Optimal frequency in extracorporeal shock wave lithotripsy: Prospective randomized study

Yı́lmaz, Erdal; Batı̇slam, Ertan; Başar, M. Murad; Tuglu, Devrim; Mert, Cagatay; Başar, Halil

doi:10.1016/j.urology.2005.06.111

Cited by 96 publications

(76 citation statements)

References 15 publications

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“…Extensive testing, both in vitro [1][2][3][4][5] and in vivo, 6 has demonstrated that the efficiency of stone fragmentation decreases by increasing SW rate. This work is corroborated by numerous human studies, [7][8][9][10][11][12][13] in which it was observed that slow rates (60-90 SW/min) yield more successful outcomes than high rates (120 SW/min).…”

Section: Introductionsupporting

confidence: 74%

“…6 These studies have shown that low rates of SW application produce more effective stone fragmentation in comparison to high rates. Clinical reports support these findings, [7][8][9][10][11][12][13] demonstrating that more successful treatment outcomes are achieved using shock rates of 60-90 SW/min vs 120 SW/min. The phenomenon underlying this rate effect is related to cavitation-specifically, residual cavitation nuclei that can persist on the order of 1 second after the collapse of primary SW-induced bubbles.…”

Section: Discussionmentioning

confidence: 77%

See 1 more Smart Citation

Acoustic Bubble Removal to Enhance SWL Efficacy at High Shock Rate: An In Vitro Study

Duryea

Roberts

Cain

et al. 2014

Journal of Endourology

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Rate-dependent efficacy has been extensively documented in shock wave lithotripsy (SWL) stone comminution, with shock waves (SWs) delivered at a low rate producing more efficient fragmentation in comparison to those delivered at high rates. Cavitation is postulated to be the primary source underlying this rate phenomenon. Residual bubble nuclei that persist along the axis of SW propagation can drastically attenuate the waveform's negative phase, decreasing the energy which is ultimately delivered to the stone and compromising comminution. The effect is more pronounced at high rates, as residual nuclei have less time to passively dissolve between successive shocks. In this study, we investigate a means of actively removing such nuclei from the field using a low-amplitude acoustic pulse designed to stimulate their aggregation and subsequent coalescence. To test the efficacy of this bubble removal scheme, model kidney stones were treated in vitro using a research electrohydraulic lithotripter. SWL was applied at rates of 120, 60, or 30 SW/min with or without the incorporation of bubble removal pulses. Optical images displaying the extent of cavitation in the vicinity of the stone were also collected for each treatment. Results show that bubble removal pulses drastically enhance the efficacy of stone comminution at the higher rates tested (120 and 60 SW/min), while optical images show a corresponding reduction in bubble excitation along the SW axis when bubble removal pulses are incorporated. At the lower rate of 30 SW/min, no difference in stone comminution or bubble excitation was detected with the addition of bubble removal pulses, suggesting that remnant nuclei had sufficient time for more complete dissolution. These results corroborate previous work regarding the role of cavitation in rate-dependent SWL efficacy, and suggest that the effect can be mitigated via appropriate control of the cavitation environment surrounding the stone.

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Section: Introductionsupporting

confidence: 74%

Section: Discussionmentioning

confidence: 77%

Acoustic Bubble Removal to Enhance SWL Efficacy at High Shock Rate: An In Vitro Study

Duryea

Roberts

Cain

et al. 2014

Journal of Endourology

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“…[38][39][40][41][42][43] This may also reduce the degree of renal injury, which may be an issue for upper ureteric stones, but is likely less relevant for mid and distal ureteral stones. Slowing treatment rate does increase treatment times.…”

Section: Treatment Ratementioning

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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“…The best results are achieved with pelvic stones and calculi of the upper and mid poles that are smaller than 2 cm, with success rates varying from 71 to 91%. 22,35,37,38 As lithotripsy equipment has developed, machines have become less powerful and their use less painful, making anesthesia unnecessary and making it possible for patients to be treated with deep analgesia, or sedated but conscious. These changes mean that the rate of calculus fragmentation achieved by modern machines is inferior to that of the first generation equipment, which can no longer be purchased.…”

Section: Resultsmentioning

confidence: 99%

O que há de novo no diagnóstico e tratamento da litíase urinária?

Mazzucchi¹,

Srougi²

2009

Rev. Assoc. Med. Bras.

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Objective. To review developments in the diagnosis and treatment of urinary lithiasis. MethOds. A review of the most important articles on the subject published in Medline indexed periodicals between 1979 and 2009. Results. Stones occur with greater frequency among people with BMI > 30. Computerized tomography without contrast provides the correct diagnosis in up to 98% of cases. Alpha-adrenergic blockers increase elimination of ureteral calculi smaller than 8 mm by 29%. The proportion of patients free from calculi after ESWL varies from 35% to 91%, depending on size and location. In between 60% and 100% of cases, renal calculi larger than 2 cm are eliminated with PCNL. Calculi of the distal ureter are successfully treated in up to 94% of cases using semi-rigid ureteroscopy, compared to 74% using ESWL. For calculi of the upper ureter success rates are around 77% and 91% for ureteroscopy and 41% and 82% for ESWL. cOnclusiOn. The association between urinary lithiasis and Diabetes mellitus, is well-established. Computerized tomography without contrast is currently the gold standard for diagnosis of urinary lithiasis. In Brazil, ESWL is the method of choice for treating renal calculi smaller than 2 cm and with tomographic density < 1000 HU, except those of the lower pole, where the ideal limit for treatment is 1 cm. Percutaneous nephrolithotripsy is the best method of treating renal calculi larger than 2 cm and semi-rigid ureteroscopy is the best treatment for calculi of the distal ureter. Flexible ureteroscopy is an option for calculi of the upper ureter and renal calculi smaller than 1.5 cm that do not respond to ESWL or where PCNL is contraindicated.

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Optimal frequency in extracorporeal shock wave lithotripsy: Prospective randomized study

Cited by 96 publications

References 15 publications

Acoustic Bubble Removal to Enhance SWL Efficacy at High Shock Rate: An In Vitro Study

Acoustic Bubble Removal to Enhance SWL Efficacy at High Shock Rate: An In Vitro Study

CUA Guideline: Management of ureteral calculi

O que há de novo no diagnóstico e tratamento da litíase urinária?

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