijeiras" Hospital. The present study describes our experience and the results achieved during a 12-month period using endourologic procedures. During this period 65 URS procedures were performed to treat post-ESWL ureteral obstruction, and 22 to push the stone up to the kidney for subsequent ESWL treatment.

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

    PubMed

    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

    2014-04-01

    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.

  2. Can a brief period of double J stenting improve the outcome of extracorporeal shock wave lithotripsy for renal calculi sized 1 to 2 cm?

    PubMed Central

    Sharma, Rakesh; Das, Ranjit Kumar; Basu, Supriya; Dey, Ranjan Kumar; Gupta, Rupesh; Deb, Partha Pratim

    2017-01-01

    Purpose Extracorporeal shock wave lithotripsy (ESWL) is an established modality for renal calculi. Its role for large stones is being questioned. A novel model of temporary double J (DJ) stenting followed by ESWL was devised and outcomes were assessed. Materials and Methods The study included 95 patients with renal calculi sized 1 to 2 cm. Patients were randomized into 3 groups. Group 1 received ESWL only, whereas group 2 underwent stenting followed by ESWL. In group 3, a distinct model was applied in which the stent was kept for 1 week and then removed, followed by ESWL. Procedural details, analgesic requirements, and outcome were analyzed. Results Eighty-eight patients (male, 47; female, 41) were available for analysis. The patients' mean age was 37.9±10.9 years. Stone profile was similar among groups. Group 3 received fewer shocks (mean, 3,155) than did group 1 (mean, 3,859; p=0.05) or group 2 (mean, 3,872; p=0.04). The fragmentation rate was similar in group 3 (96.7%) and groups 1 (81.5%, p=0.12) and 2 (87.1%, p=0.16). Overall clearance in group 3 was significantly improved (83.3%) compared with that in groups 1 (63.0%, p=0.02) and 2 (64.5%, p=0.02) and was maintained even in lower pole stones. The percentage successful outcome in groups 1, 2, and 3 was 66.7%, 64.5%, and 83.3%, respectively (p=0.21). The analgesic requirement in group 2 was higher than in the other groups (p=0.00). Group 2 patients also had more grade IIIa (2/3) and IIIB (1/2) complications. Conclusions Stenting adversely affects stone clearance and also makes the later course uncomfortable. Our model of brief stenting followed by ESWL provided better clearance, comfort, and a modest improvement in outcome with fewer sittings and steinstrasse in selected patients with large renal calculi. PMID:28261679

  3. Noncontrast computed tomography can predict the outcome of shockwave lithotripsy via accurate stone measurement and abdominal fat distribution determination.

    PubMed

    Geng, Jiun-Hung; Tu, Hung-Pin; Shih, Paul Ming-Chen; Shen, Jung-Tsung; Jang, Mei-Yu; Wu, Wen-Jen; Li, Ching-Chia; Chou, Yii-Her; Juan, Yung-Shun

    2015-01-01

    Urolithiasis is a common disease of the urinary system. Extracorporeal shockwave lithotripsy (SWL) has become one of the standard treatments for renal and ureteral stones; however, the success rates range widely and failure of stone disintegration may cause additional outlay, alternative procedures, and even complications. We used the data available from noncontrast abdominal computed tomography (NCCT) to evaluate the impact of stone parameters and abdominal fat distribution on calculus-free rates following SWL. We retrospectively reviewed 328 patients who had urinary stones and had undergone SWL from August 2012 to August 2013. All of them received pre-SWL NCCT; 1 month after SWL, radiography was arranged to evaluate the condition of the fragments. These patients were classified into stone-free group and residual stone group. Unenhanced computed tomography variables, including stone attenuation, abdominal fat area, and skin-to-stone distance (SSD) were analyzed. In all, 197 (60%) were classified as stone-free and 132 (40%) as having residual stone. The mean ages were 49.35 ± 13.22 years and 55.32 ± 13.52 years, respectively. On univariate analysis, age, stone size, stone surface area, stone attenuation, SSD, total fat area (TFA), abdominal circumference, serum creatinine, and the severity of hydronephrosis revealed statistical significance between these two groups. From multivariate logistic regression analysis, the independent parameters impacting SWL outcomes were stone size, stone attenuation, TFA, and serum creatinine. [Adjusted odds ratios and (95% confidence intervals): 9.49 (3.72-24.20), 2.25 (1.22-4.14), 2.20 (1.10-4.40), and 2.89 (1.35-6.21) respectively, all p < 0.05]. In the present study, stone size, stone attenuation, TFA and serum creatinine were four independent predictors for stone-free rates after SWL. These findings suggest that pretreatment NCCT may predict the outcomes after SWL. Consequently, we can use these predictors for selecting

  4. Decreased Radiation Exposure and Increased Efficacy in Extracorporeal Lithotripsy Using a New Ultrasound Stone Locking System

    PubMed Central

    Ravier, Emmanuel; Promeyrat, Xavier; Codas, Ricardo; Fehri, Hakim Fassi; Crouzet, Sebastien; Martin, Xavier

    2015-01-01

    Abstract Purpose: To compare fluoroscopy duration, radiation dose, and efficacy of two ultrasound stone localization systems during extracorporeal shockwave lithotripsy (SWL) treatment. Patients and Methods: Monocentric prospective data were obtained from patients consecutively treated for renal stones using the Sonolith® i-sys (EDAP TMS) lithotripter, with fluoroscopy combined with ultrasound localization using an “outline” Automatic Ultrasound Positioning Support (AUPS) (group A), or the “free-line” Visio-Track (VT) (EDAP-TMS) hand-held three-dimensional ultrasound stone locking system (group B). Efficacy rate was defined as the within-groups proportion stone free or with partial stone fragmentation not needing additional procedures. Statistical analysis used Pearson chi-square tests for categoric variables, nonparametric Mann-Whitney tests for continuous variables, and linear regression for operator learning curve with VT. Continuous variables were reported as median (range) values. Results: Patients in group A (n=73) and group B (n=81) were comparable in baseline characteristics (age, kidney stone size, others) and in SWL application (duration, number of shocks, energy [Joules]). During SWL, the median (range) duration (seconds) of radiation exposure was 159.5 (0–690) in group A and 3.5 (0–478) in group B (P<0.001) and irradiation dose (mGy.cm2), 10598 (0–54843) in group A and 163 (0–13926) in group B (P<0.001). Fluoroscopy time significantly decreased with operator experience using VT. The efficacy rate was 54.5% in group A and 79.5% in group B (P=0.001). Conclusion: VT significantly reduced fluoroscopy use during SWL and the duration and dose of patient exposure to ionizing radiation. Stone treatment efficacy was significantly greater with VT mainly because of a better real-time monitoring of the stone. PMID:26133199

  5. Outcomes of retrograde flexible ureteroscopy and laser lithotripsy for stone disease in patients with anomalous kidneys.

    PubMed

    Ugurlu, İbrahim Mesut; Akman, Tolga; Binbay, Murat; Tekinarslan, Erdem; Yazıcı, Özgür; Akbulut, Mehmet Fatih; Özgör, Faruk; Müslümanoğlu, Ahmet Yaser

    2015-02-01

    Due to the presence of structural and anatomical differences that accompany anomalous kidneys, currently available endourological modalities such as SWL and PNL may be insufficient, or additional laparoscopic assistance may be required. The present study aims to evaluate the efficacy and safety of retrograde flexible ureterorenoscopic stone treatment in patients with kidney anomalies. Over the last 3 years, 25 patients with renal stones in anomalous kidneys were consecutively treated by flexible ureterorenoscopy and holmium:YAG laser lithotripsy. Among the 25 patients, fiberoptic or digital flexible ureterorenoscopies were performed for the management of horseshoe kidneys (n = 3), cross-fused ectopic kidney (n = 1), renal ectopies [n = 13; associated with pelvic (n = 6) or lumbar kidneys (n = 7)], renal malrotations (n = 4), and duplicate ureters (n = 4). For lithotripsy, 200 or 273 µm probes were used, and for stone retraction 1.3-1.9 Fr ZeroTip baskets were used. Success was defined as the complete absence of stones as evaluated with a CT scan 1 month after the operation. The mean patient age was 39.4 ± 15.75 years, and the mean stone size was 194.64 ± 103.93 mm(2) (range 50-393). Complete stone clearance was achieved in 16 patients (64%) after a single session. Seven of the patients with residual stones underwent a second session and the remaining three patients were subsequently treated with SWL. The overall complete clearance rate was 88% (22 patients) with ancillary procedures. There were no serious postoperative complications except for one case (4%) of urosepsis. Flexible ureterorenoscopy with holmium laser lithotripsy is a safe option for the treatment of renal stones in anomalous kidneys with satisfactory success rates.

  6. Fetotoxicity and teratogenesis of SWL treatment in the rabbit.

    PubMed

    Frankenschmidt, A; Heisler, M

    1998-02-01

    The potential effects of extracorporeal application of shockwaves on an embryo or fetus were explored in an animal model. In experimental Series A, the fetuses of 30 gravid rabbits were exposed to piezoelectrically induced and sonographically guided shockwaves on Day 25 or 20 of gestation under technical conditions corresponding to extracorporeal lithotripsy in humans. Fetotoxicity was examined by abdominal section 24 hours or 9 days later, and immediate/intermediate damage was assessed (resorptions, viability, gross injuries, and microscopic lesions of the target and neighboring fetuses). In series B, the kidneys of an additional 28 gravid rabbits (including a control group) were exposed to the same shockwave treatment on Day 11 of gestation in order to investigate indirect embryotoxic effects, including teratogenic potency. One day before the expected birth, the maternal kidneys, uteri, and adjacent organs were examined for lesions, and the 156 offspring were assessed for embryolethal, embryonoxious, or teratogenic sequelae. Shockwave targeting of the cranium, thorax, abdomen, or placenta was usually lethal to the fetuses. When the uterine wall or the space between two fetuses was targeted, the fetuses suffered from superficial hematoma, as was found in the surrounding soft tissues within a radius of 1.5 cm. Fetuses outside this region were vital and free of lesions. Shockwave treatment of the maternal kidney resulted in renal petechial hemorrhage or subcapsular hematoma. However, statistically significant embryotoxic or teratogenetic effects could be demonstrated neither from maternal data (resorptions) nor from fetal findings (body measurements, vitality test, inner organs, skeletal deformities). When using a piezoelectric lithotripter with a small focus of high energy, lesions of a fetus are to be expected only when it is located in or close to the focus. It seems that embryotoxic or teratogenic sequelae do not occur when shockwaves are focused outside the

  7. 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.

  8. The efficacy of performing shockwave lithotripsy before retrograde intrarenal surgery in the treatment of multiple or large (≥1.5 cm) nephrolithiasis: A propensity score matched analysis

    PubMed Central

    Shim, Myungsun; Park, Myungchan

    2017-01-01

    Purpose To investigate the effect of performing shockwave lithotripsy (SWL) before retrograde intrarenal surgery (RIRS) on the treatment outcomes of patients with nephrolithiasis. Materials and Methods The data of 189 patients with renal stones who underwent RIRS from July 2007 to July 2014 was reviewed retrospectively. Patients with stones larger than 1.5 cm were recommended to undergo SWL before RIRS. Patients were divided into 2 groups based on whether the preoperative SWL was performed (group 1, n=68) or not (group 2, n=121). The cohorts of the 2 groups cohorts were matched 1:1 using propensity score analysis. Patient, stone characteristics, operative parameters, and stone-free rates were compared. Results Patients in groups 1 and 2 were matched with respect to stone size, number, and location, leaving 57 patients in each group. After matching, no differences were identified between the 2 groups regarding age, body mass index, sex, stone composition, density and multiplicity. Compared to group 2 patients, patients in group 1 had fewer number of procedures performed (1.10 vs. 1.26, p=0.045) and higher stone-free rate (89.4% vs.73.6%, p=0.039). In multivariate analysis, Non lower calyceal location (odd ratio [OR], 8.215; 95% confidence interval [CI], 1.782–21.982; p=0.041), stone size (OR, 6.932; 95% CI, 1.022–18.283; p<0.001), and preoperative SWL (OR, 2.210; 95% CI, 1.058–7.157; p=0.019) were independent factors predicting a stone-free state after RIRS. Conclusions Performing SWL before RIRS may favor stone eliminations during surgery and increase the stone-free rate in selected patients. PMID:28097265

  9. 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.

  10. Patient and personnel exposure during extracorporeal lithotripsy

    SciTech Connect

    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.

  11. 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.

  12. [Lithotripsy of gallbladder calculi with extracorporeal shockwaves].

    PubMed

    Nogueira, C E; Martins, F P; Dani, R

    1991-01-01

    Two hundred and sixty two patients with gallbladder stones were prospectively evaluated at the Biliary Lithiasis Treatment Unit of the Mater Dei Hospital, Belo Horizonte, MG., and 45 (17.5%) were selected for extracorporal shock wave lithotripsy (ECSWL). From these, 32 were submitted to the procedure. One stone was present in 30 patients, 2 stones in another and 1 patient had 3 stones. The mean diameter was 14.7 mm ranging from 8 to 28 mm. ECSWL was preceded by 1 week course of ursodeoxycholic acid (8 to 10 mg/dk/day) and this medication was continued after the procedure. ECSWL was done with the Lithosthar-Plus apparatus (Siemens). Meperidine (up to 100 mg) IM and pirazolene IV was given when necessary. The intensity of the shock waves was gradually increased to a maximum (9 bar) whenever tolerated. The treatment was well succeeded in 22 cases (71%) with pulverization in 12 (38.7%). In 9 patients (29%) remaining fragments were greater than 4 mm. From these, 3 were submitted to a second session of ECSWL. In 1 patient the stone could not be properly positioned for lithotripsy. The mean number of shock waves was 2,591, ranging from 801 to 4,411. The mean duration of the sessions was 80 min, ranging from 45 to 150 min. In 3 patients, a complete disappearance of fragments was observed in intervals of 1 to 6 months after the procedure. One patient had severe pain during ECSWL and developed acute cholecystitis. One patient had sinus bradycardia. One patient with total stone pulverization, become jaundiced 1 month after ECSWL and a gallbladder carcinoma was found at surgery.(ABSTRACT TRUNCATED AT 250 WORDS)

  13. Ultrasonic lithotripsy of bladder stones.

    PubMed

    Cetin, S; Ozgür, S; Yazicioğlu, A; Unsal, K; Ilker, Y

    1988-01-01

    In the second half of 1985, 15 patients with 25 bladder stones were treated with Lutzeyer's Ultrasonic Lithotriptor. Of the patients 13 underwent additional operations, mostly transurethral resection of the prostate. The average duration of lithotripsy was 30.5 minutes. Some difficulties were experienced especially when drilling hard stones and as a complication late urethral bleeding occurred in one patient.

  14. Extracorporeal shockwave lithotripsy without radiation: Ultrasound localization is as effective as fluoroscopy

    PubMed Central

    Smith, Hazel Elizabeth; Bryant, David Alistair; KooNg, Jenny; Chapman, Richard Alexander; Lewis, Gareth

    2016-01-01

    Context: Extracorporeal shockwave lithotripsy (SWL) is the first-line treatment for renal calculi in most cases. Recent technology has allowed lithotriptor machines to localize stones using fluoroscopy or ultrasound (US). Aim: The aim of this study is to compare stone free rates (SFR) using two techniques. Methods: This is a single center retrospective cohort study. We have studied 95 patients with renal calculi undergoing first SWL treatment with localization using US (48 pts) and fluoroscopy (47 pts). SFR was defined as fragments ≤2 m at 4 weeks post procedure on x-ray or US. Patient records were reviewed. Results: Stone size and location, age and body mass index were comparable between groups. Stones ≤7 mm had better SFR with US 86% (18/21) compared to fluoroscopy 59% (10/17) P= 0.08. Overall the US group had similar SFR to the fluoroscopy group for stones of all sizes and locations with 60% (29/48) compared to 45% (21/47)P= 0.18. Radiation exposure was the biggest difference between techniques with a mean radiation dose (mGy/cm2) in the US group of 103 (0–233) and 2113 (241–7821) in the fluoroscopy group. Radiation use in the US group was due to the use of a single shot pre- and post-procedure, this could be reduced to zero. Conclusions: Our data show equivalent outcomes using US compared to the traditional fluoroscopy localization technique. We would encourage departments to develop the use of US localization to reduce radiation exposure to patients. PMID:28057991

  15. [Quantitative renal DMSA scintigraphy after extracorporeal lithotripsy].

    PubMed

    Coulange, C; Siles, S; Rossi, D; Vaillant, J L; Soler, B; Kaphan, G; Rampal, M

    1990-01-01

    This study reports the results of renal DMSA isotope scan before and after EDAP extracorporeal lithotripsy in 106 patients. An isotope scan was performed before lithotripsy and on the fourth day after lithotripsy and again on the 90th day when alterations were observed on the first post-lithotripsy scan. The assessment of any sequelae was based on the scale of colours of the spectrum, which revealed three types of modifications. The analysis of the results is divided into three periods according to the development in our lithotripsy technique: high firing rates had a success rate of only 40%, with renal scars on isotope scans in 2/3 of cases; low frequency firing rates had a 55% success rate and induced minor changes which were virtually always reversible; in contrast, low frequency firing rates during the 3rd period had a 60% success rate with scars on isotope scans in 1/3 of cases. These isotope scan modifications also depended on the site of the stone. In conclusion, lithotripsy definitely induces renal modifications. The renal parenchyma cannot remain indifferent to lithotripsy beyond a certain threshold. A homogeneous multicentre study with a common protocol is necessary to compare the various lithotriptors and to define cautious and coherent indications for each lithotriptor in the treatment of renal stones.

  16. Extracorporeal shockwave lithotripsy for salivary calculi in pediatric patients.

    PubMed

    Ottaviani, F; Marchisio, P; Arisi, E; Capaccio, P

    2001-10-01

    Salivary gland lithiasis is uncommon in pediatric patients. Color Doppler ultrasonography (US) enables an accurate diagnosis of lithiasis to be made without exposure to the radiation of traditional imaging techniques. The development of minimally invasive techniques in the ENT field has made salivary lithotripsy a feasible alternative to traditional invasive surgery. The safety and efficacy of shock wave lithotripsy for salivary calculi were evaluated in pediatric patients. Seven children (5 males; age 4-15 years) with single calculi (mean diameter 4.4 mm) of the submandibular (n = 4) and parotid glands (n = 3) underwent extracorporeal electromagnetic shock wave lithotripsy (EESWL). In four cases the stone was intraductal (two submandibular and two parotideal) and in the remaining three cases it was intraparenchymal (two submandibular and one parotideal). In one case sedative anesthesia was performed. The mean number of therapeutic sessions was five. Patients were followed up clinically and with US for 6-72 months (mean 32 months). Complete disintegration of the calculi was achieved in five cases while in two cases a residual fragment < 2 mm in diameter was observed. None of the patients had recurrence of calculi in the treated gland. Mild self-limited adverse effects (pain, swelling of the gland, self-limiting bleeding from the duct, cutaneous petechiae) were observed in four cases. Our data suggest that EESWL is effective, safe and well tolerated; the minimal invasiveness of the technique suggests that EESWL should be used as the primary approach to salivary calculi in pediatric patients. The continuous US monitoring enables the efficacy of EESWL to be evaluated during both treatment and follow-up, with only slight discomfort for the pediatric patient.

  17. 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.

  18. Surgical intervention for urolithiasis: does it result in long-term medical complications?

    PubMed

    Krambeck, Amy E

    2016-01-01

    The association of shock wave lithotripsy (SWL) and hypertension is a controversial subject. This Commentary discusses the article by Denberg et al., which found an association between new-onset hypertension and SWL, but not ureteroscopy. Ureteroscopy has improved significantly since its introduction and now plays a role as a primary initial treatment for stone disease.

  19. [Biliary extracorporeal shock-wave lithotripsy].

    PubMed

    Jakobeit, C; Greiner, L

    1992-07-14

    Since 1985/86, more than 200 patients with problematic intra- and extrahepatic bile duct stones were treated with ESWL. Results are excellent and comparable with ESWL's success-story in urinary stone disease, abandoning widely open surgery for bile duct stones. In gallbladder-stone treatment, ESWL (always combined with bile acid litholysis) is only promising or successful in a carefully selected subset (10 to 15%) of all symptomatic patients (with good gallbladder contractility, limited stone volume and sonolucent stones).

  20. 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.

  1. [Extracorporeal shockwave lithotripsy in patients with coagulation disorders].

    PubMed

    Ruiz Marcellán, F J; Mauri Cunill, A; Cabré Fabré, P; Argentino Gancedo Rodríguez, V; Güell Oliva, J A; Ibarz Servio, L; Ramón Dalmau, M

    1992-03-01

    During treatment of renal lithiasis with extracorporeal shock wave lithotripsy (ESWL) hemorrhagic events, especially renal hematoma, may present. A coagulation study is warranted in order to institute hemotherapy for blood factor deficiencies. We reviewed the records of 4,000 patients that had undergone ESWL. Of these, 17 (12 males, 5 females) presented coagulation disorders. The bleeding diatheses were due to platelet deficiency in 6 cases, plasma defects in 5, platelet and plasma disorders in 2, and capillary wall defects in 5 cases. The underlying cause was hepatosplenic disease in 12 cases, iatrogenic in 1, connectivopathy and corticoids in 2, and capillary purpura of unknown cause in 2 cases. Due to this protocol, no patient presented hemorrhage or hematoma from shock wave-induced lesions. These results show that a complete coagulation study must be performed in order to institute the necessary measures in patients with disorders of hemostasis due to the high risk of hematoma repeatedly reported in the literature.

  2. [Long-term results of treating children with kidney and ureteral stones with extracorporeal lithotripsy].

    PubMed

    Dzeranov, N K; Pugachev, A G; Romanov, G V

    2002-01-01

    Long-term outcomes of urolithiasis treatment with extracorporeal lithotripsy (ECLT) have been analysed for 132 children using, as the basic criterion, data of dynamic nephroscintigraphy. The results of ECLT were considered regarding characteristics of the concrement, inflammatory process, parameters of the shock wave. It was found that low-energy restruction regimens in minimal number of impulses per session and adequate intervals between them prevent irreversible changes in renal parenchyma in response to focused shock waves. Monitoring and adequate treatment late after ECLT lead to recovery of renal function if obstructive complications and stone formation are found early and if the course of the inflammation is controlled.

  3. Percutaneous nephroscopic with holmium laser and ultrasound lithotripsy for complicated renal calculi.

    PubMed

    Gu, Zhengqin; Qi, Jun; Shen, Haibo; Liu, Jianhe; Chen, Jianhua

    2010-07-01

    The aim of this work is to validate the clinical efficacy of the high-power holmium:YAG laser with percutaneous nephrolithotripsy (PCNL) in combination with ultrasound lithotripsy for complicated renal calculi. From November 2006 to December 2007, 60 patients with complicated renal calculi were treated with PCNL, where an F24 standard renal access tract was established by percutaneous renal puncture under the guidance of B-mode ultrasound, and stones were fragmented and cleared by high-power holmium laser in combination with ultrasound under an F20.8 nephroscope. Of the 60 patients with complicated renal calculi, 20 were complete staghorn calculi and 30 were partial staghorn calculi, of which six patients were accompanied with renal insufficiency; two were solitary calculi, and eight were caliceal diverticular calculi. Calculi were removed by one attempt in 49 patients and by two attempts in 11 patients; through one tract in 50 patients and through two and three tracts in ten patients. The stone-free rate was 81.7%. No injury to the pleura and abdominal organs occurred during the intraoperative puncture. No postoperative blood transfusion was needed in any patient, nor did fever and secondary hemorrhage occur. The mean operation duration was 98 min (range, 60-150 min), and the mean lithotripsy time was 45 min (range, 30-85 min). Additional postoperative extracorporeal shock wave lithotripsy (ESWL) was performed on six patients. High-power holmium laser PCNL in combination with ultrasound lithotripsy is safe, effective, and minimally invasive, with a high stone-free rate, especially for complicated renal calculi.

  4. 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.

  5. Superior Mesenteric Artery Dissection after Extracorporeal Shockwave Lithotripsy

    PubMed Central

    Bakoyiannis, Christos; Anastasiou, Ioannis; Koutsoumpelis, Andreas; Fragiadis, Evangelos; Felesaki, Eleni; Kafeza, Marina; Georgopoulos, Sotirios; Tsigris, Christos

    2012-01-01

    The use of shockwave lithotripsy is currently the mainstay of treatment in renal calculosis. Several complications including vessel injuries have been implied to extracorporeal shockwave lithotripsy. We report an isolated dissection of the superior mesenteric artery in a 60-year-old male presenting with abdominal pain which occurred three days after extracorporeal shockwave lithotripsy. The patient was treated conservatively and the abdominal pain subsided 24 hours later. The patient's history, the course of his disease, and the timing may suggest a correlation between the dissection and the ESWL. PMID:23304627

  6. [Initial experience with preorally administered dipotassium clorazepate and tilidine-naloxone in extracorporeal shockwave lithotripsy].

    PubMed

    Hankemeier, U; Herberhold, D

    1986-12-01

    After 70 treatments with extracorporeal shock wave lithotripsy (ESWL), using a combination of dipotassiumclorazepate p.o. 12 h before treatment and tilidin-naloxon 45 min before ESWL, 56 patients reported to be painfree or only minor, well-tolerable pain. Informed consent was obtained in all patients for this pilot study, leaving the possibility of further pain medication. 7 patients asked for an additional analgesic (fentanyl) and another 7 patients required a sedative (midazolam). No further anesthesiologic procedures were necessary. Nausea was observed in one patient as a possible side-effect of tilidin. To confirm these preliminary results, a prospective randomized study is currently conducted.

  7. 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.

  8. [The history of extracorporeal shockwave lithotripsy in Spain].

    PubMed

    Ruíz Marcellán, Francisco Javier; Ibarz Servio, Luis

    2007-10-01

    We give a historical outline of urinary lithiasis with emphasis in the alternative therapeutic options to surgery. We expose the previous steps that led to the birth of extracorporeal shockwave lithotripsy and its implementation in our country.

  9. Successful endoscopic treatment of colonic gallstone ileus using electrohydraulic lithotripsy.

    PubMed

    Zielinski, Martin D; Ferreira, Lincoln E; Baron, Todd H

    2010-03-28

    The surgical management of gallstone ileus is complex and potentially highly morbid. Initial management requires enterolithotomy and is generally followed by fistula resection at a later date. There have been reports of gallstone extraction using various endoscopic modalities to relieve the obstruction, however, to date, there has never been a published case of endoscopic stone extraction from the colon using electrohydraulic lithotripsy. In this report, we present the technique employed to successfully perform an electrohydraulic lithotripsy for removal of a large gallstone impacted in the sigmoid colon. A cavity was excavated in an obstructing 4.1 cm lamellated stone in the sigmoid colon using electrohydraulic lithotripsy. A screw stent retractor and stent extractor bored a larger lumen which allowed for guidewire advancement and stone fracture via serial pneumatic balloon dilatation. The stone fragments were removed. Electrohydraulic lithotripsy is a safe and effective method to treat colonic obstruction in the setting of gallstone ileus.

  10. Does extracorporeal shockwave lithotripsy cause hypertension?

    PubMed

    Montgomery, B S; Cole, R S; Palfrey, E L; Shuttleworth, K E

    1989-12-01

    Several series have suggested that the incidence of hypertension following extracorporeal shockwave lithotripsy (ESWL) may be as high as 8%. In this study, changes in blood pressure and the incidence of hypertension have been observed in 733 patients 12 to 44 months after renal ESWL on the Dornier HM3. The incidence of hypertension following ESWL was 8.1%. In patients with a pre-ESWL diastolic pressure less than 90 mmHg, the incidence of those with a diastolic greater than or equal to 100 mm Hg post-operatively was significantly greater than that predicted by historical data. There was no overall change in the mean blood pressure of the group. The hypertensive risk of ESWL remains unclear. However, blood pressure surveillance should be performed following ESWL and a prospective study is required.

  11. [Percutaneous nephrostomy associated with extracorporeal shockwave lithotripsy in the treatment of renoureteral lithiasis].

    PubMed

    Larrea Masvidal, E; García Serrano, C; Hernández Silverio, D; Castillo Rodriguez, M; Valdes Gómez, A C; Báez Hernández, D; Ramirez Hernández, L

    1993-01-01

    From a series of 5000 cases that had undergone extracorporeal shock wave lithotripsy at the Hospital Clinico Quirúrgico "Hermanos Ameijeiras" from March, 1986 to April, 1988, 220 cases that required percutaneous nephrostomy due to obstructive hydronephrosis from stone fragments were studied. We analyzed the clinical, radiological and ultrasound features of these cases, as well as the criteria for performing percutaneous nephrostomy. We identified the risk factors that made the procedure necessary, particularly urinary tract infection. No important complications ascribable to the foregoing procedure were observed. Performing the procedure early improved patient clinical course and reduced cost of treatment. To eliminate stone fragments completely, percutaneous nephrostomy was combined with other procedures in 198 cases (90%). The stone fragments were passed spontaneously in 10 cases (4.5%) following diversion. At 2 months 190 cases (86%) were completely stone free, 18 (8%) had residual stones and 12 (6%) required open surgery. The foregoing results show that percutaneous nephrostomy is a very useful procedure in septic-obstructive complications following extracorporeal shock wave lithotripsy and acquiring the skill to perform it is essential.

  12. Long-term effects of pediatric extracorporeal shockwave lithotripsy on renal function

    PubMed Central

    Akin, Yigit; Yucel, Selcuk

    2014-01-01

    Introduction Extracorporeal shock wave lithotripsy (ESWL) is a well-known and successful treatment modality. In addition, it can be used in premature infants. ESWL is used to treat kidney and ureter stones in children. However, although it is a preferred noninvasive treatment in that setting, there is debate about its long-term effects on growing kidneys in children. Objectives To investigate the long-term effects of pediatric ESWL on renal function in light of updated literature. Methods PubMed and Medline were searched for studies on ESWL in a pediatric population with keywords including efficacy, child, kidney calculi, ureter calculi, lithotripsy, injury, vascular trauma, and shock waves. The research was limited to the English literature during a period from 1980 to 2014. In total, 3,000 articles were evaluated, but only 151 papers were considered. Only the manuscripts directly related to the reviewed subjects were included in the current study. Results However, the acute effects of ESWL in kidney are well-described. Although there are limited studies on the long-term effects of ESWL in children, there is a widespread opinion that ESWL is not affecting renal functions in the long-term. Conclusion ESWL is a safe, effective, and noninvasive treatment option in children. Although ESWL can cause some acute effects in the kidney, there is no long-term effect on the growing kidneys of children. PMID:24892029

  13. 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

  14. [Treatment of renoureteral lithiasis using extracorporeal shockwave lithotripsy. Experience in Cuba].

    PubMed

    Larrea Masvidal, E; García Serrano, C; Hernández Silverio, D; Castillo Rodríguez, M; Casals Armada, J; Valdés Gómez, C; Báez Hernández, D

    1989-01-01

    Herein we present our experience in 5,000 cases of reno-ureteral lithiasis submitted to treatment at the Extracorporeal Lithotripsy Unit of Hermanos Ameijeiras Hospital in Havana, Cuba, from April 1986 and during a period spanning 30 months. Treatment was exclusively by extracorporeal shock wave lithotripsy (ESWL) in 85.5% of the patients and in combination with other procedures in 14.5% (endoscopic maneuvers in 5.9%, percutaneous nephrostomy 4.4%, open surgery 3.6%, and percutaneous nephrolithotripsy 0.6%). Complications were observed in 7% of the cases: ureteric obstruction (6.4%) with or without infection, perirenal hematoma (0.4%), and obstructive anuria (0.2%); acute urinary infection of different clinical types, some of which were very severe, were observed concomitantly in 2.6% of these patients. Two months following treatment, 86% of the cases were completely stone-free. At 6 months 96.2% were completely stone-free; the remaining 3.8% were classed as residual lithiasis. The pathologic conditions that put patients at high therapeutic risk and the possible complications that could arise were identified. The efficacy of the Dornier HM-3 lithotripter and the health care system that permits its extensive use are highlighted.

  15. 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

  16. Efficacy of the lithotripsy in treating lower pole renal stones.

    PubMed

    Cui, Helen; Thomee, Eeke; Noble, Jeremy G; Reynard, John M; Turney, Benjamin W

    2013-06-01

    Use of extracorporeal lithotripsy is declining in North America and many European countries despite international guidelines advocating it as a first-line therapy. Traditionally, lithotripsy is thought to have poor efficacy at treating lower pole renal stones. We evaluated the success rates of lithotripsy for lower pole renal stones in our unit. 50 patients with lower pole kidney stones ≤15 mm treated between 3/5/11 and 19/4/12 were included in the study. Patients received lithotripsy on a fixed-site Storz Modulith SLX F2 lithotripter according to a standard protocol. Clinical success was defined as stone-free status or asymptomatic clinically insignificant residual fragments (CIRFs) ≤3 mm at radiological follow-up. The mean stone size was 7.8 mm. The majority of stones (66 %) were between 5 and 10 mm. 28 % of stones were between 10 and 15 mm. For solitary lower pole stones complete stone clearance was achieved in 63 %. Total stone clearance including those with CIRFs was achieved in 81 % of patients. As expected, for those with multiple lower pole stones the success rates were lower: complete clearance was observed in 39 % and combined clearance including those with CIRFs was 56 %. Overall, complete stone clearance was observed in 54 % of patients and clearance with CIRFs was achieved in 72 % of patients. Success rate could not be attributed to age, stone size or gender. Our outcome data for the treatment of lower pole renal stones (≤15 mm) compare favourably with the literature. With this level of stone clearance, a non-invasive, outpatient-based treatment like lithotripsy should remain the first-line treatment option for lower pole stones. Ureteroscopy must prove that it is significantly better either in terms of clinical outcome or patient satisfaction to justify replacing lithotripsy.

  17. Preventing stone retropulsion during intracorporeal lithotripsy.

    PubMed

    Elashry, Osama M; Tawfik, Ahmad M

    2012-12-01

    Several studies of ureteroscopic treatment for ureteral stones have reported that most stone clearance failures can be attributed to stone fragment retropulsion. Stone retropulsion can result in increased operative time and cost-resulting from the need to change from the semi-rigid ureteroscope to a flexible instrument to chase migrated calculi-and additional procedures to treat residual migrated fragments are often required. The degree of migration depends mainly on the energy source used for lithotripsy; pneumatic and electrohydraulic lithotripters are associated with a greater degree of retropulsion than lasers. Different stone-trapping strategies and devices have been developed to minimize stone migration. Novel devices include the Lithovac(®) suction device, the Passport(™) balloon, the Stone Cone(™), the PercSys Accordion(®), the NTrap(®), and stone baskets such as the LithoCatch(™), the Parachute(™), and the Escape(®). Some authors have also reported on the use of lubricating jelly and BackStop(®) gel (a reverse thermosensitive polymeric plug); these devices are instilled proximal to the stone prior to the application of kinetic energy in order to prevent retrograde stone migration.

  18. Time-resolved imaging of cavitation effects during laser lithotripsy

    NASA Astrophysics Data System (ADS)

    Siano, Salvatore; Pini, Roberto; Salimbeni, Renzo; Vannini, Matteo

    1995-01-01

    We devised a diagnostic technique based on a pump-and-probe scheme that provided time- resolved imaging of photofragmentation effects during laser lithotripsy. The evolution of the cavitation bubble induced on kidney stone samples by underwater irradiation with a XeCl excimer laser is presented and analyzed.

  19. Control of Acoustic Cavitation with Application to Lithotripsy.

    DTIC Science & Technology

    2007-11-02

    cavitation contributes to kidney stone comminution and tissue damage. An electrical spark at the near focus of an underwater ellipsoidal reflector was the...Control of acoustic cavitation (sound-induced bubble activity) is the subject of this dissertation. Application is to clinical lithotripsy where

  20. Clearance of refractory bile duct stones with extracorporeal shockwave lithotripsy

    PubMed Central

    Ellis, R; Jenkins, A; Thompson, R; Ede, R

    2000-01-01

    BACKGROUND—Extracorporeal shockwave lithotripsy (ESWL) has been used since the mid-1980s to fragment bile duct stones which cannot be removed endoscopically. Early machines required general anaesthesia and immersion in a waterbath.
AIMS—To investigate the effectiveness of the third generation Storz Modulith SL20 lithotriptor in fragmenting bile duct stones that could not be cleared by mechanical lithotripsy.
METHODS—Eighty three patients with retained bile duct stones were treated. All patients received intravenous benzodiazepine sedation and pethidine analgesia. Stones were targeted by fluoroscopy following injection of contrast via a nasobiliary drain or T tube. Residual fragments were cleared at endoscopic retrograde cholangiopancreatography.
RESULTS—Complete stone clearance was achieved in 69 (83%) patients and in 18 of 24 patients (75%) who required more than one ESWL treatment. Stone clearance was achieved in all nine patients (100%) with intrahepatic stones and also in nine patients (100%) referred following surgical exploration of the bile duct. Complications included six cases of cholangitis and one perinephric haematoma which resolved spontaneously.
CONCLUSION—Using the Storz Modulith, 83% of refractory bile duct calculi were cleared with a low rate of complications. These results confirm that ESWL is an excellent alternative to surgery in those patients in whom endoscopic techniques have failed.


Keywords: lithotripsy; bile duct calculi; extracorporeal lithotripsy PMID:11034593

  1. [Endoscopic contact lithotripsy--modern alternative in the therapy of patients with large stones of the common bile duct].

    PubMed

    Ohorodnyk, P V; Kolomiĭtsev, V I; Kushniruk, O I; Deĭnychenko, A H; Khrystiuk, D I

    2013-09-01

    The peculiarities of therapeutic ERCP and contact lithotripsy in patients with choledocholithiasis were studied. 6516 patients (age from 11 to 94 years old) with choledocholithiasis were examined Endoscopic sphincterotomy/balloon dilation with stone extraction was effective in 5507 (84.5%), in 539 (8.8%)--we achieved bile ducts clearance by using mechanical or electrohydraulic lithotripsy. Additional usage of contact lithotripsy increased the effectiveness of therapeutic ERCP to 93.2%. Contact lithotripsy decreased number of specific for ERCP complication from 7.83% to 1.57% in patients with large (> 25mm) stones. Electrohydraulic lithotripsy was successful in destruction of hard bile stones, when mechanical lithotripsy failed.

  2. 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.

  3. Detection of acoustic emission from cavitation in tissue during clinical extracorporeal lithotripsy.

    PubMed

    Coleman, A J; Choi, M J; Saunders, J E

    1996-01-01

    A 1-MHz focused hydrophone has been used to search for acoustic emission expected to arise from cavitation occurring in tissue during clinical extracorporeal shock-wave lithotripsy (ESWL). The hydrophone is acoustically coupled to the patient's skin and the focus directed at depth in tissue under ultrasound guidance. The measured amplitude-time variation of the acoustic emission from tissue near the shock-wave focus of the Storz Modulith SL20 lithotripter has been examined in four patients. There is evidence of increased amplitude acoustic emission at 1 MHz from regions within tissue that also appear hyperechoic in simultaneously acquired ultrasound images. The acoustic emission from these regions decays from an initial peak to the noise level in about 500 microseconds following each shock-wave pulse. Within this period, a second peak, often of higher amplitude than the first, is typically observed about 100 microseconds after the shockwave. The time between the initial and second peaks is found to increase with increasing shock-wave amplitude. The results are similar to those previously observed from cavitation induced by shock-wave exposure in water and indicate that the 1-MHz acoustic emission arises from inertial cavitation in tissue during clinical ESWL.

  4. 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.

  5. [Extracorporeal shock wave lithotripsy: prophylaxis, complications and therapy].

