New Generation Shock Wave Lithotripsy

Wilbert, D. M.; Reichenberger, Helmut; Noske, Erich; Riedmiller, H.; Alken, P.; Hohenfellner, R.

doi:10.1016/s0022-5347(17)43259-9

Cited by 77 publications

(20 citation statements)

References 3 publications

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“…During this period, the prevalence of kidney stones in the United States has risen significantly from 3.8% in 1980 to 8.8% in 2010 (2,3), in parallel with the increase in metabolic syndrome (e.g., obesity and diabetes) of the population (4,5). Previous technological improvements in SWL were mainly focused on operator convenience and patient comfort, as exemplified by the use of dry coupling and large source aperture in contemporary lithotripters (6), except for the introduction of electromagnetic (EM) technology for shock wave generation in the late 1980s (7). Currently, EM lithotripters have eclipsed electrohydraulic (EH) lithotripters, such as the first-generation Dornier HM3, as the preferred technology in SWL (8).…”

mentioning

confidence: 99%

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

Neisius

Smith

Sankin

et al. 2014

Proc. Natl. Acad. Sci. U.S.A.

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The efficiency of shock wave lithotripsy (SWL), a noninvasive firstline 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. electromagnetic lithotripter | lens modification | stone fragmentation

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mentioning

confidence: 99%

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

Neisius

Smith

Sankin

et al. 2014

Proc. Natl. Acad. Sci. U.S.A.

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“…All patients were treated with the Lithostar Siemens lithotriptor. The use and technical aspects of this machine have been described previously [3]. Shock waves are gen erated by an electromagnetic source and focused by biconcave acoustic lens system [4], The energy varies from 12.6 to 21.3 V. The total number of shock waves delivered with each treatment varied from 400 to 4,000.…”

Section: Methodsmentioning

confidence: 99%

Second-Generation Lithotripsy: A Safe, Noninvasive, Ambulatory Procedure

Baert¹,

Claes²,

Billiet³

et al. 1989

Urol Int

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A total of 600 patients underwent 696 treatments of extracorporeal Shockwave lithotripsy (ESWL) during the period between June and November 1987. Our progressively increasing experience with the second-generation device shows that this new unit is as effective as the conventional one, and reveals several advantages. The focusing of the stone is easier; therapy time is shorter; general or regional anesthesia is no longer necessary; distal ureteral stones can be disintegrated, and adjuvant procedures are easily performed during the ESWL session. Of the last 400 patients of our series, 76% were treated on an outpatient basis without any major complications.

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“…The energy is focused with an 'acoustic lens' system, which can be used for several hundred thousand shock waves with no need to replace the elements [7]. A variation used by another system is that the repelling membrane is formed as a cylinder and the sound waves are reflected by a surrounding parabolic reflector.…”

Section: Electromagnetic Sourcementioning

confidence: 99%

A comparative review of extracorporeal shock wave generation

Wilbert

2002

BJU International

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SummaryShock waves are specific sound waves produced by shockwave generators; the generators currently available have different physical properties and represent different technical solutions. The measurement of shock-wave pressure is necessary in laboratory settings to define the physical characteristics of a given shock-wave source. Under clinical conditions other variables, e.g. the stone-free rate or the percentage of complications, are used to describe the efficacy and safety of a lithotripter.

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New Generation Shock Wave Lithotripsy

Cited by 77 publications

References 3 publications

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

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

Second-Generation Lithotripsy: A Safe, Noninvasive, Ambulatory Procedure

A comparative review of extracorporeal shock wave generation

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