The Use of Chemical Treatments for Improved Comminution of Artificial Stones

Heimbach, D.; Kourambas, John; Zhong, Pei; Jacobs, Joachim; Hesse, Albrecht; Mueller, Stefanie J.; Delvecchio, Fernado; Cocks, F. H.; Preminger, Glenn M.

doi:10.1097/01.ju.0000118962.31123.fd

Cited by 15 publications

(5 citation statements)

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“…First, although the widespread use of shockwave lithotripsy as the Wrst-choice treatment is accepted for a variety of urological clinics [3,8,12], we believe that joint shock wave action and chemolytic irrigation [4,6,7] should provide much more rapid removal of COM and especially, COM + COD stones from the human urinary tract. Second, for some patients, installation of nephrostomic catheters or stents into a kidney is required [6,12,14].…”

Section: Discussionmentioning

confidence: 99%

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Chemolysis of calcium oxalate stones: study in vitro and possible clinical application

et al. 2011

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The flow cell modeling clinical conditions have been used to study the interaction between dilute chemolytic solutions and large calcium oxalate renal stones. The stone treatment with 5% disodium ethylenediaminetetraacetate aqueous solutions or citrate buffer are found not to provide notable disruption of the samples studied. The significant improvement is reached with the mixed compositions containing both natural and synthetic chelating reagents:citrate and ethylenediaminetetraacetate ions as well as an antibiotic. Description of the chemolytic irrigation, numerical results and their possible clinical application are the main topic of the present research.

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Section: Discussionmentioning

confidence: 99%

“…Abnormal biomineralization in the urinary tract aZicts patients worldwide [1][2][3][4][5][6][7][8]. From 3 to 14% of the population in Europe and the United States suVer from renal stones formation, most of which are composed of calcium oxalate hydrates [1][2][3].…”

Section: Introductionmentioning

confidence: 99%

Chemolysis of calcium oxalate stones: study in vitro and possible clinical application

et al. 2011

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“…Such information could be used to obtain more precise estimates of the material properties, for use in a model that would estimate the number of cycles to failure. One can target chemical alteration of the stone with a goal toward further weakening it to enhance the action of shock-wave lithotripsy, 36 in a way that could be understood with a theory of the kind presented here. If, for example, the particulate phase is weakened, particulates will carry a smaller fraction of the load, hence weakening the stone.…”

Section: Discussionmentioning

confidence: 99%

Fatigue of kidney stones with heterogeneous microstructure subjected to shock‐wave lithotripsy

Zohdi

Szeri

2005

J Biomed Mater Res

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In this article a theoretical framework is developed for the mechanics of kidney stones with an isotropic, random microstructure--such as those comprised of cystine or struvite. The approach is based on a micromechanical description of kidney stones comprised of crystals in a binding matrix. Stress concentration functions are developed to determine load sharing of the particle phase and the binding matrix phase. Measurements have shown the inclusions to be considerably harder than the binder; consequently, loading of a stone leads to higher stresses in the inclusions than in the binder. As an illustration of the theory, the fatigue of kidney stones subject to shock-wave lithotripsy is considered. Stress concentration functions are used to construct fatigue-life estimates for each phase, as a function of the volume fraction and of the mechanical properties of the constituents, as well as the loading from SWL. The failure of the binding matrix, or of the particulate phase, is determined explicitly in a model for the accumulation of distributed damage. The theory can be used to assess the importance of microscale heterogeneity on the comminution of renal calculi, and to estimate the number of cycles to failure in terms of measurable material properties.

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“…The stone burden is assessed at regular intervals and the chemolysis continues for 24–48 h after the last radiographic stone is visible. Research suggests that concurrent use with shock wave lithotripsy may provide a useful adjunctive measure for improving the efficacy of stone comminution [24].…”

Section: Dissolution Therapymentioning

confidence: 99%

Urolithiasis – medical therapies

Spernat

Kourambas

2011

BJU International

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What ' s known on the subject? and What does the study add? The medical management of urolithiasis is complex. There are many papers written on the topic and many confl icting views. It can be diffi cult for physicians to interpret these data and have a stepwise approach to the medical treatment of stones.Thus this study provides a framework and a review of the literature to allow physicians to practise evidence-based medicine when medically managing urolithiasis. SUMMARYThis review paper provides a summary of medical therapies available for urolithiasis. The summary includes general medical advice, prophylactic medications, dissolution therapy and medical expulsion therapy. The paper is designed to provide a management strategy for all physicians who treat urolithiasis, from general practitioners, to emergency physicians, to urologists. OBJECTIVE• To provide an up to date review of the literature in relation to the medical management of stone disease. This will encompass prophylaxis, dissolution therapy and medical expulsion therapy. PATIENTS AND METHODS• First-time stone formers do not regularly have a full urine and electrolyte evaluation due to the low incidence of a reversible metabolic cause.• However, stone disease is common and over a lifetime urolithiasis can affect up to 10 -15% of the population. RESULTS• Medical management of stone disease encompasses preventative measures, medical dissolution and medical expulsion therapy. CONCLUSIONS• Recurrent stone formers should have dietary optimization to decrease the risk of further stones.• Furthermore, the correct use of prophylactic and therapeutic medications can decrease the morbidity associated with ureteric calculi.

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The Use of Chemical Treatments for Improved Comminution of Artificial Stones

Abstract: These results indicate that appropriate chemical treatments may provide a useful adjunctive modality for improving the efficacy of stone comminution during shock wave lithotripsy.

Cited by 15 publications

References 15 publications

Chemolysis of calcium oxalate stones: study in vitro and possible clinical application

Chemolysis of calcium oxalate stones: study in vitro and possible clinical application

Fatigue of kidney stones with heterogeneous microstructure subjected to shock‐wave lithotripsy

Urolithiasis – medical therapies

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