    PubMed

    Zogović, J

    1997-01-01

    ESWL has proved to be a safe and effective method in the treatment of urinary tract calculosis. The method is hardly invasive when compared to all other methods known so far, except for the treatment of calculosis with a selective pharmacotherapy. Moreover, the method is contactless, extracorporeal, mostly necessitating no anaesthesia and spasmoanalgesic therapy, except in the very small number of patients. The importance of the problem of urinary tract calculosis is enormous. Calculosis affects children, and particularly adults, predominantly psychically and physically active individuals in the most productive phase of their lives as well as elderly population. All this makes considerable its adverse effects on health, producing great interest of specialists for this disease. However, the incidence of the disease requires much better surveillance of the patients, since the preventive measures must be undertaken in time as they are of utmost importance. The treatment of urinary tract calculosis has brought great improvements enabling resolution of all types of concrements, irrespectively of their size and chemical composition, in absence of surgical incisions and anaesthesia, except for the small number of patients. Therefore, ESWL therapy has been most advantageous in different types of lithotriptors, particularly lithotriptors of the second generation, such as lithostar lithotripter. Renal calculi are the most convenient for this therapeutical procedure. Ever since its introduction into the clinical practice, the method has become the first therapeutical choice in the treatment of urinary tract calculosis. The indications for this type of therapy are enlarger and now they include all types of urinary tract calculi. Hospitalization and convalescence periods following ESWL are reduced when compared to nephrolithotomy, pyelotomy or ureterolithotomy. The study included a series of 2034 patients treated by this method. Our results revealed a low morbidity rate. Transitory haematuria occurred in almost all patients. Significant fall in haemoglobin levels was extremely rare, occurring only in four of patients with prolonged haematuria resolved following blood transfusion. In 321 patients enormous "Steinstrasse" was evidenced. In 54 patients percutaneous nephrostoma was created. Ureteroscopical removal of the stone was attempted in 14 patients; however, the success was moderate. Urosepsis developed in 29 patients. In 107 patients of the series, heart-related problems were recorded during and immediately after ESWL treatment. Paroxysmal supraventricular tachycardia was recorded in 20 patients. Arterial hypertension was evidenced in 63 patients, although they had previous history of hypotension. Skin lesions were found in 1004 patients, and none of them necessitated the therapy. It may be concluded that ESWL is the optimal method in the treatment of urinary tract calculosis; it is free of risk of development of predicted and unpredicted complications, which are now readily resolved failing to induce higher mortality rates among the patients treated by this method. The patients with cardiac problems should be previously well compensated, and after achievement of satisfactory compensation (sinus rhythm of the heart, etc.), the patients may be subjected to the treatment. This therapeutical postulate also applies to patients with coagulation disorders, when they are first subjected to an intensive treatment; after the satisfactory condition is accomplished they can undergo the treatment without any risk of haemorrhage or similar complications. Silica ureteral probes protect the kidney from complications following ESWL. Morbidity induced by ureteral obstruction is minimized, particularly if calculi of greater size than 2.5 cm are treated. Careful assessment is mandatory in patients at high risk, as well as appropriate preoperative conselling with relevant specialists. (ABSTRACT TRUNCATED)

  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. Control of acoustic cavitation with application to lithotripsy

    NASA Astrophysics Data System (ADS)

    Bailey, Michael Rollins

    Control of acoustic cavitation, which is sound-induced growth and collapse of bubbles, is the subject of this dissertation. Application is to extracorporeal shock wave lithotripsy (ESWL), used to treat kidney stones. Cavitation is thought to help comminute stones yet may damage tissue. Can cavitation be controlled? The acoustic source in a widely used clinical lithotripter is an electrical spark at the near focus of an underwater ellipsoidal reflector. To control cavitation, we used rigid reflectors, pressure release reflectors, and pairs of reflectors aligned to have a common focus and a controlled delay between sparks. Cavitation was measured with aluminum foil, which was placed along the axis at the far focus of the reflector(s). Collapsing bubbles pitted the foil. Pit depth measured with a profilometer provided a relative measure of cavitation intensity. Cavitation was also measured with a focused hydrophone, which detected the pressure pulse radiated in bubble collapse. Acoustic pressure signals produced by the reflectors were measured with a PVdF membrane hydrophone, digitally recorded, and input into a numerical version of the Gilmore equation (F. R. Gilmore, 'The growth or collapse of a spherical bubble in a viscous compressible liquid,' Rep#26-4, California Institute of Technology, Pasadena (1952), pp.1-40.). Maximum pressure produced in a spherical bubble was calculated and employed as a relative measure of collapse intensity. Experimental and numerical results demonstrate cavitation can be controlled by an appropriately delayed auxiliary pressure pulse. When two rigid-reflector pulses are used, a long interpulse delay (150-200 μs) of the second pulse 'kicks' the collapsing bubble and intensifies cavitation. Foil pit depth and computed pressure three times single pulse values were obtained. Conversely, a short delay (<90 μs) 'stifles' bubble growth and weakens cavitation. A single pressure release reflector time- reverses the rigid-reflector waveform

  8. 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.

  9. Treatment of calculi in kidneys with congenital anomalies: an assessment of the efficacy of lithotripsy.

    PubMed

    Al-Tawheed, Adel R; Al-Awadi, Khaleel A; Kehinde, Elijah O; Abdul-Halim, Hamdy; Hanafi, Akram M; Ali, Yusuf

    2006-10-01

    We studied the effectiveness of extracorporeal shock wave lithotripsy (ESWL) in the treatment of stones in kidneys with congenital anomalies to determine factors that may affect the results. Patients found to have renal calculi in kidneys with different types of congenital anomalies were treated using ESWL. All patients were investigated by intravenous urography (IVU) to confirm the diagnosis. J stents were inserted prior to therapy in renal units with calculi exceeding 1.5 cm in diameter. Complications encountered and factors affecting success using this treatment modality were analysed. Twenty-five patients (18 males, 7 females) were studied between August 1988 and July 2005. There were nine patients with horseshoe kidneys, eight with ectopic kidneys, three with malrotated kidneys, two with duplex renal system, and one patient each with polycystic kidneys and hypoplastic kidney. The IVU showed 31 isolated calyceal or renal pelvic stones with mean stone burden of 1.44cc. All 25 patients were treated by lithotripsy. Twenty-four (77.4%) renal units (in 19 patients) were completely cleared of stones, 2 (6.5%) renal units (2 patients) were partially cleared of calculi and the procedures failed in 5 (16.1%) renal units (4 patients). Out of five renal units in which the procedures failed, open surgery was performed in three renal units and percutaneous nephrolithotomy (PCNL) was performed in two. None of the 25 patients developed any major complications. No significant adverse changes in renal function tests were observed at 3-month follow-up. The stone-free rate was influenced and reduced by stone size and location in the pelvi-calyceal system. Calculi in kidneys with congenital anomalies may be treated successfully by ESWL as a first-line therapy in the majority of patients. With position modifications, localization of stones may be facilitated and disintegrated. The outcome in patients so treated does not differ significantly from that in those with normal kidneys.

  10. Laparoscopic Transcystic Treatment Biliary Calculi by Laser Lithotripsy

    PubMed Central

    Jin, Lan; Zhang, Zhongtao

    2016-01-01

    Background and Objectives: Laparoscopic transcystic common bile duct exploration (LTCBDE) is a complex procedure requiring expertise in laparoscopic and choledochoscopic skills. The purpose of this study was to investigate the safety and feasibility of treating biliary calculi through laparoscopic transcystic exploration of the CBD via an ultrathin choledochoscope combined with dual-frequency laser lithotripsy. Methods: From August 2011 through September 2014, 89 patients at our hospital were treated for cholecystolithiasis with biliary calculi. Patients underwent laparoscopic cholecystectomy and exploration of the CBD via the cystic duct and the choledochoscope instrument channel. A dual-band, dual-pulse laser lithotripsy system was used to destroy the calculi. Two intermittent laser emissions (intensity, 0.12 J; pulse width 1.2 μs; and pulse frequency, 10 Hz) were applied during each contact with the calculi. The stones were washed out by water injection or removed by a stone-retrieval basket. Results: Biliary calculi were removed in 1 treatment in all 89 patients. No biliary tract injury or bile leakage was observed. Follow-up examination with type-B ultrasonography or magnetic resonance cholangiopancreatography 3 months after surgery revealed no instances of retained-calculi–related biliary tract stenosis. Conclusion: The combined use of laparoscopic transcystic CBD exploration by ultrathin choledochoscopy and dual-frequency laser lithotripsy offers an accurate, convenient, safe, effective method of treating biliary calculi. PMID:27904308

  11. 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.

  12. 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

  13. 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.

  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.

  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. 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.

  18. 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.

  19. 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.

  20. 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.

  1. Efficacy and safety of novel digital single-operator peroral cholangioscopy-guided laser lithotripsy for complicated biliary stones

    PubMed Central

    Wong, John CT; Tang, Raymond SY; Teoh, Anthony YB; Sung, Joseph JY; Lau, James YW

    2017-01-01

    Background/study aims Laser lithotripsy can effectively fragment complicated biliary stones, but current cholangioscopes are limited by fragility, restricted mobility or moderate visual resolution. The efficacy and safety of a new digital single-operator peroral cholangioscope to guide laser lithotripsy were evaluated. Patients and methods In this prospective single-center series, consecutive patients with complicated biliary stones, defined as impacted stones > 1.5 cm in size and wider than the more distal common bile duct, or stones that failed extraction by basket mechanical lithotripsy, underwent ERCP and SpyGlass DS peroral cholangioscope (Boston Scientific, Marlborough, United States)-guided laser lithotripsy. Stone clearance rate and incidence of adverse events were determined. Results Seventeen patients (10 men, 7 women; median age 76 years) with a median biliary stone size of 2 cm underwent predominantly holmium:yttrium aluminum garnet laser lithotripsy, achieving a 94 % stone clearance rate over 1 median procedure. Lithotripsy was performed in 8 of 17 patients due to an impacted biliary stone. The remaining patients underwent lithotripsy due to prior failure of the basket mechanical lithotripter to capture or crush their stones. Post lithotripsy, 2 patients developed cholangitis and 1 patient with underlying COPD developed respiratory distress, all resolved with conservative management. There were no hemobilia, perforations, pancreatitis nor any deaths. Conclusion SpyGlass DS peroral cholangioscopy-guided laser lithotripsy is an efficient and safe modality for management of complicated biliary stones. PMID:28337482

  2. 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

  3. Is extracorporeal shockwave lithotripsy suitable treatment for lower ureteric stones?

    PubMed

    Cole, R S; Shuttleworth, K E

    1988-12-01

    Forty patients with lower ureteric calculi for which intervention was considered desirable have been treated by in situ extracorporeal shockwave lithotripsy (ESWL) on the Dornier HM3 Lithotripter using a modified technique. Stone localisation was satisfactory in all patients. Adequate disintegration was achieved in 90% of patients following one treatment; 34 patients have been followed up for at least 3 months and 27 of these are stone-free (79%). Treatment failed in 4 patients and 2 of these had dense lower ureteric stone streets as a result of previous ESWL. The retreatment rate, post-treatment auxiliary procedure rate and complication rate were minimal. It was concluded that in situ ESWL is an effective and safe method for treating certain selected lower ureteric stones and should be considered as a feasible alternative to the more conventional methods of treatment.

  4. The cavitation threshold of human tissue exposed to 0.2-MHz pulsed ultrasound: preliminary measurements based on a study of clinical lithotripsy.

    PubMed

    Coleman, A J; Kodama, T; Choi, M J; Adams, T; Saunders, J E

    1995-01-01

    Evidence of acoustic cavitation was identified in the form of transient echoes in ultrasound B-scan images of patients receiving extracorporeal shock-wave lithotripsy treatment on a Storz Modulith SL20. This lithotripter generates 10-microseconds duration pulses with a centre frequency of 0.2 MHz at a pulse repetition frequency of 1 Hz. The visual appearance of B-scan images was examined in a total of 30 patients and a quantitative analysis of echogenicity changes was carried out in six cases involving lithotripsy treatment of stones in the renal pelvis. In these patients new echoes were identified in images unaffected by movement artefacts and were found to occur in perinephric fat and adjacent muscle and kidney tissue at positions close to the axis of the shock-wave field between 1 and 2 cm in advance of the indicated beam focus of the lithotripter. The echogenicity within each region increased significantly above the background level when the output of the lithotripter was increased above a threshold value. The acoustic pressures corresponding to this threshold were measured in water using a calibrated PVDF membrane hydrophone. After correction for attenuation in tissue the cavitation thresholds, in terms of the temporal peak negative pressure, are found to lie between 1.5 MPa and 3.5 MPa in all six cases. Interpretation of the measured values in terms of the likely threshold at the higher frequencies used in diagnostic ultrasound is considered using a theoretical model.

  5. Intracorporeal or extracorporeal lithotripsy for distal ureteral calculi? Effect of stone size and multiplicity on success rates.

    PubMed

    Eden, C G; Mark, I R; Gupta, R R; Eastman, J; Shrotri, N C; Tiptaft, R C

    1998-08-01

    Over a period of 57 months, 404 patients with distal ureteral calculi were treated by in situ SWL on a Storz Modulith SL 20 lithotripter and 163 by ureteroscopy (URS) and Swiss Lithoclast stone fragmentation. The case notes on these patients were reviewed for comparison of the initial stone number and individual length and for the calculation of the stone-free, treatment, retreatment, secondary procedure, and complication rates. Complete data were available on 447 patients. The median stone length was 7.0 (range 4-25) mm in the SWL group and 8.0 (range 5-13) mm in the URS group. The single-treatment stone-free rates for the SWL and URS groups were 74.8% and 89.7%, respectively, for single stones and 50.0% and 88.9%, respectively, for multiple (>1) stones. The mean treatment rates for the SWL and URS groups were 1.97 and 1.03, respectively, for single stones and 2.83 and 1.00, respectively, for multiple stones. The mean treatment rate for single stones subjected to SWL increased with increasing stone length (1.57 for stones <8 mm and 2.38 for stones >8 mm), whereas this was not the case for patients submitted to URS (1.20 and 1.27, respectively). The re-treatment rate for each group showed a reciprocal trend. Of the SWL group, 25.9% of the patients eventually required URS to render them stone-free. Nearly all (96%) of the patients undergoing SWL were treated as outpatients. The mean hospitalization in the URS group was 1.1 days. Three patients who underwent URS sustained a ureteral perforation, which was managed successfully by double-J stent insertion. The ideal primary treatment for small (<8 mm) distal ureteral calculi is in situ SWL, with URS plus Lithoclast fragmentation being reserved for failed SWL, single stones >8 mm in length, and multiple stones.

  6. 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.

  7. Predictive Factors of the Outcome of Extracorporeal Shockwave Lithotripsy for Ureteral Stones

    PubMed Central

    Choi, Ji Woong; Song, Phil Hyun

    2012-01-01

    Purpose Extracorporeal Shock Wave Lithotripsy (ESWL) has shown successful outcomes for ureteral stones. We investigated predictive factors for failure of ESWL for treating ureteral stones. Materials and Methods A total of 153 patients who underwent ESWL between July 2006 and July 2009 for ureteral stones diagnosed by non-enhanced spiral computed tomography were divided into two groups: (group A, stone size ≤10 mm; and group B, stone size >10 mm). The failure was defined as remnant stones >4 mm. We assessed age, sex, body mass index, stone size, laterality, location, skin-to-stone distance (SSD), Hounsfield unit, and the presence of secondary signs (hydronephrosis, renal enlargement, perinephric fat stranding, and tissue rim sign). We analyzed predictive factors by using logistic regression in each group. Results The success rates were 90.2% and 68.6% in group A and B, respectively. In the univariate analysis of each group, stone size, SSD, and all secondary signs showed statistically significant differences in terms of the outcome of ESWL (p<0.05). In the multivariate logistic regression, stone size (odds ratio [OR], 50.005; 95% confidence interval [CI], 6.207 to 402.852) was an independent predictive factor in group A. The presence of perinephric fat standing (OR, 77.634; 95% CI, 1.349 to 446.558) and stone size (OR, 19.718; 95% CI, 1.600 to 243.005) were independent predictive factors in group B. Conclusions Stone size is an independent predictive factor influencing failure of ESWL for treating ureteral stones. In larger ureteral stones (>10 mm), the presence of perinephric fat stranding is also an independent predictive factor. PMID:22741053

  8. Massive Pulmonary Calculi Embolism: A Novel Complication of Pneumatic Lithotripsy: A Case Report.

    PubMed

    Zhang, Lin; Zhou, Yiwu

    2015-07-01

    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.

  9. Successful Treatment of Mirizzi’s Syndrome Using SpyGlass Guided Laser Lithotripsy

    PubMed Central

    Issa, Hussain; Bseiso, Bahaa; Almousa, Fadel; Al-Salem, Ahmed H.

    2012-01-01

    The majority of common bile duct stones can be effectively treated by endoscopic sphincterotomy and stone extraction using basket or balloon extractor. Stones more than 2 cm in diameter on the other hand require mechanical, electrohyraulic lithotripsy and sphincterotomy and balloon dilation. Mechanical lithotripsy may not be successful because of the size, consistency and site of the stones. In these cases, laser lithotripsy is the treatment of choice. This however requires direct visualization of the stone which may not be feasible for impacted cystic duct stones. This report describes the successful treatment of difficult cystic duct stones in two patients with Mirizzi’s syndrome type I using per oral Spyglass and intraductal holmium: YAG Laser Lithotripter. PMID:27785198

  10. 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.

  11. Review on Lithotripsy and Cavitation in Urinary Stone Therapy.

    PubMed

    Ghorbani, Morteza; Oral, Ozlem; Ekici, Sinan; Gozuacik, Devrim; Kosar, Ali

    2016-01-01

    Cavitation is the sudden formation of vapor bubbles or voids in liquid media and occurs after rapid changes in pressure as a consequence of mechanical forces. It is mostly an undesirable phenomenon. Although the elimination of cavitation is a major topic in the study of fluid dynamics, its destructive nature could be exploited for therapeutic applications. Ultrasonic and hydrodynamic sources are two main origins for generating cavitation. The purpose of this review is to give the reader a general idea about the formation of cavitation phenomenon and existing biomedical applications of ultrasonic and hydrodynamic cavitation. Because of the high number of the studies on ultrasound cavitation in the literature, the main focus of this review is placed on the lithotripsy techniques, which have been widely used for the treatment of urinary stones. Accordingly, cavitation phenomenon and its basic concepts are presented in Section II. The significance of the ultrasound cavitation in the urinary stone treatment is discussed in Section III in detail and hydrodynamic cavitation as an important alternative for the ultrasound cavitation is included in Section IV. Finally, side effects of using both ultrasound and hydrodynamic cavitation in biomedical applications are presented in Section V.

  12. 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.

  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. 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.

  15. [Extracorporeal shockwave lithotripsy of stones in lower calices of kidney].

    PubMed

    Martov, A G; Peniukova, I V; Moskalenko, S A; Peniukov, V G; Peniukov, D V; Balykov, I S

    2013-01-01

    The article presents the results of the study aimed to evaluation of possible relationship between anatomical structure of the renal pelvis of the kidney, the size of the stone and the effectiveness of extracorporeal shockwave lithotripsy (ESWL) of stones in lower calices of kidney, defined as "stone-free state". ESWL was performed in 285 patients. Sizes of stones varied from 5 to 25 mm. With interval distribution of stone sizes, the greatest number of cases was detected with size of 5 to 12 mm. The destruction of stone required one ESWL session in 196 cases, and three sessions only in 12 cases. The total number of pulses per one stone did not exceed 9500, and more than 70% of the stones have been effectively destroyed with less than 3000 pulses. The result of treatment was assessed 3-4 months after the last ESWL session on the basis of ultrasound and X-ray examination using nominal (dichotomous) scale. In addition, for verification of significant (expected and unexpected) correlations, exploratory analysis of the correlation matrices of factors possibly affecting the discharge of stone fragments was performed. Positive treatment outcome was recorded in 212 (74.4%) patients. Residual stone fragments (> or = 5 mm) were identified in 73 (25.6%) patients; in 69 patients fragments corresponded to the initial localization and 4 fragments were located in the pelvis and calices of middle and lower segments of the kidney. Statistical processing found no association between the size of the stone and the number of ESWL sessions required for its destruction (P = 0,4056). The analysis of relationship between the nature of the complications and size of stone revealed differences, but there were no significant differences in median test (p = 0.1067). Based on exploratory analysis and correlations identified, in-depth evaluation was carried out on three factors: the size of the stone, length of lower calices neck, and pyelocaliceal corner. Width of lower calices neck as a

  16. [A case of gallstone ileus treated with electrohydraulic lithotripsy guided by colonoscopy].

    PubMed

    Shin, Kyung Hwa; Kim, Dong Uk; Choi, Moon Gi; Kim, Won Jin; Ryu, Dong Yup; Lee, Bong Eun; Kim, Gwang Ha; Song, Geun Am

    2011-02-01

    A 63-year-old woman was admitted to the hospital with abdominal pain and nausea. Her abdomen was distended with obstructive bowel sounds on exam. There was diffuse abdominal tenderness but no palpable masses. Abdominal computed tomography (CT) scan revealed a large gallstone in the ileum. Surgical intervention was deferred given patient's known significant liver cirrhosis (Child-Pugh class B). Instead colonoscopy was performed and a large gallstone was found to be impacted at the ileocecal valve. The gallstone was fragmented using electrohydraulic lithotripsy (EHL) and then retrieved with snare and forceps. The patient made a full recovery and was eventually discharged home. This is the first reported case of an impacted gallstone at the ileocecal valve with successful colonoscopic treatment using electrohydraulic lithotripsy in Korea. This case highlights the potential therapeutic benefits for colonscopic retrieval of a gallstone impacted at the ileocecal valve in well selected individuals.

  17. Transurethral holmium-YAG laser lithotripsy for large symptomatic prostatic calculi: initial experience.

    PubMed

    Goyal, Neeraj Kumar; Goel, Apul; Sankhwar, Satyanarayan

    2013-08-01

    Symptomatic prostatic calculi are a rare clinical entity with wide range of management options, however, there is no agreement about the preferred method for treating these symptomatic calculi. In this study we describe our experience of transurethral management of symptomatic prostatic calculi using holmium-YAG laser lithotripsy. Patients with large, symptomatic prostatic stones managed by transurethral lithotripsy using holmium-YAG laser over 3-year duration were included in this retrospective study. Patients were evaluated for any underlying pathological condition and calculus load was determined by preoperative X-ray KUB film/CT scan. Urethrocystoscopy was performed using 30° cystoscope in lithotomy position under spinal anesthesia, followed by transurethral lithotripsy of prostatic calculi using a 550 μm laser fiber. Stone fragments were disintegrated using 100 W laser generators (VersaPulse PowerSuite 100 W, LUMENIS Surgical, CA). Larger stone fragments were retreived using Ellik's evacuator while smaller fragments got flushed under continuous irrigation. Five patients (median age 42 years) with large symptomatic prostatic calculi were operated using the described technique. Three patients had idiopathic stones while rest two had bulbar urethral stricture and neurogenic bladder, respectively. Median operative time was 62 min. All the patients were stone free at the end of procedure. Median duration of catheterization was 2 days. Significant improvement was observed in symptoms score and peak urinary flow and none of the patient had any complication. Transurethral management using holmium-YAG laser lithotripsy is a safe and highly effective, minimally invasive technique for managing symptomatic prostatic calculi of all sizes with no associated morbidity.

  18. Combining ultrasonography and noncontrast helical computerized tomography to evaluate Holmium laser lithotripsy

    PubMed Central

    Mi, Jia; Li, Jie; Zhang, Qinglu; Wang, Xing; Liu, Hongyu; Cao, Yanlu; Liu, Xiaoyan; Sun, Xiao; Shang, Mengmeng; Liu, Qing

    2016-01-01

    Abstract The purpose of the study was to establish a mathematical model for correlating the combination of ultrasonography and noncontrast helical computerized tomography (NCHCT) with the total energy of Holmium laser lithotripsy. In this study, from March 2013 to February 2014, 180 patients with single urinary calculus were examined using ultrasonography and NCHCT before Holmium laser lithotripsy. The calculus location and size, acoustic shadowing (AS) level, twinkling artifact intensity (TAI), and CT value were all documented. The total energy of lithotripsy (TEL) and the calculus composition were also recorded postoperatively. Data were analyzed using Spearman's rank correlation coefficient, with the SPSS 17.0 software package. Multiple linear regression was also used for further statistical analysis. A significant difference in the TEL was observed between renal calculi and ureteral calculi (r = –0.565, P < 0.001), and there was a strong correlation between the calculus size and the TEL (r = 0.675, P < 0.001). The difference in the TEL between the calculi with and without AS was highly significant (r = 0.325, P < 0.001). The CT value of the calculi was significantly correlated with the TEL (r = 0.386, P < 0.001). A correlation between the TAI and TEL was also observed (r = 0.391, P < 0.001). Multiple linear regression analysis revealed that the location, size, and TAI of the calculi were related to the TEL, and the location and size were statistically significant predictors (adjusted r2 = 0.498, P < 0.001). A mathematical model correlating the combination of ultrasonography and NCHCT with TEL was established; this model may provide a foundation to guide the use of energy in Holmium laser lithotripsy. The TEL can be estimated by the location, size, and TAI of the calculus. PMID:27930563

  19. 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.

  20. Therapy and Prevention of Postoperative Urosepsis of Ureter Endoscopic Lithotripsy for Non-infection.

    PubMed

    Shen, Jun; Sun, Fa; Chen, Fang-Min; Wu, Zhi-Ping; Li, Sheng-Wen

    2016-03-20

    Objective To analyze the risk factors causing postoperative urosepsis in ureter endoscopic lithotripsy without infection preoperatively, in order to make a more effective and safer preventive and therapeutic strategy.Methods From January 2010 to January 2015, 5 ureteral calculus patients undergoing ureter endoscopic lithotripsy with holmium laser were retrospectively enrolled in this clinical study. These patients suffered urosepsis postoperatively confirmed by the clinical presentations and laboratory Results, while they had no infection in their blood and urine preoperatively. Without delay, 5 patients were treated by anti-inflammation and anti-shock.Results The vasopressor drug was stopped gradually after 12-36 hours. The body temperature was recovered to normal in 2 or 3 days, and the blood and urine test Results were not abnormal in 7 days. At last, 5 patients were all cured.Conclusions Stone and operation themselves are potential factors to cause urosepsis after ureter endoscopic lithotripsy. Especially for patients who had not presented infection preoperatively, careful preparation preoperatively, corrective manipulation, low pressure irrigation, drainage and controlling time during operation, and early diagnosis, appropriate treatment postoperatively are the key to cure and prevent urosepsis.

  1. [The characteristics or urolithiasis in flight personnel and the treatment results using a method of extracorporeal shockwave lithotripsy on the Russian lithotripter Urat-P2].

    PubMed

    Garilevich, B A; Avdeĭchuk, Iu I

    1995-01-01

    Urolithiasis occurs more frequently in the pilots than in the ground-service personnel. To decrease a damaging effect of the focused shock waves on the renal tissue while using remote lithotripsy technique, a new domestic-certified lithotriptor "URAT-P2" which shows a significantly low energy of shock wave with sufficient effectiveness of crushing the renal stones, is devised. Urolithiasis in the pilots is apparent at the early stages of its development and its complicated forms are less common than in the subjects of other professions. The stones are predominantly located in the renal calyces (73,3% of cases), in the left kidney and urethra in 63,3% of cases and there were urate stones in 40% of cases. The clinical use of the URAT-P2 complex in 30 pilots indicated that it holds advantages over the production domestic-certified lithotriptor. The stones are crushed in all the patients but the complications associated with a negative effect of the focused shock waves on the renal tissue are absent. The use of the new lithotriptor for treating urolithiasis in the pilots will allow one to improve the treatment response and to maintain professional worthiness of the pilots for a long time.

  2. 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

  3. 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.

  4. Treatment selection for urolithiasis: percutaneous nephrolithomy, ureteroscopy, shock wave lithotripsy, and active monitoring.

    PubMed

    Desai, Mahesh; Sun, Yinghao; Buchholz, Noor; Fuller, Andrew; Matsuda, Tadashi; Matlaga, Brian; Miller, Nicole; Bolton, Damien; Alomar, Mohammad; Ganpule, Arvind

    2017-03-16

    Urolithiasis is a significant worldwide source of morbidity, constituting a common urological disease that affects between 10 and 15% of the world population. Recent technological and surgical advances have replaced the need for open surgery with less invasive procedures. The factors which determine the indications for percutaneous nephrolithotomy include stone factors (stone size, stone composition, and stone location), patient factors (habitus and renal anomalies), and failure of other treatment modalities (ESWL and flexible ureteroscopy). The accepted indications for PCNL are stones larger than 20 mm(2), staghorn and partial staghorn calculi, and stones in patients with chronic kidney disease. The contraindications for PCNL include pregnancy, bleeding disorders, and uncontrolled urinary tract infections. Flexible ureteroscopy can be one of the options for lower pole stones between 1.5 and 2 cm in size. This option should be exercised in cases of difficult lower polar anatomy and ESWL-resistant stones. Flexible ureteroscopy can also be an option for stones located in the diverticular neck or a diverticulum. ESWL is the treatment to be discussed as a option in all patient with renal stones (excluding lower polar stones) between size 10 and 20 mm. In addition, in lower polar stones of size between 10 and 20 mm if the anatomy is favourable, ESWL is the option. In proximal ureteral stones, ESWL should be considered as a option with flexible ureteroscopy Active monitoring has a limited role and can be employed in post-intervention (PCNL or ESWL) residual stones, in addition, asymptomatic patients with no evidence of infection and fragments less than 4 mm can be monitored actively.

  5. Cavitation bubble cluster activity in the breakage of stones by shock wave lithotripsy

    NASA Astrophysics Data System (ADS)

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

    2002-05-01

    High-speed photography was used to investigate cavitation at the surface of artificial and natural kidney stones during exposure to lithotripter shock pulses in vitro. It was observed that numerous individual bubbles formed over virtually the entire surface of the stone, but these bubbles did not remain independent and combined with one another to form larger bubbles and bubble clusters. The movement of bubble boundaries across the surface left portions of the stone bubble free. The biggest cluster grew to envelop the proximal end of the stone (6.5 mm diameter artificial stone) then collapsed to a small spot that over multiple shots formed a crater in that face of the stone. The bubble clusters that developed at the sides of stones tended to align along fractures and to collapse into these cracks. High-speed camera images demonstrated that cavitation-mediated damage to stones was due not to the action of solitary, individual bubbles, but to the forceful collapse of dynamic clusters of bubbles. [Work supported by NIH DK43881.

  6. 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

  7. Efficacy of retrograde ureteropyeloscopic holmium laser lithotripsy for intrarenal calculi >2 cm.

    PubMed

    Bader, M J; Gratzke, C; Walther, S; Weidlich, P; Staehler, M; Seitz, M; Sroka, R; Reich, O; Stief, C G; Schlenker, B

    2010-10-01

    The objectives of this study are to assess the efficacy and safety of retrograde ureteroscopic holmium laser lithotripsy for intrarenal calculi greater than 2 cm in diameter. A total of 24 patients with a stone burden >2 cm were treated with retrograde ureteroscopic laser lithotripsy. Primary study endpoints were number of treatments until the patient was stone free and perioperative complications with a follow-up of at least 3 months after intervention. In 24 patients (11 women and 13 men, 20-78 years of age), a total of 40 intrarenal calculi were treated with retrograde endoscopic procedures. At the time of the initial procedure, calculi had an average total linear diameter of 29.75 ± 1.57 mm and an average stone volume of 739.52 ± 82.12 mm(3). The mean number of procedures per patient was 1.7 ± 0.8 (range 1-3 procedures). The overall stone-free rate was 92%. After 1, 2 and 3 procedures 54, 79 and 92% of patients were stone free, respectively. There were no major complications. Minor postoperative complications included pyelonephritis in three cases (7.5%), of whom all responded immediately to parenteral antibiotics. In one patient the development of steinstrasse in the distal ureter required ureteroscopic fragment disruption and basketing. Ureteroscopy with holmium laser lithotripsy represents an efficient treatment option and allows the treatment of large intrarenal calculi of all compositions and throughout the whole collecting system even for patients with a stone burden of more than 2 cm size.

  8. 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.

  9. Nonstented versus routine stented ureteroscopic holmium laser lithotripsy: a prospective randomized trial.

    PubMed

    Shao, Yi; Zhuo, Jian; Sun, Xiao-Wen; Wen, Wei; Liu, Hai-Tao; Xia, Shu-Jie

    2008-10-01

    We conducted a prospective, randomized study to evaluate whether postoperative ureteral stenting is necessary after ureteroscopic holmium laser lithotripsy. A total of 115 consecutive patients with distal or middle ureteral calculi amenable to ureteroscopic holmium laser lithotripsy were prospectively randomized into stented group (n = 58) and nonstented group (n = 57). The stent was routinely placed in the treated ureter for 2 weeks. The outcomes were measured with postoperative patient symptoms, stone-free rates, early and late postoperative complications, and cost-effectiveness. The postoperative symptoms were measured with Ureteral Stent Symptom Questionnaire (USSQ). All patients completed a 12-week follow-up. There was no significant difference between two groups with respect to the patient age, stone size, stone location and mean operative time. According to the USSQ, the symptoms of the stented group were significantly worse compared to the nonstented group (P = 0.0001). In the stented group, two patients had high fever for 1 week after the operation, stent migration was found in two patients, and the stents had to be removed earlier in five patients because of severe pain or hematuria. The cost of the stented group was significantly higher than the nonstented group. The stone-free rate was 100% in both groups. No hydronephrosis or ureteral stricture was detected by intravenous pyelogram in the 12th week postoperative follow-up. In conclusion, we believe that routine stenting after ureteroscopic intracorporeal lithotripsy with the holmium laser is not necessary as long as the procedure is uncomplicated for distal or middle ureteral calculis less than 2 cm.

  10. Value of focal applied energy quotient in treatment of ureteral lithiasis with shock waves.

    PubMed

    Arrabal-Polo, Miguel Angel; Arrabal-Martin, Miguel; Palao-Yago, Francisco; Mijan-Ortiz, Jose Luis; Zuluaga-Gomez, Armando

    2012-08-01

    The treatment of ureteral lithiasis by extracorporeal shock wave lithotripsy (ESWL) is progressively being abandoned owing to advances in endoscopic lithotripsy. The purpose of this paper is to analyze the causes as to why ESWL is less effective-with a measurable parameter: focal applied energy quotient (FAEQ) that allows us to apply an improvement project in ESWL results for ureteral lithiasis. A prospective observational cohort study with 3-year follow-up and enrollment period was done with three groups of cases. In Group A, 83 cases of ureteral lithiasis were treated by endoscopic lithotripsy using Holmiun:YAG laser. In Group B, 81 cases of ureteral lithiasis were treated by ESWL using Doli-S device (EMSE 220F-XXP). In Group C, 65 cases of ureteral lithiasis were treated by ESWL using Doli-S device (EMSE 220F-XXP) (FAEQ >10). Statistical study and calculation of RR, NNT, Chi-square test, Fisher's exact test, and Student's t test were done. Efficiency quotient (EQ) and focal applied energy quotient [FAEQ = (radioscopy seconds/number of shock waves) × ESWL session J] were analyzed. From the results, the success rate of the treatment using Holmium:YAG laser lithotripsy and ESWL is found to be 94 and 48%, respectively, with a statistically significant difference (p < 0.001). Success rate of endoscopic laser lithotripsy for lumbar ureteral stones was 82% versus 57% of ESWL (p = 0.611). In Group B, FAEQ was 8.12. In Group C, success rate was 93.84% with FAEQ of 10.64%. When we compare results from endoscopic lithotripsy with Holmium:YAG laser in Group B with results from ESWL with FAEQ >10, we do not observe absolute benefit choosing one or the other. In conclusion, the application of ESWL with FAEQ >10, that is, improving radiologic focalization of the calculus and increasing the number of Joules/SW, makes possible a treatment as safe and equally efficient as Holmium:YAG laser lithotripsy in ureteral lithiasis less than 13 mm.

  11. 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.

  12. A review of the physical properties and biological effects of the high amplitude acoustic field used in extracorporeal lithotripsy.

    PubMed

    Coleman, A J; Saunders, J E

    1993-01-01

    Extracorporeal shockwave lithotripsy (ESWL) has now been used for more than a decade in the treatment of urinary stone disease. During this period there has been a wide range of studies on the physical properties of the high-amplitude focussed fields used in ESWL and the biological effects of exposure to such fields, including their ability to fragment hard concretions. These studies form a distinct body of knowledge whose relevance to the broader literature on biological effects from lower amplitude exposures has yet to be fully evaluated. This review attempts to present the main results of biological-effects studies in ESWL along with what is known of the physical properties of lithotripsy fields with the aim of assisting this evaluation. In general, the reported biological effects of lithotripsy fields are compatible with those that have been observed at those lower amplitudes of focussed pulsed ultrasound in which transient cavitation is the dominant mechanism of interaction. The relatively large amplitudes and low frequencies in ESWL, however, make it a more potent generator of transient cavitation than most other forms of medical ultrasound. Biological-effects studies with lithotripsy fields may, therefore, be expected to extend our understanding of the nature of transient cavitation and, in particular, its effects in mammalian tissue.

  13. 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.

  14. Dependence of calculus retropulsion dynamics on fiber size and radiant exposure during Ho:YAG lithotripsy.

    PubMed

    Lee, Ho; Ryan, Robert T; Kim, Jeehyun; Choi, Bernard; Arakeri, Navanit V; Teichman, Joel M H; Welch, A J

    2004-08-01

    During pulsed laser lithotripsy, the calculus is subject to a strong recoil momentum which moves the calculus away from laser delivery and prolongs the operation. This study was designed to quantify the recoil momentum during Ho:YAG laser lithotripsy. The correlation among crater shape, debris trajectory, laser-induced bubble and recoil momentum was investigated. Calculus phantoms made from plaster of Paris were ablated with free running Ho:YAG lasers. The dynamics of recoil action of a calculus phantom was monitored by a high-speed video camera and the laser ablation craters were examined with Optical Coherent Tomography (OCT). Higher radiant exposure resulted in larger ablation volume (mass) which increased the recoil momentum. Smaller fibers produced narrow craters with a steep contoured geometry and decreased recoil momentum compared to larger fibers. In the presence of water, recoil motion of the phantom deviated from that of phantom in air. Under certain conditions, we observed the phantom rocking towards the fiber after the laser pulse. The shape of the crater is one of the major contributing factors to the diminished recoil momentum of smaller fibers. The re-entrance flow of water induced by the bubble collapse is considered to be the cause of the rocking of the phantom.

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

    PubMed

    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.

  16. Spatiotemporal dynamics of underwater conical shock wave focusing

    NASA Astrophysics Data System (ADS)

    Hoffer, P.; Lukes, P.; Akiyama, H.; Hosseini, H.

    2016-12-01

    The paper presents an experimental study on spatiotemporal dynamics of conical shock waves focusing in water. A multichannel pulsed electrohydraulic discharge source with a cylindrical ceramic-coated electrode was used. Time-resolved visualizations revealed that cylindrical pressure waves were focused to produce conical shock wave reflection over the axis of symmetry in water. Positive and negative pressures of 372 MPa and -17 MPa at the focus with 0.48 mm lateral and 22 mm axial extension (-6 dB) were measured by a fiber-optic probe hydrophone. The results clearly show the propagation process leading to the high-intensity underwater shock wave. Such strong and sharp shock wave focusing offers better localization for extracorporeal lithotripsy or other non-invasive medical shock wave procedures.

