Second-Generation Lithotripters: A Comparative Study

Rassweiler, Jens; Westhauser, A.; Bub, P.; Eisenberger, F.

doi:10.1089/end.1988.2.193

Cited by 52 publications

(19 citation statements)

References 13 publications

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“…Cor responding to our experience [8] with extracorporeal shock waves lithotripsy (i.e. EDAP LT01, Wolf Piezolith 2200), we found a remarkable improvement in disinte grative efficacy by using lower frequencies (1)(2)(3)(4)(5)(6)(7)(8)(9)(10).…”

Section: Stone Modelsupporting

confidence: 51%

“…The stone model we used proved to be effective in a previous study comparing different second-generation lithotripters [8]. It represents a standardized piece of plaster (3.5 X 3.5 X 1.5 cm) on which 100 shock waves were applied using different frequencies The experiments were performed utilizing either a fixed laser fiber or a fiber which was moved along concentric circles.…”

Section: Stone Modelmentioning

confidence: 99%

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Technical Considerations Using a Pulsed Neodym-YAG Laser for Endoscopic Shock Wave Lithotripsy

Rassweiler¹,

Irion²,

Strauss³

et al. 1989

Eur Urol

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Section: Stone Modelsupporting

confidence: 51%

Section: Stone Modelmentioning

confidence: 99%

Technical Considerations Using a Pulsed Neodym-YAG Laser for Endoscopic Shock Wave Lithotripsy

Rassweiler¹,

Irion²,

Strauss³

et al. 1989

Eur Urol

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“…Principally, two types of pain are experienced during shock-wave lithotripsy: superficial discomfort at the surface of the skin and visceral pain in the kidney. Rassweiler and co-workers [66] reported data on pain sensation obtained during a self-trial study using a five-level dolor scale. Schneider and Ell [75] quantified the sensation of pain by randomizing volunteers, measuring their EEGs during shock-wave treatment, and interviewing these volunteers after the treatment according to the McGill pain questionnaire.…”

Section: Side Effectsmentioning

confidence: 99%

Biological effects of shock waves

1990

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Summary.Extracorporeal shock wave lithotripsy has become established worldwide as the method of choice for the treatment of nephrolithiasis and ureterolithiasis over the last 10 years. Although initial studies showed no damaging effects of the shock waves on organs and tissues, numerous recent reports have presented evidence for severe acute effects and chronic complications after shock wave treatment. The pathophysiological effects on kidneys and the histopathological effects on organs or tissues in man and animal, and also the effects on ceils in culture and tumors are sumarized. Suspended and immobilized cell cultures were used to characterize and quantify the efficacy of shock wave. Extended applications of shock waves and possible modifications to shock wave generators are discussed.A reproducible generation of shock waves in fluids was first reported by Eisenmenger [31,32], who described an electromagnetic arrangement using a flat solenoid and a metal membrane. About 20 years later, underwater sparkgap-induced shock waves were used for kidney stone disintegration [17], a procedure that has become clinical routine [30]. In the meantime, the third generation of lithotripters has been developed (Siemens Lithostar Plus, Dornier Compact, Storz Modulith). Most of them are equipped with electromagnetic shock-wave emitters (EMSE), but piezo-electric shock-wave sources (Piezolith 2500, Diasonics) with similar properties for stone fragmentation are also in clinical use. However, all commercially available shock-wave generators (spark gap, electromagnetic, piezo-electric) produce side effects that accompany stone disintegration in patients. Furthermore, their biological effects are described as injuries to organs or tissues in vivo that have been exposed to the focal area of shock waves and as damage to cells in culture that have been treated with shock waves. * Dedicated to Prof. Dr. Wolfgang Eisenmenger on the occasion of his 60th birthday Side effectsIn kidney-or gallstone treatment with shock waves, side effects are equivocally classified and certainly depend not only on the number and energy of the applied shock waves but also on the disposition of the patients. Petechial bleeding of the skin that can be observed macroscopically has been found in about 10% of patients [29]. Varying degrees of subcapsular fluid collection and hemorrhage have been detected using different methods [4,37,71].Most of the damage typically caused by shock-wave treatments is routinely observed and is not considered to represent severe pathological change, but the occurrence of perirenal hematoma has increased significantly in patients with pre-existing or poorly controllable hypertension [47]. Physiological tests have revealed only minor, transient reductions of renal plasma flow in the treated kidney [45,82] and no clinically relevant changes in blood chemistry [17]. Furthermore, cytoplasmic enzymes have been reported to be only transiently released into the blood and urine of shock-wave-treated patients [46]. Kishimoto et al. [46] ha...

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“…Sonolith 3000, Edap LT01, Domier HM4), some manufacturers have modified their machines to the requirements of third-generation lithotriptors: ( 1 ) Domier MPL 9000-X fitted with an integrated C arm for fluoro scopic stone localization [6,10]; (2) Wolf Piezolith 2500 utilizing an improved energy source providing higher shock-wave pressure and 'in-line' fluoroscopy [7]; (3) Siemens Lithostar plus provides and additional shockwave source with a larger aperture and higher pressure together with coaxial ultrasound for stone localization [11,12]; (3) Domier MFL 5000-U has added a lateral ultra sound probe to the fluoroscopic location system [1], In contrast to these lithotriptors, the Storz Modulith SL 20 represents the first machine developed with the characteristics of a third-generation lithotriptor, thus ful filling all postulated criteria.…”

Section: Clinical Experiencementioning

confidence: 99%

“…The 5 failure cases included 2 stones in a caliceal diverticulum. Moreover, 12 patients with biliary calculi ( 11 gallstones and 1 bile duct stone) were successfully treated; 1 of these cases required a second treatment session.However, despite great technical progress, each machine still has its specific shortcomings [3,8,9,10].Therefore, new lithotriptors (third-generation ma chines) should aim at overcoming these drawbacks and possess the following characteristics: (1) extension of indications to urinary and biliary calculi; (2) the same or even better efficacy than the Domier HM3; (3) treat ment without or with minimal analgesia; (4) multi functional use of the lithotriptor (i.e. endoscopy), and (5) lower costs and maintenance than the Domier HM3.…”

mentioning

confidence: 99%