Perirenal Hematomas Caused by SWL with EDAP LT-01 Lithotripter

Ueda, Shogo; Matsuoka, Kei; Yamashita, Takuro; Kunimi, Hiroshi; Noda, Shinshi; Eto, Kosaku

doi:10.1089/end.1993.7.11

Cited by 20 publications

(9 citation statements)

References 9 publications

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“…Indeed, patient studies have suggested that focal width can affect outcomes with lower stone‐free rates for narrow focal width lithotriptors [18–22]. Focal width has also been implicated in SWL injury, with the suggestion of an increased occurrence of adverse effects with narrow focal width machines [23,24].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of shock wave lithotripsy injury in the pig using a narrow focal zone lithotriptor

Connors¹,

McAteer²,

Evan³

et al. 2012

BJU International

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OBJECTIVE To assess renal injury in a pig model after treatment with a clinical dose of shock waves using a narrow focal zone (≈ 3 mm) lithotriptor (Modulith SLX, Karl Storz Lithotripsy). MATERIALS AND METHODS The left kidney of anaesthetized female pigs were treated with 2000 or 4000 shock waves (SWs) at 120 SWs/min, or 2000 SWs at 60 SWs/min using the Storz SLX. Measures of renal function (glomerular filtration rate and renal plasma flow) were collected before and 1 h after shock wave lithotripsy (SWL) and the kidneys were harvested for histological analysis and morphometric quantitation of haemorrhage in the renal parenchyma with lesion size expressed as a percentage of functional renal volume (FRV). A fibre-optic probe hydrophone was used to determine acoustic output and map the focal width of the lithotriptor. Data for the SLX were compared with data from a previously published study in which pigs of the same age (7–8 weeks) were treated (2000 SWs at 120 or 60 SWs/min) using an unmodified Dornier HM3 lithotriptor. RESULTS Treatment with the SLX produced a highly focused lesion running from cortex to medulla and often spanning the full thickness of the kidney. Unlike the diffuse interstitial haemorrhage observed with the HM3, the SLX lesion bore a blood-filled core of near-complete tissue disruption devoid of histologically recognizable kidney structure. Despite the intensity of tissue destruction at the core of the lesion, measures of lesion size based on macroscopic determination of haemorrhage in the parenchyma were not significantly different from kidneys treated using the HM3 (2000 SWs, 120 SWs/min: SLX, 1.86 ± 0.52% FRV; HM3, 3.93 ± 1.29% FRV). Doubling the SW dose of the SLX from 2000 to 4000 SWs did not significantly increase lesion size. In addition, slowing the firing rate of the SLX to 60 SWs/min did not reduce the size of the lesion (2.16 ± 0.96% FRV) compared with treatment at 120 SWs/min, as was the case with the HM3 (0.42 ± 0.23% FRV vs 3.93 ± 1.29% FRV). Renal function fell significantly below baseline in all treated groups but was similar for both lithotriptors. Focal width of the SLX (≈ 2.6 mm) was about one-third that of the HM3 (≈ 8 mm) while peak pressures were higher (SLX at power level 9: P+ ≈ 90 MPa, P− ≈ −12 MPa; HM3 at 24 kV: P+ ≈ 46 MPa, P−≈−8 MPa). CONCLUSIONS The lesion produced by the SLX (narrow focal width, high acoustic pressure) was a more focused, more intense form of tissue damage than occurs with the HM3. Slowing the SW rate to 60 SWs/min, a strategy shown to be effective in reducing injury with the HM3, was not protective with the SLX. These findings suggest that the focal width and acoustic output of a lithotriptor affect the renal response to SWL.