  17. Fragmentation process during Ho:YAG laser lithotripsy revealed by time-resolved imaging

    NASA Astrophysics Data System (ADS)

    Beghuin, Didier; Delacretaz, Guy P.; Schmidlin, Franz R.; Rink, Klaus

    1998-01-01

    The stone fragmentation process induced 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. We used artificial and cystine kidney stones. We observed that, although the fragmentation process is accompanied with the formation of a cavitation bubble, cavitation has a minimal incidence on stone fragmentation. Fragment ejection is mainly due to a direct laser stone heating and vaporization of stone organic constituents and interstitial water. The minimal effect of the cavitation bubble for fragmentation is confirmed by acoustic transients measurements, which reveal weak pressure transients. This is in contrast with the fragmentation mechanisms induced by laser of shorter pulse duration.

  18. Report on the first 1000 patients treated at St Thomas' Hospital by extracorporeal shockwave lithotripsy.

    PubMed

    Palfrey, E L; Bultitude, M I; Challah, S; Pemberton, J; Shuttleworth, K E

    1986-12-01

    Since March 1985, over 1000 patients have been treated on the lithotripter at St Thomas' Hospital. Since it is the only machine in the country offering treatment to National Health Service patients at no cost to the referring Health Authority, there has been a heavy demand for treatment and 97% of referrals have been accepted. Analysis of the first 1000 patients shows extracorporeal shockwave lithotripsy (ESWL) to be a safe procedure with a low morbidity rate and no mortality. The number of patients who were stone-free 3 months after treatment was low (44.1%) compared with the numbers reported in other series. The most likely reasons for this are the poor follow-up rate (48.9%), the stringent criteria for the diagnosis of "stone-free" and a possible skewed referral and follow-up pattern.

  19. Comparative evaluation of general, epidural and spinal anaesthesia for extracorporeal shockwave lithotripsy.

    PubMed Central

    Rickford, J. K.; Speedy, H. M.; Tytler, J. A.; Lim, M.

    1988-01-01

    The results of a prospective randomised evaluation of general anaesthesia (GA), epidural anaesthesia (EA) and spinal anaesthesia (SA) for extracorporeal shockwave lithotripsy are presented. GA provided speed and reliability but resulted in a high incidence of postoperative nausea, vomiting and sore throat. Both regional techniques conferred the advantages of an awake, cooperative patient, but EA required a longer preparation time than SA and more supplementary treatment with fentanyl or midazolam. A major drawback associated with the use of SA was a 42% incidence of postspinal headache. All three techniques were associated with hypotension on placement in the hoisl; bath immersion resulted in significant rises in blood pressure in the EA and SA groups and a more variable (overall non-significant) response in the GA group. PMID:3044238

  20. Flexible ureteroscopic laser lithotripsy for upper urinary tract stone disease in patients with spinal cord injury.

    PubMed

    Tepeler, Abdulkadir; Sninsky, Brian C; Nakada, Stephen Y

    2015-11-01

    The objective of this study is to present the outcomes of flexible ureteroscopic laser lithotripsy (URS) for upper urinary tract stone disease in spinal cord injury (SCI) patients performed by a single surgeon. A retrospective analysis was performed for SCI patients treated with flexible URS for proximal ureter and kidney stone disease by a single surgeon between 2003 and 2013. Patient characteristics, operative outcomes, metabolic evaluation, and stone analyses were assessed in detail. A total of 27 URS procedures were performed for urolithiasis in 21 renal units of 19 patients. The mean age was 52.1 ± 15.6 years (16-72) and mean BMI was 29.2 ± 7.3 kg/m(2) (20-45.7). Etiology of SCI was trauma (n: 10), multiple sclerosis (n: 6), cerebrovascular accident (n: 1), or undetermined (n: 2). The mean stone size was 15.9 ± 8.6 (6-40) mm. In the 27 URS procedures, stones were located in the ureter (n: 5), the kidney (n: 14), and both areas (n: 8). Mean hospitalization time was 2.0 ± 2.4 (0-10) days. Postoperative complications were observed in 6 cases (22.2%). Three major complications included urosepsis (n: 1) and respiratory failure (n: 2), that were observed postoperatively and required admission to the intensive care unit. The 2 minor complications were hypotension, fever and UTI, and required medical treatment. Fourteen (66.6%) of the 21 renal units were stone free. Calcium phosphate carbonate (n: 9) and struvite (n: 5) were the primary stone compositions detected. Hypocitraturia (n: 6), hypercalciuria (n: 5), hypernaturia (n: 5), hyperoxaluria (n: 4), and hyperuricosuria (n: 1) were common abnormalities in 24-h urine analysis. Ureteroscopic laser lithotripsy can be an effective treatment modality for SCI patients with upper urinary tract calculi.

  1. National Practice Pattern and Time Trends in Treatment of Upper Urinary Tract Calculi in Korea: a Nationwide Population-Based Study

    PubMed Central

    2016-01-01

    Despite high prevalence of upper urinary tract calculi (UUTC), there are few studies regarding patterns of care in Asian populations. We investigated treatment patterns and time trends in patients with newly diagnosed UUTC in Korea using the National Health Insurance database that includes de-identified claims from a random 2% sample of the entire population (> 1 million people). A total of 14,282 patients who received active treatments, including shock wave lithotripsy (SWL), ureteroscopic surgery (URS), percutaneous nephrolithotomy (PNL), and uretero/pyelolithotomy (UPL), for newly diagnosed UUTC between 2003 and 2013 were included. The number of primary and all treated cases of UUTC significantly (43% and 103.3%, respectively) increased over the 10-year period. While patients undergoing SWL, URS, PNL, and UPL as primary treatment increased by 43.7%, 31.9%, 87.5%, and 0%, respectively, the relative proportion undergoing each treatment remained constant over the 10 years (SWL > 90%, URS 4.5% to 7.8%, PNL 0.4% to 1.0%, and UPL < 0.4%, respectively). Multinomial logistic regression analysis showed that age > 40 years (compared to age < 30 years) was significantly associated with URS, PNL, and UPL, rather than SWL, while patients living in urban or suburban/rural areas (compared to metropolitan) were significantly less likely to undergo URS and PNL. In summary, the majority of Korean patients underwent SWL as primary treatment for UUTC, and the predominant use of SWL remained steady over a 10-year period in Korea. Our results will be valuable in examining treatment patterns and time trends in Korean UUTC patients. PMID:27822940

  2. National Practice Pattern and Time Trends in Treatment of Upper Urinary Tract Calculi in Korea: a Nationwide Population-Based Study.

    PubMed

    Park, Jinsung; Suh, Beomseok; Lee, Myung Shin; Woo, Seung Hyo; Shin, Dong Wook

    2016-12-01

    Despite high prevalence of upper urinary tract calculi (UUTC), there are few studies regarding patterns of care in Asian populations. We investigated treatment patterns and time trends in patients with newly diagnosed UUTC in Korea using the National Health Insurance database that includes de-identified claims from a random 2% sample of the entire population (> 1 million people). A total of 14,282 patients who received active treatments, including shock wave lithotripsy (SWL), ureteroscopic surgery (URS), percutaneous nephrolithotomy (PNL), and uretero/pyelolithotomy (UPL), for newly diagnosed UUTC between 2003 and 2013 were included. The number of primary and all treated cases of UUTC significantly (43% and 103.3%, respectively) increased over the 10-year period. While patients undergoing SWL, URS, PNL, and UPL as primary treatment increased by 43.7%, 31.9%, 87.5%, and 0%, respectively, the relative proportion undergoing each treatment remained constant over the 10 years (SWL > 90%, URS 4.5% to 7.8%, PNL 0.4% to 1.0%, and UPL < 0.4%, respectively). Multinomial logistic regression analysis showed that age > 40 years (compared to age < 30 years) was significantly associated with URS, PNL, and UPL, rather than SWL, while patients living in urban or suburban/rural areas (compared to metropolitan) were significantly less likely to undergo URS and PNL. In summary, the majority of Korean patients underwent SWL as primary treatment for UUTC, and the predominant use of SWL remained steady over a 10-year period in Korea. Our results will be valuable in examining treatment patterns and time trends in Korean UUTC patients.

  3. Factors predicting success of emergency extracorporeal shockwave lithotripsy (eESWL) in ureteric calculi--a single centre experience from the United Kingdom (UK).

    PubMed

    Panah, A; Patel, S; Bourdoumis, A; Kachrilas, S; Buchholz, N; Masood, J

    2013-10-01

    Few studies show that "emergency extracorporeal shockwave lithotripsy (eESWL)" reduces the incidence of ureteroscopy in patients with ureteric calculi. We assess success of eESWL and look to study and identify factors which predict successful outcome. We retrospectively studied patients presenting with their first episode of ureteric colic undergoing eESWL (within 72 h of presentation) over a 5-year period. Patient's age, gender, stone size and location, time between presentation and ESWL, number of shock waves and ESWL sessions, and Hounsfield units (HU) were recorded. 97 patients (mean age 40 years; 76 males, 21 females) were included. 71 patients were stone free after eESWL (73.2 %) (group 1) and 26 patients failed treatment and proceeded to ureteroscopy (group 2). The two groups were well matched for age and gender. Mean stone size in group 1 and 2 was 6.4 mm and 7.7 mm, respectively, (p = 0.00141). Stone location was 34, 21, and 16 in upper, middle and lower ureter in group 1 compared to 11, 5, and 10 in group 2, respectively. Mean HU in group 1 was 480 and 612 in group 2 (p value 0.0036). In group 2, significantly, more patients received treatment after 24 h compared with group 1 (38 vs 22.5 %). The number of shock waves, maximal intensity, and ESWL sessions were not significantly different in the two groups. No complications were noted. eESWL is safe and effective in patients with ureteric colic. Stone size and Hounsfield units are important factors in predicting success. Early treatment (≤24 h) minimizes stone impaction and increases the success rate of ESWL.

  4. Surgical management of urolithiasis in spinal cord injury patients.

    PubMed

    Nabbout, Philippe; Slobodov, Gennady; Culkin, Daniel J

    2014-06-01

    Urolithiasis is a common condition in patients with spinal cord injury (SCI). Surgical management of stones in this population is more challenging and associated with lower clearance rates than the general population. The rate of complications - specifically infectious complications - is also high due to the chronic bacterial colonization. Shock wave lithotripsy (SWL) has a low clearance rate of 44-73 %. Percutaneous nephrolithotripsy is indicated for larger nephrolithiasis, but multiple procedures may be required to clear the stones. Ureteroscopy has been associated with low success rates because of difficulty in obtaining ureteral access. Historically, bladder stones were managed with open surgery or SWL. Recently, good results have been reported with the combination of endoscopic and laparoscopic techniques. Surgical management of urolithiasis in patients with SCI should be performed in high-volume centers in light of the technical challenges and higher rate of perioperative complications.

  5. 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

  6. 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

  7. Generation of shear waves as an effective mechanism of dynamic load of the lithotripter shock wave on the kidney stone

    NASA Astrophysics Data System (ADS)

    Sapozhnikov, Oleg A.; Cleveland, Robin O.; Bailey, Michael R.; Crum, Lawrence A.

    2003-10-01

    A number of stone comminution mechanisms have been studied in lithotripsy. Except cavitation erosion, these mechanisms (namely, spallation, dynamic fatigue, shear, and circumferential compression) are associated with stresses generated in the stone by the shock wave. The mechanical load on the stone depends on the waveform and stone structure, size, and shape. We modeled the propagation of lithotripter shock waves through a cylindrical stone with a finite differences simulation based on Lame's equation. The stone parameters were similar to those of natural kidney stones. A new mechanism of tensile stress generation is predicted that may be 5-10 times more efficient than spalling. Shear elasticity of the stone gave rise to the peak tensile strain in the bulk of the stone; this strain occurs near the stone axis due to coherent arrival of shear waves from the front edges of the stone. The position of the region of maximum strain and direction of corresponding tensile forces is similar to those predicted by the spalling mechanism. The modeling also showed that circumferential compression is not activated by the dynamic load produced by a short shock wave typical for lithotripsy. [Work supported by NIH PO1 DK43881, RO1 DK55674 and FOGARTY, CDRF, ONRIFO, and NSBRI.

  8. 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

  9. Outcome analysis of holmium laser and pneumatic lithotripsy in the endoscopic management of lower ureteric calculus in pediatric patients: a prospective study

    PubMed Central

    Jhanwar, Ankur; Bansal, Ankur; Sankhwar, Satyanarayan; Kumar, Manoj; Kanodia, Gautam; Prakash, Gaurav

    2016-01-01

    ABSTRACT Objective: To analyse outcomes of holmium laser and pneumatic lithotripsy in treatment of lower ureteric calculus in pediatric patients. Materials and methods: Prospective study conducted between August 2013 and July 2015. Inclusion criteria were lower ureteric calculus with stone size ≤1.5cms. Exclusion criteria were other than lower ureteric calculus, stone size ≥1.5cms, congenital renal anomalies, previous ureteral stone surgery. Patients were divided into two groups. Group A underwent pneumatic and group B underwent laser lithotripsy procedure. Patient's baseline demographic and peri-operative data were recorded and analysed. Post operatively X-ray/ultrasound KUB (Kidney, ureter and bladder) was performed to assess stone free status. Results: A total of 76 patients who met the inclusion criteria to ureteroscopic intracorporeal lithotripsy were included. Group A and B included 38 patients in each. Mean age was 12.5±2.49 in Group A and 11.97±2.74 years in Group B respectively (p=0.38). Overall success rate was 94.73% in Group A and 100% in Group B, respectively (p=0.87). Conclusion: Holmium Laser lithotripsy is as efficacious as pneumatic lithotripsy and can be used safely for the endoscopic management of lower ureteric calculus in pediatric patients. However, holmium laser requires more expertise and it is a costly alternative. PMID:27622283

  10. [Urinary lithotripsy in children. Multicenter study of the Pediatric Urology Study Group].

    PubMed

    Van Kote, G; Lottmann, H; Fremond, B; Mourey, E; Dore, B; Daoud, S; Valla, J S; Garcia, S; Beurton, D; Poddevin, F; Biserte, J; Villar, F; Lacombe, A

    1999-01-01

    The authors present the results of a survey conducted among French paediatric urologists belonging to the Groupe d'Etudes en Urologie Pédiatrique (GEUP) (Paediatric Urology Study Group). This study, based on 122 cases observed in 13 centres, is not exhaustive, but is nevertheless statistically significant. The preoperative assessment confirms the usual findings of urinary stones in children: pyelonephritis, haematuria and abdominal pain, the usual presenting complaint, concomitant malformative uropathy (10% of cases) and a predominance of calcium stones. More than 200 stones were treated, larger than 10 millimeters in diameter in one-third of cases. Renal stones, mainly caliceal (more than 50%), included 11 staghorn calculi. This study also included 22 ureteric stones, mainly in the pelvic ureter, and 2 bladder stones. Lithotripsy was ultrasound-guided in 2/3 of cases and required general anaesthesia in about 3/4 of cases. Ureteric catheterization was required in 19 infants preoperatively, but in only 2 infants (stein strasse) postoperatively. One or two lithotripsy sessions were sufficient in most cases, but 4 sessions were necessary in 5 patients, to the same kidney in 1 case. The mean hospital stay was 2 to 3 days, but the procedure was performed on an outpatient basis in 15 cases. The immediate postoperative course was uneventful and asymptomatic. This survey revealed about 10% of complete failures, corresponding to solitary caliceal stones in 2/3 of cases; 29 partial failures were essentially due to lower caliceal stones and staghorn calculi; 84 successes (stone-free), mainly pelvic or simple caliceal stones. Scintigraphy did not reveal any immediate postoperative impairment of renal function. This study reported a success rate of about 70%, regardless of the type of apparatus used. Assessment of the results of ESWL requires sufficient follow-up both concerning the outcome of fragmented stones and evaluation of possible functional repercussions. This survey

  11. CT visible internal stone structure, but not Hounsfield unit value, of calcium oxalate monohydrate (COM) calculi predicts lithotripsy fragility in vitro.

    PubMed

    Zarse, Chad A; Hameed, Tariq A; Jackson, Molly E; Pishchalnikov, Yuri A; Lingeman, James E; McAteer, James A; Williams, James C

    2007-08-01

    Calcium oxalate monohydrate (COM) stones are often resistant to breakage using shock wave (SW) lithotripsy. It would be useful to identify by computed tomography (CT) those COM stones that are susceptible to SW's. For this study, 47 COM stones (4-10 mm in diameter) were scanned with micro CT to verify composition and also for assessment of heterogeneity (presence of pronounced lobulation, voids, or apatite inclusions) by blinded observers. Stones were then placed in water and scanned using 64-channel helical CT. As with micro CT, heterogeneity was assessed by blinded observers, using high-bone viewing windows. Then stones were broken in a lithotripter (Dornier Doli-50) over 2 mm mesh, and SW's counted. Results showed that classification of stones using micro CT was highly repeatable among observers (kappa = 0.81), and also predictive of stone fragility. Stones graded as homogeneous required 1,874 +/- 821 SW/g for comminution, while stones with visible structure required half as many SW/g, 912 +/- 678. Similarly, when stones were graded by appearance on helical CT, classification was repeatable (kappa = 0.40), and homogeneous stones required more SW's for comminution than did heterogeneous stones (1,702 +/- 993 SW/g, compared to 907 +/- 773). Stone fragility normalized to stone size did not correlate with Hounsfield units (P = 0.85). In conclusion, COM stones of homogeneous structure require almost twice as many SW's to comminute than stones of similar mineral composition that exhibit internal structural features that are visible by CT. This suggests that stone fragility in patients could be predicted using pre-treatment CT imaging. The findings also show that Hounsfield unit values of COM stones did not correlate with stone fragility. Thus, it is stone morphology, rather than X-ray attenuation, which correlates with fragility to SW's in this common stone type.

  12. 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.

  13. Transurethral lithotripsy with holmium-YAG laser of a large exogenous prostatic calculus.

    PubMed

    Hasegawa, Masanori; Ohara, Rei; Kanao, Kent; Nakajima, Yosuke

    2011-04-01

    Prostatic calculi are classified into two types, endogenous and exogenous calculi, based on their origin. Endogenous calculi are commonly observed in elderly men; however, exogenous prostatic calculi are extremely rare. We report here the case of a 51-year-old man who suffered incontinence and pollakiuria with a giant exogenous prostatic calculus almost completely replacing the prostatic tissue. X-rays and computed tomography demonstrated a large calculus of 65 × 58 mm in the small pelvic cavity. The patient underwent a transurethral lithotripsy with a holmium-YAG laser and a total of 85 g of disintegrated stones was retrieved and chemical stone analysis revealed the presence of magnesium ammonium phosphate. The incontinence improved and the voiding volume increased dramatically, and no stone recurrence in the prostatic fossa occurred at the 2 years follow-up. The etiology of this stone formation seemed to be based on some exogenous pathways combined with urinary stasis and chronic urinary infection due to compression fracture of the lumbar vertebra.

  14. 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.

  15. Investigation on the impact of pulse duration for laser induced lithotripsy

    NASA Astrophysics Data System (ADS)

    Sroka, Ronald; Kiris, Tugba; Fiedler, Sebastian; Scheib, Gabriel; Kuznetsova, Julia; Pongratz, Thomas

    2014-03-01

    Objective: In-vitro investigation of Ho:YAG-laser induced stone fragmentation was performed to identify potential impacts of different pulse durations on stone fragmentation characteristics. Materials and Methods: An innovative Ho:YAG laser system (Swiss LaserClast, EMS S.A., Nyon, Switzerland) with selectable long- or short pulse mode was tested with regard to its fragmentation properties. The pulse duration depends on the specific laser parameter used. Fragmentation tests (hand held, hands free, single pulse induced crater) on artificial BEGO-Stones and fiber burn back tests were performed under reproducible experimental conditions. Additionally, the repulsion of long versus short laser pulses was compared using the pendulum set-up. Results: Differences in fragmentation rates between the two pulse duration regimes were seen. The difference was, however, not statistically significant. Using long pulse mode, the fiber burn back is nearly negligible while in short pulse mode an increased burn back was seen. The results of the pendulum test showed that the deviation induced by the momentum of shorter pulses is increased compared to longer pulses. Conclusion: Long pulse-mode showed reduced side effects like repulsion and fiber burn back in comparison to short pulse-mode while fragmentation rates remained at a comparable level. Lower push back and reduced burn back of longer laser pulses may results in better clinical outcome of laser lithotripsy and more convenient handling during clinical use.

  16. The relative contribution of waves, tides, and nontidal residuals to extreme total water levels on U.S. West Coast sandy beaches

    USGS Publications Warehouse

    Serafin, Katherine A.; Ruggiero, Peter; Stockdon, Hilary F.

    2017-01-01

    To better understand how individual processes combine to cause flooding and erosion events, we investigate the relative contribution of tides, waves, and nontidal residuals to extreme total water levels (TWLs) at the shoreline of U.S. West Coast sandy beaches. Extreme TWLs, defined as the observed annual maximum event and the simulated 100 year return level event, peak in Washington, and are on average larger in Washington and Oregon than in California. The relative contribution of wave-induced and still water levels (SWL) to the 100 year TWL event is similar to that of the annual maximum event; however, the contribution of storm surge to the SWL doubles across events. Understanding the regional variability of TWLs will lead to a better understanding of how sea level rise, changes in storminess, and possible changes in the frequency of major El Niños may impact future coastal flooding and erosion along the U.S. West Coast and elsewhere.

  17. Holmium Laser Lithotripsy with Semi-Rigid Ureteroscopy: A First-Choice Treatment for Impacted Ureteral Stones in Children?

    PubMed Central

    Adanur, Senol; Aydin, Hasan Riza; Ozkaya, Fatih; Ziypak, Tevfik; Polat, Ozkan

    2014-01-01

    Background We aimed to assess the effectiveness of semi-rigid ureteroscopy and holmium laser lithotripsy in the treatment of impacted ureteral stones in children. Material/Methods We evaluated a total of 32 children under the age of 18 years treated with ureteroscopic holmium laser lithotripsy for impacted ureteral stones between January 2005 and July 2013. Their stone-free state was defined as the absence of any residual stone on radiologic evaluation performed 4 weeks postoperatively. Complications were evaluated according to the modified Clavien classification. Result The mean patient age was 9.5±5.1 years (range 1–18 years). Seven (21.8%) of the stones were located in the proximal ureter, 9 (28.2%) were in the mid-ureter, and 16 (50%) were in the distal ureter. The mean stone size was calculated as being 10.46±3.8 mm2 (range 5–20). The stone-free rate was 93.75% (30/32 patients) following primary URS. Additional treatment was required for only 2 (6.25%) of the patients. After the procedure, a D-J stent was placed in all the patients. The total complication rate was 15.6% (5 patients). The 10 total complications in these 5 patients were 5 (15.6%) Grade I, 1 (3.1%) Grade II, 2 (6.25%) Grade IIIa, and 2 (6.25%) Grade IIIb. The mean follow-up period was 16.5 months (range 3–55). Conclusions For the treatment of impacted ureteral stones in children, holmium laser lithotripsy with semi-rigid ureteroscopy, with its low retreatment requirement and acceptable complication rates, is an effective and reliable method in experienced and skilled hands as a first-choice treatment approach. PMID:25415256

  18. 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

  19. Fiber optic muzzle brake tip for reducing fiber burnback and stone retropulsion during thulium fiber laser lithotripsy

    NASA Astrophysics Data System (ADS)

    Hutchens, Thomas C.; Gonzalez, David A.; Irby, Pierce B.; Fried, Nathaniel M.

    2017-01-01

    The experimental thulium fiber laser (TFL) is being explored as an alternative to the current clinical gold standard Holmium:YAG laser for lithotripsy. The near single-mode TFL beam allows coupling of higher power into smaller optical fibers than the multimode Holmium laser beam profile, without proximal fiber tip degradation. A smaller fiber is desirable because it provides more space in the ureteroscope working channel for increased saline irrigation rates and allows maximum ureteroscope deflection. However, distal fiber tip burnback increases as fiber diameter decreases. Previous studies utilizing hollow steel sheaths around recessed distal fiber tips reduced fiber burnback but increased stone retropulsion. A "fiber muzzle brake" was tested for reducing both fiber burnback and stone retropulsion by manipulating vapor bubble expansion. TFL lithotripsy studies were performed at 1908 nm, 35 mJ, 500 μs, and 300 Hz using a 100-μm-core fiber. The optimal stainless steel muzzle brake tip tested consisted of a 1-cm-long, 560-μm-outer-diameter, 360-μm-inner-diameter tube with a 275-μm-diameter through hole located 250 μm from the distal end. The fiber tip was recessed a distance of 500 μm. Stone phantom retropulsion, fiber tip burnback, and calcium oxalate stone ablation studies were performed ex vivo. Small stones with a mass of 40±4 mg and 4-mm-diameter were ablated over a 1.5-mm sieve in 25±4 s (n=10) without visible distal fiber tip burnback. Reduction in stone phantom retropulsion distance by 50% and 85% was observed when using muzzle brake tips versus 100-μm-core bare fibers and hollow steel tip fibers, respectively. The muzzle brake fiber tip simultaneously provided efficient stone ablation, reduced stone retropulsion, and minimal fiber degradation during TFL lithotripsy.

  20. 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.

  1. A comparison of Stone Cone versus lidocaine jelly in the prevention of ureteral stone migration during ureteroscopic lithotripsy

    PubMed Central

    Bastawisy, Mohamed; Gameel, Tarek; Radwan, Mohamed; Ramadan, Ahmed; Alkathiri, Mutie; Omar, Adel

    2011-01-01

    Background: Intracorporeal lithotripsy modalities and stone removal devices have been created to facilitate endoscopic management of ureteral stones. These devices, along with improved techniques, have resulted in stone-free rates greater than 95% with low morbidity. However, problems remain that preclude consistent 100% stone-free rates with endoscopic treatment of ureteral calculi. Retrograde migration during ureteroscopic procedures remains a significant problem. Objectives: The aim of this study was to compare the Stone Cone device and instillation of lubricating lidocaine jelly as two methods to prevent retrograde stone migration during ureteroscopic lithotripsy. Patients and methods: This study included patients suffering from ureteral stones that were treated with intracorporeal lithotripsy using the pneumatic Lithoclast. These patients were divided into two groups. In group I, the Stone Cone device was used, while in group II, lidocaine jelly 2% concentration was used. Results: This study included 40 patients with a mean age of 38.6 ± 9.3 years (20 patients in each group). There was no significant difference between the groups with regards to stone site, size or state of the upper urinary tract by excretory urography. The pneumatic Lithoclast allowed successful fragmentation of all calculi into small fragments. Upward stone migration did not occur in patients in the Stone Cone group, while in the lidocaine jelly group it occurred in three patients (15%). The operative time in the Stone Cone group ranged between 30 and 55 minutes (mean, 41.8 ± 5.3), while in the lidocaine jelly group it ranged between 40 and 71 minutes (mean, 51.4 ± 3.4), and this difference was statistically significant (p < 0.05). Conclusion: The Stone Cone is safe and efficient in preventing proximal stone migration during ureteroscopic pneumatic lithotripsy. It maintained continuous ureteral access and demonstrated a statistically significant advantage over the

  2. Air bubble-shock wave interaction adjacent to gelantine surface

    NASA Astrophysics Data System (ADS)

    Lush, P. A.; Tomita, Y.; Onodera, O.; Takayama, K.; Sanada, N.; Kuwahara, M.; Ioritani, N.; Kitayama, O.

    1990-07-01

    The interaction between a shock wave and an air bubble-adjacent to a gelatine surface is investigated in order to simulate human tissue damage resulting from extracorporeal shock wave lithotripsy. Using high speed cine photography it is found that a shock wave of strength 11 MPa causes 1-3 mm diameter bubbles to produce high velocity microjets with penetration rates of approximately 110 m/s and penetration depths approximately equal to twice the initial bubble diameter. Theoretical considerations for liquid impact on soft solid of similar density indicate that microjet velocities will be twice the penetration rate, i.e. 220 m/s in the present case. Such events are the probable cause of observed renal tissue damage.

  3. [Percutaneous nephrolitholapaxy combined with extracorporeal shockwave lithotripsy in the treatment of staghorn lithiasis].

    PubMed

    Larrea Masvidal, E; García Serrano, C; Castillo Rodríguez, M; Hernández Silverio, D; Casals Armada, J; Valdés Gómez, C; Báez Hernández, D

    1990-05-01

    From December, 1988 to July, 1989, 41 patients with renal or juxtapyelic ureteral calculi were submitted to percutaneous litholapaxy (PCN) at the Stone Center of the Hermanos Amerijeiras Hospital in Havana. This series comprise our early experience utilizing this procedure. PCN was initially limited to pelvic and juxtapyelic ureteric calculi with dilated renal cavities. It was subsequently used in combination with extracorporeal lithotripsy (ESWL) in the treatment of staghorn stones. The present study analyzed the results achieved with PCN in 30 patients with staghorn calculi; 21 (70%) incomplete staghorns and 9 (30%) complete staghorns. Posteriorly, 6 additional borderline staghorns were completely removed by PCN and are not included in the present study. PCN was performed to reduce stone mass and for placement of a large renal drain to permit subsequent ESWL. At two months following treatment, 86.6% of the patients were completely stone-free. The remaining 13.4% with stone remnants presented anatomic and functional renal conditions that allow us to predict complete elimination within a short period of time. Since 6 months had not elapsed in these cases, these were not considered as residual fragments. One patient presented massive absorption of fluids. This was the only observed major and non-lethal complication. Episodes of fever were observed in 23% post-PCN. No patient presented severe sepsis. In our view, PCN combined with ESWL is one of the currently available therapeutic options in the treatment of staghorn calculi. This approach permits adequate resolution of cases that would have otherwise required surgery.

  4. 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

  5. Single-session ureteroscopy with holmium laser lithotripsy for multiple stones.

    PubMed

    Takazawa, Ryoji; Kitayama, Sachi; Tsujii, Toshihiko

    2012-12-01

    Multiple stones are found in 20-25% of patients with urolithiasis. The stone multiplicity is a powerful adverse factor influencing the treatment outcome after shockwave lithotripsy, although guidelines for the treatment of multiple stones have not been well established yet. Herein we report our most recent experience of a single-session ureteroscopy for multiple stones. Between September 2008 and December 2011, 51 patients with multiple stones (total 146 stones) in different locations (37unilateral, 14 bilateral) underwent a total of 65 ureteroscopic procedures. Operative time, stone-free rates and complications were evaluated. Stone-free status was defined as no fragments in the ureter and the absence of >2 mm fragments in the kidney. The mean stone number per patient was 2.9 ± 1.7 and the mean stone burden (cumulative stone length) was 21.5 ± 11.6 mm. The mean number of procedures was 1.3 ± 0.6. Overall, the stone-free rate after a single session was 80% (41/51). In patients with stone burden <20 mm and ≥20 mm, stone-free rates after a single session were 92% (23/25) and 69% (18/26), respectively. Multivariate analysis showed that the stone burden and the presence of impacted stones were the factors significantly influencing the treatment outcome. Stone location did not have a strong influence on the outcome. No major intraoperative complications were identified. Our findings suggest that ureteroscopy is an efficient treatment for multiple stones. For patients with stone burden <20 mm, either unilaterally or bilaterally, a single session of ureteroscopy is a favorable treatment option with a high stone-free rate.

  6. An integrated fiber and stone basket device for use in Thulium fiber laser lithotripsy

    NASA Astrophysics Data System (ADS)

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

    2014-03-01

    The Thulium fiber laser (TFL) is being explored as an alternative laser lithotripter to the Holmium:YAG laser. The TFL's superior near-single mode beam profile enables higher power transmission through smaller fibers with reduced proximal fiber tip damage. Recent studies have also reported that attaching hollow steel tubing to the distal fiber tip decreases fiber degradation and burn-back without compromising stone ablation rates. However, significant stone retropulsion was observed, which increased with pulse rate. In this study, the hollow steel tip fiber design was integrated with a stone basket to minimize stone retropulsion during ablation. A device was constructed consisting of a 100-μm-core, 140-μm-OD silica fiber outfitted with 5-mm-long stainless steel tubing at the distal tip, and integrated with a 1.3-Fr (0.433-mm-OD) disposable nitinol wire basket, to form an overall 1.9-Fr (0.633-mm- OD) integrated device. This compact design may provide several potential advantages including increased flexibility, higher saline irrigation rates through the ureteroscope working channel, and reduced fiber tip degradation compared to separate fiber and stone basket manipulation. TFL pulse energy of 31.5 mJ with 500 μs pulse duration and pulse rate of 500 Hz was delivered through the integrated fiber/basket device in contact with human uric acid stones, ex vivo. TFL stone ablation rates measured 1.5 +/- 0.2 mg/s, comparable to 1.7 +/- 0.3 mg/s (P > 0.05) using standard bare fiber tips separately with a stone basket. With further development, this device may be useful for minimizing stone retropulsion, thus enabling more efficient TFL lithotripsy at higher pulse rates.

  7. 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.

  8. [Stone Cone® in ureteroscopic ballistic lithotripsy of proximal ureteral stones].

    PubMed

    Arancio, M; Guglielmetti, S; Delsignore, A; Landi, A; Marchetti, C; Mina, A; Marcato, M; Martinengo, C

    2008-01-01

    Stone Cone® (Microvasive-Boston Scientific Corp, USA) is a device which prevents retrograde calculus migration during endoscopic ureterolithotripsy. We have studied the safety and efficacy of this device in endoscopic ureterolithotripsy with ballistic energy in proximal ureteral stones. MATERIALS AND METHODS. From 01/02/2006 to 01/02/2008 we carried out 36 ureterorenoscopies (URS) for proximal ureteral stones (average age: 46, range: 15-73). A ballistic energy was used for stones fragmentation. In 18 patients (Group A) we carried out URS with the aid of Stone Cone®, which was not used in the other 18 patients (Group B). Semirigid 8 Ch or 10 Ch Storz ureteroscope and ballistic lithotriptor Swiss Lithoclast Master EMS® were used. In cases of migration, edema, and ureteral damage, a ureteral stent was used. RESULTS. In Group B patients (URS performed without Stone Cone®) the migration of the whole stone, or of clinically significant fragments, occurred 8 times (45%). All of these patients underwent external shockwave lithotripsy (ESWL) at a center equipped with a lithotriptor. A ureteral stent was placed in 14 cases (78%). In Group A, the migration of a stone requiring ESWL treatment occurred only once (5%). The ureteral stent was placed 8 times (45%). We had no significant complications during the procedure. CONCLUSIONS. The Stone Cone® is a safe and easy-to-use device. The cost of this device can be balanced by the reduction of postoperative ESWL treatments for lithiasic fragments pushing up into the kidneys (p<0.01), and of ureteral stent applications at the end of the procedure (p<0.05).

  9. Minimally invasive surgical treatment for large impacted upper ureteral stones: Ureteroscopic lithotripsy or percutaneous nephrolithotomy?

    PubMed Central

    Bozkurt, Ibrahim Halil; Yonguc, Tarik; Arslan, Burak; Degirmenci, Tansu; Gunlusoy, Bulent; Aydogdu, Ozgu; Koras, Omer

    2015-01-01

    Introduction: The management of patients with large impacted upper ureteral stones is difficult; there is no standard treatment. We compared the outcomes of percutaneous nephrolithotomy (PCNL) and ureteroscopic lithotripsy (UL) to treat large (≥1.5 cm), impacted, upper ureteral stones. Methods: In total, 86 patients with large impacted upper ureteral stones were included in this study. Of these patients 41 underwent UL and 45 underwent PCNL. The inclusion criteria were: longest diameter of stone ≥1.5 cm, the localization of stone between the lower border of L4 spine and ureteropelvic junction and impacted stone. Results: In the UL group, we were unable to reach the stone in 3 patients because of ureteral stricture and edema despite balloon dilation. Of these 3 patients, we were unable to optimally visualize the stone in 2 patients due to bleeding and mucosal injury following balloon dilation. The stricture was too firm and could not be passed in the third patient. Also in the UL group, 15 patients had stones or big fragments which migrated into the renal collecting system. In the PCNL group, 21 patients had concurrent renal stones <1 cm and stones were successfully removed in all patients. No statistically significant difference was found between groups in terms of operation time. Mean hospital stay was significantly shorter in the UL group. Success rates were 82.3% in the UL group and 97.6% in the PCNL group (p = 0.001). Conclusion: The recent study confirms that PCNL is a safe and effective minimally invasive procedure with acceptable complication rates in the treatment of patients with large, impacted upper ureteral stones. PMID:25844097

  10. Hollow steel tips for reducing distal fiber burn-back during thulium fiber laser lithotripsy.

    PubMed

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

    2013-07-01

    The use of thulium fiber laser (TFL) as a potential alternative laser lithotripter to the clinical holmium:YAG laser is being studied. The TFL's Gaussian spatial beam profile provides efficient coupling of higher laser power into smaller core fibers without proximal fiber tip degradation. Smaller fiber diameters are more desirable, because they free up space in the single working channel of the ureteroscope for increased saline irrigation rates and allow maximum ureteroscope deflection. However, distal fiber tip degradation and "burn-back" increase as fiber diameter decreases due to both excessive temperatures and mechanical stress experienced during stone ablation. To eliminate fiber tip burn-back, the distal tip of a 150-μm core silica fiber was glued inside 1-cm-long steel tubing with fiber tip recessed 100, 250, 500, 1000, or 2000 μm inside the steel tubing to create the hollow-tip fiber. TFL pulse energy of 34 mJ with 500-μs pulse duration and 150-Hz pulse rate was delivered through the hollow-tip fibers in contact with human calcium oxalate monohydrate urinary stones during ex vivo studies. Significant fiber tip burn-back and degradation was observed for bare 150-μm core-diameter fibers. However, hollow steel tip fibers experienced minimal fiber burn-back without compromising stone ablation rates. A simple, robust, compact, and inexpensive hollow fiber tip design was characterized for minimizing distal fiber burn-back during the TFL lithotripsy. Although an increase in stone retropulsion was observed, potential integration of the hollow fiber tip into a stone basket may provide rapid stone vaporization, while minimizing retropulsion.

  11. 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.

  12. Dynamical response of a bubble submitted to two following shock waves

    NASA Astrophysics Data System (ADS)

    Jullien, Marie-Caroline

    2002-11-01

    A numerical study of the dynamical response of a bubble submitted to two following shock waves is reported. After the passage of a shock wave, a micron-size bubble expands enormously, reaching millimeter size, and then inertially collapses; this is the so-called cavitation phenomenon. The influence of the passage of a second shock wave on the bubble inertial collapse control is investigated. This control may have a considerable impact for drug delivery or gene transfer, by the use of extracorporeal shock wave lithotripsy, which is a technique already used in medical treatment for kidney stones. It is shown that the dynamical response of the bubble qualitatively depends strongly on the forcing shape. Furthermore, for a given forcing shape, the dynamical response depends on both the delay and forcing amplitude ratio between the two applied shock waves. [This work has been done in collaboration with Ruediger Toegel, Claus-Dieter Ohl, and Detlef Lohse (Twente University).

  13. Suppression of shocked-bubble expansion due to tissue confinement with application to shock-wave lithotripsy

    PubMed Central

    Freund, Jonathan B.

