First Series Using Ultrasonic Propulsion and Burst Wave Lithotripsy to Treat Ureteral Stones

Abstract

Purpose:Our goal was to test transcutaneous focused ultrasound in the form of ultrasonic propulsion and burst wave lithotripsy to reposition ureteral stones and facilitate passage in awake subjects.Materials and Methods:Adult subjects with a diagnosed proximal or distal ureteral stone were prospectively recruited. Ultrasonic propulsion alone or with burst wave lithotripsy was administered by a handheld transducer to awake, unanesthetized subjects. Efficacy outcomes included stone motion, stone passage, and pain relief. Safety outcome was the reporting of associated anticipated or adverse events.Results:Twenty-nine subjects received either ultrasonic propulsion alone (n = 16) or with burst wave lithotripsy bursts (n = 13), and stone motion was observed in 19 (66%). The stone passed in 18 (86%) of the 21 distal ureteral stone cases with at least 2 weeks follow‐up in an average of 3.9±4.9 days post-procedure. Fragmentation was observed in 7 of the burst wave lithotripsy cases. All subjects tolerated the procedure with average pain scores (0-10) dropping from 2.1±2.3 to 1.6±2.0 (P = .03). Anticipated events were limited to hematuria on initial urination post-procedure and mild pain. In total, 7 subjects had associated discomfort with only 2.2% (18 of 820) propulsion bursts.Conclusions:This study supports the efficacy and safety of using ultrasonic propulsion and burst wave lithotripsy in awake subjects to reposition and break ureteral stones to relieve pain and facilitate passage.

Physical Techniques to Remove Residual Stone Fragments in the Urinary System

“…A prospective study investigated the relocation of ureteral stones and ejection of RF under percutaneous focused ultrasound by evaluating ultrasonic propulsion and shockwave lithotripsy, and the findings showed calculi movement in 19 (66%) of the 29 adult patients with proximal or distal ureteral calculi who received ultrasound propulsion alone and 13 patients who underwent blasting-wave lithotripsy. In that study, 18 (86%) of the 21 individuals with distal ureteral stones passed the stones, proving the efficacy of ultrasonic propulsion in lowering ureteral calculi, fracturing stones to reduce discomfort, and encouraging calculi evacuation [36]. These investigations show that ultrasonic propulsion strategies are safe and effective for enhancing RF ejection.…”

Re: First Series Using Ultrasonic Propulsion and Burst Wave Lithotripsy to Treat Ureteral Stones. Reply.

“…To the Editor: We would like to thank Dr Bower for his comment on our study. 1 Indeed, while bilateral excision is associated with lack of spontaneous erections after prostatectomy, there are many factors that concur to the achievement of satisfactory postoperative potency. Nerve preservation is one of those.…”

“…To the Editor: Hall et al report the first series using ultrasonic propulsion and burst wave lithotripsy (BWL) to treat ureteral stones. 1 The technology represents a nonsurgical, clinic-based method of repositioning and fragmenting stones to facilitate their natural clearance. The preliminary results are promising and may lead to a paradigm change in how we treat kidney stones.…”

First Series Using Ultrasonic Propulsion and Burst Wave Lithotripsy to Treat Ureteral Stones. Letter.

“…To the Editor: I read with great interest the work of Martini et al 1 and find the 3 categories of risk for contralateral extraprostatic extension quite valuable. However, I feel the conclusion is overstated.…”

“…To this end, we have created a care pathway in our health system for our Emergency Department kidney stone patients which increases urological referrals and standardizes Emergency Department diagnosis and treatment. 1 In our current state of the workforce, where urology subspecialty availability may be limited, especially in nonurban regions, BWL and ultrasonic propulsion may offer unique strategies to mitigate the risk of stone disease in a variety of contexts. We further encourage the urology community to collaborate and develop processes and procedures to define which actions are appropriate and safe in the acute care setting.…”