Fracture mechanics model of stone comminution in ESWL and implications for tissue damage

Lokhandwalla, Murtuza; Sturtevant, B.

doi:10.1088/0031-9155/45/7/316

Cited by 130 publications

(72 citation statements)

References 27 publications

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“…Many proposed mechanisms, such as spallation (Lubock, 1989), geometric superfocusing (Gracewski et al, 1993;Xi and Zhong, 2001), circumferential squeezing (Eisenmenger, 2001), and shear-induced failure (Xi and Zhong, 2001;Cleveland and Sapozhnikov, 2005;Sapozhnikov et al, 2007) were demonstrated during the fragmentation process in the early stage of SWL, when the stones are of sufficient size to favor the development of large stress concentrations. Other proposed mechanisms, such as dynamic fatigue (Lokhandwalla and Sturtevant, 2000) and cavitation (Coleman et al, 1987;Sass et al, 1991;Philipp and Lauterborn, 1998), describe processes that influence stone fragmentation throughout the entire course of SWL. Despite previous efforts, a disconnection still exists between the proposed mechanisms and the lithotripter shock wave (LSW) parameters that drive the stone fracture processes in SWL (Cleveland and McAteer, 2007;Sapozhnikov et al, 2007).…”

Section: Introductionmentioning

confidence: 99%

“…Therefore, the overall process of stone fragmentation in SWL is best described by the concept of dynamic fatigue (Lokhandwalla and Sturtevant, 2000). Briefly, under transient loading produced by LSW-generated stress waves and/or cavitation bubble collapse, fracture is facilitated by the opening of pre-existing microcracks (or flaws) and their a) Author to whom correspondence should be addressed.…”

Section: Introductionmentioning

confidence: 99%

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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: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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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“…Breakage tends to be gradual and stones fail by a process of fatigue due to repetitive stress 8,9. Shock waves create microcracks that progressively lengthen and expand until failure occurs.…”

Section: How Shock Waves Break Stones and Damage Tissuementioning

confidence: 99%

The Acute and Long-Term Adverse Effects of Shock Wave Lithotripsy

McAteer

Evan

2008

Seminars in Nephrology

152

105

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Shock wave lithotripsy (SWL) has proven to be a highly effective treatment for the removal of kidney stones. Shock waves (SW's) can be used to break most stone types, and because lithotripsy is the only non-invasive treatment for urinary stones SWL is particularly attractive. On the downside SWL can cause vascular trauma to the kidney and surrounding organs. This acute SW damage can be severe, can lead to scarring with a permanent loss of functional renal volume, and has been linked to potentially serious long-term adverse effects. A recent retrospective study linking lithotripsy to the development of diabetes mellitus has further focused attention on the possibility that SWL may lead to life-altering chronic effects 1 . Thus, it appears that what was once considered to be an entirely safe means to eliminate renal stones can elicit potentially severe unintended consequences. The purpose of this review is to put these findings in perspective. The goal is to explain the factors that influence the severity of SWL injury, update current understanding of the long-term consequences of SW damage, describe the physical mechanisms thought to cause SWL injury, and introduce treatment protocols to improve stone breakage and reduce tissue damage. Keywordslithotripsy; shock waves; urinary stones; kidney; injury; vascular trauma The Advantages and Limitations of SWLShock wave lithotripsy employs high energy acoustic pulses (shock waves) generated outside the body to break stones within the kidney and ureter. As such SWL is the only non-invasive method available to remove stones. In the early years following its introduction SWL was considered an option for the treatment of virtually any stone type in any anatomical location. Urologists soon learned, however, that the urinary tract has a limited ability to clear stone fragments and that ureteral obstruction could occur if the mass of stone debris was too high. As such SWL is now used to treat otherwise uncomplicated solitary stones, or a combined stone burden of less than 2 cm (on KUB), located in the upper urinary tract (renal pelvis or proximal ureter) 2 . Not all mineral types respond well to SW's. Some calcium oxalate monohydrate stones, brushite stones and a sub-type of cystine can be highly SW-resistant 3. A noteworthy drawback of SWL is that in many cases stone fragments left behind can serve as foci for the development of new stones 4. As such, stone free rates are lower and stone Please address correspondence to: James A. McAteer, Ph.D., Professor, Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, mcateer@anatomy.iupui.edu, (FAX) 317-278-2040. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process ...

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“…12,13 Although mechanical stress generated by the incident SW causes the initial disintegration of the stone, cavitation is a necessary component for efficient fragmentation, and particularly for producing fine passable fragments (<2 mm). 13 The effect of cavitation on the fragmentation process is thought to be primarily through erosion on the stone surface, but it may also help in the formation of crack lines through which damage is spread from the surface into the bulk of the stone.…”

Section: Introductionmentioning

confidence: 99%

Enhanced High-Rate Shockwave Lithotripsy Stone Comminution in an In Vivo Porcine Model Using Acoustic Bubble Coalescence

Tamaddoni

Roberts

Duryea³

et al. 2016

Journal of Endourology

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Cavitation plays a significant role in the efficacy of stone comminution during shockwave lithotripsy (SWL). Although cavitation on the surface of urinary stones helps to improve fragmentation, cavitation bubbles along the propagation path may shield or block subsequent shockwaves (SWs) and potentially induce collateral tissue damage. Previous in vitro work has shown that applying low-amplitude acoustic waves after each SW can force bubbles to consolidate and enhance SWL efficacy. In this study, the feasibility of applying acoustic bubble coalescence (ABC) in vivo was tested. Model stones were percutaneously implanted and treated with 2500 lithotripsy SWs at 120 SW/minute with or without ABC. Comparing the results of stone comminution, a significant improvement was observed in the stone fragmentation process when ABC was used. Without ABC, only 25% of the mass of the stone was fragmented to particles <2 mm in size. With ABC, 75% of the mass was fragmented to particles <2 mm in size. These results suggest that ABC can reduce the shielding effect of residual bubble nuclei, resulting in a more efficient SWL treatment.

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Fracture mechanics model of stone comminution in ESWL and implications for tissue damage

Cited by 130 publications

References 27 publications

A heuristic model of stone comminution in shock wave lithotripsy

A heuristic model of stone comminution in shock wave lithotripsy

The Acute and Long-Term Adverse Effects of Shock Wave Lithotripsy

Enhanced High-Rate Shockwave Lithotripsy Stone Comminution in an In Vivo Porcine Model Using Acoustic Bubble Coalescence

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