    2008-01-01

    Estimates are made of the effect of tissue confinement on the response of small bubbles subjected to lithotriptor shock pressures. To do this the Rayleigh–Plesset equation, which governs the dynamics of spherical bubbles, is generalized to treat a bubble in a liquid region (blood), which is in turn encased within an elastic membrane (like a vessel’s basement membrane), beyond which a Voigt viscoelastic material models the exterior tissue. Material properties are estimated from a range of measurements available for kidneys and similar soft tissues. Special attention is given to the constitutive modeling of the basement membranes because of their expected importance due to their proximity to the bubble and their toughness. It is found that the highest expected values for the elasticity of the membrane and surrounding tissue are insufficient to suppress bubble growth. The reduced confinement of a cylindrical vessel should not alter this conclusion. Tissue viscosities taken from ultrasound measurements suppress bubble growth somewhat, though not to a degree expected to resist injury. However, the higher reported viscosities measured by other means, which are arguably more relevant to the deformations caused by growing bubbles, do indeed significantly suppress bubble expansion. PMID:18529202

  14. In vitro investigations of repulsion during laser lithotripsy using a pendulum set-up.

    PubMed

    Sroka, Ronald; Haseke, Nicolas; Pongratz, Thomas; Hecht, Volkmar; Tilki, Derya; Stief, Christian G; Bader, Markus Jürgen

    2012-05-01

    Ureteroscopic laser lithotripsy is a commonly used technique to treat ureteral calculi.The type of energy source used is one of the main influences of retrograd calculi propulsion. Using a momentum pendulum under-water set-up the induced momentum and the initial velocity were investigated. Pulsed laser light from three different clinically available laser systems, including a Ho:YAG laser, a frequency-doubled double-pulse (second harmonic generation, SHG) Nd:YAG laser and a flash-lamp pumped dye (FLPD) laser, were transmitted via flexible fibres of different core diameter to the front of the pendulum sinker. Single pulses at variable pulse energy, according to the clinical laser parameter settings, were applied to the target sinker, thus causing a repulsion-induced deflection which was documented by video recording. The maximum deflection was determined. Solving the differential equation of a pendulum gives the initial velocity, the laser-induced momentum and the efficiency of momentum transfer. The induced deflection as well as the starting velocity of the two short-duration pulsed laser systems (SHG Nd:YAG, FLPD) were similar (s (max) = 2-3.6 cm and v (0) = 150-200 mm/s, respectively), whereas both values were lower using the Ho:YAG laser with a long pulse duration (s (max) = 0.9--1.6 cm and v (0) = 60-105 mm/s, respectively). The momentum I induced by the Ho:YAG laser was only 50% and its transfer efficacy η (Repuls) was reduced to less than 5% of the values of the two short-pulsed laser systems. This investigation clearly showed the variable parts and amounts of repulsion using different pulsed lasers in an objective and reproducible manner. The momentum transfer efficiency could be determined without any physical friction problems. Further investigations are needed to compare stone fragmentation techniques with respect to laser repulsion and its clinical impact.

  15. Rigid ureteroscopic lithotripsy versus percutaneous nephrolithotomy for large proximal ureteral stones: A meta-analysis

    PubMed Central

    Hu, Henglong; Lu, Yuchao; Zhang, Jiaqiao; Qin, Baolong; Wang, Yufeng; Zhang, Zongbiao

    2017-01-01

    Object To compare the safety and efficacy of rigid ureteroscopic lithotripsy (rigid URSL) and percutaneous nephrolithotomy (PCNL) in treating large proximal ureteral stones. Methods A systematic search of PubMed, EMBASE, Cochrane Library, and Web of Science databases was performed to find out relevant studies. After literature screening according to the predetermined inclusion and exclusion criteria, data of eligible studies was extracted and then a meta-analysis was conducted via RevMan 5.3 software. Results Five randomized controlled trials (RCTs), one prospective and four retrospective cohort studies involving 837 patients were included. Patients underwent rigid URSL were associated with shorter operation time (WMD, -23.66min; 95%CI, −45.00 to -2.32; p = 0.03), shorter hospital stay (WMD, -2.76d; 95%CI, −3.51 to −2.02; p< 0.00001), lower 3rd-day (RR, 0.73; 95%CI, 0.66 to 0.82; p < 0.00001) and 1st-month (RR, 0.82; 95%CI, 0.77 to 0.87; p < 0.00001) stone-free rate, higher risk of conversion to other surgical procedures (RR, 4.28; 95%CI, 1.93 to 9.46; p = 0.0003), higher incidence of migration (RR, 28.49; 95%CI, 9.12 to 89.00; p < 0.00001) and ureteral perforation (RR, 6.06; 95%CI, 1.80 to 20.44; p = 0.004), lower risk of fever (RR, 0.64; 95%CI, 0.42 to 0.97; p = 0.04), transfusion (RR, 0.19; 95%CI, 0.04 to 0.85; p = 0.03) and hematuria (RR, 0.38; 95%CI, 0.25 to 0.57; p < 0.0001). No significant difference was observed in terms of incidence of embolization, pain and ureterostenosis. When cohort studies or studies in which flexible ureteroscopy was used as an intraoperative auxiliary procedure were excluded, we both found that most of the results kept stable. Conclusions Both PCNL and rigid URSL are safe for patients with large proximal ureteral stones while PCNL is more effective in stone clearance. PMID:28182718

  16. [Biochemical evaluation of renal lesions produced by electrohydraulic shock waves].

    PubMed

    Rodriguez Vela, L; Abadia Bayona, T; Lazaro Castillo, J; Guallar Labrador, A; Rioja Sanz, C; Rioja Sanz, L A

    1995-01-01

    The authors present a biochemical study of the renal lesions produced during extracorporeal electrohydraulic shock wave lithotripsy (ESWL). The sequential variation (before and after ESWL) of various biochemical parameters of the blood and 24-hour urine was analysed in 50 patients. A significant increase of urinary N-Acetyl-Glucosaminidase (NAG), urinary NAG/urinary creatinine quotient, proteinuria, serum creatinine and potassium was detected during the 24 hours following ESWL. A significant fall in creatinine clearance, urinary osmolarity and uric acid clearance was also detected. A positive correlation was observed between these alterations, the number of shocks and the kilovoltage used. On the 7th and 15th days, no significant difference was observed compared to the baseline values before ESWL. This can be explained by the fact that the lesions caused by shock waves are already in the repair phase.

  17. Development of a system of automatic gap-adjusted electrodes for shock wave generators

    NASA Astrophysics Data System (ADS)

    Manousakas, Ioannis; Liang, Shen-Min; Wan, Long-Ray; Wang, Chia-Hui

    2004-11-01

    In this study, a system of automatic gap-adjusted electrodes is developed for electrohydraulic shock wave generators that can be used both for extracorporeal shock wave lithotripsy (treatment of renal calculi) and for the extracorporeal shock wave therapy for musculo-skeletal disorders. This system is composed of three main components: (1) two electrodes and their bases; (2) servo motors and control software; (3) a high sensitivity CCD camera and image processing program. To verify system performance, in vitro fragmentation tests have been conducted using kidney stone phantoms. Results indicate that the efficiency of stone fragmentation using automatic gap adjustment can be increased up to 55.2%, which is twice more than without automatic gap adjustment (26.7%). This system can be applied to any commercial electrohydraulic extracorporeal shock wave lithotriptor or orthotriptor without difficulty.

  18. Functional and histologic alterations in growing solitary rat kidney as result of extracorporeal shockwaves.

    PubMed

    Ferreira, U; Claro, J de A; Rodrigues Netto, N; Denardi, F; Figueiredo, J F; Riccetto, C L

    1995-02-01

    The long-term effects of extracorporeal shockwave lithotripsy (SWL) on children treated for renal calculi are unclear. To study the effects on the immature animal, we evaluated 31 Wistar white rats that underwent right nephrectomy at 30 days of age. At 40 days of age they were divided into three groups: a control group of 10 rats that received no shockwaves; Group I (9 rats) that received 1000 shockwaves at 16.0 kV, and Group II (12 animals) that received 1000 shock waves at 17.2 kV. Six months later at maturity (7 months and 10 days of age), the following parameters were measured: (1) body and renal weight; (2) blood lithium, sodium, potassium, and creatinine; (3) fractional lithium, sodium, and potassium excretion; and (4) clearances of lithium and creatinine. The kidneys were studied grossly and histologically. We found no significant changes in overall animal and renal growth between the post-SWL and control groups. However, there were significant changes in renal function. The animals in Groups I and II presented significant increases in blood potassium compared with the control group. Furthermore, the 1000 x 17.2 kV group showed permanent histologic renal changes, including red cells in Bowman's capsule and glomerular congestion. The disorders caused by SWL are compatible with hyporeninemic hypoaldosteronism, inappropriately low plasma renin activity, and aldosterone deficiency.(ABSTRACT TRUNCATED AT 250 WORDS)

  19. Characterization of calculus migration during Ho:YAG laser lithotripsy by high speed camera using suspended pendulum method

    NASA Astrophysics Data System (ADS)

    Zhang, Jian James; Rajabhandharaks, Danop; Xuan, Jason Rongwei; Chia, Ray W. J.; Hasenberg, Tom

    2014-03-01

    Calculus migration is a common problem during ureteroscopic laser lithotripsy procedure to treat urolithiasis. A conventional experimental method to characterize calculus migration utilized a hosting container (e.g. a "V" grove or a test tube). These methods, however, demonstrated large variation and poor detectability, possibly attributing to friction between the calculus and the container on which the calculus was situated. In this study, calculus migration was investigated using a pendulum model suspended under water to eliminate the aforementioned friction. A high speed camera was used to study the movement of the calculus which covered zero order (displacement), 1st order (speed) and 2nd order (acceleration). A commercialized, pulsed Ho:YAG laser at 2.1 um, 365-um core fiber, and calculus phantom (Plaster of Paris, 10×10×10mm cube) were utilized to mimic laser lithotripsy procedure. The phantom was hung on a stainless steel bar and irradiated by the laser at 0.5, 1.0 and 1.5J energy per pulse at 10Hz for 1 second (i.e., 5, 10, and 15W). Movement of the phantom was recorded by a high-speed camera with a frame rate of 10,000 FPS. Maximum displacement was 1.25+/-0.10, 3.01+/-0.52, and 4.37+/-0.58 mm for 0.5, 1, and 1.5J energy per pulse, respectively. Using the same laser power, the conventional method showed <0.5 mm total displacement. When reducing the phantom size to 5×5×5mm (1/8 in volume), the displacement was very inconsistent. The results suggested that using the pendulum model to eliminate the friction improved sensitivity and repeatability of the experiment. Detailed investigation on calculus movement and other causes of experimental variation will be conducted as a future study.

  20. Calculus migration characterization during Ho:YAG laser lithotripsy by high-speed camera using suspended pendulum method.

    PubMed

    Zhang, Jian James; Rajabhandharaks, Danop; Xuan, Jason Rongwei; Chia, Ray W J; Hasenberg, Thomas

    2017-04-12

    Calculus migration is a common problem during ureteroscopic laser lithotripsy procedure to treat urolithiasis. A conventional experimental method to characterize calculus migration utilized a hosting container (e.g., a "V" grove or a test tube). These methods, however, demonstrated large variation and poor detectability, possibly attributed to the friction between the calculus and the container on which the calculus was situated. In this study, calculus migration was investigated using a pendulum model suspended underwater to eliminate the aforementioned friction. A high-speed camera was used to study the movement of the calculus which covered zero order (displacement), first order (speed), and second order (acceleration). A commercialized, pulsed Ho:YAG laser at 2.1 μm, a 365-μm core diameter fiber, and a calculus phantom (Plaster of Paris, 10 × 10 × 10 mm(3)) was utilized to mimic laser lithotripsy procedure. The phantom was hung on a stainless steel bar and irradiated by the laser at 0.5, 1.0, and 1.5 J energy per pulse at 10 Hz for 1 s (i.e., 5, 10, and 15 W). Movement of the phantom was recorded by a high-speed camera with a frame rate of 10,000 FPS. The video data files are analyzed by MATLAB program by processing each image frame and obtaining position data of the calculus. With a sample size of 10, the maximum displacement was 1.25 ± 0.10, 3.01 ± 0.52, and 4.37 ± 0.58 mm for 0.5, 1, and 1.5 J energy per pulse, respectively. Using the same laser power, the conventional method showed <0.5 mm total displacement. When reducing the phantom size to 5 × 5 × 5 mm(3) (one eighth in volume), the displacement was very inconsistent. The results suggested that using the pendulum model to eliminate the friction improved sensitivity and repeatability of the experiment. A detailed investigation on calculus movement and other causes of experimental variation will be conducted as a future study.

  1. A Miniaturized, 1.9F Integrated Optical Fiber and Stone Basket for Use in Thulium Fiber Laser Lithotripsy.

    PubMed

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

    2015-10-01

    The thulium fiber laser (TFL) is being explored as an alternative laser lithotripter to the standard holmium:yttrium-aluminum-garnet laser. The more uniform beam profile of the TFL enables higher power transmission through smaller fibers. In this study, a 100-μm core, 140-μm outer-diameter (OD) silica fiber with 5-mm length hollow steel tip was integrated with 1.3F (0.433-mm OD) nitinol wire basket to form a 1.9F (0.633-mm OD) device. TFL energy of 30 mJ, 500 μs pulse duration, and 500 Hz pulse rate was delivered to human uric acid stones, ex vivo. Stone ablation rates measured 1.5 ± 0.2 mg/s, comparable to 1.7 ± 0.3 mg/s using bare fiber tips separately with stone basket. With further development, this device may minimize stone retropulsion, allowing more efficient TFL lithotripsy at higher pulse rates. It may also provide increased flexibility, higher saline irrigation rates through the ureteroscope working channel, reduce fiber degradation compared with separate fiber and basket manipulation, and reduce laser-induced nitinol wire damage.

  2. "Dry lithotripsy" by a simple modification of the Chinese lithotripter KDE-1.

    PubMed

    Wu, W; Wu, H; Zhou, X M

    1990-01-01

    We report on the improved technique upon a water bath lithotripter. With a simple water balloon device added to the Chinese KDE-1 Type water bath lithotripter, an extracorporeal shock wave dry lithotripter has been developed. From June to December 1988, there were 300 cases of upper urinary tract calculi and gallbladder stone treated with this machine with excellent results and no severe complications. The improved technique would be made reference to change old water bath machines into dry (water balloon) machines.

  3. Kidney stone ablation times and peak saline temperatures during Holmium:YAG and Thulium fiber laser lithotripsy, in vitro, in a ureteral model

    NASA Astrophysics Data System (ADS)

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

    2015-02-01

    Using a validated in vitro ureter model for laser lithotripsy, the performance of an experimental Thulium fiber laser (TFL) was studied and compared to 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. TFL (λ = 1908 nm) was operated with 35 mJ, 500 μs, 150-500 Hz, and 100-μm-core fiber. Urinary stones (60% calcium oxalate monohydrate / 40% calcium phosphate), of uniform mass and diameter (4-5 mm) were laser ablated with fibers through a flexible video-ureteroscope under saline irrigation with flow rates of 22.7 ml/min and 13.7 ml/min for the TFL and Holmium laser, respectively. The temperature 3 mm from tube's center and 1 mm above mesh sieve was measured by a thermocouple and recorded during experiments. Total laser and operation times were recorded once all stone fragments passed through a 1.5-mm sieve. Holmium laser time measured 167 +/- 41 s (n = 12). TFL times measured 111 +/- 49 s, 39 +/- 11 s, and 23 +/- 4 s, for pulse rates of 150, 300, and 500 Hz (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. 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 reduced stone retropulsion, and may provide a clinical alternative to the conventional Holmium laser for lithotripsy.

  4. Obtaining patient feedback in an outpatient lithotripsy service is facilitated by use of a touch-screen tablet (iPad™) survey.

    PubMed

    Turney, B W; Reynard, J M

    2014-08-01

    There is now a requirement for every doctor in the UK to obtain patient feedback for revalidation. This can be an onerous and time-consuming task. The objective of this study was to evaluate a novel electronic patient feedback method in an outpatient lithotripsy service setting. Between September 2013 and January 2014, 100 patients attending an outpatient lithotripsy service in Oxford were asked to complete a selection of pre-approved NHS questions about the service they had received. Questions were presented on a tablet device (iPad™) and answered using the touch screen. Departmental staff were unaware of the questions in the survey. Patients were asked to complete the survey by an independent research nurse. Questions were created online in a free-to-use web-based survey application and presented on the tablet device in a user-friendly format via an application. Data were uploaded via wifi™ to the online system. Data were viewed, automatically analysed and displayed graphically. The age range of the patients surveyed was 20-80 years of age. All 100 patients completed the survey without difficulty. All patients answered every question. Data could be automatically viewed, analysed and presented graphically. This method of collecting patient feedback proved to be rapid and efficient. The feedback highlighted a high patient satisfaction with the lithotripsy service. A touch screen tablet device is an efficient and effective method of collecting truly objective patient feedback. This method of patient feedback could be employed in other clinical environments to collect data for revalidation purposes.

  5. [Extracorporeal shockwave lithotripsy on a clam shell fragment lodged in the ileocecal valve].

    PubMed

    Ramón Dalmau, M; Ibarz Servio, L; Mauri Cunill, A; Ruiz Marcellán, F J

    1994-03-01

    Herein we describe what may be the first case of ESWL used in the treatment of mechanical ileus caused by a fragment of clam shell lodged in the terminal ileum. The 66-year-old patient was referred by the emergency department with symptoms and signs of upper GI tract obstruction. ESWL with the modified Dornier HM3 was performed under neuroleptoanalgesia with the patient in the prone decubitus position. 1700 shock waves at 20 Kv were used to achieve fragmentation and restore intestinal transit, thus avoiding surgery.

  6. Water content contribution in calculus phantom ablation during Q-switched Tm:YAG laser lithotripsy.

    PubMed

    Zhang, Jian J; Rajabhandharaks, Danop; Xuan, Jason Rongwei; Wang, Hui; Chia, Ray W J; Hasenberg, Tom; Kang, Hyun Wook

    2015-01-01

    Q-switched (QS) Tm:YAG laser ablation mechanisms on urinary calculi are still unclear to researchers. Here, dependence of water content in calculus phantom on calculus ablation performance was investigated. White gypsum cement was used as a calculus phantom model. The calculus phantoms were ablated by a total 3-J laser pulse exposure (20 mJ, 100 Hz, 1.5 s) and contact mode with N=15 sample size. Ablation volume was obtained on average 0.079, 0.122, and 0.391  mm3 in dry calculus in air, wet calculus in air, and wet calculus in-water groups, respectively. There were three proposed ablation mechanisms that could explain the effect of water content in calculus phantom on calculus ablation performance, including shock wave due to laser pulse injection and bubble collapse, spallation, and microexplosion. Increased absorption coefficient of wet calculus can cause stronger spallation process compared with that caused by dry calculus; as a result, higher calculus ablation was observed in both wet calculus in air and wet calculus in water. The test result also indicates that the shock waves generated by short laser pulse under the in-water condition have great impact on the ablation volume by Tm:YAG QS laser.

  7. Comparison of holmium:YAG and thulium fiber laser lithotripsy: ablation thresholds, ablation rates, and retropulsion effects.

    PubMed

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

    2011-07-01

    The holmium:YAG (Ho:YAG) laser lithotriptor is capable of operating at high pulse energies, but efficient operation is limited to low pulse rates (∼10 Hz) during lithotripsy. On the contrary, the thulium fiber laser (TFL) is limited to low pulse energies, but can operate efficiently at high pulse rates (up to 1000 Hz). This study compares stone ablation threshold, ablation rate, and retropulsion for the two different Ho:YAG and TFL operation modes. The TFL (λ = 1908 nm) was operated with pulse energies of 5 to 35 mJ, 500-μs pulse duration, and pulse rates of 10 to 400 Hz. The Ho:YAG laser (λ = 2120 nm) was operated with pulse energies of 30 to 550 mJ, 350-μs pulse duration, and a pulse rate of 10 Hz. Laser energy was delivered through 200- and 270-μm-core optical fibers in contact mode with human calcium oxalate monohydrate (COM) stones for ablation studies and plaster-of-Paris stone phantoms for retropulsion studies. The COM stone ablation threshold for Ho:YAG and TFL measured 82.6 and 20.8 J∕cm(2), respectively. Stone retropulsion with the Ho:YAG laser linearly increased with pulse energy. Retropulsion with TFL was minimal at pulse rates less than 150 Hz, then rapidly increased at higher pulse rates. For minimal stone retropulsion, Ho:YAG operation at pulse energies less than 175 mJ at 10 Hz and TFL operation at 35 mJ at 100 Hz is recommended, with both lasers producing comparable ablation rates. Further development of a TFL operating with both high pulse energies of 100 to 200 mJ and high pulse rates of 100 to 150 Hz may also provide an alternative to the Ho:YAG laser for higher ablation rates, when retropulsion is not a primary concern.

  8. Comparison of holmium:YAG and thulium fiber laser lithotripsy: ablation thresholds, ablation rates, and retropulsion effects

    NASA Astrophysics Data System (ADS)

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

    2011-07-01

    The holmium:YAG (Ho:YAG) laser lithotriptor is capable of operating at high pulse energies, but efficient operation is limited to low pulse rates (~10 Hz) during lithotripsy. On the contrary, the thulium fiber laser (TFL) is limited to low pulse energies, but can operate efficiently at high pulse rates (up to 1000 Hz). This study compares stone ablation threshold, ablation rate, and retropulsion for the two different Ho:YAG and TFL operation modes. The TFL (λ = 1908 nm) was operated with pulse energies of 5 to 35 mJ, 500-μs pulse duration, and pulse rates of 10 to 400 Hz. The Ho:YAG laser (λ = 2120 nm) was operated with pulse energies of 30 to 550 mJ, 350-μs pulse duration, and a pulse rate of 10 Hz. Laser energy was delivered through 200- and 270-μm-core optical fibers in contact mode with human calcium oxalate monohydrate (COM) stones for ablation studies and plaster-of-Paris stone phantoms for retropulsion studies. The COM stone ablation threshold for Ho:YAG and TFL measured 82.6 and 20.8 J/cm2, respectively. Stone retropulsion with the Ho:YAG laser linearly increased with pulse energy. Retropulsion with TFL was minimal at pulse rates less than 150 Hz, then rapidly increased at higher pulse rates. For minimal stone retropulsion, Ho:YAG operation at pulse energies less than 175 mJ at 10 Hz and TFL operation at 35 mJ at 100 Hz is recommended, with both lasers producing comparable ablation rates. Further development of a TFL operating with both high pulse energies of 100 to 200 mJ and high pulse rates of 100 to 150 Hz may also provide an alternative to the Ho:YAG laser for higher ablation rates, when retropulsion is not a primary concern.

  9. High-speed photography during laser-based gall bladder stone lithotripsy

    NASA Astrophysics Data System (ADS)

    Kokaj, Jahja O.

    2001-04-01

    Shadowgraphy of gall bladder stone, which is held by a basket and immersed in a civete is performed. The exposure time is determined by the time of a N-Dye laser pulse used as a lightening source for photography. The shadowgram is projected in the objective of a camera which is connected to a microscope. The light coming from the laser, illuminates the civete collecting optical information of the stone and physical phenomena appearing above the stone. On top of the stone a tip of optical fiber is fixed, which is used for transmitting Ho:Yag laser power to the stone. Using a computer and time delay the laser pulses used for destruction and illumination are synchronized. Since the N-Dye laser pulse is pico-second range and the Ho:Yag laser pulse is in the range of micro-second, many image frames are obtained within the time of one pulse applied during the destruction. It is known that in the process of stone destruction several phenomena like plume, plasma, shock wave and bubble formation take place. However, the physical mechanism of the stone destruction is not yet completely understood. From the obtained results the above phenomena are studied which gives new information and clue for understanding some of the mentioned phenomena. The laser power which is guided by an optical fiber into the gall bladder or kidney of the human body can damage the living tissue and cause some serious health problems. For this reason the fiber needs to be oriented properly during the action of the laser power.

  10. Assessment of shock wave lithotripters via cavitation potential

    PubMed Central

    Iloreta, Jonathan I.; Zhou, Yufeng; Sankin, Georgy N.; Zhong, Pei; Szeri, Andrew J.

    2008-01-01

    A method to characterize shock wave lithotripters by examining the potential for cavitation associated with the lithotripter shock wave (LSW) has been developed. The method uses the maximum radius achieved by a bubble subjected to a LSW as a representation of the cavitation potential for that region in the lithotripter. It is found that the maximum radius is determined by the work done on a bubble by the LSW. The method is used to characterize two reflectors: an ellipsoidal reflector and an ellipsoidal reflector with an insert. The results show that the use of an insert reduced the −6 dB volume (with respect to peak positive pressure) from 1.6 to 0.4 cm3, the −6 dB volume (with respect to peak negative pressure) from 14.5 to 8.3 cm3, and reduced the volume characterized by high cavitation potential (i.e., regions characterized by bubbles with radii larger than 429 µm) from 103 to 26 cm3. Thus, the insert is an effective way to localize the potentially damaging effects of shock wave lithotripsy, and suggests an approach to optimize the shape of the reflector. PMID:19865493

  11. Optimization on the focusing of multiple shock waves

    NASA Astrophysics Data System (ADS)

    Qiu, Shi; Eliasson, Veronica

    2016-11-01

    Focusing of multiple shock waves can lead to extreme thermodynamic conditions, which are desired for applications like shock wave lithotripsy and inertial confinement fusion. To study shock focusing effects, multiple energy sources have been placed in a circular pattern around an intended target, while the distance between each source and the target is fixed. All the sources are set to release the same amount of energy at the same time in order to create multiple identical shock waves. The object is to optimize the thermodynamic conditions at the target by rearranging the initial placement of each source. However, dealing with this optimization problem can be challenging due to the high computational cost introduced by solving the Euler equations. To avoid this issue, both numerical and analytical methods have been applied to handle shock focusing more efficiently. A numerical method, an approximate theory named Geometrical Shock Dynamics (GSD), has been utilized to describe the motion of shock. Using an analytical method, a transition curve between regular and irregular reflection has been employed to predict shock interactions. Results show that computational cost can be reduced dramatically by combining GSD and a transition curve. In addition, optimization results based on varying initial setups is discussed.

  12. Wave turbulence

    NASA Astrophysics Data System (ADS)

    Nazarenko, Sergey

    2015-07-01

    Wave turbulence is the statistical mechanics of random waves with a broadband spectrum interacting via non-linearity. To understand its difference from non-random well-tuned coherent waves, one could compare the sound of thunder to a piece of classical music. Wave turbulence is surprisingly common and important in a great variety of physical settings, starting with the most familiar ocean waves to waves at quantum scales or to much longer waves in astrophysics. We will provide a basic overview of the wave turbulence ideas, approaches and main results emphasising the physics of the phenomena and using qualitative descriptions avoiding, whenever possible, involved mathematical derivations. In particular, dimensional analysis will be used for obtaining the key scaling solutions in wave turbulence - Kolmogorov-Zakharov (KZ) spectra.

  13. Modular flexible ureteroscopy and holmium laser lithotripsy for the treatment of renal and proximal ureteral calculi: A single-surgeon experience of 382 cases.

    PubMed

    Yan, Zejun; Xie, Guohai; Yuan, Hesheng; Cheng, Yue

    2015-10-01

    To determine the safety and efficacy of modular flexible ureteroscopy and holmium laser lithotripsy for the treatment of renal and proximal ureteral calculi, a retrospective chart review of a single surgeon's 3-year modular flexible ureteroscopy experience was performed. All of the patients were treated with modular flexible ureteroscopy and holmium laser lithotripsy by a single surgeon. Stone-free status was defined as no fragments or a single fragment ≤4 mm in diameter at the 3-month follow-up. The procedure number, operative time, stone-free rates, repeat usage of the multilumen catheter, and perioperative complications were documented. The present study included 215 male patients and 167 female patients, with an average age of 48.5±13.7 years (range, 17-84 years). The mean stone size was 11.5±4.1 mm (range, 4-28 mm), and the mean total stone burden was 17.5±5.7 mm (range 15-46 mm). A total of 305 patients (79.8%) had a stone burden ≤20 mm, and 77 patients (20.2%) had a stone burden >20 mm. The mean number of primary procedures was 1.3±0.2 (range, 1-3). The stone-free rate following the first and the second procedure was 73.4 and 86.9%, respectively. The mean postoperative hospital stay was 3.1±1.2 days (range, 2-6 days). The highest clearance rates were observed for proximal ureteral stones (100%) and renal pelvic stones (88.7%), whereas the lowest clearance rates were observed for lower calyx stones (76.7%) and multiple calyx stones (77.8%). The higher the initial stone burden, the lower the postoperative stone-free rate (≤20 vs. >20 mm; 89.8 vs. 75.3%). The overall complication rate was 8.1%. The results of the present study suggest that modular flexible ureteroscopy with holmium laser lithotripsy may be considered the primary method for the treatment of renal and proximal ureteral calculi in select patients, due to its acceptable efficacy, low morbidity, and relatively low maintenance costs.

  14. Gravity Waves

    Atmospheric Science Data Center

    2013-04-19

    article title:  Gravity Waves Ripple over Marine Stratocumulus Clouds ... Imaging SpectroRadiometer (MISR), a fingerprint-like gravity wave feature occurs over a deck of marine stratocumulus clouds. Similar ... that occur when a pebble is thrown into a still pond, such "gravity waves" sometimes appear when the relatively stable and stratified air ...

  15. Study of fiber-tip damage mechanism during Ho:YAG laser lithotripsy by high-speed camera and the Schlieren method

    NASA Astrophysics Data System (ADS)

    Zhang, Jian J.; Getzan, Grant; Xuan, Jason R.; Yu, Honggang

    2015-02-01

    Fiber-tip degradation, damage, or burn back is a common problem during the ureteroscopic laser lithotripsy procedure to treat urolithiasis. Fiber-tip burn back results in reduced transmission of laser energy, which greatly reduces the efficiency of stone comminution. In some cases, the fiber-tip degradation is so severe that the damaged fiber-tip will absorb most of the laser energy, which can cause the tip portion to be overheated and melt the cladding or jacket layers of the fiber. Though it is known that the higher the energy density (which is the ratio of the laser energy fluence over the cross section area of the fiber core), the faster the fiber-tip degradation, the damage mechanism of the fibertip is still unclear. In this study, fiber-tip degradation was investigated by visualization of shockwave, cavitation/bubble dynamics, and calculus debris ejection with a high-speed camera and the Schlieren method. A commercialized, pulsed Ho:YAG laser at 2.12 um, 273/365/550-um core fibers, and calculus phantoms (Plaster of Paris, 10x10x10 mm cube) were utilized to mimic the laser lithotripsy procedure. Laser energy induced shockwave, cavitation/bubble dynamics, and stone debris ejection were recorded by a high-speed camera with a frame rate of 10,000 to 930,000 fps. The results suggested that using a high-speed camera and the Schlieren method to visualize the shockwave provided valuable information about time-dependent acoustic energy propagation and its interaction with cavitation and calculus. Detailed investigation on acoustic energy beam shaping by fiber-tip modification and interaction between shockwave, cavitation/bubble dynamics, and calculus debris ejection will be conducted as a future study.

  16. Detecting cavitation in vivo from shock-wave therapy devices

    NASA Astrophysics Data System (ADS)

    Matula, Thomas J.; Yu, Jinfei; Bailey, Michael R.

    2005-04-01

    Extracorporeal shock-wave therapy (ESWT) has been used as a treatment for plantar faciitis, lateral epicondylitis, shoulder tendonitis, non-unions, and other indications where conservative treatments have been unsuccessful. However, in many areas, the efficacy of SW treatment has not been well established, and the mechanism of action, particularly the role of cavitation, is not well understood. Research indicates cavitation plays an important role in other ultrasound therapies, such as lithotripsy and focused ultrasound surgery, and in some instances, cavitation has been used as a means to monitor or detect a biological effect. Although ESWT can generate cavitation easily in vitro, it is unknown whether or not cavitation is a significant factor in vivo. The purpose of this investigation is to use diagnostic ultrasound to detect and monitor cavitation generated by ESWT devices in vivo. Diagnostic images are collected at various times during and after treatment. The images are then post-processed with image-processing algorithms to enhance the contrast between bubbles and surrounding tissue. The ultimate goal of this research is to utilize cavitation as a means for optimizing shock wave parameters such as amplitude and pulse repetition frequency. [Work supported by APL internal funds and NIH DK43881 and DK55674.

  17. Numerical Simulation of Bubble Dynamics in Deformable Vessels

    NASA Astrophysics Data System (ADS)

    Coralic, Vedran; Colonius, Tim

    2011-11-01

    The growth and collapse of cavitation bubbles has been implicated as a potential damage mechanism leading to the rupture of blood vessels in shock wave lithotripsy (SWL). While this phenomenon has been investigated numerically, the resulting simulations have often assumed some degree of symmetry and have often failed to include a large number of influential physics, such as viscosity, compressibility, surface tension, phase change and fluid-structure interactions. We present here our efforts to explore the role that cavitation bubbles play in the rupture of blood vessels in SWL and to improve upon the current state of the numerical approach. We have developed a three-dimensional, high-order accurate, shock- and interface-capturing, multicomponent flow algorithm that accounts for the effects of viscosity and surface tension. At this time, we omit any effects due to elasticity and instead, as a first step, model tissue as a viscous and stiffened gas. We discuss preliminary results for the Rayleigh and shock-induced collapse of a gas bubble within a blood vessel and characterize the increase in vessel deformation with increasing bubble confinement and proximity to the vessel wall. This research was supported by the National Institutes of Health grant No. 2PO1DK43881.

  18. In-vitro Comminution of Model Renal Calculi using Histotripsy

    PubMed Central

    Duryea, Alexander P.; Maxwell, Adam D.; Roberts, William W.; Xu, Zhen; Hall, Timothy L.; Cain, Charles A.

    2013-01-01

    Shock wave lithotripsy (SWL) suffers from the fact that it can produce residual stone fragments of significant size (>2 mm). Mechanistically, cavitation has been shown to play an important role in the reduction of such fragments to smaller debris. In this study we assessed the feasibility of using cavitationally-based pulsed ultrasound therapy (histotripsy) to erode kidney stones. Previous work has shown that histotripsy is capable of mechanically fractionating soft tissue into fine, acellular debris. Here, we investigated the potential for translating this technology to renal calculi through the use of a commonly accepted stone model, Ultracal-30 cement. Stones were sonicated using a 1-MHz focused transducer, with 5-cycle pulses delivered at a rate of 1 kHz. Pulses having peak negative pressures ranging from 3–21 MPa were tested. Results indicate that histotripsy is capable of effectively eroding the Ultracal-30 model, achieving an average stone erosion rate of 26 mg/min at maximum treatment pressure; substantial stone erosion was only observed in the presence of a dense cavitational bubble cloud. Sequential sieving of residual stone fragments indicated that debris produced by histotripsy was smaller than 100 μm in size, and treatment monitoring showed that both the cavitational bubble cloud and model stone appear as hyperechoic regions on B-mode imaging. These preliminary results indicate that histotripsy shows promise in its use for stone comminution, and an optimized erosion process may provide a potential adjunct to conventional SWL procedures. PMID:21622053

  19. Making waves

    NASA Astrophysics Data System (ADS)

    Kruse, Karsten

    2017-01-01

    Traveling waves propagating along surfaces play an important role for intracellular organization. Such waves can appear spontaneously in reaction-diffusion systems, but only few general criteria for their existence are known. Analyzing the dynamics of the Min proteins in Escherichia coli, Levine and Kessler (2016 New J. Phys. 18 122001) now identified a new mechanism for the emergence of traveling waves that relies on conservation laws. From their analysis one can expect traveling waves to be a generic feature of systems made of proteins that have a cytoplasmic and a membrane-bound state.

  20. [Influence of extracorporeal shock wave lithotripsy (ESWL) on renal function assessed by 99mTc-DMSA scintigraphy: comparative analysis between ESWL and percutaneous nephroureterolithotripsy (PNL)].

    PubMed

    Matsuura, H; Hioki, T; Sakurai, M; Arima, K; Yanagawa, M; Sugimura, Y; Tochigi, H; Kawamura, J; Kinoshita, N; Katoh, H

    1994-12-01

    99mTc-DMSA renal scintigraphy was utilized to investigate the influence of ESWL on renal function in comparison with that of PNL. In the beginning, the reproducibility of renal uptake rate by the scintigraphy was examined in eleven healthy volunteers under both non-diuretic and diuretic states. The renal uptake rate was shown to be sufficiently reproducible in the same person in the two different trials. However, the differences and the standard deviations were shown to be a few percentages, which were not statistically significant. Changes in the repeated renal uptake rate seem to indicate not only changes of renal function with the treatment but also some technical errors. Herein, to investigate changes in renal function of the therapeutic side, the uptake ratio rate (rate of uptake rate in the therapeutic side/uptake rate in the contral lateral side) was utilized instead of uptake rate. Renal scintigraphy was carried out in 48 patients with unilateral renal stones before and after ESWL or PNL monotherapy or the combined ESWL and PNL therapies. Within one week of treatment, the uptake ratio rate significantly decreased in patients with PNL or the combined ESWL and PNL, although DMSA uptake rate in the therapeutic side did not significantly changes. Neither renal uptake rate nor uptake ratio rate significantly changed after ESWL treatment. There was no significant difference in changes of uptake ratio rate between Siemens Lithostars Plus and the improved Dornier HM-3 lithotriptors. This study indicated that ESWL monotherapy did not affect the uptake ratio rate, although PNL monotherapy and the combined ESWL and PNL therapies may affect the uptake ratio rate to some extent.

  1. Developing mobile lithotripsy services.

    PubMed

    Kates, J A; Krella, J M; Schoen, E J

    1990-03-01

    Today's health care environment forces hospitals to seek competitive advantages over other providers in their area, yet circumstances and situations exist where cooperation among providers is the only way to ensure the effective and efficient provision of quality care to area residents. In the case of new and expensive medical technology, cooperation may be necessary to make state-of-the-art treatment modalities available to the patient population in an affordable manner. The role of outside consultants and legal counsel should not be overlooked. Independent consultants can be a valuable resource in dealing with planning agencies and in preparing a Certificate of Need. In addition, reputable firms can lend additional credibility to the conduct of feasibility studies and the preparation of financial projections. Continuity in terms of staffing and committee representatives is also extremely important. In a process that covered a three-and-one-half year time period, participants can lose sight of the original goals of the venture and even interest in the project. Hospitals and physicians in northeastern Pennsylvania combined to provide an alternative to surgical intervention for the removal of kidney stones. The process was a lengthy and complicated one, but one that resulted in a service which, above all, is of benefit to those affected by kidney stone disease. The delivery network currently includes seven facilities, five as partners and two on a fee-for-service basis, with an additional five making application to join the program in the future.(ABSTRACT TRUNCATED AT 250 WORDS)

  2. Nonlinear Waves

    DTIC Science & Technology

    1989-06-15

    following surprising situation. Namely associated with the integrable nonlinear Schrodinger equations are standard numerical schemes which exhibit at...36. An Initial Boundary Value Problem for the Nonlinear Schrodinger Equations , A.S. Fokas, Physica D March 1989. 37. Evolution Theory, Periodic... gravity waves and wave excitation phenomena related to moving pressure distributions; numerical approximation and computation; nonlinear optics; and

  3. Microfluidic waves

    PubMed Central

    Utz, Marcel; Begley, Matthew R.; Haj-Hariri, Hossein

    2012-01-01

    The propagation of pressure waves in fluidic channels with elastic covers is discussed in view of applications to flow control in microfluidic devices. A theory is presented which describes pressure waves in the fluid that are coupled to bending waves in the elastic cover. At low frequencies, the lateral bending of the cover dominates over longitudinal bending, leading to propagating, non-dispersive longitudinal pressure waves in the channel. The theory addresses effects due to both the finite viscosity and compressibility of the fluid. The coupled waves propagate without dispersion, as long as the wave length is larger than the channel width. It is shown that in channels of typical microfluidic dimensions, wave velocities in the range of a few 10 m s−1 result if the channels are covered by films of a compliant material such as PDMS. The application of this principle to design microfluidic band pass filters based on standing waves is discussed. Characteristic frequencies in the range of a few kHz are readily achieved with quality factors above 30. PMID:21966667

  4. Development of laser-induced grating spectroscopy for underwater temperature measurement in shock wave focusing regions

    NASA Astrophysics Data System (ADS)

    Gojani, Ardian B.; Danehy, Paul M.; Alderfer, David W.; Saito, Tsutomu; Takayama, Kazuyoshi

    2004-02-01

    In Extracorporeal Shock Wave Lithotripsy (ESWL) underwater shock wave focusing generates high pressures at very short duration of time inside human body. However, it is not yet clear how high temperatures are enhanced at the spot where a shock wave is focused. The estimation of such dynamic temperature enhancements is critical for the evaluation of tissue damages upon shock loading. For this purpose in the Interdisciplinary Shock Wave Research Center a technique is developed which employs laser induced thermal acoustics or Laser Induced Grating Spectroscopy. Unlike most of gas-dynamic methods of measuring physical quantities this provides a non-invasive one having spatial and temporal resolutions of the order of magnitude of 1.0 mm 3 and 400 ns, respectively. Preliminary experiments in still water demonstrated that this method detected sound speed and hence temperature in water ranging 283 K to 333 K with errors of 0.5%. These results are used to empirically establish the equation of states of water, gelatin or agar cell which will work as alternatives of human tissues.

