Shock Wave Lithotripsy Damage in Human Cadaver Kidneys*

Brewer, Stephen L.; Atala, Anthony; Ackerman, Douglas; Steinbock, Greg S.

doi:10.1089/end.1988.2.333

Cited by 18 publications

(9 citation statements)

References 11 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: 97%

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: 97%

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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“…With both lithotripters a wide range for induction of a grade 1 lesion (Modulith 234-411, Lithostar Plus 220-740) and also a Correspondence to." J. Rassweiler, M.D., Urologische Klinik, Klinikum Mannheim der Universit~t Heidelberg, Theodor-Kutzer-Ufer, W-6800 Mannheim 1, Germany significant overlapping with grade 0 and 2 lesions was seen at low energy settings (levels [2][3][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][8][9].…”

Section: Discussionmentioning

confidence: 99%

“…This corresponds to the findings of Delius et al [12] and Muschter et al [35], who did not observe any qualitative difference in the lesion after 1500 SW and 3000/5000 SW using the Dornier H M 2 / H M 3 ( 1 7 -2 5 kV). Moreover, on h u m a n cadaver kidneys an arterial lesion was seen only after 10000 shocks [4]. O n the other hand, this explains why Chaussy [6] did not observe any lesions in the canine kidney after application o f 500 shocks at a low energy setting (12 kV/Dornier H M l).…”

Section: Influence Of Shockwave Numbermentioning

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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“…After many years of therapeutic application of ESWL its traumatic side effect on renal parenchyma is apparent. Histological examinations revealed damages to nephrons and also small and medium arteries around Original a focus of ultrasound wave [5,6]. Diagnostic imaging performed shortly after ESWL revealed hematoma or acute intrarenal edema [7,8].…”

Section: Introductionmentioning

confidence: 99%

Usefulness of clearance parametric images in detection of regional renal parenchyma dysfunction

et al. 2017

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Shock Wave Lithotripsy Damage in Human Cadaver Kidneys*

Cited by 18 publications

References 11 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

Usefulness of clearance parametric images in detection of regional renal parenchyma dysfunction

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