Parameters Influencing Renal Damage in Extracorporeal Shock Wave Lithotripsy: An Experimental Study in Pigs

El-Damanhoury, H.; Schaub, T.; Stadtbäumer, M.; Kunisch, M.; Störkel, S; Schild, H.; Thelen, M.; Hohenfellner, R.

doi:10.1089/end.1991.5.37

Cited by 11 publications

(9 citation statements)

References 15 publications

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“…Not surprisingly, increasing the shock number generally increases renal damage in animal [16][17][18] and human 19 kidneys. However, no study has examined the effects of a reduced dose of SWs (below typical clinical levels) on both renal function and lesion size in pediatric kidneys.…”

Section: Introduction E Xtracorporeal Shockwave Lithotripsymentioning

confidence: 98%

Reducing Shock Number Dramatically Decreases Lesion Size in a Juvenile Kidney Model

Connors

Evan

Blomgren

et al. 2006

Journal of Endourology

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Section: Introduction E Xtracorporeal Shockwave Lithotripsymentioning

confidence: 98%

Reducing Shock Number Dramatically Decreases Lesion Size in a Juvenile Kidney Model

Connors

Evan

Blomgren

et al. 2006

Journal of Endourology

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“…There have been many studies on the influence of shockwave number on renal damage (Table 5), but few on the impact of generator voltage [13,17,25,35]. Delius et al [13] demonstrated the threshold for induction of pulmonary hemorrhage by positioning canine lungs at different distances from the focus (F 2).…”

Section: Influence Of Generator Voltagementioning

confidence: 99%

“…Delius et al [13] demonstrated the threshold for induction of pulmonary hemorrhage by positioning canine lungs at different distances from the focus (F 2). Muschter et al [35] and E1-Damanhoury et al [17] showed that the trauma to a porcine kidney increased with the generator voltage when either an electrohydraulic or an electromagnetic generator voltage (kV), since the acoustic output from different shockwave sources differs significantly at the same kilovoltage. Based on our study, we strictly limited the number of impulses at the maximal energy setting of the Modulith and Lithostar Plus (Fig.…”

Section: Influence Of Generator Voltagementioning

confidence: 99%

Experimental basis of shockwave-induced renal trauma in the model of the canine kidney

et al. 1993

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Using the new electromagnetic shockwave source of the Modulith SL 20 shockwave-induced renal trauma was evaluated by acute and chronic studies in the the canine kidney model. In a further study the electromagnetic shockwave source of the Lithostar Plus Overhead module was tested. Overall, 92 kidneys were exposed to shock waves coupled either by water bath (Modulith lab type) or by water cushion (Modulith prototype, Lithostar Overhead) under ultrasound localization. The generator voltage ranged between 11 and 21 kV, the number of impulses between 25 and 2500. After application of 1500/2500 shocks the extent of the renal lesion depended strictly on the applied generator voltage and was classified into 4 grades: Grade 0, no macroscopic trauma detectable (at 11-12 kV); grade 1, petechial medullary bleeding (at 13 kV); grade 2, cortical hematoma (at 14-16 kV); and grade 3, perirenal hematoma (17-20 kV). Whereas at low and medium energy levels the number of shocks played only a minor role, at maximal generator voltage (20 kV) even 25 impulses induced a grade 2 and 600 shocks a grade 3 lesion, emphasizing the importance of shockwave limitation in the upper energy range. In shockwave-induced renal trauma a vascular lesion was predominant and cellular necrosis was secondary. Coupling with a water cushion resulted in a 15%-20% decrease in the disintegrative and traumatic effect, which was compensated for by increasing the generator voltage by 2 kV. Long-term studies showed complete restitution following grade 1 and 2 trauma, whereas after a grade 3 lesion a small segmental and capsular fibrosis without hyperplasia of the juxtaglomerular apparatus was observed. Based on the characteristic ultrasound pattern found in the first study, the threshold for induction of grade 1 lesion was investigated. With both lithotripters a wide range for induction of a grade 1 lesion (Modulith 234-411, Lithostar Plus 220-740) and also a significant overlapping with grade 0 and 2 lesions was seen at low energy settings (levels 2-4). In contrast, the range of shocks (Modulith 96-150, Lithostar Plus 90-142) and overlapping was minimal when high energy was used (levels 7-9). Finally, the disintegration-trauma coefficient combining the results obtained in a standard stone model with those of the canine kidney model was introduced.

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“…[1][2][3][4][5][6][7][8][9][10][11][12] The aim of the present study was to develop an in vitro tissue model that enables reproducible histopathologic evaluation of SW-induced renal trauma and to find a substitute for animal experiments.…”

Section: Introduction E Xtracorporial Shockwave Lithotripsy Hasmentioning

confidence: 99%

The Isolated Perfused Kidney: Anin VitroTest System for Evaluation of Renal Tissue Damage Induced by High-Energy Shockwaves Sources

Bergsdorf

Thüroff

Chaussy

2005

Journal of Endourology

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Most of our knowledge of shockwave-induced renal damage is based on animal experiments and clinical observation. We developed a tissue model using isolated porcine kidneys perfused with Berliner Blau dye in physiologic saline using a Ureteromat Perez-Castro peristaltic pump connected to the renal artery. Reproducible results were obtained under a variety of experimental conditions. Further refinements of the model might consist of interposition of tissue layers in the shockwave path or simulation of ventilatory movements.

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Parameters Influencing Renal Damage in Extracorporeal Shock Wave Lithotripsy: An Experimental Study in Pigs

Cited by 11 publications

References 15 publications

Reducing Shock Number Dramatically Decreases Lesion Size in a Juvenile Kidney Model

Reducing Shock Number Dramatically Decreases Lesion Size in a Juvenile Kidney Model

Experimental basis of shockwave-induced renal trauma in the model of the canine kidney

The Isolated Perfused Kidney: Anin VitroTest System for Evaluation of Renal Tissue Damage Induced by High-Energy Shockwaves Sources

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