Is Newer Always Better? A Comparative Study of 3 Lithotriptor Generations

Gerber, Rolf; Studer, Urs E.; Danuser, Hansjörg

doi:10.1097/01.ju.0000158042.41319.c4

Cited by 101 publications

(67 citation statements)

References 13 publications

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“…These findings are particularly relevant given that lithotripsy retreatments for incompletely comminuted stones commonly occur and undoubtedly multiply the potential for renal injury and functional impairment. Moreover, Evan et al (18) recently proposed that SWL-induced renal injury, particularly to the papilla, may actually promote the growth of brushite stones, which resist breakage by lithotripsy. If this proposal holds true, then it should draw even more attention to the potential clinical usefulness of the protective phenomenon described in this report.…”

Section: Discussionmentioning

confidence: 99%

Prevention of Lithotripsy-Induced Renal Injury by Pretreating Kidneys with Low-Energy Shock Waves

Willis¹,

Evan²,

Connors³

et al. 2006

Journal of the American Society of Nephrology

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Lithotripsy shock waves (SW) to one renal pole damage that pole but protect the opposite pole from the damage inflicted by another, immediate application of SW. This study investigated whether the protection (1) occurs when the first treatment causes no injury, (2) is caused by SW or injury, (3) exhibits a threshold, and (4) occurs when the same pole receives both treatments. Six-to 7-wk-old anesthetized female pigs were studied. The following groups were studied: group 1 (n ‫؍‬ 4), 2000 SW at 12 kV to one pole and 2000 SW at 24 kV (standard) to the opposite pole; group 2 (n ‫؍‬ 6), same as group 1 except 500 12-kV SW pretreatment; group 3 (n ‫؍‬ 8), 500 12-kV, 2000 standard SW, all to the same pole; and group 4 (n ‫؍‬ 8), same as group 3 except 100 12-kV SW pretreatment. Mean ؎ SD lesion size in group 1, first pole treated, was 0.66 ؎ 0.82% of functional renal volume (FRV; P < 0.05 versus 5.22 ؎ 3.6% FRV with no pretreatment [NP]; 95% confidence interval [CI] ؊7.0 to ؊2.1) and 0.50 ؎ 0.68% FRV in the opposite pole after 2000 standard SW (P < 0.05 versus NP; 95% CI ؊9.4 to ؊0.08). Mean lesion size (first pole) in group 2 was 0.020 ؎ 0.028% FRV (P < 0.01 versus NP; 95% CI ؊9.2 to ؊1.2) and 0.43 ؎ 0.54% FRV in the opposite pole after 2000 standard SW (P < 0.05 versus NP; 95% CI ؊8.8 to ؊0.82). Same-pole SW (groups 3 and 4) also protected. Mean lesion sizes were 0.28 ؎ 0.33% (P < 0.01 versus NP; 95% CI ؊8.0 to ؊1.9) in group 3 and 0.39 ؎ 0.48% FRV (P < 0.01 versus NP; 95% CI ؊8.2 to ؊1.7) in group 4. It is concluded that the pretreatment protocol substantially limits the renal injury that normally is caused by SWL and occurs when the pretreatment and standard SW are applied to the same pole. The threshold for the protection may be <100 SW.

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Section: Discussionmentioning

confidence: 99%

Prevention of Lithotripsy-Induced Renal Injury by Pretreating Kidneys with Low-Energy Shock Waves

Willis¹,

Evan²,

Connors³

et al. 2006

Journal of the American Society of Nephrology

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“…Since its introduction in the early 1980s, the firstgeneration Dornier HM3 electrohydraulic lithotripter has exemplified the pinnacle of efficacy in stone comminution despite several generations of lithotripters developed in its wake (Graber et al, 2003;Gerber et al, 2005;Lingeman et al, 2009). This fact has presented a primary challenge and also motivated the investigators in the field of shock wave lithotripsy (SWL) to better understand the fundamental mechanisms that contribute to the success of this noninvasive technology in kidney stone treatment (Lingeman et al, 2009;Rassweiler et al, 2011).…”

Section: Introductionmentioning

confidence: 99%

A heuristic model of stone comminution in shock wave lithotripsy

Smith

Zhong

2013

The Journal of the Acoustical Society of America

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

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“…A lot of prospective randomized trials compared electrohydraulic with electromagnetic lithotripters for stone disintegration and induced renal trauma. 17,18 These studies showed that Dornier electrohydraulic lithotripters are still the gold standard in disintegration of the pelvicaliceal stones with less renal-induced trauma and postoperative complications. 17,18 To our knowledge, there is no study that compared the two lithotripters in terms of damage on the urothelial layer.…”

mentioning

confidence: 99%

Electromagnetic and Electrohydraulic Shock Wave Lithotripsy-Induced Urothelial Damage: Is There a Difference?

Mustafa

Aburas

Helo

et al. 2017

Journal of Endourology

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Purpose: To evaluate and compare the acute effect of electromagnetic and electrohydraulic extracorporeal shockwave lithotripsy (SWL) on the urothelial layers of kidney and ureter. Materials and Methods: Fifty patients, 29 males (58%) and 21 females (42%), with an average age of 51.68 years (range: 37-70) who underwent SWL application in two different centers were included. Twenty-eight patients (56%) were treated with electrohydraulic and 22 (44%) were treated with electromagnetic lithotripsy. Urinary cytologic examinations were done immediately before and after SWL therapy and 10 days later. The average numbers of epithelial cells, red blood cells (RBC), and myocytes were counted under 40 · magnification. Results: There were significant differences in the number of epithelial cells and RBC before and after immediate application of SWL: 1.66 and 14.9 cells/field, ( p = 0.001), 5.44 and 113.45 cells/field, respectively ( p = 0.001). The number of RBC was significantly higher in patients treated with electromagnetic lithotripsy than those treated with electrohydraulic: 141.9 and 93.4 cells/field, respectively ( p = 0.02). No myocyte or basement membrane elements were detected in any of the cytologic examinations. Cytologic examinations done after 10 days of SWL therapy revealed recovery of all abnormal cytologic findings. Conclusions: The acute increments in the number of epithelial cells and RBC after SWL were statistically significant but it was not permanent. SWL-induced urinary urothelial lesion is limited to the mucosal layer and there was no evidence of damage to the basal membrane or muscle layer. Electromagnetic lithotripsy caused high numbers of RBC than the electrohydraulic device on the postimmediate urine cytologic examination.

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Is Newer Always Better? A Comparative Study of 3 Lithotriptor Generations

Cited by 101 publications

References 13 publications

Prevention of Lithotripsy-Induced Renal Injury by Pretreating Kidneys with Low-Energy Shock Waves

Prevention of Lithotripsy-Induced Renal Injury by Pretreating Kidneys with Low-Energy Shock Waves

A heuristic model of stone comminution in shock wave lithotripsy

Electromagnetic and Electrohydraulic Shock Wave Lithotripsy-Induced Urothelial Damage: Is There a Difference?

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