Effect of Stone Motion on in Vitro Comminution Efficiency of Storz Modulith SLX

Cleveland, Robin O.; Anglade, Ronald; Babayan, Richard K.

doi:10.1089/end.2004.18.629

Cited by 68 publications

(36 citation statements)

References 16 publications

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“…The results confirm previous observations that translational motion negatively affects stone fragmentation in the absence of renal stone tracking systems (Orkisz et al, 1998;Chang et al, 2001), especially for high peak pressure, narrow focus lithotripters (Cleveland et al, 2004). Furthermore, the simulated motion histograms are utilized for the prediction of stone comminution efficiencies from both lenses through the heuristic model.…”

Section: Discussionsupporting

confidence: 84%

“…A comparison of 2000 shock stone comminution results for static (n ¼ 4 stones) and simulated motions (n ¼ 44 stones) is shown for both lenses in Table III. Notably, the various simulated respiratory motions produce a reduction in stone comminution efficiencies for both lenses, similar to the observation of a previous in vitro study (Cleveland et al, 2004). However, the influence of stone motion on the efficacy of the new lens is substantially less than on the original lens, resulting in a statistically higher stone comminution efficiency overall (p < 0.0001) for the new lens.…”

Section: Effect Of Respiratory Motion On Stone Comminutionsupporting

confidence: 85%

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A heuristic model of stone comminution in shock wave lithotripsy

Smith

Zhong

2013

The Journal of the Acoustical Society of America

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A heuristic model is presented to describe the overall progression of stone comminution in shock wave lithotripsy (SWL), accounting for the effects of shock wave dose and the average peak pressure, P þ(avg) , incident on the stone during the treatment. The model is developed through adaptation of the Weibull theory for brittle fracture, incorporating threshold values in dose and P þ(avg) that are required to initiate fragmentation. The model is validated against experimental data of stone comminution from two stone types (hard and soft BegoStone) obtained at various positions in lithotripter fields produced by two shock wave sources of different beam width and pulse profile both in water and in 1,3-butanediol (which suppresses cavitation). Subsequently, the model is used to assess the performance of a newly developed acoustic lens for electromagnetic lithotripters in comparison with its original counterpart both under static and simulated respiratory motion. The results have demonstrated the predictive value of this heuristic model in elucidating the physical basis for improved performance of the new lens. The model also provides a rationale for the selection of SWL treatment protocols to achieve effective stone comminution without elevating the risk of tissue injury.

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Section: Discussionsupporting

confidence: 84%

Section: Effect Of Respiratory Motion On Stone Comminutionsupporting

confidence: 85%

A heuristic model of stone comminution in shock wave lithotripsy

Smith

Zhong

2013

The Journal of the Acoustical Society of America

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“…Previous studies have shown that lithotripters with narrow FW and high peak pressure are less effective in stone comminution if significant respiratory motion (50) or spreading of residual fragments (11) occurs during SWL. In contrast, lithotripters with broad FW and low peak pressure are effective and safe for SWL (51)(52)(53).…”

Section: Discussionmentioning

confidence: 99%

Improving the lens design and performance of a contemporary electromagnetic shock wave lithotripter

Neisius

Smith

Sankin

et al. 2014

Proc. Natl. Acad. Sci. U.S.A.

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The efficiency of shock wave lithotripsy (SWL), a noninvasive firstline therapy for millions of nephrolithiasis patients, has not improved substantially in the past two decades, especially in regard to stone clearance. Here, we report a new acoustic lens design for a contemporary electromagnetic (EM) shock wave lithotripter, based on recently acquired knowledge of the key lithotripter field characteristics that correlate with efficient and safe SWL. The new lens design addresses concomitantly three fundamental drawbacks in EM lithotripters, namely, narrow focal width, nonidealized pulse profile, and significant misalignment in acoustic focus and cavitation activities with the target stone at high output settings. Key design features and performance of the new lens were evaluated using model calculations and experimental measurements against the original lens under comparable acoustic pulse energy (E + ) of 40 mJ. The −6-dB focal width of the new lens was enhanced from 7.4 to 11 mm at this energy level, and peak pressure (41 MPa) and maximum cavitation activity were both realigned to be within 5 mm of the lithotripter focus. Stone comminution produced by the new lens was either statistically improved or similar to that of the original lens under various in vitro test conditions and was significantly improved in vivo in a swine model (89% vs. 54%, P = 0.01), and tissue injury was minimal using a clinical treatment protocol. The general principle and associated techniques described in this work can be applied to design improvement of all EM lithotripters. electromagnetic lithotripter | lens modification | stone fragmentation

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“…Targeting should be confirmed at regular intervals throughout treatment. 28 Greater use of fluoroscopy time can lead to improved outcomes. …”

Section: Targetingmentioning

confidence: 99%

CUA Guideline: Management of ureteral calculi

Ordon

Andonian²,

Blew³

et al. 2015

CUAJ

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The focus of this guideline is the management of ureteral stones. Specifically, the topics covered include: conservative management, medical expulsive therapy, active intervention with either shockwave lithotripsy (SWL) or ureteroscopy (URS), factors affecting SWL treatment success, optimizing success, and special considerations (e.g., pregnancy, urinary diversion). By performing extensive literature reviews for each topic evaluated, we have generated an evidence-based consensus on the management of ureteral stones. The objective of this guideline is to help standardize the treatment of ureteral stones to optimize treatment outcomes.

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Effect of Stone Motion on in Vitro Comminution Efficiency of Storz Modulith SLX

Cited by 68 publications

References 16 publications

A heuristic model of stone comminution in shock wave lithotripsy

A heuristic model of stone comminution in shock wave lithotripsy

Improving the lens design and performance of a contemporary electromagnetic shock wave lithotripter

CUA Guideline: Management of ureteral calculi

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