Renal Trauma and the Risk of Long-Term Complications in Shock Wave Lithotripsy

Evan, Andrew P.; Willis, Lynn R.; Lingeman, James E.; McAteer, James A.

doi:10.1159/000044874

Cited by 184 publications

(132 citation statements)

References 25 publications

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“…This image is also representative of another important observation: Large blood vessels, bile ducts, or other soft tissue inhomogeneities located prefocally in the acoustic path did not interfere with the lesion formation. Similar effects of selective tissue damage caused by ultrasound-mediated therapies have been observed in extracorporeal shock wave lithotripsy (22) and, recently, in cavitation cloud histotripsy as well (23).…”

Section: Large Vessels and Biliary Structures Adjacent To The Lesion supporting

confidence: 62%

Ultrasound-guided tissue fractionation by high intensity focused ultrasound in an in vivo porcine liver model

Khokhlova

Wang

Simon

et al. 2014

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

103

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Significance High intensity focused ultrasound (HIFU) therapy is a promising, clinically adopted method of noninvasive tissue ablation used to treat both benign and malignant conditions. This work presents, to our knowledge, the first in vivo validation of a previously developed HIFU-based method that allows for noninvasive fractionation of targeted tissue into subcellular debris—boiling histotripsy—in a large animal model. While fractionating the targeted soft tissue, boiling histotripsy is shown to spare the adjacent connective tissue structures such as blood vessels. The process can be readily targeted and monitored by B-mode ultrasound. The resulting tissue debris are liquid, which provides a potential clinical benefit over thermal ablation in the treatment of tumors that exert uncomfortable pressure on surrounding tissues.

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Section: Large Vessels and Biliary Structures Adjacent To The Lesion supporting

confidence: 62%

Ultrasound-guided tissue fractionation by high intensity focused ultrasound in an in vivo porcine liver model

Khokhlova

Wang

Simon

et al. 2014

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

103

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“…However, study of stone breakage in vitro has shown that COM stones vary dramatically in their fragility to SW's, with some stones being very resistant, and others quite fragile [5,6], and this variability is consistent with clinical experience [4]. Lithotripter SW's can produce adverse effects [7], so it is important to consider ways to reduce dosage of SW's when possible. If the level of susceptibility of a given COM stone to SW lithotripsy could be established at diagnosis, SW dosage could be tailored to that case.…”

Section: Introductionmentioning

confidence: 78%

“…At that time it was already known that some stones could be SW-resistant, and it was thought that x-ray at diagnosis could be used to avoid subjecting the patient to an ineffective procedure. It is now known that lithotripter SW's can cause significant renal injury [7], and that SW trauma may be contributory to subsequent development of other disorders [24,25]. Thus, the application of unnecessary SW's should be considered a risk to the patient, and it would be of value to determine in advance the dose of SW's required for a given stone.…”

Section: Discussionmentioning

confidence: 99%

CT visible internal stone structure, but not Hounsfield unit value, of calcium oxalate monohydrate (COM) calculi predicts lithotripsy fragility in vitro

et al. 2007

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COM stones are often resistant to breakage using shock wave (SW) lithotripsy. It would be useful to identify by computed tomography (CT) those COM stones that are susceptible to SW's. For this study, 47 COM stones (4-10 mm in diameter) were scanned with micro CT to verify composition and also for assessment of heterogeneity (presence of pronounced lobulation, voids, or apatite inclusions) by blinded observers. Stones were then placed in water and scanned using 64-channel helical CT. As with micro CT, heterogeneity was assessed by blinded observers, using high-bone viewing windows. Then stones were broken in a lithotripter (Dornier Doli-50) over 2 mm mesh, and SW's counted. Results showed that classification of stones using micro CT was highly repeatable among observers (κ=0.81), and also predictive of stone fragility. Stones graded as homogeneous required 1874±821 SW/g for comminution, while stones with visible structure required half as many SW/g, 912±678. Similarly, when stones were graded by appearance on helical CT, classification was repeatable (κ=0.40), and homogeneous stones required more SW's for comminution than did heterogeneous stones (1702±993 SW/g, compared to 907±773). Stone fragility normalized to stone size did not correlate with Hounsfield units (p=0.85). In conclusion, COM stones of homogeneous structure require almost twice as many SW's to comminute than stones of similar mineral composition that exhibit internal structural features that are visible by CT. This suggests that stone fragility in patients could be predicted using pre-treatment CT imaging. The findings also show that Hounsfield unit values of COM stones did not correlate with stone fragility. Thus, it is stone

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“…3,4 The significance of the tissue damage is still under debate, as are the mechanisms which produce it. 5,6 In addition there is no agreement as to the mechanism by which the shock waves comminute calculi. 7 The groups involved in this manuscript are part of a multi-institutional research program to address issues in SWL.…”

Section: Introductionmentioning

confidence: 99%

Design and characterization of a research electrohydraulic lithotripter patterned after the Dornier HM3

Cleveland

Bailey

Fineberg

et al. 2000

Review of Scientific Instruments

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An electrohydraulic lithotripter has been designed that mimics the behavior of the Dornier HM3 extracorporeal shock wave lithotripter. The key mechanical and electrical properties of a clinical HM3 were measured and a design implemented to replicate these parameters. Three research lithotripters have been constructed on this design and are being used in a multi-institutional, multidisciplinary research program to determine the physical mechanisms of stone fragmentation and tissue damage in shock wave lithotripsy. The acoustic fields of the three research lithotripters and of two clinical Dornier HM3 lithotripters were measured with a PVDF membrane hydrophone. The peak positive pressure, peak negative pressure, pulse duration, and shock rise time of the focal waveforms were compared. Peak positive pressures varied from 25 MPa at a voltage setting of 12 kV to 40 MPa at 24 kV. The magnitude of the peak negative pressure varied from Ϫ7 to Ϫ12 MPa over the same voltage range. The spatial variations of the peak positive pressure and peak negative pressure were also compared. The focal region, as defined by the full width half maximum of the peak positive pressure, was 60 mm long in the axial direction and 10 mm wide in the lateral direction. The performance of the research lithotripters was found to be consistent at clinical firing rates ͑up to 3 Hz͒. The results indicated that pressure fields in the research lithotripters are equivalent to those generated by a clinical HM3 lithotripter.

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Renal Trauma and the Risk of Long-Term Complications in Shock Wave Lithotripsy

Cited by 184 publications

References 25 publications

Ultrasound-guided tissue fractionation by high intensity focused ultrasound in an in vivo porcine liver model

Ultrasound-guided tissue fractionation by high intensity focused ultrasound in an in vivo porcine liver model

CT visible internal stone structure, but not Hounsfield unit value, of calcium oxalate monohydrate (COM) calculi predicts lithotripsy fragility in vitro

Design and characterization of a research electrohydraulic lithotripter patterned after the Dornier HM3

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