Optimization of treatment strategy used during shockwave lithotripsy to maximize stone fragmentation efficiency.
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BACKGROUND AND PURPOSE: Previous studies have demonstrated that treatment strategy plays a critical role in ensuring maximum stone fragmentation during shockwave lithotripsy (SWL). We aimed to develop an optimal treatment strategy in SWL to produce maximum stone fragmentation. MATERIALS AND METHODS: Four treatment strategies were evaluated using an in-vitro experimental setup that mimics stone fragmentation in the renal pelvis. Spherical stone phantoms were exposed to 2100 shocks using the Siemens Modularis (electromagnetic) lithotripter. The treatment strategies included increasing output voltage with 100 shocks at 12.3 kV, 400 shocks at 14.8 kV, and 1600 shocks at 15.8 kV, and decreasing output voltage with 1600 shocks at 15.8 kV, 400 shocks at 14.8 kV, and 100 shocks at 12.3 kV. Both increasing and decreasing voltages models were run at a pulse repetition frequency (PRF) of 1 and 2 Hz. Fragmentation efficiency was determined using a sequential sieving method to isolate fragments less than 2 mm. A fiberoptic probe hydrophone was used to characterize the pressure waveforms at different output voltage and frequency settings. In addition, a high-speed camera was used to assess cavitation activity in the lithotripter field that was produced by different treatment strategies. RESULTS: The increasing output voltage strategy at 1 Hz PRF produced the best stone fragmentation efficiency. This result was significantly better than the decreasing voltage strategy at 1 Hz PFR (85.8% vs 80.8%, P=0.017) and over the same strategy at 2 Hz PRF (85.8% vs 79.59%, P=0.0078). CONCLUSIONS: A pretreatment dose of 100 low-voltage output shockwaves (SWs) at 60 SWs/min before increasing to a higher voltage output produces the best overall stone fragmentation in vitro. These findings could lead to increased fragmentation efficiency in vivo and higher success rates clinically.
Published Version (Please cite this version)10.1089/end.2010.0732
Publication InfoYong, Daniel Z; Lipkin, Michael E; Simmons, W Neal; Sankin, Georgy; Albala, David M; Zhong, Pei; & Preminger, Glenn M (2011). Optimization of treatment strategy used during shockwave lithotripsy to maximize stone fragmentation efficiency. J Endourol, 25(9). pp. 1507-1511. 10.1089/end.2010.0732. Retrieved from https://hdl.handle.net/10161/5090.
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Associate Professor of Surgery
James F. Glenn, M.D. Distinguished Professor of Urology
1. Minimally invasive management of urologic diseases 2. Minimally invasive management of renal and ureteral stones 3. Medical management of nephrolithiasis 4. Bioeffects of shock wave lithotripsy 5. Basic physics of shock wave lithotripsy 6. Intracorporeal lithotripsy for stone fragmentation 7. Minimally invasive management of urinary tract obstruction, including ureteropelvic junction obstruction and ureteral strictures 8. Enhanced imaging modalities f
Gendell Family Professor of the Practice
Professor in the Department of Mechanical Engineering and Materials Science
My research focuses on four broad and interconnected areas in the emerging field of therapeutic ultrasound, which is located at the interface of engineering, biology and clinical medicine. Current research interests in my group include: Ultrasound-targeted gene delivery and activation Synergistic combination of high-intensity focused ultrasound (HIFU) and immunotherapy for cancer treatment Innovations in shock wave lithotripsy (SWL) technology</l
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