Relationship between the Frequency of Piezoelectric Shock Waves
and the Quality of Renal Stone Fragmentation
In vitro Study and Clinical Implications

Vallancien, G; Muñoz, Rosario Palacios; Borghi, M; Veillon, B; Jm, Brisset; Daudon, Michel

doi:10.1159/000471527

Cited by 48 publications

(28 citation statements)

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“…Consistent with earlier studies, [1][2][3][4][5][6] we observed the efficiency of SWL stone comminution to decrease as the rate of SW application was increased (Fig. 4).…”

Section: Duryea Et Alsupporting

confidence: 91%

“…The rate-dependent efficacy of SWL stone comminution has been extensively documented in previous work, both in vitro [1][2][3][4][5] and in vivo. 6 These studies have shown that low rates of SW application produce more effective stone fragmentation in comparison to high rates.…”

Section: Discussionmentioning

confidence: 93%

“…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: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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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“…Consistent with earlier studies, [1][2][3][4][5][6] we observed the efficiency of SWL stone comminution to decrease as the rate of SW application was increased (Fig. 4).…”

Section: Duryea Et Alsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 93%

Section: Introductionmentioning

confidence: 99%

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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show abstract

“…There are a number of variables that can affect the per shock efficiency of SWL, including lithotripter design, energy settings, SW electrode consumption level, and the rate at which SWs are administered [9] . The impact of the rate on SWL efficacy has been assessed by many authors using in vitro models.…”

Section: Discussionmentioning

confidence: 99%

“…Human kidney stones have also been used during in vitro studies of SW rates. Vallancien et al [9] placed single human kidney stones into plastic bags and used an LT01 piezoelectric lithotripter (EDAP Technomed, Norcross, Ga., USA). These authors administered a series of 3,000 SWs at variable frequencies of 1.25, 2.5, 5 and 10 SW/s.…”

Section: Discussionmentioning

confidence: 99%

Clinical Predictors of Stone Fragmentation Using Slow-Rate Shock Wave Lithotripsy

Chou

Liu

et al. 2007

Urol Int

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Aim: To determine efficacy and clinical predictors of stone fragmentation when using slow-rate shock wave lithotripsy (SWL). Patients and Methods: In total, 116 patients with radiopaque urinary tract stones were randomized into two groups: 57 patients were treated with SWL at 90 shocks/min, and 59 patients were treated with SWL at 120 shocks/min. The efficacy of SWL was evaluated within 1 month after treatment. Patient characteristics, features of stones, and SWL conditions were reviewed. Success rates relating to individual parameters were assessed by using chi-square and Student t tests. All factors were further entered into multivariate logistic regression analysis. Results: There were no statistically significant differences between the two groups with regard to age, sex, site and size of the stones, renal function, and total number of shock waves. In univariate analysis, the success rate was significantly related to shock wave frequency (p = 0.023), length and width of the stones (p < 0.001), total number of shock waves (p = 0.047), and age (p = 0.049). In multivariate analysis, however, only shock wave rate and stone length remained statistically significant (p = 0.021 and p = 0.046, respectively). The overall success rate was significantly higher in the group treated with 90 shocks/min (p = 0.02). However, this higher success rate was statistically significant only in patients with a stone length ≧10 mm (50.0 vs. 18.5%, p = 0.019). Conclusion: SWL at 90 shocks/min yielded better outcomes than SWL at 120 shocks/min, particularly in patients with stone lengths ≧10 mm.

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Shock‐wave Lithotripsy of Renal Calculi

Eisner

Nimmagadda

2018

Smith's Textbook of Endourology

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Relationship between the Frequency of Piezoelectric Shock Waves and the Quality of Renal Stone Fragmentation In vitro Study and Clinical Implications

Cited by 48 publications

References 0 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

Clinical Predictors of Stone Fragmentation Using Slow-Rate Shock Wave Lithotripsy

Shock‐wave Lithotripsy of Renal Calculi

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