Pathologic-Anatomic Alterations in Human Kidneys after Extracorporeal Piezoelectric Shock Wave Lithotripsy

Seitz, Gerhard; Pletzer, K.; Neisius, D.; Dippel, William F.; Gebhardt, Th.

doi:10.1089/end.1991.5.17

Cited by 11 publications

(6 citation statements)

References 16 publications

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“…3) depending on the applied generator voltage at a given n u m b e r o f impulses (Table 3). Interestingly, in our m o d e l (canine kidney) the vascular lesion was p r e d o m i n a n t [43,47], whereas cellular necrosis -as emphasized by other authors [26,28,50] -played only a m i n o r role. C o r r e s p o n d i n g to this, we did not observe any significant changes in ser u m or urinary enzymes.…”

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confidence: 52%

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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confidence: 52%

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

et al. 1993

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“…On the other hand, the organic effects of shock waves on body tissues and organs may require a radiological evaluation. [ 11 13 14 15 ] In fact, when the damage caused by shock wave energy becomes more relevant, such pathological findings consisting in micro-hemorrhage and inflammation, may become clinically significant and detectable by imaging tools. In our experience, acute and persistent flank pain, variably associated with macro-hematuria and sepsis, represented the most frequent symptom of shock wave damage, occurring in 81% of cases.…”

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confidence: 99%

Diagnostic and prognostic role of computed tomography in extracorporeal shock wave lithotripsy complications

et al. 2016

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Purpose:To evaluate the role of multidetector computed tomography (MDCT) in recognizing the complications of extracorporeal shock wave lithotripsy (ESWL) and providing a prognostic grading system for the therapeutic approach.Materials and Methods:A total of 43 patients who underwent ESWL because of urinary stone disease were assessed by 320-row MDCT examination before and after ESWL. Pre-ESWL CT unenhanced scans were performed for diagnosing stone disease. Post-ESWL CT scans were acquired before and after intravenous injection of contrast medium searching for peri-renal fluid collection or hyper-density, pyelic or ureteral wall thickening, blood clots in the urinary tract, peri- or intra-renal hematoma or abscess, active bleeding. A severity grading system of ESWL complications was established.Results:Patients were affected by renal (n = 36) or ureteral (n = 7) lithiasis. Post-ESWL CT examination detected small fluid collections and hyper-density of peri-renal fat tissue in 35/43 patients (81%), pyelic or ureteral wall thickening in 2/43 (4%), blood clots in the urinary tract in 9/43 (21%), renal abscesses or hematomas with a diameter of <2 cm in 10/43 (23%), large retroperitoneal collections in 3/43 (7%), active bleeding from renal vessels in 1/43 (2%). Mild complications were found in 30 cases; moderate in 9; severe in 4. The therapeutic choice was represented by clinical follow-up (n = 20), clinical and CT follow-up (n = 10), ureteral stenting (n = 9), drainage of large retroperitoneal collections (n = 3), and arterial embolization (n = 1).Conclusion:MDCT plays a crucial role in the diagnosis of urolithiasis and follow-up of patients treated with ESWL recognizing its complications and providing therapeutic and prognostic indications.

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“…A microscopic examination shows up characteristic evidences: haemorrhagic lesions are preferentially localised in the corticomedullar joint, probably due to differences in the density of the tissue at that level [ 33 ]; moreover, signs of damage are immediately visible from the thin vascular walls and the glomeruli [ 34 ]. Haemorrhage leads to tissue hypoxia, which can play a role in the development of apoptosis, but it has been experimentally shown that shock waves administration does not affect the apoptosis index in normal rats after 2000 and 4000 shock waves [ 35 ] and after 1-2 weeks signs of reorganisation may be noticed, while after 1 month signs of glomerular atrophy and sclerosis are noticeable in tiny areas of fibrosis.…”

Section: Classificationmentioning

confidence: 99%

Complications of Extracorporeal Shock Wave Lithotripsy for Urinary Stones: To Know and to Manage Them—A Review

D’Addessi

Vittori

Racioppi

et al. 2012

The Scientific World Journal

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To identify the possible complications after extracorporeal shock wave lithotripsy (SWL) and to suggest how to manage them, the significant literature concerning SWL treatment and complications was analyzed and reviewed. Complications after SWL are mainly connected to the formation and passage of fragments, infections, the effects on renal and nonrenal tissues, and the effects on kidney function. Each of these complications can be prevented adopting appropriate measures, such as the respect of the contraindications and the recognition and the correction of concomitant diseases or infection, and using the SWL in the most efficient and safe way, tailoring the treatment to the single case. In conclusion, SWL is an efficient and relatively noninvasive treatment for urinary stones. However, as with any other type of therapy, some contraindications and potential complications do exist. The strictness in following the first could really limit the onset and danger of the appearance of others, which however must be fully known so that every possible preventive measure be implemented.

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Pathologic-Anatomic Alterations in Human Kidneys after Extracorporeal Piezoelectric Shock Wave Lithotripsy

Cited by 11 publications

References 16 publications

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

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

Diagnostic and prognostic role of computed tomography in extracorporeal shock wave lithotripsy complications

Complications of Extracorporeal Shock Wave Lithotripsy for Urinary Stones: To Know and to Manage Them—A Review

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