Severe Hemorrhage after Extracorporeal Shock-Wave Lithotripsy

Stoller, Marshall L.; Litt, Lawrence; Salazar, Robert G.

doi:10.7326/0003-4819-111-7-612

Cited by 16 publications

(7 citation statements)

References 6 publications

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“…Therapy consisted of blood transfusions while surgery was not indicated. Large bleedings requiring removal of the kidney have been reported, as has death from severe bleeding (Stoller et al 1989). In 10 % of patients, stone fragments obstruct the ureter and block urine flow; retreatment or their mechanical removal is indicated when no spontaneous passage occurs.…”

Section: Kidney Stone Fragmentationmentioning

confidence: 99%

Medical applications and bioeffects of extracorporeal shock waves

Delius¹

1994

Shock Waves

163

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Abstract. Lithotripter shock waves are pressure pulses of microsecond duration with peak pressures of 35-120MPa fotlowed by a tensile wave. They are an established treatment modality for kidney and gallstone disease. Further applications are pancreatic and salivary stones, as well as delayed fracture healing. The latter are either on their way to become established treatments or are currently under investigation. Shock waves generate tissue damage as a side effect which has been extensively investigated in the kidney, the liver, and the gallbladder. The primary adverse effects are local destruction of blood vessels, bleedings, and formation of blood clots in vessels. Investigations on the mechanism of shock wave action revealed that lithotripters generate cavitation both in vitro and in vivo. An increase in tissue damage at higher pulse administration rates, and also at shock wave application with concomitant gas bubble injection suggested that cavitation is a major mechanism of tissue damage. Disturbances of the heart rhythm and excitation of nerves are further biological effects of shock waves; both are probably also mediated by cavitation. On the cellular level, shock waves induce damage to cell organelles; its extent is related to their energy density. They also cause a transient increase in membrane permeability which does not lead to celJ death. Administered either alone or in combination with drugs, shock waves have been shown to delay the growth of small animal tumors and even induce tumor remissions. While the role of cavitation in biological effects is widely accepted, the mechanism of stone fragmentation by shock waves is still controversial. Cavitation is detected around the stone and hyperbaric pressure suppresses fragmentation; yet major cracks are formed early before cavitation bubble collapse is observed. The latter has been regarded as evidence for a direct shock wave effect.

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Section: Kidney Stone Fragmentationmentioning

confidence: 99%

Medical applications and bioeffects of extracorporeal shock waves

Delius¹

1994

Shock Waves

163

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“…Post-lithotripsy haematuria is expected; its severity does not correlate with internal injury. In contrast, severe flank pain unresponsive to traditional analgesics is unusual and may represent lifethreatening haemorrhage (Stoller et al, 1989).…”

Section: Commentmentioning

confidence: 99%

Severe Haemorrhage after Extracorporeal Shock Wave Lithotripsy: Radiological Evaluation

Baskin

Stoller

1992

British Journal of Urology

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“…Vascular injuries during SWL could be produced by the rapid intraluminal bubble expansion in capillaries or small blood vessels or by the microjets formed due to asymmetric bubble collapse (Pishchalnikov et al, 2003;Treglia & Moscoloni, 1999;Zhong et al, 2001). Acute renal hemorrhage and damage to the surrounding renal tubules have been widely reported in both animal and human studies, including severe and permanent renal damage or even death in extreme cases (Stoller, Litt, & Salazar, 1989;Toro & Kardos, 2008;Treglia & Moscoloni, 1999). It is therefore crucial to monitor the cavitation dynamics in SWL to both optimize the stone comminution efficiency and minimize the risk of tissue injury.…”

Section: Introductionmentioning

confidence: 99%

Tri-modality cavitation mapping in shock wave lithotripsy

Sankin

et al. 2021

The Journal of the Acoustical Society of America

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Shock wave lithotripsy (SWL) has been widely used for non-invasive treatment of kidney stones.Cavitation plays an important role in stone fragmentation, yet may also contribute to renal injury during SWL. It is therefore crucial to determine the spatiotemporal distributions of cavitation activities to maximize stone fragmentation while minimizing tissue injury. Traditional cavitation detection methods include high-speed optical imaging, active cavitation mapping (ACM), and passive cavitation mapping (PCM). While each of the three methods provides unique information about the dynamics of the bubbles, PCM has most practical applications in biological tissues. To image the dynamics of cavitation bubble collapse, we previously developed a sliding-window PCM (SW-PCM) method to identify each bubble collapse with high temporal and spatial resolution. To further validate and optimize the SW-PCM method, in this work, we have developed tri-modality cavitation imaging that includes 3D high-speed optical imaging, ACM, and PCM seamlessly integrated in a single system.Using the tri-modality system, we imaged and analyzed laser-induced single cavitation bubbles in both free and constricted space and shockwave-induced cavitation clusters. Collectively, our results have demonstrated the high reliability and spatial-temporal accuracy of the SW-PCM approach, which paves the way for the future in vivo applications on large animals and humans in SWL.

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Severe Hemorrhage after Extracorporeal Shock-Wave Lithotripsy

Cited by 16 publications

References 6 publications

Medical applications and bioeffects of extracorporeal shock waves

Medical applications and bioeffects of extracorporeal shock waves

Severe Haemorrhage after Extracorporeal Shock Wave Lithotripsy: Radiological Evaluation

Tri-modality cavitation mapping in shock wave lithotripsy

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