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- Title
Combined Burst Wave Lithotripsy and Ultrasonic Propulsion for Improved Urinary Stone Fragmentation.
- Authors
Zwaschka, Theresa A.; Ahn, Justin S.; Cunitz, Bryan W.; Bailey, Michael R.; Dunmire, Barbrina; Sorensen, Mathew D.; Harper, Jonathan D.; Maxwell, Adam D.
- Abstract
<bold><italic>Purpose:</italic></bold> Burst wave lithotripsy (BWL) is a new technology in development to fragment urinary stones. Ultrasonic propulsion (UP) is a separate technology under investigation for displacing stones. We measure the effect of propulsion pulses on stone fragmentation from BWL. <bold><italic>Materials and Methods:</italic></bold> Two artificial stone models (crystalline calcite, BegoStone plaster) and human calcium oxalate monohydrate (COM) stones measuring 5 to 8 mm were subjected to ultrasound exposures in a polyvinyl chloride tissue phantom within a water bath. Stones were exposed to BWL with and without propulsion pulses interleaved for set time intervals depending on stone type. Fragmentation was measured as a fraction of the initial stone mass fragmented to pieces smaller than 2 mm. <bold><italic>Results:</italic></bold> BegoStone model comminution improved from 6% to 35% (<italic>p</italic> < 0.001) between BWL and BWL with interleaved propulsion in a 10-minute exposure. Propulsion alone did not fragment stones, whereas addition of propulsion after BWL slightly improved BegoStone model comminution from 6% to 11% (<italic>p</italic> < 0.001). BegoStone model fragmentation increased with rate of propulsion pulses. Calcite stone fragmentation improved from 24% to 39% in 5 minutes (<italic>p</italic> = 0.047) and COM stones improved from 17% to 36% (<italic>p</italic> = 0.01) with interleaved propulsion. <bold><italic>Conclusions:</italic></bold> BWL with UP improved stone fragmentation compared with BWL alone <italic>in vitro</italic>. The improvement was greatest when propulsion pulses are interleaved with BWL treatment and when propulsion pulses are applied at a higher rate. Thus, UP may be a useful adjunct to enhance fragmentation in lithotripsy <italic>in vivo</italic>.
- Subjects
LASER lithotripsy; TREATMENT of calculi; URINARY calculi; DIAGNOSTIC ultrasonic imaging; CALCIUM oxalate
- Publication
Journal of Endourology, 2018, Vol 32, Issue 4, p344
- ISSN
0892-7790
- Publication type
Article
- DOI
10.1089/end.2017.0675