Ultrasonic propulsion of kidney stones

May, Philip; Bailey, Michael R.; Harper, Jonathan D.

doi:10.1097/mou.0000000000000276

Cited by 22 publications

(10 citation statements)

References 35 publications

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“…1–8 This technique might be used clinically to facilitate passage by expelling small stones from the kidney, to relieve an obstruction in the ureter by repositioning the stone into the bladder or back into the renal pelvis, or to facilitate access and stone clearance by repositioning a stone at the time of surgery. Ultrasonic propulsion has been successfully demonstrated in a human clinical trial to move stones of various sizes and compositions.…”

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confidence: 99%

Effect of Stone Size and Composition on Ultrasonic Propulsion Ex Vivo

Janssen

Brand

Bailey

et al. 2018

Urology

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OBJECTIVE To evaluate in more detail the effectiveness of a new designed more efficient ultrasonic propulsion for large stones and specific stone compositions in a tissue phantom model. In the first clinical trial of noninvasive ultrasonic propulsion, urinary stones of unknown compositions and sizes up to 10 mm were successfully repositioned. MATERIALS AND METHODS The study included 8- to 12-mm stones of 4 different primary compositions (calcium oxalate monohydrate, ammonium acid urate, calcium phosphate, and struvite) and a renal calyx phantom consisting of a 12 mm × 30 mm well in a 10-cm block of tissue-mimicking material. Primary outcome was the number of times a stone was expelled over 10 attempts, with ultrasonic propulsion burst duration varying from 0.5 seconds to 5 seconds. RESULTS Overall success rate at expelling stones was 95%. All calcium oxalate monohydrate and ammonium acid urate stones were expelled 100% of the time. The largest stone (12 mm) became lodged within the 12-mm phantom calyx 25% of the time regardless of the burst duration. With the 0.5-second burst, there was insufficient energy to expel the heaviest stone (0.88 g), but there was sufficient energy at the longer burst durations. CONCLUSION With a single burst, ultrasonic propulsion successfully moved most stones at least 3 cm and, regardless of size or composition, expelled them from the calyx. Ultrasonic propulsion is limited to the stones smaller than the calyceal space, and for each burst duration, related to maximum stone mass.

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confidence: 99%

Effect of Stone Size and Composition on Ultrasonic Propulsion Ex Vivo

Janssen

Brand

Bailey

et al. 2018

Urology

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“…Future applications include repositioning stones prior to treatment, expediting the expulsion of residual fragments following ureteroscopy or SWL, and moving obstructing ureteropelvic junction (UPJ) stones into the kidney (to alleviate acute renal colic). The technology is currently being enhanced, and future directions include fusion of the technology with burst wave lithotripsy and stone – specific ultrasound imaging algorithms [57]. …”

Section: Recent Technical Innovationsmentioning

confidence: 99%

Recent advances in lithotripsy technology and treatment strategies: A systematic review update

Elmansy

Lingeman

2016

International Journal of Surgery

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Introduction Shock wave lithotripsy (SWL) is a well – established treatment option for urolithiasis. The technology of SWL has undergone significant changes in an attempt to better optimize the results while reducing failure rates. There are some important limitations that restrict the use of SWL. In this review, we aim to place these advantages and limitations in perspective, assess the current role of SWL, and discuss recent advances in lithotripsy technology and treatment strategies. Methods A comprehensive review was conducted to identify studies reporting outcomes on ESWL. We searched for literature (PubMed, Embase, Medline) that focused on the physics of shock waves, theories of stone disintegration, and studies on optimising shock wave application. Relevant articles in English published since 1980 were selected for inclusion. Results Efficacy has been shown to vary between lithotripters. To maximize stone fragmentation and reduce failure rates, many factors can be optimized. Factors to consider in proper patient selection include skin – to – stone distance and stone size. Careful attention to the rate of shock wave administration, proper coupling of the treatment head to the patient have important influences on the success of lithotripsy. Conclusion Proper selection of patients who are expected to respond well to SWL, as well as attention to the technical aspects of the procedure are the keys to SWL success. Studies aiming to determine the mechanisms of shock wave action in stone breakage have begun to suggest new treatment strategies to improve success rates and safety.

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“…There is an increasing interest in using arrays to generate more complex beam shapes and corresponding acoustic radiation force patterns for noncontact manipulation of particles [1]–[3]. One emerging application for this effect is noninvasive repositioning of urinary stones to facilitate stone clearance [4]–[6]. Vortex beams are characterized by null pressure in the center and a toroidal-like acoustic beam shape [7]–[9].…”

Section: Introductionmentioning

confidence: 99%

Field Characterization and Compensation of Vibrational Nonuniformity for a 256-Element Focused Ultrasound Phased Array

Ghanem

Maxwell

Kreider

et al. 2018

IEEE Trans. Ultrason., Ferroelect., Freq. Contr.

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Multielement focused ultrasound phased arrays have been used in therapeutic applications to treat large tissue volumes by electronic steering of the focus, to target multiple simultaneous foci, and to correct aberration caused by inhomogeneous tissue pathways. There is an increasing interest in using arrays to generate more complex beam shapes and corresponding acoustic radiation force patterns for manipulation of particles such as kidney stones. Toward this end, experimental and computational tools are needed to enable accurate delivery of desired transducer vibrations and corresponding ultrasound fields. The purpose of this paper was to characterize the vibrations of a 256-element array at 1.5 MHz, implement strategies to compensate for variability, and test the ability to generate specified vortex beams that are relevant to particle manipulation. The characterization of the array output was performed in water using both element-by-element measurements at the focus of the array and holography measurements for which all the elements were excited simultaneously. Both methods were used to quantify each element's output so that the power of each element could be equalized. Vortex beams generated using both compensation strategies were measured and compared to the Rayleigh integral simulations of fields generated by an idealized array based on the manufacturer's specifications. Although both approaches improved beam axisymmetry, compensation based on holography measurements had half the error relative to the simulation results in comparison to the element-by-element method.

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Ultrasonic propulsion of kidney stones

Cited by 22 publications

References 35 publications

Effect of Stone Size and Composition on Ultrasonic Propulsion Ex Vivo

Effect of Stone Size and Composition on Ultrasonic Propulsion Ex Vivo

Recent advances in lithotripsy technology and treatment strategies: A systematic review update

Field Characterization and Compensation of Vibrational Nonuniformity for a 256-Element Focused Ultrasound Phased Array

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