Evaluation of Synchronous Twin Pulse Technique for Shock Wave Lithotripsy: Determination of Optimal Parameters for In Vitro Stone Fragmentation

Sheir, Khaled Z.; Zabihi, Nasim; Lee, David I.; Teichman, Joel M.H.; Rehman, Jamil; Sundaram, Chandru P.; Heimbach, D.; Hesse, Albrecht; Delvecchio, Fernado; Zhong, Pei; Preminger, Glenn M.; Clayman, Ralph V.

doi:10.1097/01.ju.0000094188.69698.f8

Cited by 15 publications

(7 citation statements)

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“…This technique intensifies and localizes the cavitation effects by the interacting focal zones of both reflectors, resulting in a better quality and rate of stone disintegration, especially with a right angle between the axes of the reflectors [8,9]. This device had good in vitro disintegrative efficacy for both artificial (Bon(n)‐stones, and plaster of Paris) and human stones (COM, brushite and cystine) with better efficacy as the number of shock waves and the power were increased [10].…”

Section: Discussionmentioning

confidence: 99%

“…On 1999 we developed the bidirectional synchronous twin‐pulse technique with variable angles between the shock wave reflectors, and found that it improved the quality and rate of stone disintegration in vitro (especially with a right angle between the reflectors) [8]. The disintegrative efficacy for both artificial and human stones was improved as the number of shock waves and the power were increased [9,10]. Bidirectional synchronous 90° twin‐pulse‐induced tissue damage (acutely) appeared to be minimal when compared with a single pulse [11].…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of a synchronous twin‐pulse technique for shock wave lithotripsy: the first prospective clinical study

Sheir¹,

El-Diasty²,

Ismail

2005

BJU International

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obstructed urinary tract distal to the stones, or congenital abnormalities. All patients received one session and were evaluated by ultrasonography (US), urinary tract plain Xray, and complete laboratory investigations before and immediately after treatment, and after 2, 14 and 30 days. Patients requiring retreatment at the 14-day visit received a second session and were re-evaluated after 7 and 14 days. RESULTSThe mean (SD, range) stone size (longest diameter) was 12.3 (2.6, 9-18) mm. Intravenous sedation was used in 30 patients. There was mild haematuria in 25 patients on the day of treatment. During the follow-up there was no evidence of haematoma, gross renal injury, upper urinary tract obstruction or significant changes in the laboratory investigations. After 14 days, 17 patients (34%) were free of stones, with residual stones of £5 mm in 20 (40%); they were free of stones at the 1-month follow-up. Thirteen patients (26%) had residual stones of 6-9 mm, but the stones were half or less of the original size. Patients with residual stones of >5 mm had another ESWL session and were free of stones within 14 days. Thus all patients were rendered stone-free within 1 month. CONCLUSIONSSynchronous twin-pulse ESWL is promising, seems safe and effective for treating patients with renal and upper ureteric lithiasis. KEYWORDStwin-pulse lithotripsy, urinary calculi, assessment, clinical study OBJECTIVETo present the results of the first clinical study of a synchronous twin-pulse technique for extracorporeal shock-wave lithotripsy (ESWL), which is effective for in vitro stone fragmentation and safe when assessed in vivo on animal tissue. PATIENTS AND METHODSFifty patients with urinary stones (35 men and 15 women) were enrolled and treated with the TWINHEADS lithotripter. The entry criteria were: age ≥18 years, with a radio-opaque single stone in the kidney or upper ureter, a normal laboratory profile (serum creatinine, liver function, blood, bleeding and clotting times, and prothrombin concentration). The exclusion criteria included lower ureteric stones, patients with urinary tract infection,

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Evaluation of a synchronous twin‐pulse technique for shock wave lithotripsy: the first prospective clinical study

Sheir¹,

El-Diasty²,

Ismail

2005

BJU International

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“…[1415] The rationale in this concept is, that “filling” the negative part of the pressure wave with a positive pressure pulse would theoretically result in improved fragmentation and reduced cavitation with reduced parenchymal damage.…”

Section: Shockwave Sourcesmentioning

confidence: 99%

Extracorporeal shock wave lithotripsy today

Tailly

2013

Indian J Urol

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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.

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“…The idea was that the two waves would impact on the target yet cancel out peripheral damaging effects. It was found that this technique reduces and localizes the cavitation effects, together with improving the quality and rate of stone disintegration, especially with a right‐angle between the axes of the SW reflectors [6,7]. There was minimal tissue damage compared with the standard single‐pulse method in an animal study [8].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of a synchronous twin‐pulse technique for shock wave lithotripsy: a prospective randomized study of effectiveness and safety in comparison to standard single‐pulse technique

Sheir¹,

El-Halwagy²,

Abo-Elghar³

et al. 2007

BJU International

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OBJECTIVE To asses the efficacy and safety of bidirectional synchronous twin‐pulse extracorporeal shock wave lithotripsy (ESWL) compared with standard ESWL. PATIENTS AND METHODS Between March 2003 and December 2006, 240 patients with a radio‐opaque single renal stone of ≤25 mm were randomized to treatment either by the Twinheads (TH) lithotripter (FMD, Lorton, Virginia, USA) or the Dornier Lithotripter S (DLS, Dornier MedTech Europe GmbH, Germering, Germany). Before and after ESWL, urinary N‐acetyl‐B‐glucosaminidase (NAG) levels were assessed and patients were evaluated with dynamic MRI. The efficacy and complications were compared, with success defined as no residual fragments. RESULTS For stones of >10 mm the rate for the failure of disintegration was 13.3% for the DLS vs 1.4% for the TH (P = 0.009). For stones of ≤10 mm the stone‐free rate was 74.4% for the TH vs 67.7% for the DLS (P = 0.6), while for stones of >10 mm it was 78.1% and 66.7%, respectively (P = 0.14). The median (range) number of sessions in both groups was 2 (1–5). After ESWL urinary NAG levels were increased significantly in both groups; in the TH group it declined below the level before ESWL after 2 days, while in the DLS group it remained high after 7 days. In the DLS group four patients developed subcapsular or parenchymal haematoma after ESWL, vs none in the TH group. There was loss of corticomedullary differentiation after ESWL in three patients in the DLS group and only one in the TH group. In the DLS group there was a statistically significantly decrease in bilateral renal perfusion after ESWL, but no changes in the TH group. CONCLUSIONS Synchronous twin‐pulse ESWL has clinical advantages over standard ESWL in terms of safety and efficacy.

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Evaluation of Synchronous Twin Pulse Technique for Shock Wave Lithotripsy: Determination of Optimal Parameters for In Vitro Stone Fragmentation

Cited by 15 publications

References 11 publications

Evaluation of a synchronous twin‐pulse technique for shock wave lithotripsy: the first prospective clinical study

Evaluation of a synchronous twin‐pulse technique for shock wave lithotripsy: the first prospective clinical study

Extracorporeal shock wave lithotripsy today

Evaluation of a synchronous twin‐pulse technique for shock wave lithotripsy: a prospective randomized study of effectiveness and safety in comparison to standard single‐pulse technique

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