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Section: Introductionmentioning

confidence: 99%

Evaluation of shock wave lithotripsy injury in the pig using a narrow focal zone lithotriptor

Connors¹,

McAteer²,

Evan³

et al. 2012

BJU International

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“…[9][10][11][12][13][14] In addition, laboratory studies have shown that the renal lesion produced by a narrow focal width lithotripter can be more intense than that produced by a wider focal width machine, and clinical reports have suggested that a narrow focal width may be linked to an increase in the occurrence of adverse effects. [15][16][17] Previously, we undertook an evaluation of the XiXin CS2012 (or XX-ES) lithotripter. 18 This lithotripter represents a novel concept, a departure from the higher pressure, narrower focal width lithotripters that are most commonly in use.…”

mentioning

confidence: 99%

Evaluation of the LithoGold LG-380 Lithotripter:In VitroAcoustic Characterization and Assessment of Renal Injury in the Pig Model

Pishchalnikov

McAteer

Williams

et al. 2013

Journal of Endourology

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Purpose: Conduct a laboratory evaluation of a novel low-pressure, broad focal zone electrohydraulic lithotripter . Methods: Mapping of the acoustic field of the LG-380, along with a Dornier HM3, a Storz Modulith SLX, and a XiXin CS2012 (XX-ES) lithotripter was performed using a fiberoptic hydrophone. A pig model was used to assess renal response to 3000 shockwaves (SW) administered by a multistep power ramping protocol at 60 SW/min, and when animals were treated at the maximum power setting at 120 SW/min. Injury to the kidney was assessed by quantitation of lesion size and routine measures of renal function. Results: SW amplitudes for the LG-380 ranged from (P + /P -) 7/-1.8 MPa at PL-1 to 21/-4 MPa at PL-11 while focal width measured *20 mm, wider than the HM3 (8 mm), SLX (2.6 mm), or XX-ES (18 mm). For the LG-380, there was gradual narrowing of the focal width to *10 mm after 5000 SWs, but this had negligible effect on breakage of model stones, because stones positioned at the periphery of the focal volume (10 mm off-axis) broke nearly as well as stones at the target point. Kidney injury measured less than 0.1% FRV (functional renal volume) for pigs treated using a gradual power ramping protocol at 60 SW/min and when SWs were delivered at maximum power at 120 SW/min. Conclusions: The LG-380 exhibits the acoustic characteristics of a low-pressure, wide focal zone lithotripter and has the broadest focal width of any lithotripter yet reported. Although there was a gradual narrowing of focal width as the electrode aged, the efficiency of stone breakage was not affected. Because injury to the kidney was minimal when treatment followed either the recommended slow SW-rate multistep ramping protocol or when all SWs were delivered at fast SW-rate using maximum power, this appears to be a relatively safe lithotripter.

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“…The first reports of hematoma associated with aspirin therapy were in 1990; one patient was described as taking ''two aspirins per day'' before SWL and needed surgical evacuation, 60 while the other stopped aspirin 10 days before treatment and was treated conservatively. 61 A further three series have reported on antiplatelet therapy; in a small series, two of nine patients with haematomas were receiving aspirin up to treatment; 62 in a series of 402 patients, 16 subcapsular hematomas were found with a significant correlation to antiplatelet therapy; 63 and in the largest series of 31 hematomas, only one patient was receiving aspirin therapy. 58 In these studies the patients reported presented with symptomatic hematoma and do not reflect the true incidence of all hematoma; therefore, it is difficult to surmise the true effect of antiplatelet therapy.…”

Section: Coagulation and Plateletsmentioning

confidence: 99%

Shockwave Lithotripsy: Arterial Aneurysms and Vascular Complications

Tse

Qazi

Halsall

et al. 2011

Journal of Endourology

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There is currently no high-level evidence to suggest that SWL in the presence of arterial aneurysm is unsafe. Experimental work on ex vivo human tissue does not suggest that SWL is causative to aneurysm rupture. With the availability of CT imaging in modern clinical practice, aneurysms of the arterial tree should be identified as part of the investigation of urinary tract calculi. SWL can be safely performed in patients with AAA, but monitoring postprocedure is mandatory, along with access to emergency vascular surgery support; importantly, any onset of new pain or symptoms should be aggressively investigated by radiologic imaging in the first instance.

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Perirenal Hematomas Caused by SWL with EDAP LT-01 Lithotripter

Cited by 20 publications

References 9 publications

Evaluation of shock wave lithotripsy injury in the pig using a narrow focal zone lithotriptor

Evaluation of shock wave lithotripsy injury in the pig using a narrow focal zone lithotriptor

Evaluation of the LithoGold LG-380 Lithotripter:In VitroAcoustic Characterization and Assessment of Renal Injury in the Pig Model

Shockwave Lithotripsy: Arterial Aneurysms and Vascular Complications

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