  5. Development of Laser-induced Grating Spectroscopy for Underwater Temperature Measurement in Shock Wave Focusing Regions

    NASA Technical Reports Server (NTRS)

    Gojani, Ardian B.; Danehy, Paul M.; Alderfer, David W.; Saito, Tsutomu; Takayama, Kazuyoshi

    2003-01-01

    In Extracorporeal Shock Wave Lithotripsy (ESWL) underwater shock wave focusing generates high pressures at very short duration of time inside human body. However, it is not yet clear how high temperatures are enhanced at the spot where a shock wave is focused. The estimation of such dynamic temperature enhancements is critical for the evaluation of tissue damages upon shock loading. For this purpose in the Interdisciplinary Shock Wave Research Center a technique is developed which employs laser induced thermal acoustics or Laser Induced Grating Spectroscopy. Unlike most of gasdynamic methods of measuring physical quantities this provides a non-invasive one having spatial and temporal resolutions of the order of magnitude of 1.0 mm3 and 400 ns, respectively. Preliminary experiments in still water demonstrated that this method detected sound speed and hence temperature in water ranging 283 K to 333 K with errors of 0.5%. These results may be used to empirically establish the equation of states of water, gelatin or agar cells which will work as alternatives of human tissues.

  6. Gravity waves

    NASA Technical Reports Server (NTRS)

    Fritts, David

    1987-01-01

    Gravity waves contributed to the establishment of the thermal structure, small scale (80 to 100 km) fluctuations in velocity (50 to 80 m/sec) and density (20 to 30%, 0 to peak). Dominant gravity wave spectrum in the middle atmosphere: x-scale, less than 100 km; z-scale, greater than 10 km; t-scale, less than 2 hr. Theorists are beginning to understand middle atmosphere motions. There are two classes: Planetary waves and equatorial motions, gravity waves and tidal motions. The former give rise to variability at large scales, which may alter apparent mean structure. Effects include density and velocity fluctuations, induced mean motions, and stratospheric warmings which lead to the breakup of the polar vortex and cooling of the mesosphere. On this scale are also equatorial quasi-biennial and semi-annual oscillations. Gravity wave and tidal motions produce large rms fluctuations in density and velocity. The magnitude of the density fluctuations compared to the mean density is of the order of the vertical wavelength, which grows with height. Relative density fluctuations are less than, or of the order of 30% below the mesopause. Such motions may cause significant and variable convection, and wind shear. There is a strong seasonal variation in gravity wave amplitude. Additional observations are needed to address and quantify mean and fluctuation statistics of both density and mean velocity, variability of the mean and fluctuations, and to identify dominant gravity wave scales and sources as well as causes of variability, both temporal and geographic.

  7. Moreton Waves

    NASA Technical Reports Server (NTRS)

    Thompson, B. J.

    1999-01-01

    "Moreton waves," named for the observer who popularized them, are a solar phenomenon also known in scientific literature as "Moreton-Ramsey wave," "flare waves," "flare-associated waves," "MHD blast waves," "chromospheric shock fronts" and various other combinations of terms which connote violently propagating impulsive disturbances. It is unclear whether all of the observations to which these terms have been applied pertain to a single physical phenomenon: there has perhaps been some overlap between the observations and the assumed physical properties of the observed occurrence. Moreton waves are ideally observed in the wings of H alpha, and appear as semi-circular fronts propagating at speeds ranging from several hundred to over a thousand km/sec. They form an arc, or "brow shape" which can span up to 180 degrees. Extrapolating the speed and locations of the arc indicates that the phenomenon's origin intersects well with the impulsive phase of the associated H alpha flare (if the flare exhibits an impulsive phase). However, the arc may not form or may not be observable until it is tens of megameters from the flaring region, and subsequently can propagate to distances exceeding 100 megameters. The high speeds and distances of propagation, plus the associated radio and energetic particle observations, provided strong evidence of a coronal, rather than a chromospheric origin. The H alpha manifestation of the wave is assumed to be the "ground track" or "skirt" of a three-dimensional disturbance.

  8. Atmospheric Waves

    NASA Technical Reports Server (NTRS)

    2007-01-01

    With its Multispectral Visible Imaging Camera (MVIC), half of the Ralph instrument, New Horizons captured several pictures of mesoscale gravity waves in Jupiter's equatorial atmosphere. Buoyancy waves of this type are seen frequently on Earth - for example, they can be caused when air flows over a mountain and a regular cloud pattern forms downstream. In Jupiter's case there are no mountains, but if conditions in the atmosphere are just right, it is possible to form long trains of these small waves. The source of the wave excitation seems to lie deep in Jupiter's atmosphere, below the visible cloud layers at depths corresponding to pressures 10 times that at Earth's surface. The New Horizons measurements showed that the waves move about 100 meters per second faster than surrounding clouds; this is about 25% of the speed of sound on Earth and is much greater than current models of these waves predict. Scientists can 'read' the speed and patterns these waves to learn more about activity and stability in the atmospheric layers below.

  9. Characterization of the HIFU-induced cloud cavitation for the optimization of high pressure concentration for lithotripsy

    NASA Astrophysics Data System (ADS)

    Ikeda, Teiichiro; Yoshizawa, Shin; Kaneko, Yukio; Matsumoto, Yoichiro

    2006-05-01

    The bubble cloud is a highly scattering object; to the contrary, it is also a strong pressure wave enhancer, if the wavelength and amplitude of the wave is appropriate ones. We've been investigated the stone erosion enhancement in the existence of bubble cloud on the stone surface by using high frequency waveform that immediately followed by low frequency trailing pulse (C-C waveform; Cavitation Control waveform). For the optimization of the high pressure concentration it is needed to know, "how the enhancement of the pressure wave through the bubble cloud" and "how we can estimate the efficiency thorough the passive detection of the reflected signal from the bubble cloud". We measured the "Transmittance" and "Reflection" by two types of acoustic emission sensors, PCD (Passive Cavitation Detector) and DCD (Direct Collapse Detector). The results well depict the characteristics of the HIFU-induced bubble cloud responses. The response curves reveal that the local maxima of the "Transmittance" and "Reflection" occur at the different bubble cloud volume. The PCD signal is higher in the larger bubble cloud band. The DCD signal is larger in the smaller bubble cloud band. These tendencies imply the therapeutic effect through the bubble cloud is optimized in the small bubble cloud region and too much bubbles scatter the incoming ultrasound wave and the ultrasound wave does not efficiently propagates inward the bubble cloud. Thus, for the optimization of the bubble cloud collapse, the cavitation threshold can be the lower limit and the large scattering amplitude from bubble cloud can be the upper limit of the ultrasound conditions.

  10. Modulation of short waves by long waves. [ocean wave interactions

    NASA Technical Reports Server (NTRS)

    Reece, A. M., Jr.

    1978-01-01

    Wave-tank experiments were performed to investigate the cyclic short-wave energy changes, related in phase to an underlying long wave, which occur during active generation of the short-wave field by wind. Measurements of time series of the short-wave slope were made by a laser-optical system, where the basic long-wave parameters were controlled and wind speeds were accurately reproducible. The short-wave slope variances were found to exhibit cyclic variations that are related to the phase of the long wave. The variations result from two combined effects: (1) the short wave frequency is varied by the long-wave orbital velocity; (2) the energy of the short waves is modulated by the actions of aerodynamic and hydrodynamic couplings that operate on the short waves in a manner related to the long-wave phase.

  11. The role of shear and longitudinal waves in the kidney stone comminution by a lithotripter shock pulse

    NASA Astrophysics Data System (ADS)

    Sapozhnikov, Oleg A.; Cleveland, Robin O.; Bailey, Michael R.

    2001-05-01

    Shock wave lithotripsy has been in clinical use for 20 years but there is no consensus as to the main mechanism of kidney stone comminution. Experiments show that several mechanisms might be involved, including cavitation, spallation, and dynamic fatigue. Until recently, little attention was paid to shear elasticity of the stone material, i.e., mechanical load was mainly attributed to the longitudinal waves. In a previous numerical study, we found that shear elasticity resulted in tremendous change in the stress pattern inside cylindrical stones. The numerical model has been extended to study elastic waves in asymmetric inhomogeneous stones. Strains and stresses in the stone are calculated based on the Lamé equation for an isotropic elastic medium. Lithotripter shock waves of various temporal and spatial profiles were considered according to several clinical models of lithotripters. Maximum compression, tensile and shear stresses are predicted as a function of stone dimension and shape. The model predicts that both shear and longitudinal waves play an important role in creating the regions of excess stresses where cracks can be formed. The results of modeling are compared with the experimental observations. [Work supported by ONRIFO, CRDF, NIH-Fogarty, RFBR, NIH, and Whitaker Foundation.

  12. Reorganization of pathological control functions of memory-A neural model for tissue healing by shock waves

    NASA Astrophysics Data System (ADS)

    Wess, Othmar

    2005-04-01

    Since 1980 shock waves have proven effective in the field of extracorporeal lithotripsy. More than 10 years ago shock waves were successfully applied for various indications such as chronic pain, non-unions and, recently, for angina pectoris. These fields do not profit from the disintegration power but from stimulating and healing effects of shock waves. Increased metabolism and neo-vascularization are reported after shock wave application. According to C. J. Wang, a biological cascade is initiated, starting with a stimulating effect of physical energy resulting in increased circulation and metabolism. Pathological memory of neural control patterns is considered the reason for different pathologies characterized by insufficient metabolism. This paper presents a neural model for reorganization of pathological reflex patterns. The model acts on associative memory functions of the brain based on modification of synaptic junctions. Accordingly, pathological memory effects of the autonomous nervous system are reorganized by repeated application of shock waves followed by development of normal reflex patterns. Physiologic control of muscle and vascular tone is followed by increased metabolism and tissue repair. The memory model may explain hyper-stimulation effects in pain therapy.

  13. Laser lithotripsy of gallstones: alexandrite and rhodamine-6G versus coumarin dye laser: fragmentation and fiber burn-off in vitro

    NASA Astrophysics Data System (ADS)

    Hochberger, Juergen; Bredt, Marion; Mueller, Gudrun; Hahn, Eckhart G.; Ell, Christian

    1993-05-01

    In the following study three different pulsed laser lithotripsy systems were compared for the fine fragmentation of identical sets of natural and synthetic gallstones `in vitro.' Using a pulsed coumarin dye laser (504 nm), a pulsed rhodamine 6G dye laser (595 nm), and a pulsed Alexandrite laser (755 nm) a total of 184 concrements of known chemical composition, size, and weight were disintegrated to a fragment size of

  14. Experimentally validated multiphysics computational model of focusing and shock wave formation in an electromagnetic lithotripter

    PubMed Central

    Fovargue, Daniel E.; Mitran, Sorin; Smith, Nathan B.; Sankin, Georgy N.; Simmons, Walter N.; Zhong, Pei

    2013-01-01

    A multiphysics computational model of the focusing of an acoustic pulse and subsequent shock wave formation that occurs during extracorporeal shock wave lithotripsy is presented. In the electromagnetic lithotripter modeled in this work the focusing is achieved via a polystyrene acoustic lens. The transition of the acoustic pulse through the solid lens is modeled by the linear elasticity equations and the subsequent shock wave formation in water is modeled by the Euler equations with a Tait equation of state. Both sets of equations are solved simultaneously in subsets of a single computational domain within the BEARCLAW framework which uses a finite-volume Riemann solver approach. This model is first validated against experimental measurements with a standard (or original) lens design. The model is then used to successfully predict the effects of a lens modification in the form of an annular ring cut. A second model which includes a kidney stone simulant in the domain is also presented. Within the stone the linear elasticity equations incorporate a simple damage model. PMID:23927200

  15. Experimentally validated multiphysics computational model of focusing and shock wave formation in an electromagnetic lithotripter.

    PubMed

    Fovargue, Daniel E; Mitran, Sorin; Smith, Nathan B; Sankin, Georgy N; Simmons, Walter N; Zhong, Pei

    2013-08-01

    A multiphysics computational model of the focusing of an acoustic pulse and subsequent shock wave formation that occurs during extracorporeal shock wave lithotripsy is presented. In the electromagnetic lithotripter modeled in this work the focusing is achieved via a polystyrene acoustic lens. The transition of the acoustic pulse through the solid lens is modeled by the linear elasticity equations and the subsequent shock wave formation in water is modeled by the Euler equations with a Tait equation of state. Both sets of equations are solved simultaneously in subsets of a single computational domain within the BEARCLAW framework which uses a finite-volume Riemann solver approach. This model is first validated against experimental measurements with a standard (or original) lens design. The model is then used to successfully predict the effects of a lens modification in the form of an annular ring cut. A second model which includes a kidney stone simulant in the domain is also presented. Within the stone the linear elasticity equations incorporate a simple damage model.

  16. A Review of Computational Methods in Materials Science: Examples from Shock-Wave and Polymer Physics

    PubMed Central

    Steinhauser, Martin O.; Hiermaier, Stefan

    2009-01-01

    This review discusses several computational methods used on different length and time scales for the simulation of material behavior. First, the importance of physical modeling and its relation to computer simulation on multiscales is discussed. Then, computational methods used on different scales are shortly reviewed, before we focus on the molecular dynamics (MD) method. Here we survey in a tutorial-like fashion some key issues including several MD optimization techniques. Thereafter, computational examples for the capabilities of numerical simulations in materials research are discussed. We focus on recent results of shock wave simulations of a solid which are based on two different modeling approaches and we discuss their respective assets and drawbacks with a view to their application on multiscales. Then, the prospects of computer simulations on the molecular length scale using coarse-grained MD methods are covered by means of examples pertaining to complex topological polymer structures including star-polymers, biomacromolecules such as polyelectrolytes and polymers with intrinsic stiffness. This review ends by highlighting new emerging interdisciplinary applications of computational methods in the field of medical engineering where the application of concepts of polymer physics and of shock waves to biological systems holds a lot of promise for improving medical applications such as extracorporeal shock wave lithotripsy or tumor treatment. PMID:20054467

  17. Autophagy activation protects shock wave induced renal tubular epithelial cell apoptosis may through modulation of Akt/ GSK-3β pathway

    PubMed Central

    Long, Qingzhi; Li, Xiang; He, Hui; He, Dalin

    2016-01-01

    Purpose: Extracorporeal shock wave lithotripsy (ESWL) is well documented to exert destructive effect to renal cells and its mechanism is not clear. Autophagy is one of cell basic response for stressful conditions and it is important to determine cell's fate. The aim of this study is to elucidate the role of autophagy in the process of shock wave-induced renal cells injury. Methods: NRK-52E cell, a rat renal tubular epithelial cell, was exposed to shock wave at the voltage of 14KV. GFP-LC3 puncta was used to monitor Autophagy flux in the process of shock wave injury. Autophagic relative proteins, such as light chain 3 (LC3), beclin-1 and p62, were also examined. Cell variability and apoptosis were detected when inhibition autophagy with 3-methyladenine (3MA) or stimulating its activity with rapamycin during the process of shock wave injury. The role of Akt/ GSK-3β and its connection with autophagy in the process of shock wave injury were also investigated. Results: Shock wave was confirmed to activate autophagy in renal cells, which was manifested in LC3-II turnover, beclin-1 induction and degradation of p62. Inhibition autophagy enhanced cell damage or apoptosis, whereas its stimulating was able to exert protection from shock wave injury. Akt/ GSK-3β, a cell-survival signaling pathway, can also be activated during the process. And its activation could be suppressed by blockade autophagy. Conclusion: Autophagy is a self-protective response for renal cells from shock wave injury. The cyto-protection of autophagy may be connected with modulation Akt/ GSK-3β pathway. PMID:27994511

  18. Making WAVES.

    ERIC Educational Resources Information Center

    Hindes, Victoria A.; Hom, Keri; Brookshaw, Keith

    About 46% of high school graduates enrolled in California State Universities need remedial courses in both math and English to prepare them for college level. These students typically earned B averages in their high school math and English classes. In order to address this issue, Shasta College launched Operation WAVES (Win by Achieving Valuable…

  19. Comparison of the effectiveness and safety of MPL 9000 and Lithostar Modularis shockwave lithotriptors: treatment results of 263 children.

    PubMed

    Aksoy, Yilmaz; Ziypak, Tevfik; Yapanoglu, Turgut

    2009-04-01

    In this study, we aimed to compare the treatment results of two different shock wave lithotripsy (SWL) machines used in the management of pediatric urolithiasis. Between January 1993 and October 2004, Dornier MPL 9000 (electrohydraulic) had been used, and since then Siemens Lithostar Modularis (electromagnetic) has been used. The last evaluation was done 3 months after SWL treatment in terms of the success rate, use of anesthesia and complications. A total of 263 children (171 boys and 92 girls), with an age range of 9 months-14 years (mean age 8.1 +/- 3.8 years) were included in this study. Of the patients treated with the Dornier MPL 9000, 60.1% (173/104) required general anesthesia and 69 needed sedation. In contrast, for all patients treated with the Lithostar Modularis necessitated only sedo-analgesia (90 children). The hospital stay was shorter for Siemens Lithostar Modularis than those of Dornier MPL 9000 (26.2 vs. 35.5 h, P = 0.03). The success rate for the electromagnetic unit (86.5%) was almost identical that achieved with the electrohydraulic unit (85.2%) in the stones for the different location. Success rates were compared for stone burden subsets, the differences were insignificant for both lithotriptors (P > 0.05, for all). The electromagnetic unit had a significantly higher success rate for distal ureteral calculi (86.2 vs. 54.5%, P = 0.034). The efficiency quotients (EQ) for distal ureteral calculi were significantly different in favor of electromagnetic machine (56 vs. 40%). The complication rates for SWL were not significantly different for electrohydraulic and electromagnetic lithotriptors (8.7 and 6.2%, respectively). This study showed that SWL treatment was effective and safe in pediatric urolithiasis using both electrohydraulic and electromagnetic machines. Electromagnetic machine was more effective than electrohydraulic one for distal ureteral calculi. Additionally, the electromagnetic lithotriptor has significant clinical advantages over the

  20. On neutron surface waves

    SciTech Connect

    Ignatovich, V. K.

    2009-01-15

    It is shown that neutron surface waves do not exist. The difference between the neutron wave mechanics and the wave physics of electromagnetic and acoustic processes, which allows the existence of surface waves, is analyzed.

  1. Gravity Waves

    NASA Technical Reports Server (NTRS)

    Vanzandt, T. E.

    1985-01-01

    Atmospheric parameters fluctuate on all scales. In the mesoscale these fluctuations are occasionally sinusoidal so that they can be interpreted as gravity waves. Usually, however, the fluctuations are noise like, so that their cause is not immediately evident. Results of mesoscale observations in the 20 to 120 m altitude range that are suitable for incorporation into a model atmosphere are very limited. In the stratosphere and lower mesosphere observations are sparse and very little data has been summarized into appropriate form. There is much more data in the upper mesosphere and lower thermosphere, but again very little of it has been summarized. The available mesoscale spectra of horizontal wind u versus vertical wave number m in the 20 to 120 km altitude range are shown together with a spectrum from the lower atmosphere for comparison. Further information about these spectra is given. In spite of the large range of altitudes and latitudes, the spectra from the lower atmosphere (NASA, 1971 and DEWAN, 1984) are remarkably similar in both shape and amplitude. The mean slopes of -2.38 for the NASA spectrum and -2.7 for the Dewan spectra are supported by the mean slope of -2.75 found by ROSENBERG et al. (1974). The mesospheric spectrum is too short to establish a shape. Its amplitude is about an order of magnitude larger than the NASA spectrum in the same wave number range. The NASA and Dewan spectra suggest that the mesoscale spectra in the lower atmosphere are insensitive to meteorological conditions.

  2. Making Waves: Seismic Waves Activities and Demonstrations

    NASA Astrophysics Data System (ADS)

    Braile, S. J.; Braile, L. W.

    2011-12-01

    The nature and propagation of seismic waves are fundamental concepts necessary for understanding the exploration of Earth's interior structure and properties, plate tectonics, earthquakes, and seismic hazards. Investigating seismic waves is also an engaging approach to learning basic principles of the physics of waves and wave propagation. Several effective educational activities and demonstrations are available for teaching about seismic waves, including the stretching of a spring to demonstrate elasticity; slinky wave propagation activities for compressional, shear, Rayleigh and Love waves; the human wave activity to demonstrate P- and S- waves in solids and liquids; waves in water in a simple wave tank; seismic wave computer animations; simple shake table demonstrations of model building responses to seismic waves to illustrate earthquake damage to structures; processing and analysis of seismograms using free and easy to use software; and seismic wave simulation software for viewing wave propagation in a spherical Earth. The use of multiple methods for teaching about seismic waves is useful because it provides reinforcement of the fundamental concepts, is adaptable to variable classroom situations and diverse learning styles, and allows one or more methods to be used for authentic assessment. The methods described here have been used effectively with a broad range of audiences, including K-12 students and teachers, undergraduate students in introductory geosciences courses, and geosciences majors.

  3. Capillary rogue waves.

    PubMed

    Shats, M; Punzmann, H; Xia, H

    2010-03-12

    We report the first observation of extreme wave events (rogue waves) in parametrically driven capillary waves. Rogue waves are observed above a certain threshold in forcing. Above this threshold, frequency spectra broaden and develop exponential tails. For the first time we present evidence of strong four-wave coupling in nonlinear waves (high tricoherence), which points to modulation instability as the main mechanism in rogue waves. The generation of rogue waves is identified as the onset of a distinct tail in the probability density function of the wave heights. Their probability is higher than expected from the measured wave background.

  4. Full-wave modeling of therapeutic ultrasound: Nonlinear ultrasound propagation in ideal fluids

    NASA Astrophysics Data System (ADS)

    Ginter, Siegfried; Liebler, Marko; Steiger, Eckard; Dreyer, Thomas; Riedlinger, Rainer E.

    2002-05-01

    The number of applications of high-intense, focused ultrasound for therapeutic purposes is growing. Besides established applications like lithotripsy, new applications like ultrasound in orthopedics or for the treatment of tumors arise. Therefore, new devices have to be developed which provide pressure waveforms and distributions in the focal zone specifically for the application. In this paper, a nonlinear full-wave simulation model is presented which predicts the therapeutically important characteristics of the generated ultrasound field for a given transducer and initial pressure signal. A nonlinear acoustic approximation in conservation form of the original hydrodynamic equations for ideal fluids rather than a wave equation provides the base for the nonlinear model. The equations are implemented with an explicit high-order finite-difference time-domain algorithm. The necessary coefficients are derived according to the dispersion relation preserving method. Simulation results are presented for two different therapeutic transducers: a self-focusing piezoelectric and one with reflector focusing. The computational results are validated by comparison with analytical solutions and measurements. An agreement of about 10% is observed between the simulation and experimental results.

  5. Effects of shock waves on oxidative stress in parotid gland of rat.

    PubMed

    Garca, M Fatih; Kavak, Servet; Gecit, Ilhan; Meral, Ismail; Demir, Halit; Turan, Mahfuz; Çeğin, Bilal; Bektas, Hava; Çankaya, Hakan

    2014-06-01

    This study was designed to investigate whether extracorporeal shock wave lithotripsy (ESWL) exposure to parotid gland produces an oxidative stress in parotid glands of rats. Twelve male Wistar-albino rats, 6 months of age with an average body weight of 250-300 g, were divided randomly into two groups, each consisting of six rats. The animals in the first group did not receive any treatment and served as control. The left parotid glands of animals in group 2 (ESWL treated) received a thousand 18 kV shock waves after anesthetizing the rats with 50 mg/kg of ketamine. The animals in both groups were killed 72 hours after the ESWL treatment, and the parotid glands were harvested for the determination of lipid peroxidation product malondialdehyde (MDA), antioxidant glutathione (GSH) levels and the activities of antioxidant enzymes such as superoxide dismutase (SOD), GSH-Px and catalase (CAT). It was found that MDA level increased in parotid glands of rats after the ESWL treatment. The SOD, GSH-Px and CAT enzyme activities, and the level of antioxidant GSH decreased in parotid gland of rats after the ESWL treatment. It was concluded that short-term ESWL treatment caused an increase in the free radical production and a decrease in the antioxidant enzyme activity in parotid glands of ESWL-treated rats.

  6. Nonlinear Waves.

    DTIC Science & Technology

    1986-05-27

    con- €"" straints:’. *’Permanent address: Dipartimento di Fisica . Universita di Roma 1. 00185 u 11lia. tr(a U(x)) = 0. (7a. 2469 1. Math,. PyS. 26 (10...Tenenblat Universidade de Brasilia Departamento de Matematica Brasilia, Brasil September 1985 , - . Abstract The generalized wave equation and generalized...Permanent addrems: Dipartimento di Fisica . Universita di Roma t3 U, 0. Roma. Italy The linear limit of i3) provides the most general solution ot 2614 J. MatM

  7. Wave Dissipation and Balance - NOPP Wave Project

    DTIC Science & Technology

    2014-09-30

    processes that affect wind-generated ocean gravity waves. The various dissipative processes that contribute to the spectral wave evolution are isolated...over mature ocean surface wave spectra. J. Phys. Oceanogr., 34:3345–2358, 2004. K. Hasselmann. On the non-linear energy transfer in a gravity wave...P. Giovanangeli. Air flow structure over short- gravity breaking water waves. Boundary-Layer Meteorol., 126:477–705, 2008. doi: 10.1007/s10546-007

  8. CMS-Wave

    DTIC Science & Technology

    2014-10-27

    2014 2. REPORT TYPE 3. DATES COVERED 00-00-2014 to 00-00-2014 4. TITLE AND SUBTITLE CMS -Wave 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM...Program CMS -Wave CMS -Wave is a two-dimensional spectral wind-wave generation and transformation model that employs a forward-marching, finite...difference method to solve the wave action conservation equation. Capabilities of CMS -Wave include wave shoaling, refraction, diffraction, reflection

  9. Waves at Navigation Structures

    DTIC Science & Technology

    2014-10-27

    upgrades the Coastal Modeling System’s ( CMS ) wave model CMS -Wave, a phase-averaged spectral wave model, and BOUSS-2D, a Boussinesq-type nonlinear wave...provided by this work unit address these critical needs of the Corps’ navigation mission. Description Issue Addressed CMS -Wave application at Braddock...Bay, NY WaveNet application in Gulf of Mexico CMS -Wave and BOUSS-2D are two numerical wave models, and WaveNet and TideNet are two web-based

  10. ASTER Waves

    NASA Technical Reports Server (NTRS)

    2000-01-01

    The pattern on the right half of this image of the Bay of Bengal is the result of two opposing wave trains colliding. This ASTER sub-scene, acquired on March 29, 2000, covers an area 18 kilometers (13 miles) wide and 15 kilometers (9 miles) long in three bands of the reflected visible and infrared wavelength region. The visible and near-infrared bands highlight surface waves due to specular reflection of sunlight off of the wave faces.

    Advanced Spaceborne Thermal Emission and Reflection Radiometer (ASTER) is one of five Earth-observing instruments launched December 18, 1999, on NASA's Terra satellite. The instrument was built by Japan's Ministry of International Trade and Industry. A joint U.S./Japan science team is responsible for validation and calibration of the instrument and the data products. Dr. Anne Kahle at NASA's Jet Propulsion Laboratory, Pasadena, California, is the U.S. science team leader; Moshe Pniel of JPL is the project manager. ASTER is the only high-resolution imaging sensor on Terra. The primary goal of the ASTER mission is to obtain high-resolution image data in 14 channels over the entire land surface, as well as black and white stereo images. With revisit time of between 4 and 16 days, ASTER will provide the capability for repeat coverage of changing areas on Earth's surface. Advanced Spaceborne Thermal Emission and Reflection Radiometer (ASTER) is one of five Earth-observing instruments launched December 18, 1999, on NASA's Terra satellite. The instrument was built by Japan's Ministry of International Trade and Industry. A joint U.S./Japan science team is responsible for validation and calibration of the instrument and the data products. Dr. Anne Kahle at NASA's Jet Propulsion Laboratory, Pasadena, California, is the U.S. science team leader; Moshe Pniel of JPL is the project manager. ASTER is the only high-resolution imaging sensor on Terra. The primary goal of the ASTER mission is to obtain high-resolution image data in 14 channels

  11. MiniJFil®: A New Safe and Effective Stent for Well-Tolerated Repeated Extracorporeal Shockwave Lithotripsy or Ureteroscopy for Medium-to-Large Kidney Stones?

    PubMed Central

    Vogt, Benoit; Desfemmes, Francois-Noel; Desgrippes, Arnaud; Ponsot, Yves

    2016-01-01

    Background Percutaneous nephrolithotomy (PCNL) is recommended for treating staghorn stones or stones measuring > 20 mm. Extracorporeal shockwave lithotripsy (ESWL) or flexible ureteroscopy (URS) may be used as a complement. However, PCNL can cause trauma to the kidney parenchyma, and patients may find a noninvasive procedure, such as ESWL, to be more attractive. Objectives The aim of this study was to evaluate the clinical efficiency of MiniJFil® stenting associated with ESWL or second-line URS for the treatment of medium-to-large kidney stones. The MiniJFil® is a stent reduced to a suture of 0.3F attached to a renal pigtail. The entire ureter is occupied only by the suture of the stent. Methods We retrospectively analyzed the data of 28 patients. Twenty-four patients had kidney stones measuring > 15 mm (group 1) and four patients had staghorn stones (group 2). All of the patients were fitted with MiniJFil® 2 - 3 weeks before any treatment. ESWL was always our first-line therapy. Stone-free (SF) status was defined as no evidence of stones. Results In group 1, the mean largest and cumulative stone diameters, respectively, were 18.7 ± 5.7 mm and 45.0 ± 12.0 mm. In group 2, the mean volume was 6,288.4 ± 2,733.0 mm3. The overall SF was 96.4% (100% for group 1 and 75% for group 2). The mean number of sessions of ESWL and URS, respectively, was 1.4 ± 0.7 and 0.8 ± 0.9 in group 1 and 4.0 ± 2.0 and 1.5 ± 1.3 in group 2. The mean times to achieve these rates were 3.2 ± 1.7 months and 5.6 ± 2.3 months for groups 1 and 2, respectively. One patient in group 2 was treated with only three sessions of ESWL. Renal colic was observed in only five patients (17.9%). Conclusions MiniJFil® stenting is safe and may be an alternative for the treatment of kidney stones during minimally invasive procedures. PMID:27878116

  12. Semi-rigid ureteroscopic lithotripsy versus laparoscopic ureterolithotomy for large upper ureteral stones: a meta – analysis of randomized controlled trials

    PubMed Central

    Torricelli, Fabio C. M.; Monga, Manoj; Marchini, Giovanni S.; Srougi, Miguel; Nahas, William C.; Mazzucchi, Eduardo

    2016-01-01

    ABSTRACT Introduction: To provide a systematic review and meta-analysis of randomized controlled trials (RCT) comparing semi-rigid ureteroscopic lithotripsy (URS) with laparoscopic ureterolithotomy (LU) for the treatment of the large proximal ureteral stone. Materials and methods: A systematic literature review was performed in June 2015 using the PubMed, Scopus, and Web of Science databases to identify relevant studies. Article selection proceeded according to the search strategy based on Preferred Reporting Items for Systematic Reviews and Meta-analysis criteria. Results: Six RCT including 646 patients were analyzed, 325 URS cases (50.3%) and 321 LU cases (49.7%). URS provided a significantly shorter operative time (weighted mean difference [WMD] = −31.26 min; 95%CI −46.88 to −15.64; p<0.0001) and length of hospital stay (WMD = −1.48 days; 95%CI −2.78 to −0.18; p=0.03) than LU. There were no significant differences in terms of overall complications (OR = 0.78; 95%CI 0.21-2.92; p=0.71) and major complications – Clavien ≥3 – (OR = 1.79; 95%CI 0.59-5.42; p=0.30). LU led to a significantly higher initial stone-free rate (OR = 8.65; 95%CI 4.18-17.91; p<0.00001) and final stone-free rate (OR = 6.41; 95%CI 2.24-18.32; p=0.0005) than URS. There was a significantly higher need for auxiliary procedures in URS cases (OR = 6.58; 95%CI 3.42-12.68; p<0.00001). Conclusions: Outcomes with LU for larger proximal ureteral calculi are favorable compared to semi-rigid URS and should be considered as a first-line alternative if flexible ureteroscopy is not available. Utilization of flexible ureteroscopy in conjunction with semi-rigid ureteroscopy may impact these outcomes, and deserves further systematic evaluation. PMID:27564273

  13. Waves and Tsunami Project

    ERIC Educational Resources Information Center

    Frashure, K. M.; Chen, R. F.; Stephen, R. A.; Bolmer, T.; Lavin, M.; Strohschneider, D.; Maichle, R.; Micozzi, N.; Cramer, C.

    2007-01-01

    Demonstrating wave processes quantitatively in the classroom using standard classroom tools (such as Slinkys and wave tanks) can be difficult. For example, waves often travel too fast for students to actually measure amplitude or wavelength. Also, when teaching propagating waves, reflections from the ends set up standing waves, which can confuse…

  14. Surface wave tomography

    NASA Technical Reports Server (NTRS)

    Anderson, D. L.

    1984-01-01

    Vertically polarized shear wave velocity (VSV), determined primarily from fundamental mode Rayleigh waves, and the difference between the velocity of horizontally polarized shear waves (VSH) and VSV, therefore a measure of anisotropy, are shown.

  15. Auroral plasma waves

    NASA Technical Reports Server (NTRS)

    Gurnett, Donald A.

    1989-01-01

    A review is given of auroral plasma wave phenomena, starting with the earliest ground-based observations and ending with the most recent satellite observations. Two types of waves are considered, electromagnetic and electrostatic. Electromagnetic waves include auroral kilometric radiation, auroral hiss, ELF noise bands, and low-frequency electric and magnetic noise. Electrostatic waves include upper hybrid resonance emissions, electron cyclotron waves, lower hybrid waves, ion cyclotron waves and broadband electrostatic noise. In each case, a brief overview is given describing the observations, the origin of the instability, and the role of the waves in the physics of the auroral acceleration region.

  16. Dispersive wave emission from wave breaking.

    PubMed

    Conforti, Matteo; Trillo, Stefano

    2013-10-01

    We show that pulses undergoing wave breaking in nonlinear weakly dispersive fibers radiate, owing to phase-matching (assisted by higher-order dispersion) of linear dispersive waves with the shock-wave front. Our theoretical results perfectly explain the radiation observed recently from pulses propagating in the normal dispersion (i.e., nonsolitonic) regime.

  17. Lasers in the management of calcified urinary tract stents

    NASA Astrophysics Data System (ADS)

    Nseyo, Unyime O.; Tunuguntla, Hari S. G. R.; Crone, Michael

    2003-06-01

    Indwelling double J ureteral stents are used for internal urinary diversion for ureteral obstruction and post-surgical drainage of the upper urinary tract. Stent calcification is a serious complication especially in those with forgotten stents. In a retrospective review of 16 patients (10 male and 6 female) we found holmium laser to be highly effective in the management of calcified stents. Encrustations/calcifications were noted on the distal end of the sent in 6 patiens (37.5%), middle and distal portions in 2 patients (12.5%), along the entire length of the stent in 3 patients (18.75%), lower portion of the stent in 4 patients (25%) and at the upper and lower ends of the stent in one patient (6.25%). Cystolitholapaxy, retrograde ureteroscopy (URS) with holmium: YAG (yttrium-aluminum-garnet) laser intracorporeal lithotripsy, percutaneous nephrostolithotomy (PNL) and antegrade URS with holmium: YAG laser intracorporeal lithotripsy were effectively performed without intraoperative complications. Lithotripsy became necessary before stent removal in 11 patients (68.75%). Holmium laser lithotripsy was useful in managing 7 patients (43.75%), and shockwave lithotripsy (SWL) in 6 patients (37.5%). In two patients (12.5%) both holmium and SWL were used before the stent can be removed.

  18. A Simple Wave Driver

    ERIC Educational Resources Information Center

    Temiz, Burak Kagan; Yavuz, Ahmet

    2015-01-01

    This study was done to develop a simple and inexpensive wave driver that can be used in experiments on string waves. The wave driver was made using a battery-operated toy car, and the apparatus can be used to produce string waves at a fixed frequency. The working principle of the apparatus is as follows: shortly after the car is turned on, the…

  19. Finsler p p -waves

    NASA Astrophysics Data System (ADS)

    Fuster, Andrea; Pabst, Cornelia

    2016-11-01

    In this work we present Finsler gravitational waves. These are a Finslerian version of the well-known p p -waves, generalizing the very special relativity line element. Our Finsler p p -waves are an exact solution of Finslerian Einstein's equations in vacuum and describe gravitational waves propagating in an anisotropic background.

  20. Phonons, Atoms, and Waves

    ERIC Educational Resources Information Center

    Reid, John S.

    1977-01-01

    Discussed are how the thermal vibrations of a solid are described in terms of lattice waves, how these waves interact with other waves, or with themselves, and how one is led from such a description in terms of waves to the concept of a phonon. (Author/MA)

  1. Planetary plasma waves

    NASA Technical Reports Server (NTRS)

    Gurnett, Donald A.

    1993-01-01

    The primary types of plasma waves observed in the vicinity of the planets Venus, Mars, Earth, Jupiter, Saturn, Uranus, and Neptune are described. The observations are organized according to the various types of plasma waves observed, ordered according to decreasing distance from the planet, starting from the sunward side of the planet, and ending in the region near the closest approach. The plasma waves observed include: electron plasma oscillations and ion acoustic waves; trapped continuum radiation; electron cyclotron and upper hybrid waves; whistler-mode emissions; electrostatic ion cyclotron waves; and electromagnetic ion cyclotron waves.

  2. Teleseismic S wave microseisms.

    PubMed

    Nishida, Kiwamu; Takagi, Ryota

    2016-08-26

    Although observations of microseisms excited by ocean swells were firmly established in the 1940s, the source locations remain difficult to track. Delineation of the source locations and energy partition of the seismic wave components are key to understanding the excitation mechanisms. Using a seismic array in Japan, we observed both P and S wave microseisms excited by a severe distant storm in the Atlantic Ocean. Although nonlinear forcing of an ocean swell with a one-dimensional Earth model can explain P waves and vertically polarized S waves (SV waves), it cannot explain horizontally polarized S waves (SH waves). The precise source locations may provide a new catalog for exploring Earth's interior.

  3. Bubble Proliferation or Dissolution of Cavitation Nuclei in the Beam Path of a Shock-Wave Lithotripter

    NASA Astrophysics Data System (ADS)

    Frank, Spencer; Lautz, Jaclyn; Sankin, Georgy N.; Szeri, Andrew J.; Zhong, Pei

    2015-03-01

    It is hypothesized that the decreased treatment efficiency in contemporary shock-wave lithotripters is related to tensile wave attenuation due to cavitation in the prefocal beam path. Utilizing high-speed imaging of the beam path and focal pressure waveform measurements, tensile attenuation is associated with bubble proliferation. By systematically testing different combinations of pulse-repetition frequency and gas concentration, we modulate the bubble-dissolution time to identify which conditions lead to bubble proliferation and show that reducing bubble proliferation in the beam path significantly improves acoustic transmission and stone comminution efficiency in vitro. In addition to experiments, a bubble-proliferation model is developed that takes gas diffusion across the bubble wall and bubble fragmentation into account. By aligning the model with experimental observations, the number of daughter bubbles produced after a single lithotripter bubble collapse is estimated to be in the range of 253 ˜510 . This finding is on the same order of magnitude with previous measurements of an isolated bubble collapse in a lithotripter field by Pishchalnikov, McAteer, and Williams [BJU Int. 102, 1681 (2008), 10.1111/j.1464-410X.2008.07896.x], and this estimate improves the general understanding of lithotripsy bubble dynamics in the beam path.

  4. The change in upper tract urolithiasis composition, surgical treatments and outcomes of para and quadriplegic patients over time.

    PubMed

    Clifton, Marisa M; Gettman, Matthew T; Patterson, David E; Rangel, Laureano; Krambeck, Amy E

    2014-10-01

    Stone disease in patients with spinal cord injury is a source of morbidity and mortality. Previous studies have indicated a decrease in infection-based urolithiasis in recent decades. We aimed to identify changes in stone composition and surgical outcomes in patients with para and quadriplegia over time. A retrospective review of para and quadriplegic patients from 1986 to 2011 who underwent surgical intervention for urolithiasis was performed, identifying 95 patients. The Mantel-Haenszel Chi square test was used to compare change in stone composition over time. The mean patient age was 44.0 years (range 18-88) and treatment included percutaneous nephrolithotomy (PCNL) 40 (42.1 %), ureteroscopy 28 (29.5 %), shock wave lithotripsy (SWL) 26 (27.4 %), and nephrectomy 1 (1 %). Overall stone-free status was found in 47.4 % with 19.0 % requiring a repeat procedure. The median hospital stay for patients undergoing SWL was 2.5 days, ureteroscopy 5 days, and PCNL 6 days. Infection-based stone composition was identified in 23 patients (36.5 %). We evaluated the linear change in percent of each stone component over time and identified increasing components of calcium oxalate dihydrate (p = 0.002) and calcium carbonate (p = 0.009). However, over a period of 25 years, the incidence of infection-based stone did not change (p = 0.57). Para and quadriplegic patients with urolithiasis can be difficult to treat surgically with prolonged hospitalizations, low stone-free status, and often require additional procedures. Despite improvements in antibiotic agents and management of neurogenic bladders, infection-based calculi continue to be a significant source of morbidity to this patient population.

  5. Calyceal Diverticula: A Comprehensive Review

    PubMed Central

    Waingankar, Nikhil; Hayek, Samih; Smith, Arthur D; Okeke, Zeph

    2014-01-01

    Calyceal diverticula are rare outpouchings of the upper collecting system that likely have a congenital origin. Stones can be found in up to 50% of calyceal diverticula, although, over the combined reported series, 96% of patients presented with stones. Diagnosis is best made by intravenous urography or computed tomography urogram. Shock wave lithotripsy (SWL) is an option for first-line therapy in patients with stone-bearing diverticula that have radiologically patent necks in mid- to upper-pole diverticula and small stone burdens. Stone-free rates are the lowest with SWL, although patients report being asymptomatic following therapy in up to 75% of cases with extended follow-up. Ureteroscopy (URS) is best suited for management of anteriorly located mid- to upperpole diverticular stones. Drawbacks to URS include difficulty in identifying the ostium and low rate of obliteration. Percutaneous management is best used in posteriorly located mid- to lower-pole stones, and offers the ability to directly ablate the diverticulum. Percutaneous nephrolithotomy remains effective in the management of upperpole diverticula, but carries the risk of pulmonary complications unless subcostal access strategies such as triangulation or renal displacement are used. Laparoscopic surgery provides definitive management, but should be reserved for cases with large stones in anteriorly located diverticula with thin overlying parenchyma, and cases that are refractory to other treatment. This article reviews the current theories on the pathogenesis of calyceal diverticula. The current classification is examined in addition to the current diagnostic methods. Here we summarize an extensive review of the literature on the outcomes of the different treatment approaches. PMID:24791153

  6. Weakly nonlinear magnetohydrodynamic wave interactions

    SciTech Connect

    Webb, G.M.; Brio, M.; Kruse, M.T.; Zank, G.P.

    1999-06-01

    Equations describing weakly nonlinear magnetohydrodynamic (MHD) wave interactions in one Cartesian space dimension are discussed. For wave propagation in uniform media, the wave interactions of interest consist of: (a) three-wave resonant interactions in which high frequency waves, may evolve on long space and time scales if the wave phases satisfy the resonance conditions; (b) Burgers self-wave steepening for the magnetoacoustic waves, and (c) mean wave field effects, in which a particular wave interacts with the mean wave field of the other waves. For wave propagation in non-uniform media, further linear wave mixing terms appear in the equations. The equations describe four types of resonant triads: slow-fast magnetosonic wave interaction; Alfv{acute e}n-entropy wave interaction; Alfv{acute e}n-magnetosonic wave interaction; and magnetosonic-entropy wave interaction. The formalism is restricted to coherent wave interactions. {copyright} {ital 1999 American Institute of Physics.}

  7. Wave Dissipation and Balance - NOPP Wave Project

    DTIC Science & Technology

    2012-09-30

    ocean with the atmosphere, land and solid Earth. Waves also define in many ways the appearance of the ocean seen by remote- sensing instruments. Beyond...waves, sediments and remote sensing systems, and to improve our forecasting and hindcasting capacity of these phenomena from the global ocean to the...feedback on the wave model quality APPROACH AND WORK PLAN By combining theoretical advances with numerical models, remote sensing and field

  8. ULF Waves at Mercury

    NASA Astrophysics Data System (ADS)

    Kim, E.-H.; Boardsen, S. A.; Johnson, J. R.; Slavin, J. A.

    2016-02-01

    This chapter provides a brief overview of the observed characteristics of ultra-low-frequency (ULF) waves at Mercury. It shows how field-aligned propagating ULF waves at Mercury can be generated by externally driven fast compressional waves (FWs) via mode conversion at the ion-ion hybrid resonance. Then, the chapter reviews the interpretation that the strong magnetic compressional waves near and its harmonics observed with 20 of Mercury's magnetic equator could be the ion Bernstein wave (IBW) mode. A recent statistical study of ULF waves at Mercury based on MESSENGER data reported the occurrence and polarization of the detected waves. The chapter further introduces the field line resonance and the electromagnetic ion Bernstein waves to explain such waves, and shows that both theories can partially explain the observations.

  9. Fracture channel waves

    NASA Astrophysics Data System (ADS)

    Nihei, Kurt T.; Yi, Weidong; Myer, Larry R.; Cook, Neville G. W.; Schoenberg, Michael

    1999-03-01

    The properties of guided waves which propagate between two parallel fractures are examined. Plane wave analysis is used to obtain a dispersion equation for the velocities of fracture channel waves. Analysis of this equation demonstrates that parallel fractures form an elastic waveguide that supports two symmetric and two antisymmetric dispersive Rayleigh channel waves, each with particle motions and velocities that are sensitive to the normal and tangential stiffnesses of the fractures. These fracture channel waves degenerate to shear waves when the fracture stiffnesses are large, to Rayleigh waves and Rayleigh-Lamb plate waves when the fracture stiffnesses are low, and to fracture interface waves when the fractures are either very closely spaced or widely separated. For intermediate fracture stiffnesses typical of fractured rock masses, fracture channel waves are dispersive and exhibit moderate to strong localization of guided wave energy between the fractures. The existence of these waves is examined using laboratory acoustic measurements on a fractured marble plate. This experiment confirms the distinct particle motion of the fundamental antisymmetric fracture channel wave (A0 mode) and demonstrates the ease with which a fracture channel wave can be generated and detected.

  10. Cutting Head for Ultrasonic Lithotripsy

    NASA Technical Reports Server (NTRS)

    Angulo, E. D.; Goodfriend, R.

    1987-01-01

    Kidney stones lodged in urinary tract disintegrated with increased safety and efficiency by cutting head attached to end of vibrated wire probe. Aligns probe with stone and enables probe to vibrate long enough to disintegrate stone. Design of cutting head reduces risk of metal-fatigue-induced breakage of probe tip leaving metal fragments in urinary tract. Teeth of cutting head both seat and fragment kidney stone, while extension of collar into catheter lessens mechanical strain in probe wire, increasing probe life and lessening danger of in situ probe breakage.

  11. Cutting Head for Ultrasonic Lithotripsy

    NASA Technical Reports Server (NTRS)

    Angulo, Earl D. (Inventor); Goodfriend, Roger (Inventor)

    1989-01-01

    A cutting head for attachment to the end of the wire probe of an ultrasonic kidney stone disintegration instrument. The cutting head has a plurality of circumferentially arranged teeth formed at one end thereof to provide a cup-shaped receptacle for kidney stones encountered during the disintegration procedure. An integral reduced diameter collar diminishes stress points in the wire and reduces breakage thereof.

  12. Kidney stones and lithotripsy - discharge

    MedlinePlus

    ... have pain and nausea when the stone pieces pass. This can happen soon after treatment and may ... water in the weeks after treatment. This helps pass any pieces of stone that still remain. Your ...

  13. Mobile versus fixed site lithotripsy.

    PubMed Central

    Lewis, C.; Burgess, N. A.; Feneley, R. C.; Matthews, P. N.

    1991-01-01

    The efficacy of a mobile Dornier HM4 lithotriptor, was compared with that of a fixed site Siemens Lithostar. A total of 115 calculi in 98 patients were treated, 55 on the mobile Dornier and 60 on the Lithostar. The groups were similar except for stone size, the mean of the Lithostar group being 11 mm compared with 7.7 mm in the Dornier group. Fragmentation rates were not significantly different, 88% and 75% on the mobile and fixed site machines, respectively and, at 3 months follow-up 66% and 46% were stone free or with fragments of less than 2 mm. There were no serious complications, and the incidence of mild complications was similar in the two groups. We conclude that the mobile Dornier HM4 is an effective lithotriptor and can offer several advantages over fixed site machines. PMID:1929134

  14. Cutting head for ultrasonic lithotripsy

    NASA Technical Reports Server (NTRS)

    Anguluo, E. D.; Goodfriend, R. (Inventor)

    1985-01-01

    A cutting head for attachment to the end of the wire probe of an ultrasonic kidney stone disintegration instrument is described. The cutting head has a plurality of circumferentially arranged teeth formed at one end thereof to provide a cup shaped receptacle for kidney stones encountered during the disintegration procedure. An integral reduced diameter collar diminishes stress points in the wire and reduce breakage thereof.

  15. Wave Meteorology and Soaring

    NASA Technical Reports Server (NTRS)

    Wiley, Scott

    2008-01-01

    This viewgraph document reviews some mountain wave turbulence and operational hazards while soaring. Maps, photographs, and satellite images of the meteorological phenomena are included. Additionally, photographs of aircraft that sustained mountain wave damage are provided.

  16. Detonation Wave Profile

    SciTech Connect

    Menikoff, Ralph

    2015-12-14

    The Zel’dovich-von Neumann-Doering (ZND) profile of a detonation wave is derived. Two basic assumptions are required: i. An equation of state (EOS) for a partly burned explosive; P(V, e, λ). ii. A burn rate for the reaction progress variable; d/dt λ = R(V, e, λ). For a steady planar detonation wave the reactive flow PDEs can be reduced to ODEs. The detonation wave profile can be determined from an ODE plus algebraic equations for points on the partly burned detonation loci with a specified wave speed. Furthermore, for the CJ detonation speed the end of the reaction zone is sonic. A solution to the reactive flow equations can be constructed with a rarefaction wave following the detonation wave profile. This corresponds to an underdriven detonation wave, and the rarefaction is know as a Taylor wave.

  17. The Iowa wave machines

    NASA Astrophysics Data System (ADS)

    Daffron, John D.; Greenslade, Thomas B.; Stille, Dale

    2010-03-01

    Wave machines are a staple of demonstration lectures, and a good pair of wave machines can make the idea of transverse and longitudinal waves clearly evident to students. The demonstration apparatus collection of the University of Iowa contains examples of transverse and longitudinal wave machines that will be of interest to readers of The Physics Teacher. These machines probably date from about 1925 and may have been locally produced. You too can build them.

  18. WaveNet

    DTIC Science & Technology

    2015-10-30

    modeling and planning missions which require metocean data ( winds , waves, tides, water levels). It allows users to access, process, and analyze wave...and wind data from different data sources (Figure 1), and provides a combination of analysis and graphical capabilities to minimize the complexity and...employs techniques to minimize complexity and uncertainty of data processing. WaveNet is a decision-support tool that provides wave and wind data

  19. Oceanic wave measurement system

    NASA Technical Reports Server (NTRS)

    Holmes, J. F.; Miles, R. T. (Inventor)

    1980-01-01

    An oceanic wave measured system is disclosed wherein wave height is sensed by a barometer mounted on a buoy. The distance between the trough and crest of a wave is monitored by sequentially detecting positive and negative peaks of the output of the barometer and by combining (adding) each set of two successive half cycle peaks. The timing of this measurement is achieved by detecting the period of a half cycle of wave motion.

  20. Coronal heating by waves

    NASA Technical Reports Server (NTRS)

    Hollweg, J. V.

    1983-01-01

    Alfven waves or Alfvenic surface waves carry enough energy into the corona to provide the coronal energy requirements. Coronal loop resonances are an appealing means by which large energy fluxes enter active region loops. The wave dissipation mechanism still needs to be elucidated, but a Kolmogoroff turbulent cascade is fully consistent with the heating requirements in coronal holes and active region loops.

  1. Waves of Hanta

    NASA Astrophysics Data System (ADS)

    Abramson, Guillermo

    2003-03-01

    A spatially extended model of the hantavirus infection in deer mice is analyzed. Traveling waves solutions of the infected and susceptible populations are studied in different regimes, controlled by an environmental parameter. The wave of infection is shown to lag behind the wave of susceptible population, and the delay between the two is analyzed numerically and through a piecewise linearization.

  2. Wave turbulence in annular wave tank

    NASA Astrophysics Data System (ADS)

    Onorato, Miguel; Stramignoni, Ettore

    2014-05-01

    We perform experiments in an annular wind wave tank at the Dipartimento di Fisica, Universita' di Torino. The external diameter of the tank is 5 meters while the internal one is 1 meter. The tank is equipped by two air fans which can lead to a wind of maximum 5 m/s. The present set up is capable of studying the generation of waves and the development of wind wave spectra for large duration. We have performed different tests including different wind speeds. For large wind speed we observe the formation of spectra consistent with Kolmogorv-Zakharov predictions.

  3. Fast wave current drive

    SciTech Connect

    Goree, J.; Ono, M.; Colestock, P.; Horton, R.; McNeill, D.; Park, H.

    1985-07-01

    Fast wave current drive is demonstrated in the Princeton ACT-I toroidal device. The fast Alfven wave, in the range of high ion-cyclotron harmonics, produced 40 A of current from 1 kW of rf power coupled into the plasma by fast wave loop antenna. This wave excites a steady current by damping on the energetic tail of the electron distribution function in the same way as lower-hybrid current drive, except that fast wave current drive is appropriate for higher plasma densities.

  4. Spectra of Surface Waves

    DTIC Science & Technology

    1989-03-22

    with a wave follower during Marsen. J. Gophysical Res. 88, 9844-9849. 11. Hughes, B.A., 1978. The effects on internal waves on surface waves : 2...Spectra of Surface Waves K. Watson March 1989 JSR-88-130 Approved for public release; distribution unlimited. DTIC SELECTE JUN0 11989 0 JASONE The...Arlington, VA 22209 8503Z 11. TITLE (hlde Secvfty Cof.kaftn) SPECTRA OF SURFACE WAVES (U) 12. PERSONAL AUTHOfRS) K. Watson 13a. TYPE OF REPORT 13b. TIME

  5. Waves of energy

    NASA Astrophysics Data System (ADS)

    Smith, F. G. W.; Charlier, R. H.

    1981-06-01

    Possible means for harnessing the energy contained in ocean waves are considered. Problems associated with the low-grade nature of wave energy and the rate at which wave crests approach are pointed out, and simple devices already in use for the supply of energy to bell buoys, whistle buoys and lighted buoys are noted. Attention is then given to wave energy conversion systems based on the focusing of waves onto a narrow ramp leading to a reservoir from which water is released to power a turbine generator; a slightly submerged circular shell which directs waves into its center cavity where waves act to turn a turbine (the Dam-Atoll); a long vertical pipe with an internal valve allowing water to move in an upward direction (the Isaacs wave-energy pump); a turbine located at the bottom of an open-topped pipe (the Masuda buoy); a completely submerged closed air chamber from which runs a large pipe open to the sea; a wave piston which acts by the compression of air to drive a turbine; a massive structure with upper and lower reservoirs (the Russel rectifier); and devices which consist of floating or submerged objects which transfer wave energy to pumps (the Salter duck and Cockerell raft.) It is concluded that although wave-powered generators are not likely to become competitive in the near future or provide more than a small portion of world demand, they may be found useful under special conditions.

  6. [F-waves].

    PubMed

    Wang, F C; Massart, N; Kaux, J-F; Bouquiaux, O

    2011-12-01

    F-waves result from the discharge of the motoneurons following their antidromic activation. The F-wave appears, as an indirect (the F-wave latency decreases when the stimulation site moves away from the muscular detection) and late response (occurring after the M response). In practice, the most useful parameter is the F-wave minimal latency, provided that at least seven distinct F-waves are evoked. When the analysis is relative either to the controlateral side, or to a former examination, this parameter is one of most sensitive in electroneuromyography. F-wave evocation implies conduction along the entire peripheral nervous system, and particularly its proximal part, which is not investigated by nervous trunks conduction velocity studies. Thus, F wave study is the most useful in plexopathies and polyradiculonevritis. In the early phase of Guillain-Barré syndrome, their absence may be the unique sign indicative of proximal conduction blocks.

  7. Cycloidal Wave Energy Converter

    SciTech Connect

    Stefan G. Siegel, Ph.D.

    2012-11-30

    This program allowed further advancing the development of a novel type of wave energy converter, a Cycloidal Wave Energy Converter or CycWEC. A CycWEC consists of one or more hydrofoils rotating around a central shaft, and operates fully submerged beneath the water surface. It operates under feedback control sensing the incoming waves, and converts wave power to shaft power directly without any intermediate power take off system. Previous research consisting of numerical simulations and two dimensional small 1:300 scale wave flume experiments had indicated wave cancellation efficiencies beyond 95%. The present work was centered on construction and testing of a 1:10 scale model and conducting two testing campaigns in a three dimensional wave basin. These experiments allowed for the first time for direct measurement of electrical power generated as well as the interaction of the CycWEC in a three dimensional environment. The Atargis team successfully conducted two testing campaigns at the Texas A&M Offshore Technology Research Center and was able to demonstrate electricity generation. In addition, three dimensional wave diffraction results show the ability to achieve wave focusing, thus increasing the amount of wave power that can be extracted beyond what was expected from earlier two dimensional investigations. Numerical results showed wave cancellation efficiencies for irregular waves to be on par with results for regular waves over a wide range of wave lengths. Using the results from previous simulations and experiments a full scale prototype was designed and its performance in a North Atlantic wave climate of average 30kW/m of wave crest was estimated. A full scale WEC with a blade span of 150m will deliver a design power of 5MW at an estimated levelized cost of energy (LCOE) in the range of 10-17 US cents per kWh. Based on the new results achieved in the 1:10 scale experiments these estimates appear conservative and the likely performance at full scale will

  8. Computational modelling of the interaction of shock waves with multiple gas-filled bubbles in a liquid

    NASA Astrophysics Data System (ADS)

    Betney, M. R.; Tully, B.; Hawker, N. A.; Ventikos, Y.

    2015-03-01

    This study presents a computational investigation of the interactions of a single shock wave with multiple gas-filled bubbles in a liquid medium. This work illustrates how multiple bubbles may be used in shock-bubble interactions to intensify the process on a local level. A high resolution front-tracking approach is used, which enables explicit tracking of the gas-liquid interface. The collapse of two identical bubbles, one placed behind the other is investigated in detail, demonstrating that peak pressures in a two bubble arrangement can exceed those seen in single bubble collapse. Additionally, a parametric investigation into the effect of bubble separation is presented. It is found that the separation distance has a significant effect on both the shape and velocity of the main transverse jet of the second bubble. Extending this analysis to effects of relative bubble size, we show that if the first bubble is sufficiently small relative to the second, it may become entirely entrained in the second bubble main transverse jet. In contrast, if the first bubble is substantially larger than the second, it may offer it significant protection from the incident shock. This protection is utilised in the study of a triangular array of three bubbles, with the central bubble being significantly smaller than the outer bubbles. It is demonstrated that, through shielding of bubbles until later in the collapse process, pressures over five times higher than the maximum pressure observed in the single bubble case may be achieved. This corresponds to a peak pressure that is approximately 40 times more intense than the incident shock wave. This work has applications in a number of different fields, including cavitation erosion, explosives, targeted drug delivery/intensification, and shock wave lithotripsy.

  9. Linear Elastic Waves

    NASA Astrophysics Data System (ADS)

    Revenough, Justin

    Elastic waves propagating in simple media manifest a surprisingly rich collection of phenomena. Although some can't withstand the complexities of Earth's structure, the majority only grow more interesting and more important as remote sensing probes for seismologists studying the planet's interior. To fully mine the information carried to the surface by seismic waves, seismologists must produce accurate models of the waves. Great strides have been made in this regard. Problems that were entirely intractable a decade ago are now routinely solved on inexpensive workstations. The mathematical representations of waves coded into algorithms have grown vastly more sophisticated and are troubled by many fewer approximations, enforced symmetries, and limitations. They are far from straightforward, and seismologists using them need a firm grasp on wave propagation in simple media. Linear Elastic Waves, by applied mathematician John G. Harris, responds to this need.

  10. RADIATION WAVE DETECTION

    DOEpatents

    Wouters, L.F.

    1960-08-30

    Radiation waves can be detected by simultaneously measuring radiation- wave intensities at a plurality of space-distributed points and producing therefrom a plot of the wave intensity as a function of time. To this end. a detector system is provided which includes a plurality of nuclear radiation intensity detectors spaced at equal radial increments of distance from a source of nuclear radiation. Means are provided to simultaneously sensitize the detectors at the instant a wave of radiation traverses their positions. the detectors producing electrical pulses indicative of wave intensity. The system further includes means for delaying the pulses from the detectors by amounts proportional to the distance of the detectors from the source to provide an indication of radiation-wave intensity as a function of time.

  11. Hysteresis of ionization waves

    SciTech Connect

    Dinklage, A.; Bruhn, B.; Testrich, H.; Wilke, C.

    2008-06-15

    A quasi-logistic, nonlinear model for ionization wave modes is introduced. Modes are due to finite size of the discharge and current feedback. The model consists of competing coupled modes and it incorporates spatial wave amplitude saturation. The hysteresis of wave mode transitions under current variation is reproduced. Sidebands are predicted by the model and found in experimental data. The ad hoc model is equivalent to a general--so-called universal--approach from bifurcation theory.

  12. Millimeter Wave Ocular Effects

    DTIC Science & Technology

    1987-02-20

    illustrates the rabbit head in holder by photography (a), thermography (b) and thermographic profile (c). The temperature of the cornea was measured using an...and graphs of profiles of the 40 temperatures difference (final-initial) of the rabbit cornea heated by the focused beam of millimeter waves from the...antenna. 5. Cooling of the cornea by air flow. 43 6. Temperature as a function of power applied using 45 continuous wave millimeter waves of

  13. Kinesthetic Transverse Wave Demonstration

    NASA Astrophysics Data System (ADS)

    Pantidos, Panagiotis; Patapis, Stamatis

    2005-09-01

    This is a variation on the String and Sticky Tape demonstration "The Wave Game," suggested by Ron Edge. A group of students stand side by side, each one holding a card chest high with both hands. The teacher cues the first student to begin raising and lowering his card. When he starts lowering his card, the next student begins to raise his. As succeeding students move their cards up and down, a wave such as that shown in the figure is produced. To facilitate the process, students' motions were synchronized with the ticks of a metronome (without such synchronization it was nearly impossible to generate a satisfactory wave). Our waves typically had a frequency of about 1 Hz and a wavelength of around 3 m. We videotaped the activity so that the students could analyze the motions. The (17-year-old) students had not received any prior instruction regarding wave motion and did not know beforehand the nature of the exercise they were about to carry out. During the activity they were asked what a transverse wave is. Most of them quickly realized, without teacher input, that while the wave propagated horizontally, the only motion of the transmitting medium (them) was vertical. They located the equilibrium points of the oscillations, the crests and troughs of the waves, and identified the wavelength. The teacher defined for them the period of the oscillations of the motion of a card to be the total time for one cycle. The students measured this time and then several asserted that it was the same as the wave period. Knowing the length of the waves and the number of waves per second, the next step can easily be to find the wave speed.

  14. Thermal-Wave Microscope

    NASA Technical Reports Server (NTRS)

    Jones, Robert E.; Kramarchuk, Ihor; Williams, Wallace D.; Pouch, John J.; Gilbert, Percy

    1989-01-01

    Computer-controlled thermal-wave microscope developed to investigate III-V compound semiconductor devices and materials. Is nondestructive technique providing information on subsurface thermal features of solid samples. Furthermore, because this is subsurface technique, three-dimensional imaging also possible. Microscope uses intensity-modulated electron beam of modified scanning electron microscope to generate thermal waves in sample. Acoustic waves generated by thermal waves received by transducer and processed in computer to form images displayed on video display of microscope or recorded on magnetic disk.

  15. Optical rogue waves.

    PubMed

    Solli, D R; Ropers, C; Koonath, P; Jalali, B

    2007-12-13

    Recent observations show that the probability of encountering an extremely large rogue wave in the open ocean is much larger than expected from ordinary wave-amplitude statistics. Although considerable effort has been directed towards understanding the physics behind these mysterious and potentially destructive events, the complete picture remains uncertain. Furthermore, rogue waves have not yet been observed in other physical systems. Here, we introduce the concept of optical rogue waves, a counterpart of the infamous rare water waves. Using a new real-time detection technique, we study a system that exposes extremely steep, large waves as rare outcomes from an almost identically prepared initial population of waves. Specifically, we report the observation of rogue waves in an optical system, based on a microstructured optical fibre, near the threshold of soliton-fission supercontinuum generation--a noise-sensitive nonlinear process in which extremely broadband radiation is generated from a narrowband input. We model the generation of these rogue waves using the generalized nonlinear Schrödinger equation and demonstrate that they arise infrequently from initially smooth pulses owing to power transfer seeded by a small noise perturbation.

  16. A reduced-order, single-bubble cavitation model with applications to therapeutic ultrasound

    PubMed Central

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

    2011-01-01

    Cavitation often occurs in therapeutic applications of medical ultrasound such as shock-wave lithotripsy (SWL) and high-intensity focused ultrasound (HIFU). Because cavitation bubbles can affect an intended treatment, it is important to understand the dynamics of bubbles in this context. The relevant context includes very high acoustic pressures and frequencies as well as elevated temperatures. Relative to much of the prior research on cavitation and bubble dynamics, such conditions are unique. To address the relevant physics, a reduced-order model of a single, spherical bubble is proposed that incorporates phase change at the liquid-gas interface as well as heat and mass transport in both phases. Based on the energy lost during the inertial collapse and rebound of a millimeter-sized bubble, experimental observations were used to tune and test model predictions. In addition, benchmarks from the published literature were used to assess various aspects of model performance. Benchmark comparisons demonstrate that the model captures the basic physics of phase change and diffusive transport, while it is quantitatively sensitive to specific model assumptions and implementation details. Given its performance and numerical stability, the model can be used to explore bubble behaviors across a broad parameter space relevant to therapeutic ultrasound. PMID:22088026

  17. A model for damage of microheterogeneous kidney stones

    NASA Astrophysics Data System (ADS)

    Szeri, Andrew J.; Zohdi, Tarek I.; Blake, John R.

    2005-04-01

    In this paper, a theoretical framework is developed for the mechanics of kidney stones with an isotropic, random microstructure-such as those comprised of cystine or struvite. The approach is based on a micromechanical description of kidney stones comprised of crystals in a binding matrix. Stress concentration functions are developed to determine load sharing of the particle phase and the binding matrix phase. As an illustration of the theory, the fatigue of kidney stones subject to shock wave lithotripsy is considered. Stress concentration functions are used to construct fatigue life estimates for each phase, as a function of the volume fraction and of the mechanical properties of the constituents, as well as the loading from SWL. The failure of the binding matrix is determined explicitly in a model for the accumulation of distributed damage. Also considered is the amount of material damaged in a representative non-spherical collapse of a cavitation bubble near the stone surface. The theory can be used to assess the importance of microscale heterogeneity on the comminution of renal calculi and to estimate the number of cycles to failure in terms of measurable material properties.

  18. Filling cystoureterography facilitates stone visualization in patients with previously inserted double-J ureteral stents.

    PubMed

    Kravchick, Sergey George; Shumalinsky, Dmitry; Jeshurun-Koren, Michael; Stepnov, Eugen; Cytron, Shmuel

    2005-06-01

    In our study, we assessed the ability of a filling cystogram to induce vesicoureteral reflux (VUR) and to evaluate its role in stone targeting during ESWL in the presence of a double-J ureteral stent (JJ-S). Filling cystoureterography was performed during ESWL in 17 patients with previously inserted 4.7 F JJ-S. The examination ended with stone localization. In every procedure, 3,500 shock waves were delivered with an energy range of 18-23 kV. Patients were evaluated 4 weeks after ESWL. A stone-free result was defined as no evidence of calculi in the first or second visits. Because contrast material was employed in this study, we also evaluated its possible interference with the results of lithotripsy. All radiolucent or poorly calcified stones were successfully localized. In four patients, rhythmic suprapubic manual pressure was performed to initiate VUR. Reflux was low grade in 35% and high grade in 65% of renal units. The efficiency quotient reached 59%. In vitro artificial stones were successfully disintegrated both in water and solutions of Ultravist. In the presence of a JJ-S, filling cystography can easily localize radiolucent stones during SWL. No special catheters or stents are required for this technique. Ultravist in particular does not affect the results of ESWL unfavorably.

  19. [Use of levofloxacin in the antibiotic prophylaxis for diagnostic procedures in urology].

    PubMed

    Trinchieri, Alberto; Mangiarotti, Barbara; Lizzano, Renata

    2002-03-01

    Chemoprophylaxis is the use of antimicrobial agents before contamination in the hope of preventing infections. The need for prophylaxis depends on the type of procedure and the risk for each individual patient. The risk for infection from urethral catheterization in a hospital setting is 5% for men and 10-20% for women, after routine cystoscopy is 4.7%, after transurethral resection of the bladder (TURB) is 39%, after transurethral resection of the prostate (TURP) is 6-43%, after transrectal biopsy of the prostate is 6.2-87%, and after shock wave lithotripsy is 5.7%. On this basis prophylactic treatment is recommended in all patients for transrectal prostate biopsy and transurethral surgery and in patients with increased risk of infection for diagnostic endoscopy of the urinary tract and SWL. Risk factors such as age, immunosuppression, metabolic dysfunction (e.g., diabetes), reduced general condition, prolonged operative time and bleeding, should be considered. Broad-spectrum cephalosporin, penicillins and fluoroquinolones are most often used. The choice of the drug also depends on its pharmacokinetic properties that should secure effective tissue levels during the procedure. Levofloxacin meets these criteria and reduces the incidence of infection after transrectal prostate biopsy and endoscopy of the urinary tract.

  20. A reduced-order, single-bubble cavitation model with applications to therapeutic ultrasound.

    PubMed

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

    2011-11-01

    Cavitation often occurs in therapeutic applications of medical ultrasound such as shock-wave lithotripsy (SWL) and high-intensity focused ultrasound (HIFU). Because cavitation bubbles can affect an intended treatment, it is important to understand the dynamics of bubbles in this context. The relevant context includes very high acoustic pressures and frequencies as well as elevated temperatures. Relative to much of the prior research on cavitation and bubble dynamics, such conditions are unique. To address the relevant physics, a reduced-order model of a single, spherical bubble is proposed that incorporates phase change at the liquid-gas interface as well as heat and mass transport in both phases. Based on the energy lost during the inertial collapse and rebound of a millimeter-sized bubble, experimental observations were used to tune and test model predictions. In addition, benchmarks from the published literature were used to assess various aspects of model performance. Benchmark comparisons demonstrate that the model captures the basic physics of phase change and diffusive transport, while it is quantitatively sensitive to specific model assumptions and implementation details. Given its performance and numerical stability, the model can be used to explore bubble behaviors across a broad parameter space relevant to therapeutic ultrasound.

  1. Oceanic-wave-measurement system

    NASA Technical Reports Server (NTRS)

    Holmes, J. F.; Miles, R. T.

    1980-01-01

    Barometer mounted on bouy senses wave heights. As wave motion raises and lowers barometer, pressure differential is proportional to wave height. Monitoring circuit samples barometer output every half cycle of wave motion and adds magnitudes of adjacent positive and negative peaks. Resulting output signals, proportional to wave height, are transmitted to central monitoring station.

  2. Power from Ocean Waves.

    ERIC Educational Resources Information Center

    Newman, J. N.

    1979-01-01

    Discussed is the utilization of surface ocean waves as a potential source of power. Simple and large-scale wave power devices and conversion systems are described. Alternative utilizations, environmental impacts, and future prospects of this alternative energy source are detailed. (BT)

  3. Those Elusive Gravitational Waves

    ERIC Educational Resources Information Center

    MOSAIC, 1976

    1976-01-01

    The presence of gravitational waves was predicted by Einstein in his theory of General Relativity. Since then, scientists have been attempting to develop a detector sensitive enough to measure these cosmic signals. Once the presence of gravitational waves is confirmed, scientists can directly study star interiors, galaxy cores, or quasars. (MA)

  4. Mask Waves Benchmark

    DTIC Science & Technology

    2007-10-01

    24 . Measured frequency vs. set frequency for all data .............................................. 23 25. Benchmark Probe#1 wave amplitude variation...4 8 A- 24 . Wave amplitude by probe, blower speed, lip setting for 0.768 Hz on the short I b an k...frequency and wavemaker bank .................................... 24 B- 1. Coefficient of variation as percentage for all conditions for long bank and bridge

  5. Gravitational waves from inflation

    NASA Astrophysics Data System (ADS)

    Guzzetti, M. C.; Bartolo, N.; Liguori, M.; Matarrese, S.

    2016-09-01

    The production of a stochastic background of gravitational waves is a fundamental prediction of any cosmological inflationary model. The features of such a signal encode unique information about the physics of the Early Universe and beyond, thus representing an exciting, powerful window on the origin and evolution of the Universe. We review the main mechanisms of gravitational-wave production, ranging from quantum fluctuations of the gravitational field to other mechanisms that can take place during or after inflation. These include e.g. gravitational waves generated as a consequence of extra particle production during inflation, or during the (p)reheating phase. Gravitational waves produced in inflation scenarios based on modified gravity theories and second-order gravitational waves are also considered. For each analyzed case, the expected power spectrum is given. We discuss the discriminating power among different models, associated with the validity/violation of the standard consistency relation between tensor-to-scalar ratio r and tensor spectral index nT. In light of the prospects for (directly/indirectly) detecting primordial gravitational waves, we give the expected present-day gravitational radiation spectral energy-density, highlighting the main characteristics imprinted by the cosmic thermal history, and we outline the signatures left by gravitational waves on the Cosmic Microwave Background and some imprints in the Large-Scale Structure of the Universe. Finally, current bounds and prospects of detection for inflationary gravitational waves are summarized.

  6. Advanced Gravitational Wave Detectors

    NASA Astrophysics Data System (ADS)

    Blair, D. G.; Howell, E. J.; Ju, L.; Zhao, C.

    2012-02-01

    Part I. An Introduction to Gravitational Wave Astronomy and Detectors: 1. Gravitational waves D. G. Blair, L. Ju, C. Zhao and E. J. Howell; 2. Sources of gravitational waves D. G. Blair and E. J. Howell; 3. Gravitational wave detectors D. G. Blair, L. Ju, C. Zhao, H. Miao, E. J. Howell, and P. Barriga; 4. Gravitational wave data analysis B. S. Sathyaprakash and B. F. Schutz; 5. Network analysis L. Wen and B. F. Schutz; Part II. Current Laser Interferometer Detectors: Three Case Studies: 6. The Laser Interferometer Gravitational-Wave Observatory P. Fritschel; 7. The VIRGO detector S. Braccini; 8. GEO 600 H. Lück and H. Grote; Part III. Technology for Advanced Gravitational Wave Detectors: 9. Lasers for high optical power interferometers B. Willke and M. Frede; 10. Thermal noise, suspensions and test masses L. Ju, G. Harry and B. Lee; 11. Vibration isolation: Part 1. Seismic isolation for advanced LIGO B. Lantz; Part 2. Passive isolation J-C. Dumas; 12. Interferometer sensing and control P. Barriga; 13. Stabilizing interferometers against high optical power effects C. Zhao, L. Ju, S. Gras and D. G. Blair; Part IV. Technology for Third Generation Gravitational Wave Detectors: 14. Cryogenic interferometers J. Degallaix; 15. Quantum theory of laser-interferometer GW detectors H. Miao and Y. Chen; 16. ET. A third generation observatory M. Punturo and H. Lück; Index.

  7. The Relativistic Wave Vector

    ERIC Educational Resources Information Center

    Houlrik, Jens Madsen

    2009-01-01

    The Lorentz transformation applies directly to the kinematics of moving particles viewed as geometric points. Wave propagation, on the other hand, involves moving planes which are extended objects defined by simultaneity. By treating a plane wave as a geometric object moving at the phase velocity, novel results are obtained that illustrate the…

  8. Slow frictional waves

    NASA Astrophysics Data System (ADS)

    Viswanathan, Koushik; Sundaram, Narayan; Chandrasekar, Srinivasan

    Stick-slip, manifest as intermittent tangential motion between two dry solid surfaces, is a friction instability that governs diverse phenomena from automobile brake squeals to earthquakes. We show, using high-speed in situ imaging of an adhesive polymer interface, that low velocity stick-slip is fundamentally of three kinds, corresponding to passage of three different surface waves -- separation pulses, slip pulses and the well-known Schallamach waves. These waves, traveling much slower than elastic waves, have clear distinguishing properties. Separation pulses and Schallamach waves involve local interface separation, and propagate in opposite directions while slip pulses are characterized by a sharp stress front and do not display any interface detachment. A change in the stick-slip mode from separation to slip pulse is effected simply by increasing the normal force. Together, these three waves constitute all possible stick-slip modes in adhesive friction and are shown to have direct analogues in muscular locomotory waves in soft bodied invertebrates. A theory for slow wave propagation is also presented which is capable of explaining the attendant interface displacements, velocities and stresses.

  9. Waves in polar lows

    NASA Astrophysics Data System (ADS)

    Orimolade, A. P.; Furevik, B. R.; Noer, G.; Gudmestad, O. T.; Samelson, R. M.

    2016-08-01

    In a rather stationary fetch, one would not expect large waves in polar low situations. However, the picture changes when one considers a moving fetch. The significant wave heights that may be associated with the recorded polar lows on the Norwegian continental shelf from December 1999 to October 2015 are estimated using a one-dimensional parametric wave model. A comparison of the measured and the forecasted significant wave heights in two recent polar low cases in the Barents Sea is presented. The estimated significant wave heights show that the values could have been up to and above 9 m. The forecasted significant wave heights considerably underestimated the measured significant wave heights in the two recent polar low cases that are considered. Furthermore, a generalization of the fetch-limited wave equation in polar lows is proposed, which allows the wind field to vary in space and time, and is shown to give results that are consistent with the one-dimensional parametric model.

  10. Thermal-Wave Imaging.

    ERIC Educational Resources Information Center

    Rosencwaig, Allan

    1982-01-01

    Thermal features of and beneath the surface of a sample can be detected and imaged with a thermal-wave microscope. Various methodologies for the excitation and detection of thermal waves are discussed, and several applications, primarily in microelectronics, are presented. (Author)

  11. Search for Gravitational Waves

    NASA Astrophysics Data System (ADS)

    Tsubono, K.

    The current status of the experimental search for gravitational waves is reviewed here. The emphasis is on the Japanese TAMA project. We started operation of the TAMA300 laser interferometric detector in 1999, and are now collecting and analyzing observational data to search for gravitational wave signals.

  12. Extracorporeal shock waves stimulate frog sciatic nerves indirectly via a cavitation-mediated mechanism.

    PubMed Central

    Schelling, G.; Delius, M.; Gschwender, M.; Grafe, P.; Gambihler, S.

    1994-01-01

    Shock waves (SWs) are single pressure pulses with amplitudes up to over 100 MPa, a rise time of only a few nanoseconds, and a short duration of approximately 2 microseconds. Their clinical application for stone destruction causes pain, indicating nerve stimulation by SWs. To examine this phenomenon, sciatic nerves of frogs were exposed to SWs in an organ bath. The SWs were generated with an experimental Dornier lithotripter model XL1 at an operating voltage of 15 kV. The nerves were mounted in a chamber which allowed electrical nerve stimulation and the registration of electrically and SW-induced compound action potentials (SWCAPs). The chamber was filled with frog Ringer's solution. In a standardized protocol. The first experiment established that 95.0 +/- 4.7% of administered SWs induced action potentials which were lower in amplitude (1.45 +/- 1.14 versus 1.95 +/- 0.95 mV, p = 0.004) but similar in shape to electrically induced compound action potentials. In a second experiment, it was shown that the site of origin of the SWCAPs could be correctly determined by simultaneous recording of action potentials at both ends of the nerve. The mechanism of shock wave stimulation was examined by experiments 3 and 4. In experiment 3, in contrast to the previous experiments, SW exposure of the nerves was performed 6 cm outside the shock wave focus. This resulted in a mean probability of inducing a SWCAP of only 4%. After gas bubble administration, this probability increased to 86% for the first SW released immediately after bubble application and declined to 56% for the second, 21% for the third, to 0 for the 10th SW after fluid injection. This indicates that cavitation, the interaction between shock waves and gas bubbles in fluid or tissues, was involved in SWCAP generation. In experiment 4, nerves were again exposed in the focus, however, the Ringer's solution surrounding the nerve was replaced by polyvinyl alcohol (PVA). PVA is a solution with low cavitation activity

  13. SQUARE WAVE AMPLIFIER

    DOEpatents

    Leavitt, M.A.; Lutz, I.C.

    1958-08-01

    An amplifier circuit is described for amplifying sigmals having an alternating current component superimposed upon a direct current component, without loss of any segnnent of the alternating current component. The general circuit arrangement includes a vibrator, two square wave amplifiers, and recombination means. The amplifier input is connected to the vibrating element of the vibrator and is thereby alternately applied to the input of each square wave amplifier. The detailed circuitry of the recombination means constitutes the novelty of the annplifier and consists of a separate, dual triode amplifier coupled to the output of each square wave amplifier with a recombination connection from the plate of one amplifier section to a grid of one section of the other amplifier. The recombination circuit has provisions for correcting distortion caused by overlapping of the two square wave voltages from the square wave amplifiers.

  14. Experiments on excitation waves

    NASA Astrophysics Data System (ADS)

    Müller, S. C.

    Recent trends in the experimentation on chemical and biochemical excitation waves are presented. In the Belousov-Zhabotinsky reaction, which is the most suitable chemical laboratory system for the study of wave propagation in excitable medium, the efficient control of wave dynamics by electrical fields and by light illumination is illustrated. In particular, the effects of a feedback control are shown. Further new experiments in this system are concerned with three-dimensional topologies and boundary effects. Important biological applications are found in the aggregation of slime mould amoebae, in proton waves during oscillatory glycolysis, and in waves of spreading depression in neuronal tissue as studied by experiments in chicken retina. Numerical simulations with appropriate reaction-diffusion models complement a large number of these experimental findings.

  15. Vector financial rogue waves

    NASA Astrophysics Data System (ADS)

    Yan, Zhenya

    2011-11-01

    The coupled nonlinear volatility and option pricing model presented recently by Ivancevic is investigated, which generates a leverage effect, i.e., stock volatility is (negatively) correlated to stock returns, and can be regarded as a coupled nonlinear wave alternative of the Black-Scholes option pricing model. In this Letter, we analytically propose vector financial rogue waves of the coupled nonlinear volatility and option pricing model without an embedded w-learning. Moreover, we exhibit their dynamical behaviors for chosen different parameters. The vector financial rogue wave (rogon) solutions may be used to describe the possible physical mechanisms for the rogue wave phenomena and to further excite the possibility of relative researches and potential applications of vector rogue waves in the financial markets and other related fields.

  16. Project GlobWave

    NASA Astrophysics Data System (ADS)

    Busswell, Geoff; Ash, Ellis; Piolle, Jean-Francois; Poulter, David J. S.; Snaith, Helen; Collard, Fabrice; Sheera, Harjit; Pinnock, Simon

    2010-12-01

    The ESA GlobWave project is a three year initiative, funded by ESA and CNES, to service the needs of satellite wave product users across the globe. Led by Logica UK, with support from CLS, IFREMER, SatOC and NOCS, the project will provide free access to satellite wave data and products in a common format, both historical and in near real time, from various European and American SAR and altimeter missions. Building on the successes of similar projects for Sea Surface Temperature and ocean colour, the project aims to stimulate increased use and analysis of satellite wave products. In addition to common-format satellite data the project will provide comparisons with in situ measurements, interactive data analysis tools and a pilot spatial wave forecast verification scheme for operational forecast production centres. The project will begin operations in January 2010, with direction from regular structured user consultation.

  17. Electromagnetic wave energy converter

    NASA Technical Reports Server (NTRS)

    Bailey, R. L. (Inventor)

    1973-01-01

    Electromagnetic wave energy is converted into electric power with an array of mutually insulated electromagnetic wave absorber elements each responsive to an electric field component of the wave as it impinges thereon. Each element includes a portion tapered in the direction of wave propagation to provide a relatively wideband response spectrum. Each element includes an output for deriving a voltage replica of the electric field variations intercepted by it. Adjacent elements are positioned relative to each other so that an electric field subsists between adjacent elements in response to the impinging wave. The electric field results in a voltage difference between adjacent elements that is fed to a rectifier to derive dc output power.

  18. Gravity-Wave astronomy

    NASA Astrophysics Data System (ADS)

    Grishchuk, Leonid Petrovich

    The article concerns astronomical phenomena , related with discovery of gravitational waves of various nature: 1) primordial (relic) gravitational waves, analogous to MWBR 2) gravitational waves due to giant collisions in the Universe between 2a) Macroscopic black Holes in the centers of Galaxies 2b) Tidal disruption of neutron stars by Black holes 2c) deformations of the space-time by stellar mass Black Holes moving near giant Black Holes in the centers of Galaxies 2d) Supernovae phenomena 2e) accretion phenomena on Black Holes and Neutron stars. The Earth based interferometric technics (LIGO Project) to detect gravitational waves is described as well as the perspectiva for a space Laser Interferometric Antena (LISA)is discussed. The article represents a modified text of the Plenary talk "Gravity-Wave astronomy" given at the XI International gravitational Conference (July 1986, Stockholm, Sweden).

  19. Sculpting Waves (Presentation Recording)

    NASA Astrophysics Data System (ADS)

    Engheta, Nader

    2015-09-01

    In electronics controlling and manipulating flow of charged carriers has led to design of numerous functional devices. In photonics, by analogy, this is done through controlling photons and optical waves. However, the challenges and opportunities are different in these two fields. Materials control waves, and as such they can tailor, manipulate, redirect, and scatter electromagnetic waves and photons at will. Recent development in condensed matter physics, nanoscience, and nanotechnology has made it possible to tailor materials with unusual parameters and extreme characteristics and with atomic precision and thickness. One can now construct structures much smaller than the wavelengths of visible light, thus ushering in unprecedented possibilities and novel opportunities for molding fields and waves at the nanoscale with desired functionalities. At such subwavelength scales, sculpting optical fields and waves provides a fertile ground for innovation and discovery. I will discuss some of the exciting opportunities in this area, and forecast some future directions and possibilities.

  20. Spatial equation for water waves

    NASA Astrophysics Data System (ADS)

    Dyachenko, A. I.; Zakharov, V. E.

    2016-02-01

    A compact spatial Hamiltonian equation for gravity waves on deep water has been derived. The equation is dynamical and can describe extreme waves. The equation for the envelope of a wave train has also been obtained.

  1. Standing Waves on a Shoestring.

    ERIC Educational Resources Information Center

    Hendrix, Laura

    1992-01-01

    Describes the construction of a wave generator used to review the algebraic relationships of wave motion. Students calculate and measure the weight needed to create tension to generate standing waves at the first eight harmonics. (MDH)

  2. Dynamics of baroclinic wave systems

    NASA Technical Reports Server (NTRS)

    Barcilon, Albert; Weng, Hengyi

    1989-01-01

    The research carried out in the past year dealt with nonlinear baroclinic wave dynamics. The model consisted of an Eady baroclinic basic state and uneven Elkman dissipation at the top and bottom boundaries with/without slopes. The method of solution used a truncated spectral expansion with three zonal waves and one or two meridional modes. Numerical experiments were performed on synoptic scale waves or planetary scale waves with/without wave-wave interaction.

  3. Wave phenomena in sunspots

    NASA Astrophysics Data System (ADS)

    Löhner-Böttcher, Johannes

    2016-03-01

    Context: The dynamic atmosphere of the Sun exhibits a wealth of magnetohydrodynamic (MHD) waves. In the presence of strong magnetic fields, most spectacular and powerful waves evolve in the sunspot atmosphere. Allover the sunspot area, continuously propagating waves generate strong oscillations in spectral intensity and velocity. The most prominent and fascinating phenomena are the 'umbral flashes' and 'running penumbral waves' as seen in the sunspot chromosphere. Their nature and relation have been under intense discussion in the last decades. Aims: Waves are suggested to propagate upward along the magnetic field lines of sunspots. An observational study is performed to prove or disprove the field-guided nature and coupling of the prevalent umbral and penumbral waves. Comprehensive spectroscopic observations at high resolution shall provide new insights into the wave characteristics and distribution across the sunspot atmosphere. Methods: Two prime sunspot observations were carried out with the Dunn Solar Telescope at the National Solar Observatory in New Mexico and with the Vacuum Tower Telescope at the Teide Observatory on Tenerife. The two-dimensional spectroscopic observations were performed with the interferometric spectrometers IBIS and TESOS. Multiple spectral lines are scanned co-temporally to sample the dynamics at the photospheric and chromospheric layers. The time series (1 - 2.5 h) taken at high spatial and temporal resolution are analyzed according to their evolution in spectral intensities and Doppler velocities. A wavelet analysis was used to obtain the wave power and dominating wave periods. A reconstruction of the magnetic field inclination based on sunspot oscillations was developed. Results and conclusions: Sunspot oscillations occur continuously in spectral intensity and velocity. The obtained wave characteristics of umbral flashes and running penumbral waves strongly support the scenario of slow-mode magnetoacoustic wave propagation along the

  4. Wave action power plant

    SciTech Connect

    Lucia, L.V.

    1982-03-16

    A wave action power plant powered by the action of water waves has a drive shaft rotated by a plurality of drive units, each having a lever pivotally mounted on and extending from said shaft and carrying a weight, in the form of a float, which floats on the waves and rocks the lever up and down on the shaft. A ratchet mechanism causes said shaft to be rotated in one direction by the weight of said float after it has been raised by wave and the wave has passed, leaving said float free to move downwardly by gravity and apply its full weight to pull down on the lever and rotate the drive shaft. There being a large number of said drive units so that there are always some of the weights pulling down on their respective levers while other weights are being lifted by waves and thereby causing continuous rotation of the drive shaft in one direction. The said levers are so mounted that they may be easily raised to bring the weights into a position wherein they are readily accessible for cleaning the bottoms thereof to remove any accumulation of barnacles, mollusks and the like. There is also provided means for preventing the weights from colliding with each other as they independently move up and down on the waves.

  5. Shoaling internal solitary waves

    NASA Astrophysics Data System (ADS)

    Sutherland, B. R.; Barrett, K. J.; Ivey, G. N.

    2013-09-01

    The evolution and breaking of internal solitary waves in a shallow upper layer as they approach a constant bottom slope is examined through laboratory experiments. The waves are launched in a two-layer fluid through the standard lock-release method. In most experiments, the wave amplitude is significantly larger than the depth of the shallow upper layer so that they are not well described by Korteweg-de Vries theory. The dynamics of the shoaling waves are characterized by the Iribarren number, Ir, which measures the ratio of the topographic slope to the square root of the characteristic wave slope. This is used to classify breaking regimes as collapsing, plunging, surging, and nonbreaking for increasing values of Ir. For breaking waves, the maximum interface descent, Hi⋆, is predicted to depend upon the topographic slope, s, and the incident wave's amplitude and width, Asw and Lsw, respectively, as Hi⋆≃4sAswLsw. This prediction is corroborated by our experiments. Likewise, we apply simple heuristics to estimate the speed of interface descent, and we characterize the speed and range of the consequent upslope flow of the lower layer after breaking has occurred.

  6. Undamped electrostatic plasma waves

    SciTech Connect

    Valentini, F.; Perrone, D.; Veltri, P.; Califano, F.; Pegoraro, F.; Morrison, P. J.; O'Neil, T. M.

    2012-09-15

    Electrostatic waves in a collision-free unmagnetized plasma of electrons with fixed ions are investigated for electron equilibrium velocity distribution functions that deviate slightly from Maxwellian. Of interest are undamped waves that are the small amplitude limit of nonlinear excitations, such as electron acoustic waves (EAWs). A deviation consisting of a small plateau, a region with zero velocity derivative over a width that is a very small fraction of the electron thermal speed, is shown to give rise to new undamped modes, which here are named corner modes. The presence of the plateau turns off Landau damping and allows oscillations with phase speeds within the plateau. These undamped waves are obtained in a wide region of the (k,{omega}{sub R}) plane ({omega}{sub R} being the real part of the wave frequency and k the wavenumber), away from the well-known 'thumb curve' for Langmuir waves and EAWs based on the Maxwellian. Results of nonlinear Vlasov-Poisson simulations that corroborate the existence of these modes are described. It is also shown that deviations caused by fattening the tail of the distribution shift roots off of the thumb curve toward lower k-values and chopping the tail shifts them toward higher k-values. In addition, a rule of thumb is obtained for assessing how the existence of a plateau shifts roots off of the thumb curve. Suggestions are made for interpreting experimental observations of electrostatic waves, such as recent ones in nonneutral plasmas.

  7. Global Coronal Waves

    NASA Astrophysics Data System (ADS)

    Chen, P. F.

    2016-02-01

    After the Solar and Heliospheric Observatory (SOHO) was launched in 1996, the aboard Extreme Ultraviolet Imaging Telescope (EIT) observed a global coronal wave phenomenon, which was initially named ``EIT wave" after the telescope. The bright fronts are immediately followed by expanding dimmings. It has been shown that the brightenings and dimmings are mainly due to plasma density increase and depletion, respectively. Such a spectacular phenomenon sparked long-lasting interest and debates. The debates were concentrated on two topics, one is about the driving source, and the other is about the nature of this wavelike phenomenon. The controversies are most probably because there may exist two types of large-scale coronal waves that were not well resolved before the Solar Dynamics Observatory (SDO) was launched: one is a piston-driven shock wave straddling over the erupting coronal mass ejection (CME), and the other is an apparently propagating front, which may correspond to the CME frontal loop. Such a two-wave paradigm was proposed more than 13 years ago, and now is being recognized by more and more colleagues. In this paper, we review how various controversies can be resolved in the two-wave framework and how important it is to have two different names for the two types of coronal waves.

  8. Glutamatergic Retinal Waves

    PubMed Central

    Kerschensteiner, Daniel

    2016-01-01

    Spontaneous activity patterns propagate through many parts of the developing nervous system and shape the wiring of emerging circuits. Prior to vision, waves of activity originating in the retina propagate through the lateral geniculate nucleus (LGN) of the thalamus to primary visual cortex (V1). Retinal waves have been shown to instruct the wiring of ganglion cell axons in LGN and of thalamocortical axons in V1 via correlation-based plasticity rules. Across species, retinal waves mature in three stereotypic stages (I–III), in which distinct circuit mechanisms give rise to unique activity patterns that serve specific functions in visual system refinement. Here, I review insights into the patterns, mechanisms, and functions of stage III retinal waves, which rely on glutamatergic signaling. As glutamatergic waves spread across the retina, neighboring ganglion cells with opposite light responses (ON vs. OFF) are activated sequentially. Recent studies identified lateral excitatory networks in the inner retina that generate and propagate glutamatergic waves, and vertical inhibitory networks that desynchronize the activity of ON and OFF cells in the wavefront. Stage III wave activity patterns may help segregate axons of ON and OFF ganglion cells in the LGN, and could contribute to the emergence of orientation selectivity in V1. PMID:27242446

  9. Wave-wave interactions in solar type III radio bursts

    SciTech Connect

    Thejappa, G.; MacDowall, R. J.

    2014-02-11

    The high time resolution observations from the STEREO/WAVES experiment show that in type III radio bursts, the Langmuir waves often occur as localized magnetic field aligned coherent wave packets with durations of a few ms and with peak intensities well exceeding the strong turbulence thresholds. Some of these wave packets show spectral signatures of beam-resonant Langmuir waves, down- and up-shifted sidebands, and ion sound waves, with frequencies, wave numbers, and tricoherences satisfying the resonance conditions of the oscillating two stream instability (four wave interaction). The spectra of a few of these wave packets also contain peaks at f{sub pe}, 2f{sub pe} and 3 f{sub pe} (f{sub pe} is the electron plasma frequency), with frequencies, wave numbers and bicoherences (computed using the wavelet based bispectral analysis techniques) satisfying the resonance conditions of three wave interactions: (1) excitation of second harmonic electromagnetic waves as a result of coalescence of two oppositely propagating Langmuir waves, and (2) excitation of third harmonic electromagnetic waves as a result of coalescence of Langmuir waves with second harmonic electromagnetic waves. The implication of these findings is that the strong turbulence processes play major roles in beam stabilization as well as conversion of Langmuir waves into escaping radiation in type III radio bursts.

  10. Demonstration of Shear Waves, Lamb Waves, and Rayleigh Waves by Mode Conversion.

    ERIC Educational Resources Information Center

    Leung, W. P.

    1980-01-01

    Introduces an experiment that can be demonstrated in the classroom to show that shear waves, Rayleigh waves, and Lamb waves can be easily generated and observed by means of mode conversion. (Author/CS)

  11. The biological effects of extracorporeal shock wave therapy (eswt) on tendon tissue.

    PubMed

    Notarnicola, Angela; Moretti, Biagio

    2012-01-01

    There is currently great interest in the use of Extracorporeal Shock Wave Therapy (ESWT) and in clarifying the mechanisms of action in tendon pathologies. The success rate ranges from 60% to 80% in epicondylitis, plantar fasciitis, cuff tendinitis, trocanteritis, Achilles tendinitis or jumper's knee. In contrast to urological treatments (lithotripsy), where shockwaves are used to disintegrate renal stones, in musculoskeletal treatments (orthotripsy), shockwaves are not being used to disintegrate tissues, but rather to microscopically cause interstitial and extracellular biological responses and tissue regeneration. The researchers are interesting to investigate the biological effects which support the clinical successes. Some authors speculated that shockwaves relieve pain in insertional tendinopathy by hyper-stimulation analgesia. Many recent studies demonstrated the modulations of shockwave treatment including neovascularization, differentiation of mesenchymal stem cells and local release of angiogenetic factors. The experimental findings confirm that ESWT decrease the expression of high levels of inflammatory mediators (matrix metalloproteinases and inter-leukins). Therefore, ESWT produces a regenerative and tissue-repairing effect in musculoskeletal tissues, not merely a mechanical disintegrative effect as generally before assumed. Based on the encouraging results of clinical and experimental studies, the potential of ESWT appears to be emerging. The promising outcome after this non-invasive treatment option in tendinitis care justifies the indication of shockwave therapy. Further studies have to be performed in order or determine optimum treatment parameters and will bring about an improvement in accordance with evidence-based medicine. Finally, meta-analysis studies are necessary to demonstrate the efficacy and safety of ESWT in treating tendinopathies.

  12. The biological effects of extracorporeal shock wave therapy (eswt) on tendon tissue

    PubMed Central

    Notarnicola, Angela; Moretti, Biagio

    2012-01-01

    Summary There is currently great interest in the use of Extracorporeal Shock Wave Therapy (ESWT) and in clarifying the mechanisms of action in tendon pathologies. The success rate ranges from 60% to 80% in epicondylitis, plantar fasciitis, cuff tendinitis, trocanteritis, Achilles tendinitis or jumper’s knee. In contrast to urological treatments (lithotripsy), where shockwaves are used to disintegrate renal stones, in musculoskeletal treatments (orthotripsy), shockwaves are not being used to disintegrate tissues, but rather to microscopically cause interstitial and extracellular biological responses and tissue regeneration. The researchers are interesting to investigate the biological effects which support the clinical successes. Some authors speculated that shockwaves relieve pain in insertional tendinopathy by hyper-stimulation analgesia. Many recent studies demonstrated the modulations of shockwave treatment including neovascularization, differentiation of mesenchymal stem cells and local release of angiogenetic factors. The experimental findings confirm that ESWT decrease the expression of high levels of inflammatory mediators (matrix metalloproteinases and inter-leukins). Therefore, ESWT produces a regenerative and tissue-repairing effect in musculoskeletal tissues, not merely a mechanical disintegrative effect as generally before assumed. Based on the encouraging results of clinical and experimental studies, the potential of ESWT appears to be emerging. The promising outcome after this non-invasive treatment option in tendinitis care justifies the indication of shockwave therapy. Further studies have to be performed in order or determine optimum treatment parameters and will bring about an improvement in accordance with evidence-based medicine. Finally, meta-analysis studies are necessary to demonstrate the efficacy and safety of ESWT in treating tendinopathies. PMID:23738271

  13. Towards Gravitational Wave Astronomy

    NASA Astrophysics Data System (ADS)

    Losurdo, Giovanni

    This chapter is meant to introduce the reader to the forthcoming network of second-generation interferometric detectors of gravitational waves, at a time when their construction is close to completion and there is the ambition to detect gravitational waves for the first time in the next few years and open the way to gravitational wave astronomy. The legacy of first-generation detectors is discussed before giving an overview of the technology challenges that have been faced to make advanced detectors possible. The various aspects outlined here are then discussed in more detail in the subsequent chapters of the book.

  14. Circular rogue wave clusters.

    PubMed

    Kedziora, David J; Ankiewicz, Adrian; Akhmediev, Nail

    2011-11-01

    Using the Darboux transformation technique and numerical simulations, we study the hierarchy of rational solutions of the nonlinear Schrödinger equation that can be considered as higher order rogue waves in this model. This analysis reveals the existence of rogue wave clusters with a high level of symmetry in the (x,t) plane. These structures arise naturally when the shifts in the Darboux scheme are taken to be eigenvalue dependent. We have found single-shell structures where a central higher order rogue wave is surrounded by a ring of first order peaks on the (x,t) plane.

  15. Lattice Waves, Spin Waves, and Neutron Scattering

    DOE R&D Accomplishments Database

    Brockhouse, Bertram N.

    1962-03-01

    Use of neutron inelastic scattering to study the forces between atoms in solids is treated. One-phonon processes and lattice vibrations are discussed, and experiments that verified the existence of the quantum of lattice vibrations, the phonon, are reviewed. Dispersion curves, phonon frequencies and absorption, and models for dispersion calculations are discussed. Experiments on the crystal dynamics of metals are examined. Dispersion curves are presented and analyzed; theory of lattice dynamics is considered; effects of Fermi surfaces on dispersion curves; electron-phonon interactions, electronic structure influence on lattice vibrations, and phonon lifetimes are explored. The dispersion relation of spin waves in crystals and experiments in which dispersion curves for spin waves in Co-Fe alloy and magnons in magnetite were obtained and the reality of the magnon was demonstrated are discussed. (D.C.W)

  16. Dark- and bright-rogue-wave solutions for media with long-wave-short-wave resonance.

    PubMed

    Chen, Shihua; Grelu, Philippe; Soto-Crespo, J M

    2014-01-01

    Exact explicit rogue-wave solutions of intricate structures are presented for the long-wave-short-wave resonance equation. These vector parametric solutions feature coupled dark- and bright-field counterparts of the Peregrine soliton. Numerical simulations show the robustness of dark and bright rogue waves in spite of the onset of modulational instability. Dark fields originate from the complex interplay between anomalous dispersion and the nonlinearity driven by the coupled long wave. This unusual mechanism, not available in scalar nonlinear wave equation models, can provide a route to the experimental realization of dark rogue waves in, for instance, negative index media or with capillary-gravity waves.

  17. Wave Dissipation and Balance - NOPP Wave Project

    DTIC Science & Technology

    2011-09-01

    with a common structure , and now estimating the “cumulative term” with the breaking probabilities used for the main dissipation term. This has led to a...captured by the new parameterizations, but that will require the analysis of more detailed measurement campaigns Ardhuin et al. (2011b). These result have...much more flat bias as a function of wave height (figure 1). A detailed case study of the February 2011 storm Quirin, in the North Atlantic, has shown

  18. Measurement of high frequency waves using a wave follower

    NASA Technical Reports Server (NTRS)

    Tang, S.; Shemdin, O. H.

    1983-01-01

    High frequency waves were measured using a laser-optical sensor mounted on a wave follower. Measured down-wind wave slope spectra are shown to be wind speed dependent; the mean square wave-slopes are generally larger than those measured by Cox and Munk (1954) using the sun glitter method.

  19. Resonance wave pumping with surface waves

    NASA Astrophysics Data System (ADS)

    Carmigniani, Remi; Gharib, Morteza; Violeau, Damien; Caltech-ENPC Collaboration

    2015-11-01

    The valveless impedance pump enables the production or amplification of a flow without the use of integrated mobile parts, thus delaying possible failures. It is usually composed of fluid-filled flexible tubing, closed by solid tubes. The flexible tube is pinched at an off-centered position relative to the tube ends. This generates a complex wave dynamic that results in a pumping phenomenon. It has been previously reported that pinching at intrinsic resonance frequencies of the system results in a strong pulsating flow. A case of a free surface wave pump is investigated. The resonance wave pump is composed of a rectangular tank with a submerged plate separating the water into a free surface and a recirculation rectangular section connected through two openings at each end of the tank. A paddle placed at an off-center position above the submerged plate is controlled in a heaving motion with different frequencies and amplitudes. Similar to the case of valveless impedance pump, we observed that near resonance frequencies strong pulsating flow is generated with almost no oscillations. A linear theory is developed to pseudo-analytically evaluate these frequencies. In addition, larger scale applications were simulated using Smoothed Particle Hydrodynamic codes.

  20. Traveling-wave photodetector

    DOEpatents

    Hietala, Vincent M.; Vawter, Gregory A.

    1993-01-01

    The traveling-wave photodetector of the present invention combines an absorptive optical waveguide and an electrical transmission line, in which optical absorption in the waveguide results in a photocurrent at the electrodes of the electrical transmission line. The optical waveguide and electrical transmission line of the electrically distributed traveling-wave photodetector are designed to achieve matched velocities between the light in the optical waveguide and electrical signal generated on the transmission line. This velocity synchronization provides the traveling-wave photodetector with a large electrical bandwidth and a high quantum efficiency, because of the effective extended volume for optical absorption. The traveling-wave photodetector also provides large power dissipation, because of its large physical size.

  1. Traveling-wave photodetector

    DOEpatents

    Hietala, V.M.; Vawter, G.A.

    1993-12-14

    The traveling-wave photodetector of the present invention combines an absorptive optical waveguide and an electrical transmission line, in which optical absorption in the waveguide results in a photocurrent at the electrodes of the electrical transmission line. The optical waveguide and electrical transmission line of the electrically distributed traveling-wave photodetector are designed to achieve matched velocities between the light in the optical waveguide and electrical signal generated on the transmission line. This velocity synchronization provides the traveling-wave photodetector with a large electrical bandwidth and a high quantum efficiency, because of the effective extended volume for optical absorption. The traveling-wave photodetector also provides large power dissipation, because of its large physical size. 4 figures.

  2. Turbulence generation by waves

    SciTech Connect

    Kaftori, D.; Nan, X.S.; Banerjee, S.

    1995-12-31

    The interaction between two-dimensional mechanically generated waves, and a turbulent stream was investigated experimentally in a horizontal channel, using a 3-D LDA synchronized with a surface position measuring device and a micro-bubble tracers flow visualization with high speed video. Results show that although the wave induced orbital motion reached all the way to the wall, the characteristics of the turbulence wall structures and the turbulence intensity close to the wall were not altered. Nor was the streaky nature of the wall layer. On the other hand, the mean velocity profile became more uniform and the mean friction velocity was increased. Close to the free surface, the turbulence intensity was substantially increased as well. Even in predominantly laminar flows, the introduction of 2-D waves causes three dimensional turbulence. The turbulence enhancement is found to be proportional to the wave strength.

  3. Heat Wave Safety Checklist

    MedlinePlus

    ... heat has caused more deaths than all other weather events, including floods. A heat wave is a ... care for heat- related emergencies … ❏ Listen to local weather forecasts and stay aware of upcoming temperature changes. ❏ ...

  4. Nonlinear thermal surface waves

    NASA Astrophysics Data System (ADS)

    Gradov, O. M.; Stenflo, L.

    1984-09-01

    It is shown that density profile modifications near a plasma surface can survive at moving localized spots because of the radiation pressure of leaking wave field fluctuations. The properties of these luminous surface cavitons are studied.

  5. WindWaveFloat

    SciTech Connect

    Weinstein, Alla

    2011-11-01

    Presentation from the 2011 Water Peer Review includes in which principal investigator Alla Weinstein discusses project progress in development of a floating offshore wind structure - the WindFloat - and incorporation therin of a Spherical Wave Energy Device.

  6. Magnetoresistive waves in plasmas

    NASA Astrophysics Data System (ADS)

    Felber, F. S.; Hunter, R. O., Jr.; Pereira, N. R.; Tajima, T.

    1982-10-01

    The self-generated magnetic field of a current diffusing into a plasma between conductors can magnetically insulate the plasma. Propagation of magnetoresistive waves in plasmas is analyzed. Applications to plasma opening switches are discussed.

  7. Sound wave transmission (image)

    MedlinePlus

    When sounds waves reach the ear, they are translated into nerve impulses. These impulses then travel to the brain where they are interpreted by the brain as sound. The hearing mechanisms within the inner ear, can ...

  8. Inventing the Wave Catchers.

    ERIC Educational Resources Information Center

    Fisher, Arthur

    1983-01-01

    Physicists and engineers advance the state of several arts in the design of gravitational-wave detection equipment. Provides background information and discusses the equipment (including laser interferometer), its use, and results of several experimental studies. (JN)

  9. Near Shore Wave Processes

    DTIC Science & Technology

    2016-06-07

    to breaking waves described using the roller concept (Lippmann and Thornton, 1999), alongshore wind stress, cross-shore advection of mean momentum of...Lippmann and Thornton, 1999), and O[10] percent improvement by including the momentum mixing by the advection of the longshore current momentum by the mean...process modeling of breaking waves, momentum mixing due to the interaction of longshore and cross-shore vertical mean profiles, and bottom shear stress

  10. Vortex waves in sunspots

    NASA Astrophysics Data System (ADS)

    López Ariste, A.; Centeno, R.; Khomenko, E.

    2016-06-01

    Context. Waves in the magnetized solar atmosphere are one of the favourite means of transferring and depositing energy into the solar corona. The study of waves brings information not just on the dynamics of the magnetized plasma, but also on the possible ways in which the corona is heated. Aims: The identification and analysis of the phase singularities or dislocations provide us with a complementary approach to the magnetoacoustic and Aflvén waves propagating in the solar atmosphere. They allow us to identify individual wave modes, shedding light on the probability of excitation or the nature of the triggering mechanism. Methods: We use a time series of Doppler shifts measured in two spectral lines, filtered around the three-minute period region. The data show a propagating magnetoacoustic slow mode with several dislocations and, in particular, a vortex line. We study under what conditions the different wave modes propagating in the umbra can generate the observed dislocations. Results: The observed dislocations can be fully interpreted as a sequence of sausage and kink modes excited sequentially on average during 15 min. Kink and sausage modes appear to be excited independently and sequentially. The transition from one to the other lasts less than three minutes. During the transition we observe and model the appearance of superoscillations inducing large phase gradients and phase mixing. Conclusions: The analysis of the observed wave dislocations leads us to the identification of the propagating wave modes in umbrae. The identification in the data of superoscillatory regions during the transition from one mode to the other may be an important indicator of the location of wave dissipation.

  11. Sound Waves Levitate Substrates

    NASA Technical Reports Server (NTRS)

    Lee, M. C.; Wang, T. G.

    1982-01-01

    System recently tested uses acoustic waves to levitate liquid drops, millimeter-sized glass microballoons, and other objects for coating by vapor deposition or capillary attraction. Cylindrical contactless coating/handling facility employs a cylindrical acoustic focusing radiator and a tapered reflector to generate a specially-shaped standing wave pattern. Article to be processed is captured by the acoustic force field under the reflector and moves as reflector is moved to different work stations.

  12. Kinematics Under Wind Waves

    DTIC Science & Technology

    1989-09-01

    components of the total velocity field, negligible measurement noise, and a completely linear wave field. Yefimov and Khristoforov (1971) have investigated...The directional spreading of the real wave field must also be considered ([82] and [3]). Yefimov and Khristoforov concluded that the spectrum of the...different. As observed by Yefimov and Khristoforov the upper linit of high coherence decreased with increasing depth (Figure 9). The horizontal

  13. Wave Propagation Program

    SciTech Connect

    McCandless, Kathleen; Petersson, Anders; Nilsson, Stefan; Sjogreen, Bjorn

    2007-01-08

    WPP is a massively parallel, 3D, C++, finite-difference elastodynamic wave propagation code. Typical applications for wave propagation with WPP include: evaluation of seismic event scenarios and damage from earthquakes, non-destructive evaluation of materials, underground facility detection, oil and gas exploration, predicting the electro-magnetic fields in accelerators, and acoustic noise generation. For more information, see User’s Manual [1].

  14. WaveNet

    DTIC Science & Technology

    2014-10-27

    Studies (WIS), Coastal Data Information Program (CDIP), Great Lakes Observing System (GLOS), Great Lakes Coastal Forecasting System (GLCFS), and...Army Engineer Research and Development Center,CIRP - The Coastal Inlets Research Program,3909 Halls Ferry Road,Vicksburg,MS,39180 8. PERFORMING... Coastal Inlets Research Program WaveNet WaveNet is a web-based, Graphical-User-Interface (GUI) data management tool developed for the Corps’ coastal

  15. Millimeter Wave Nonreciprocal Devices.

    DTIC Science & Technology

    1983-01-03

    gradients of the dc bias field saturation magnetization , or magnetic anisotrophy can control mode properties of magnetostatic waves (MSW) propagating in...measures microwave magnetic field patterns of magnetostatic waves in LPE- YIG thin films has been developed. The probe’s sensing element is either a... magnetic resonance mode of a YIG sphere. Theoretical analyses show that there is a critical ratio between the -4-Ai p. , , . , l!~ mj radius of the

  16. Hysteretic Faraday waves.

    PubMed

    Périnet, Nicolas; Falcón, Claudio; Chergui, Jalel; Juric, Damir; Shin, Seungwon

    2016-06-01

    We report on the numerical and theoretical study of the subcritical bifurcation of parametrically amplified waves appearing at the interface between two immiscible incompressible fluids when the layer of the lower fluid is very shallow. As a critical control parameter is surpassed, small amplitude surface waves bifurcate subcritically toward highly nonlinear ones with twice their amplitude. We relate this hysteresis with the change of shear stress using a simple stress balance, in agreement with numerical results.

  17. Ultrasonic Lamb wave tomography

    NASA Astrophysics Data System (ADS)

    Leonard, Kevin R.; Malyarenko, Eugene V.; Hinders, Mark K.

    2002-12-01

    Nondestructive evaluation (NDE) of aerospace structures using traditional methods is a complex, time-consuming process critical to maintaining mission readiness and flight safety. Limited access to corrosion-prone structure and the restricted applicability of available NDE techniques for the detection of hidden corrosion or other damage often compound the challenge. In this paper we discuss our recent work using ultrasonic Lamb wave tomography to address this pressing NDE technology need. Lamb waves are ultrasonic guided waves, which allow large sections of aircraft structures to be rapidly inspected for structural flaws such as disbonds, corrosion and delaminations. Because the velocity of Lamb waves depends on thickness, for example, the travel times of the fundamental Lamb modes can be converted into a thickness map of the inspection region. However, extracting quantitative information from Lamb wave data has always involved highly trained personnel with a detailed knowledge of mechanical waveguide physics. Our work focuses on tomographic reconstruction to produce quantitative maps that can be easily interpreted by technicians or fed directly into structural integrity and lifetime prediction codes. Laboratory measurements discussed here demonstrate that Lamb wave tomography using a square perimeter array of transducers with algebraic reconstruction tomography is appropriate for detecting flaws in aircraft materials. The speed and fidelity of the reconstruction algorithms as well as practical considerations for person-portable array-based systems are discussed in this paper.

  18. Traveling-Wave Tubes

    NASA Technical Reports Server (NTRS)

    Kory, Carol L.

    1998-01-01

    The traveling-wave tube (TWT) is a vacuum device invented in the early 1940's used for amplification at microwave frequencies. Amplification is attained by surrendering kinetic energy from an electron beam to a radio frequency (RF) electromagnetic wave. The demand for vacuum devices has been decreased largely by the advent of solid-state devices. However, although solid state devices have replaced vacuum devices in many areas, there are still many applications such as radar, electronic countermeasures and satellite communications, that require operating characteristics such as high power (Watts to Megawatts), high frequency (below 1 GHz to over 100 GHz) and large bandwidth that only vacuum devices can provide. Vacuum devices are also deemed irreplaceable in the music industry where musicians treasure their tube-based amplifiers claiming that the solid-state and digital counterparts could never provide the same "warmth" (3). The term traveling-wave tube includes both fast-wave and slow-wave devices. This article will concentrate on slow-wave devices as the vast majority of TWTs in operation fall into this category.

  19. Ocean wave electric generators

    SciTech Connect

    Rosenberg, H.R.

    1986-02-04

    This patent describes an apparatus for generating electricity from ocean waves. It consists of: 1.) a hollow buoyant duck positioned in the path of waves including a core about the center axis of which the duck rotates, a lower chamber portion having liquid therein and an upper chamber portion having air therein. The air is alternately compressed and expanded by the liquid in the chamber during the rotational motion of the duck caused by waves. A turbine mounted in the upper portion of the duck is driven by the compressed and expanded air. A generator is coupled to the turbine and operated to produce electrical energy and an air bulb; 2.) a spine having a transverse axial shaft anchoring the spine to the ocean floor. The upper portion of the spine engages the duck to maintain the duck in position. The spine has a curved configuration to concentrate and direct wave energy. The spine configuration acts as a scoop to increase the height of wave peaks and as a foil to increase the depth of wave troughs.

  20. A simple wave driver

    NASA Astrophysics Data System (ADS)

    Kağan Temiz, Burak; Yavuz, Ahmet

    2015-08-01

    This study was done to develop a simple and inexpensive wave driver that can be used in experiments on string waves. The wave driver was made using a battery-operated toy car, and the apparatus can be used to produce string waves at a fixed frequency. The working principle of the apparatus is as follows: shortly after the car is turned on, the wheel starts to turn at a constant angular speed. A rod that is fixed on the wheel turns at the same constant angular speed, too. A tight string that the wave will be created on is placed at a distance where the rod can touch the string. During each rotation of the wheel, the rod vibrates the string up and down. The vibration frequency of this rod equals the wheel’s rotation frequency, and this frequency value can be measured easily with a small magnet and a bicycle speedometer. In this way, the frequency of the waves formed in the rope can also be measured.

  1. The gravitational wave decade

    NASA Astrophysics Data System (ADS)

    Conklin, John

    2016-03-01

    With the expected direct detection of gravitational waves by Advanced LIGO and pulsar timing arrays in the near future, and with the recent launch of LISA Pathfinder this can arguably be called the decade of gravitational waves. Low frequency gravitational waves in the mHz range, which can only be observed from space, provide the richest science and complement high frequency observatories on the ground. A space-based observatory will improve our understanding of the formation and growth of massive black holes, create a census of compact binary systems in the Milky Way, test general relativity in extreme conditions, and enable searches for new physics. LISA, by far the most mature concept for detecting gravitational waves from space, has consistently ranked among the nation's top priority large science missions. In 2013, ESA selected the science theme ``The Gravitational Universe'' for its third large mission, L3, under the Cosmic Visions Program, with a planned launch date of 2034. NASA has decided to join with ESA on the L3 mission as a junior partner and has recently assembled a study team to provide advice on how NASA might contribute to the European-led mission. This talk will describe these efforts and the activities of the Gravitational Wave Science Interest Group and the L3 Study Team, which will lead to the first space-based gravitational wave observatory.

  2. Wave Momentum Flux Parameter: A Descriptor for Nearshore Waves

    DTIC Science & Technology

    2004-07-16

    characterizing the wave nonlinearity. D 2004 Elsevier B.V. All rights reserved. Keywords: Coastal structures; Iribarren number; Nonlinear waves; Solitary...Local Iribarren number, n tanaffiffiffiffiffiffi H=L p Deepwater Iribarren number, no tanaffiffiffiffiffiffiffiffiffi Ho=Lo p or...solitary waves, although there are some definitions for solitary wave length which would allow use of the other wave parameters.2. The Iribarren number One

  3. Rain waves-wind waves interaction application to scatterometry

    NASA Technical Reports Server (NTRS)

    Kharif, C.; Giovanangeli, J. P.; Bliven, L.

    1989-01-01

    Modulation of a rain wave pattern by longer waves has been studied. An analytical model taking into account capillarity effects and obliquity of short waves has been developed. Modulation rates in wave number and amplitude have been computed. Experiments were carried out in a wave tank. First results agree with theoretical models, but higher values of modulation rates are measured. These results could be taken into account for understanding the radar response from the sea surface during rain.

  4. Invariants of 4-wave interactions

    NASA Astrophysics Data System (ADS)

    Balk, A.; Ferapontov, E.

    1993-05-01

    We give a complete description of one-dimensional 4-wave resonance interactions in which some extra quantities (besides momentum, energy, number of quasiparticles) are conserved. In this way we obtain new consideration laws for the kinetic equations for waves. In particular, we consider waves in optical fibers, the system of four resonantly interacting wave packets, long wave interactions of annihilation-creation type, various wave systems with quadratic dispersion laws. The results can be important for various problems concerning nonlinear wave dynamics, e.g. for nonlinear optics of waveguides.

  5. Role of lasertripsy in the management of ureteral calculi: experience with alexandrite laser system in 232 patients.

    PubMed

    Jung, P; Wolff, J M; Mattelaer, P; Jakse, G

    1996-08-01

    In 232 patients with ureteral stones, lasertripsy was used as primary treatment or as second-line therapy after extracorporeal shockwave lithotripsy (SWL). In all patients, a semirigid 6.5F ureteroscope or a flexible 6F ureteroscope was used. Lithotripsy was performed employing an alexandrite laser with an energy of 50 to 65 mJ. The immediate success rate was 67.5% for stones in the upper ureter, 86.1% for those in the midureter, and 94.5% for those in the distal ureter. In 16.5% of the treatments, it was necessary to insert a double-J stent. A perforation of the ureter happened in two patients (0.9%), but no laser-related complications were seen. Stone fragmentation was not dependent on stone composition or size. Using small semirigid or flexible ureteroscopes, lasertripsy of ureteral stones is a minimally invasive treatment with an insignificant complication rate. In case of midureteral stones, our results revealed a higher immediate stone-free rate than is reported in the literature after treatment by SWL, and we can therefore recommend lasertripsy as primary treatment. For upper ureteral stones, lasertripsy can be recommended as a helpful auxillary procedure. Furthermore, in cases of distal ureteral stones, lasertripsy challenges SWL as the primary treatment.

  6. Longitudinal shear wave and transverse dilatational wave in solids.

    PubMed

    Catheline, S; Benech, N

    2015-02-01

    Dilatation wave involves compression and extension and is known as the curl-free solution of the elastodynamic equation. Shear wave on the contrary does not involve any change in volume and is the divergence-free solution. This letter seeks to examine the elastodynamic Green's function through this definition. By separating the Green's function in divergence-free and curl-free terms, it appears first that, strictly speaking, the longitudinal wave is not a pure dilatation wave and the transverse wave is neither a pure shear wave. Second, not only a longitudinal shear wave but also a transverse dilatational wave exists. These waves are shown to be a part of the solution known as coupling terms. Their special motion is carefully described and illustrated.

  7. Reflection and Refraction of Acoustic Waves by a Shock Wave

    NASA Technical Reports Server (NTRS)

    Brillouin, J.

    1957-01-01

    The presence of sound waves in one or the other of the fluid regions on either side of a shock wave is made apparent, in the region under superpressure, by acoustic waves (reflected or refracted according to whether the incident waves lie in the region of superpressure or of subpressure) and by thermal waves. The characteristics of these waves are calculated for a plane, progressive, and uniform incident wave. In the case of refraction, the refracted acoustic wave can, according to the incidence, be plane, progressive, and uniform or take the form of an 'accompanying wave' which remains attached to the front of the shock while sliding parallel to it. In all cases, geometrical constructions permit determination of the kinematic characteristics of the reflected or refractive acoustic waves. The dynamic relationships show that the amplitude of the reflected wave is always less than that of the incident wave. The amplitude of the refracted wave, whatever its type, may in certain cases be greater than that of the incident wave.

  8. Potential changes of wave steepness and occurrence of rogue waves

    NASA Astrophysics Data System (ADS)

    Bitner-Gregersen, Elzbieta M.; Toffoli, Alessandro

    2015-04-01

    Wave steepness is an important characteristic of a sea state. It is also well established that wave steepness is one of the parameter responsible for generation of abnormal waves called also freak or rogue waves. The study investigates changes of wave steepness in the past and future wave climate in the North Atlantic. The fifth assessment report IPCC (2013) uses four scenarios for future greenhouse gas concentrations in the atmosphere called Representative Concentration Pathways (RCP). Two of these scenarios RCP 4.5 and RCP 8.5 have been selected to project future wave conditions in the North Atlantic. RCP 4.5 is believed to achieve the political target of a maximum global mean temperature increase of 2° C while RPC 8.5 is close to 'business as usual' and expected to give a temperature increase of 4° C or more. The analysis includes total sea, wind sea and swell. Potential changes of wave steepness for these wave systems are shown and compared with wave steepness derived from historical data. Three historical data sets with different wave model resolutions are used. The investigations show also changes in the mean wind direction as well as in the relative direction between wind sea and swell. Consequences of wave steepness changes for statistics of surface elevation and generation of rogue waves are demonstrated. Uncertainties associated with wave steepness projections are discussed.

  9. Optical Dark Rogue Wave

    NASA Astrophysics Data System (ADS)

    Frisquet, Benoit; Kibler, Bertrand; Morin, Philippe; Baronio, Fabio; Conforti, Matteo; Millot, Guy; Wabnitz, Stefan

    2016-02-01

    Photonics enables to develop simple lab experiments that mimic water rogue wave generation phenomena, as well as relativistic gravitational effects such as event horizons, gravitational lensing and Hawking radiation. The basis for analog gravity experiments is light propagation through an effective moving medium obtained via the nonlinear response of the material. So far, analogue gravity kinematics was reproduced in scalar optical wave propagation test models. Multimode and spatiotemporal nonlinear interactions exhibit a rich spectrum of excitations, which may substantially expand the range of rogue wave phenomena, and lead to novel space-time analogies, for example with multi-particle interactions. By injecting two colliding and modulated pumps with orthogonal states of polarization in a randomly birefringent telecommunication optical fiber, we provide the first experimental demonstration of an optical dark rogue wave. We also introduce the concept of multi-component analog gravity, whereby localized spatiotemporal horizons are associated with the dark rogue wave solution of the two-component nonlinear Schrödinger system.

  10. Bent Marshak Waves

    SciTech Connect

    Hurricane, O A; Hammer, J H

    2005-10-11

    Radiation driven heat waves (Marshak Waves) are ubiquitous in astrophysics and terrestrial laser driven high energy density plasma physics (HEDP) experiments. Generally, the equations describing Marshak waves are so nonlinear, that solutions involving more than one spatial dimension require simulation. However, in this paper we show how one may analytically solve the problem of the two-dimensional nonlinear evolution of a Marshak wave, bounded by lossy walls, using an asymptotic expansion in a parameter related to the wall albedo and a simplification of the heat front equation of motion. Three parameters determine the nonlinear evolution, a modified Markshak diffusion constant, a smallness parameter related to the wall albedo, and the spacing of the walls. The final nonlinear solution shows that the Marshak wave will be both slowed and bent by the non-ideal boundary. In the limit of a perfect boundary, the solution recovers the original diffusion-like solution of Marshak. The analytic solution will be compared to a limited set of simulation results and experimental data.

  11. Optical Dark Rogue Wave.

    PubMed

    Frisquet, Benoit; Kibler, Bertrand; Morin, Philippe; Baronio, Fabio; Conforti, Matteo; Millot, Guy; Wabnitz, Stefan

    2016-02-11

    Photonics enables to develop simple lab experiments that mimic water rogue wave generation phenomena, as well as relativistic gravitational effects such as event horizons, gravitational lensing and Hawking radiation. The basis for analog gravity experiments is light propagation through an effective moving medium obtained via the nonlinear response of the material. So far, analogue gravity kinematics was reproduced in scalar optical wave propagation test models. Multimode and spatiotemporal nonlinear interactions exhibit a rich spectrum of excitations, which may substantially expand the range of rogue wave phenomena, and lead to novel space-time analogies, for example with multi-particle interactions. By injecting two colliding and modulated pumps with orthogonal states of polarization in a randomly birefringent telecommunication optical fiber, we provide the first experimental demonstration of an optical dark rogue wave. We also introduce the concept of multi-component analog gravity, whereby localized spatiotemporal horizons are associated with the dark rogue wave solution of the two-component nonlinear Schrödinger system.

  12. Waves in Motion

    NASA Astrophysics Data System (ADS)

    McGourty, L.; Rideout, K.

    2005-12-01

    "Waves in Motion" This teaching unit was created by Leslie McGourty and Ken Rideout under the Research Experience for Teachers (RET) program at MIT Haystack Observatory during the summer of 2005. The RET program is funded by a grant from the National Science Foundation. The goals of this teaching unit are to deepen students' understanding about waves, wave motion, and the electromagnetic spectrum as a whole. Specifically students will comprehend the role radio waves play in our daily lives and in the investigation of the universe. The lessons can be used in a high school physics, earth science or astronomy curriculum. The unit consists of a series of interlocking lectures, activities, and investigations that can be used as stand alone units to supplement a teacher's existing curriculum, as an independent investigation for a student, or as a long exploration into radio astronomy with a theme of waves in space: how and where they carry their information. Special emphasis is given to the Relativity theories in honor of the "World Year of Physics" to celebrate Einstein's 1905 contributions. The lessons are currently being implemented at the high school level, the preliminary results of which will be presented. At the end of the academic year, the units will be evaluated and updated, reflecting student input and peer review after which they will be posted on the internet for teachers to use in their classrooms.

  13. Rupture, waves and earthquakes.

    PubMed

    Uenishi, Koji

    2017-01-01

    Normally, an earthquake is considered as a phenomenon of wave energy radiation by rupture (fracture) of solid Earth. However, the physics of dynamic process around seismic sources, which may play a crucial role in the occurrence of earthquakes and generation of strong waves, has not been fully understood yet. Instead, much of former investigation in seismology evaluated earthquake characteristics in terms of kinematics that does not directly treat such dynamic aspects and usually excludes the influence of high-frequency wave components over 1 Hz. There are countless valuable research outcomes obtained through this kinematics-based approach, but "extraordinary" phenomena that are difficult to be explained by this conventional description have been found, for instance, on the occasion of the 1995 Hyogo-ken Nanbu, Japan, earthquake, and more detailed study on rupture and wave dynamics, namely, possible mechanical characteristics of (1) rupture development around seismic sources, (2) earthquake-induced structural failures and (3) wave interaction that connects rupture (1) and failures (2), would be indispensable.

  14. Optical Dark Rogue Wave

    PubMed Central

    Frisquet, Benoit; Kibler, Bertrand; Morin, Philippe; Baronio, Fabio; Conforti, Matteo; Millot, Guy; Wabnitz, Stefan

    2016-01-01

    Photonics enables to develop simple lab experiments that mimic water rogue wave generation phenomena, as well as relativistic gravitational effects such as event horizons, gravitational lensing and Hawking radiation. The basis for analog gravity experiments is light propagation through an effective moving medium obtained via the nonlinear response of the material. So far, analogue gravity kinematics was reproduced in scalar optical wave propagation test models. Multimode and spatiotemporal nonlinear interactions exhibit a rich spectrum of excitations, which may substantially expand the range of rogue wave phenomena, and lead to novel space-time analogies, for example with multi-particle interactions. By injecting two colliding and modulated pumps with orthogonal states of polarization in a randomly birefringent telecommunication optical fiber, we provide the first experimental demonstration of an optical dark rogue wave. We also introduce the concept of multi-component analog gravity, whereby localized spatiotemporal horizons are associated with the dark rogue wave solution of the two-component nonlinear Schrödinger system. PMID:26864099

  15. Rupture, waves and earthquakes

    NASA Astrophysics Data System (ADS)

    Uenishi, Koji

    2017-01-01

    Normally, an earthquake is considered as a phenomenon of wave energy radiation by rupture (fracture) of solid Earth. However, the physics of dynamic process around seismic sources, which may play a crucial role in the occurrence of earthquakes and generation of strong waves, has not been fully understood yet. Instead, much of former investigation in seismology evaluated earthquake characteristics in terms of kinematics that does not directly treat such dynamic aspects and usually excludes the influence of high-frequency wave components over 1 Hz. There are countless valuable research outcomes obtained through this kinematics-based approach, but "extraordinary" phenomena that are difficult to be explained by this conventional description have been found, for instance, on the occasion of the 1995 Hyogo-ken Nanbu, Japan, earthquake, and more detailed study on rupture and wave dynamics, namely, possible mechanical characteristics of (1) rupture development around seismic sources, (2) earthquake-induced structural failures and (3) wave interaction that connects rupture (1) and failures (2), would be indispensable.

  16. Fast wave current drive

    NASA Astrophysics Data System (ADS)

    Goree, J.; Ono, M.; Colestock, P.; Horton, R.; McNeill, D.; Park, H.

    1985-07-01

    Experiments on the fast wave in the range of high ion cyclotron harmonics in the ACT-1 device show that current drive is possible with the fast wave just as it is for the lower hybrid wave, except that it is suitable for higher plasma densities. A 140° loop antenna launched the high ion cyclotron harmonic fast wave [ω/Ω=O(10)] into a He+ plasma with ne≂4×1012 cm-3 and B=4.5 kG. Probe and magnetic loop diagnostics and FIR laser scattering confirmed the presence of the fast wave, and the Rogowski loop indicated that the circulating plasma current increased by up to 40A with 1 kW of coupled power, which is comparable to lower hybrid current drive in the same device with the same unidirectional fast electron beam used as the target for the rf. A phased antenna array would be used for FWCD in a tokamak without the E-beam.

  17. Pilot-Wave Hydrodynamics

    NASA Astrophysics Data System (ADS)

    Bush, John W. M.

    2015-01-01

    Yves Couder, Emmanuel Fort, and coworkers recently discovered that a millimetric droplet sustained on the surface of a vibrating fluid bath may self-propel through a resonant interaction with its own wave field. This article reviews experimental evidence indicating that the walking droplets exhibit certain features previously thought to be exclusive to the microscopic, quantum realm. It then reviews theoretical descriptions of this hydrodynamic pilot-wave system that yield insight into the origins of its quantum-like behavior. Quantization arises from the dynamic constraint imposed on the droplet by its pilot-wave field, and multimodal statistics appear to be a feature of chaotic pilot-wave dynamics. I attempt to assess the potential and limitations of this hydrodynamic system as a quantum analog. This fluid system is compared to quantum pilot-wave theories, shown to be markedly different from Bohmian mechanics and more closely related to de Broglie's original conception of quantum dynamics, his double-solution theory, and its relatively recent extensions through researchers in stochastic electrodynamics.

  18. Vacuum Kundt waves

    NASA Astrophysics Data System (ADS)

    McNutt, David; Milson, Robert; Coley, Alan

    2013-03-01

    We discuss the invariant classification of vacuum Kundt waves using the Cartan-Karlhede algorithm and determine the upper bound on the number of iterations of the Karlhede algorithm to classify the vacuum Kundt waves (Collins (1991 Class. Quantum Grav. 8 1859-69), Machado Ramos (1996 Class. Quantum Grav. 13 1589)). By choosing a particular coordinate system we partially construct the canonical coframe used in the classification to study the functional dependence of the invariants arising at each iteration of the algorithm. We provide a new upper bound, q ⩽ 4, and show that this bound is sharp by analyzing the subclass of Kundt waves with invariant count beginning with (0, 1,…) to show that the class with invariant count (0, 1, 3, 4, 4) exists. This class of vacuum Kundt waves is shown to be unique as the only set of metrics requiring the fourth covariant derivatives of the curvature. We conclude with an invariant classification of the vacuum Kundt waves using a suite of invariants.

  19. Tango waves in a bidomain model of fertilization calcium waves

    NASA Astrophysics Data System (ADS)

    Li, Yue-Xian

    2003-12-01

    Fertilization of an egg cell is marked by one or several Ca 2+ waves that travel across the intra-cellular space, called fertilization Ca 2+ waves. Patterns of Ca 2+ waves observed in mature or immature oocytes include traveling fronts and pulses as well as concentric and spiral waves. These patterns have been studied in other excitable media in physical, chemical, and biological systems. Here, we report the discovery of a new wave phenomenon in the numerical study of a bidomain model of fertilization Ca 2+ waves. This wave is a front that propagates in a back-and-forth manner that resembles the movement of tango dancers, thus is called a tango wave. When the medium is excitable, a forward-moving tango wave can generate traveling pulses that propagate down the space without reversal. The study shows that the occurrence of tango waves is related to spatial inhomogeneity in the local dynamics. This is tested and confirmed by simulating similar waves in a medium with stationary spatial inhomogeneity. Similar waves are also obtained in a FitzHugh-Nagumo system with a linear spatial ramp. In both the bidomain model of Ca 2+ waves and the FitzHugh-Nagumo system, the front is stable when the slope of a linear ramp is large. As the slope decreases beyond a critical value, front oscillations occur. The study shows that tango waves facilitate the dispersion of localized Ca 2+. Key features of the bidomain model underlying the occurrence of tango waves are revealed. These features are commonly found in egg cells of a variety of species. Thus, we predict that tango waves can occur in real egg cells provided that a slowly varying inhomogeneity does occur following the sperm entry. The observation of tango wave-like waves in nemertean worm and ascidian eggs seems to support such a prediction.

  20. Neural field theory of nonlinear wave-wave and wave-neuron processes

    NASA Astrophysics Data System (ADS)

    Robinson, P. A.; Roy, N.

    2015-06-01

    Systematic expansion of neural field theory equations in terms of nonlinear response functions is carried out to enable a wide variety of nonlinear wave-wave and wave-neuron processes to be treated systematically in systems involving multiple neural populations. The results are illustrated by analyzing second-harmonic generation, and they can also be applied to wave-wave coalescence, multiharmonic generation, facilitation, depression, refractoriness, and other nonlinear processes.

  1. IR Hot Wave

    SciTech Connect

    Graham, T. B.

    2010-04-01

    The IR Hot Wave{trademark} furnace is a breakthrough heat treatment system for manufacturing metal components. Near-infrared (IR) radiant energy combines with IR convective heating for heat treating. Heat treatment is an essential process in the manufacture of most components. The controlled heating and cooling of a metal or metal alloy alters its physical, mechanical, and sometimes chemical properties without changing the object's shape. The IR Hot Wave{trademark} furnace offers the simplest, quickest, most efficient, and cost-effective heat treatment option for metals and metal alloys. Compared with other heat treatment alternatives, the IR Hot Wave{trademark} system: (1) is 3 to 15 times faster; (2) is 2 to 3 times more energy efficient; (3) is 20% to 50% more cost-effective; (4) has a {+-}1 C thermal profile compared to a {+-}10 C thermal profile for conventional gas furnaces; and (5) has a 25% to 50% smaller footprint.

  2. Standing wave compressor

    DOEpatents

    Lucas, Timothy S.

    1991-01-01

    A compressor for compression-evaporation cooling systems, which requires no moving parts. A gaseous refrigerant inside a chamber is acoustically compressed and conveyed by means of a standing acoustic wave which is set up in the gaseous refrigerant. This standing acoustic wave can be driven either by a transducer, or by direct exposure of the gas to microwave and infrared sources, including solar energy. Input and output ports arranged along the chamber provide for the intake and discharge of the gaseous refrigerant. These ports can be provided with optional valve arrangements, so as to increase the compressor's pressure differential. The performance of the compressor in either of its transducer or electromagnetically driven configurations, can be optimized by a controlling circuit. This controlling circuit holds the wavelength of the standing acoustical wave constant, by changing the driving frequency in response to varying operating conditions.

  3. TIMING OF SHOCK WAVES

    DOEpatents

    Tuck, J.L.

    1955-03-01

    This patent relates to means for ascertaining the instant of arrival of a shock wave in an exploslve charge and apparatus utilizing this means to coordinate the timing of two operations involving a short lnterval of time. A pair of spaced electrodes are inserted along the line of an explosive train with a voltage applied there-across which is insufficient to cause discharge. When it is desired to initiate operation of a device at the time the explosive shock wave reaches a particular point on the explosive line, the device having an inherent time delay, the electrodes are located ahead of the point such that the ionization of the area between the electrodes caused by the traveling explosive shock wave sends a signal to initiate operation of the device to cause it to operate at the proper time. The operated device may be photographic equipment consisting of an x-ray illuminating tube.

  4. Hysteretic Faraday waves

    NASA Astrophysics Data System (ADS)

    Périnet, Nicolas; Falcón, Claudio; Chergui, Jalel; Shin, Seungwon; Juric, Damir

    2016-11-01

    We study with numerical simulations the two-dimensional Faraday waves in two immiscible incompressible fluids when the lower fluid layer is shallow. After the appearance of the well known subharmonic stationary waves, a further instability is observed while the control parameter passes a secondary threshold. A new state then arises, composed of stationary waves with about twice the original pattern amplitude. The bifurcation presents hysteresis: there exists a finite range of the control parameter in which both states are stable. By means of a simple stress balance, we show that a change of the shear stress can explain this hysteresis. Our predictions based on this model are in agreement with our numerical results. Project funded by FONDECYT Grants 1130354, 3140522 and the National Research Foundation of Korea (NRF- 2014R1A2A1A11051346). Computations supported by the supercomputing infrastructures of the NLHPC (ECM-02) and GENCI (IDRIS).

  5. The gravitational wave experiment

    NASA Technical Reports Server (NTRS)

    Bertotti, B.; Ambrosini, R.; Asmar, S. W.; Brenkle, J. P.; Comoretto, G.; Giampieri, G.; Less, L.; Messeri, A.; Wahlquist, H. D.

    1992-01-01

    Since the optimum size of a gravitational wave detector is the wave length, interplanetary dimensions are needed for the mHz band of interest. Doppler tracking of Ulysses will provide the most sensitive attempt to date at the detection of gravitational waves in the low frequency band. The driving noise source is the fluctuations in the refractive index of interplanetary plasma. This dictates the timing of the experiment to be near solar opposition and sets the target accuracy for the fractional frequency change at 3.0 x 10 exp -14 for integration times of the order of 1000 sec. The instrumentation utilized by the experiment is distributed between the radio systems on the spacecraft and the seven participating ground stations of the Deep Space Network and Medicina. Preliminary analysis is available of the measurements taken during the Ulysses first opposition test.

  6. Communication at millimeter waves

    NASA Astrophysics Data System (ADS)

    Kamal, A. K.; Christopher, P. F.

    The advantage and disadvantages of millimeter waves for terrestrial and satellite communications are enumerated. Atmospheric attenuation is discussed in detail, with brief attention given to signal loss in particulates, sandstorms, snow, hail, and fog. Short closed forms are then found for gaseous attenuation on ground-satellite paths. An exponential rain loss probability density function is used in generating atmospheric loss at arbitrary required availability. It is pointed out that this loss (as a function of frequency) can be used to pick optimum carrier frequencies as a function of location, required availability, elevation angle, and system cost. An estimate is made of the rate-of-change of millimeter wave device availability. Special attention is given to GaAs FETs, not only because they will be useful, but because one phase of their millimeter wave performance is predictable: their noise performance as a function of frequency can be estimated with the aid of a Fukui equation.

  7. Discrete wave equation upscaling

    NASA Astrophysics Data System (ADS)

    Fichtner, Andreas; Hanasoge, Shravan M.

    2017-01-01

    We present homogenisation technique for the uniformly discretised wave equation, based on the derivation of an effective equation for the low-wavenumber component of the solution. The method produces a down-sampled, effective medium, thus making the solution of the effective equation less computationally expensive. Advantages of the method include its conceptual simplicity and ease of implementation, the applicability to any uniformly discretised wave equation in one, two or three dimensions, and the absence of any constraints on the medium properties. We illustrate our method with a numerical example of wave propagation through a one-dimensional multiscale medium, and demonstrate the accurate reproduction of the original wavefield for sufficiently low frequencies.

  8. Piezoelectric wave motor

    DOEpatents

    Yerganian, Simon Scott

    2003-02-11

    A piezoelectric motor having a stator in which piezoelectric elements are contained in slots formed in the stator transverse to the desired wave motion. When an electric field is imposed on the elements, deformation of the elements imposes a force perpendicular to the sides of the slot, deforming the stator. Appropriate frequency and phase-shifting of the electric field will produce a wave in the stator and motion in a rotor. In a preferred aspect, the piezoelectric elements are configured so that deformation of the elements in the direction of an imposed electric field, generally referred to as the d.sub.33 direction, is utilized to produce wave motion in the stator. In a further aspect, the elements are compressed into the slots so as to minimize tensile stresses on the elements in use.

  9. Piezoelectric wave motor

    DOEpatents

    Yerganian, Simon Scott

    2001-07-17

    A piezoelectric motor having a stator in which piezoelectric elements are contained in slots formed in the stator transverse to the desired wave motion. When an electric field is imposed on the elements, deformation of the elements imposes a force perpendicular to the sides of the slot, deforming the stator. Appropriate frequency and phase shifting of the electric field will produce a wave in the stator and motion in a rotor. In a preferred aspect, the piezoelectric elements are configured so that deformation of the elements in direction of an imposed electric field, generally referred to as the d.sub.33 direction, is utilized to produce wave motion in the stator. In a further aspect, the elements are compressed into the slots so as to minimize tensile stresses on the elements in use.

  10. Solar system plasma waves

    NASA Technical Reports Server (NTRS)

    Gurnett, Donald A.

    1995-01-01

    An overview is given of spacecraft observations of plasma waves in the solar system. In situ measurements of plasma phenomena have now been obtained at all of the planets except Mercury and Pluto, and in the interplanetary medium at heliocentric radial distances ranging from 0.29 to 58 AU. To illustrate the range of phenomena involved, we discuss plasma waves in three regions of physical interest: (1) planetary radiation belts, (2) planetary auroral acceleration regions and (3) the solar wind. In each region we describe examples of plasma waves that are of some importance, either due to the role they play in determining the physical properties of the plasma, or to the unique mechanism involved in their generation.

  11. Planetary radio waves

    NASA Technical Reports Server (NTRS)

    Goertz, C. K.

    1986-01-01

    Three planets, the earth, Jupiter and Saturn are known to emit nonthermal radio waves which require coherent radiation processes. The characteristic features (frequency spectrum, polarization, occurrence probability, radiation pattern) are discussed. Radiation which is externally controlled by the solar wind is distinguished from internally controlled radiation which only originates from Jupiter. The efficiency of the externally controlled radiation is roughly the same at all three planets (5 x 10 to the -6th) suggesting that similar processes are active there. The maser radiation mechanism for the generation of the radio waves and general requirements for the mechanism which couples the power generator to the region where the radio waves are generated are briefly discussed.

  12. Human waves in stadiums

    NASA Astrophysics Data System (ADS)

    Farkas, I.; Helbing, D.; Vicsek, T.

    2003-12-01

    Mexican wave first widely broadcasted during the 1986 World Cup held in Mexico, is a human wave moving along the stands of stadiums as one section of spectators stands up, arms lifting, then sits down as the next section does the same. Here we use variants of models originally developed for the description of excitable media to demonstrate that this collective human behaviour can be quantitatively interpreted by methods of statistical physics. Adequate modelling of reactions to triggering attempts provides a deeper insight into the mechanisms by which a crowd can be stimulated to execute a particular pattern of behaviour and represents a possible tool of control during events involving excited groups of people. Interactive simulations, video recordings and further images are available at the webpage dedicated to this work: http://angel.elte.hu/wave.

  13. The Virtual Wave Observatory (VWO)

    NASA Technical Reports Server (NTRS)

    Fung, Shing F.

    2008-01-01

    Heliophysics wave data are currently not easily searchable by computers, making identifying pertinent wave data features for analyses and cross comparisons difficult and laborious. Since wave data analysis requires specialized knowledge about waves, which spans the spectrum of microphysics to macrophysics, researchers having varied expertise cannot easily use wave data. To resolve these difficulties and to allow wave data to contribute more fully to Heliophysics research, we are developing a Virtual Wave Observatory (VWO) whose goal is to enable all Heliophysics wave data to become searchable, understandable and usable by the Heliophysics community. The VWO objective is to enable search of multiple and distributed wave data (from both active and passive measurements). This presentation provides and overview of the VWO, a new VxO component within the emerging distributed Heliophysics data and model environment.

  14. Explosive plane-wave lens

    DOEpatents

    Marsh, S.P.

    1988-03-08

    An explosive plane-wave air lens which enables a spherical wave form to be converted to a planar wave without the need to specially machine or shape explosive materials is described. A disc-shaped impactor having a greater thickness at its center than around its periphery is used to convert the spherical wave into a plane wave. When the wave reaches the impactor, the center of the impactor moves first because the spherical wave reaches the center of the impactor first. The wave strikes the impactor later in time as one moves radially along the impactor. Because the impactor is thinner as one moves radially outward, the velocity of the impactor is greater at the periphery than at the center. An acceptor explosive is positioned so that the impactor strikes the acceptor simultaneously. Consequently, a plane detonation wave is propagated through the acceptor explosive. 4 figs.

  15. Explosive plane-wave lens

    DOEpatents

    Marsh, Stanley P.

    1988-01-01

    An explosive plane-wave air lens which enables a spherical wave form to be converted to a planar wave without the need to specially machine or shape explosive materials is described. A disc-shaped impactor having a greater thickness at its center than around its periphery is used to convert the spherical wave into a plane wave. When the wave reaches the impactor, the center of the impactor moves first because the spherical wave reaches the center of the impactor first. The wave strikes the impactor later in time as one moves radially along the impactor. Because the impactor is thinner as one moves radially outward, the velocity of the impactor is greater at the periphery than at the center. An acceptor explosive is positioned so that the impactor strikes the acceptor simultaneously. Consequently, a plane detonation wave is propagated through the acceptor explosive.

  16. Explosive plane-wave lens

    DOEpatents

    Marsh, S.P.

    1987-03-12

    An explosive plane-wave air lens which enables a spherical wave form to be converted to a planar wave without the need to specially machine or shape explosive materials is described. A disc-shaped impactor having a greater thickness at its center than around its periphery is used to convert the spherical wave into a plane wave. When the wave reaches the impactor, the center of the impactor moves first because the spherical wave reaches the center of the impactor first. The wave strikes the impactor later in time as one moves radially along the impactor. Because the impactor is thinner as one moves radially outward, the velocity of the impactor is greater at the periphery than at the center. An acceptor explosive is positioned so that the impactor strikes the acceptor simultaneously. Consequently, a plane detonation wave is propagated through the acceptor explosive. 3 figs., 3 tabs.

  17. Adaptive multiconfigurational wave functions

    SciTech Connect

    Evangelista, Francesco A.

    2014-03-28

    A method is suggested to build simple multiconfigurational wave functions specified uniquely by an energy cutoff Λ. These are constructed from a model space containing determinants with energy relative to that of the most stable determinant no greater than Λ. The resulting Λ-CI wave function is adaptive, being able to represent both single-reference and multireference electronic states. We also consider a more compact wave function parameterization (Λ+SD-CI), which is based on a small Λ-CI reference and adds a selection of all the singly and doubly excited determinants generated from it. We report two heuristic algorithms to build Λ-CI wave functions. The first is based on an approximate prescreening of the full configuration interaction space, while the second performs a breadth-first search coupled with pruning. The Λ-CI and Λ+SD-CI approaches are used to compute the dissociation curve of N{sub 2} and the potential energy curves for the first three singlet states of C{sub 2}. Special attention is paid to the issue of energy discontinuities caused by changes in the size of the Λ-CI wave function along the potential energy curve. This problem is shown to be solvable by smoothing the matrix elements of the Hamiltonian. Our last example, involving the Cu{sub 2}O{sub 2}{sup 2+} core, illustrates an alternative use of the Λ-CI method: as a tool to both estimate the multireference character of a wave function and to create a compact model space to be used in subsequent high-level multireference coupled cluster computations.

  18. On the generation of internal wave modes by surface waves

    NASA Astrophysics Data System (ADS)

    Harlander, Uwe; Kirschner, Ian; Maas, Christian; Zaussinger, Florian

    2016-04-01

    Internal gravity waves play an important role in the ocean since they transport energy and momentum and the can lead to mixing when they break. Surface waves and internal gravity waves can interact. On the one hand, long internal waves imply a slow varying shear current that modifies the propagation of surface waves. Surface waves generated by the atmosphere can, on the other hand, excite internal waves by nonlinear interaction. Thereby a surface wave packet consisting of two close frequencies can resonate with a low frequency internal wave (Phillips, 1966). From a theoretical point of view, the latter has been studied intensively by using a 2-layer model, i.e. a surface layer with a strong density contrast and an internal layer with a comparable weak density contrast (Ball, 1964; Craig et al., 2010). In the present work we analyse the wave coupling for a continuously stratified fluid using a fully non-linear 2D numerical model (OpenFoam) and compare this with laboratory experiments (see Lewis et al. 1974). Surface wave modes are used as initial condition and the time development of the dominant surface and internal waves are studied by spectral and harmonic analysis. For the simple geometry of a box, the results are compared with analytical spectra of surface and gravity waves. Ball, F.K. 1964: Energy transfer between external and internal gravity waves. J. Fluid Mech. 19, 465. Craig, W., Guyenne, P., Sulem, C. 2010: Coupling between internal and surface waves. Natural Hazards 57, 617-642. Lewis, J.E., Lake, B.M., Ko, D.R.S 1974: On the interaction of internal waves and surfacr gravity waves, J. Fluid Mech. 63, 773-800. Phillips, O.M. 1966: The dynamics of the upper ocean, Cambridge University Press, 336pp.

  19. Shear wave transmissivity measurement by color Doppler shear wave imaging

    NASA Astrophysics Data System (ADS)

    Yamakoshi, Yoshiki; Yamazaki, Mayuko; Kasahara, Toshihiro; Sunaguchi, Naoki; Yuminaka, Yasushi

    2016-07-01

    Shear wave elastography is a useful method for evaluating tissue stiffness. We have proposed a novel shear wave imaging method (color Doppler shear wave imaging: CD SWI), which utilizes a signal processing unit in ultrasound color flow imaging in order to detect the shear wave wavefront in real time. Shear wave velocity is adopted to characterize tissue stiffness; however, it is difficult to measure tissue stiffness with high spatial resolution because of the artifact produced by shear wave diffraction. Spatial average processing in the image reconstruction method also degrades the spatial resolution. In this paper, we propose a novel measurement method for the shear wave transmissivity of a tissue boundary. Shear wave wavefront maps are acquired by changing the displacement amplitude of the shear wave and the transmissivity of the shear wave, which gives the difference in shear wave velocity between two mediums separated by the boundary, is measured from the ratio of two threshold voltages required to form the shear wave wavefronts in the two mediums. From this method, a high-resolution shear wave amplitude imaging method that reconstructs a tissue boundary is proposed.

  20. The role of Biot slow waves in electroseismic wave phenomena.

    PubMed

    Pride, Steven R; Garambois, Stéphane

    2002-02-01

    The electromagnetic fields that are generated as a spherical seismic wave (either P or S) traverses an interface separating two porous materials are numerically modeled both with and without the generation of Biot slow waves at the interface. In the case of an incident fast-P wave, the predicted electric-field amplitudes when slow waves are neglected can easily be off by as much as an order of magnitude. In the case of an incident S wave, the error is much smaller (typically on the order of 10% or less) because not much S-wave energy gets converted into slow waves. In neglecting the slow waves, only six plane waves (reflected and transmitted fast-P, S, and EM waves) are available with which to match the eight continuity conditions that hold at each interface. This overdetermined problem is solved by placing weights on the eight continuity conditions so that those conditions that are most important for obtaining the proper response are emphasized. It is demonstrated that when slow waves are neglected, it is best to also neglect the continuity of the Darcy flow and fluid pressure across an interface. The principal conclusion of this work is that to properly model the electromagnetic (EM) fields generated at an interface by an incident seismic wave, the full Biot theory that allows for generation of slow waves must be employed.