Show simple item record Albala, DM Lipkin, ME Preminger, GM Sankin, Georgy Simmons, WN Yong, DZ Zhong, P
dc.coverage.spatial United States 2012-01-20T17:34:37Z 2011-09
dc.description.abstract 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.
dc.language eng
dc.language.iso en_US
dc.relation.ispartof J Endourol
dc.relation.isversionof 10.1089/end.2010.0732
dc.subject Humans
dc.subject Kidney Calculi
dc.subject Lithotripsy
dc.subject Phantoms, Imaging
dc.subject Treatment Outcome
dc.title Optimization of treatment strategy used during shockwave lithotripsy to maximize stone fragmentation efficiency.
dc.type Journal article
duke.description.issue 9
duke.description.volume 25
pubs.begin-page 1507
pubs.end-page 1511
pubs.issue 9
pubs.organisational-group Biomedical Engineering
pubs.organisational-group Clinical Science Departments
pubs.organisational-group Duke
pubs.organisational-group Mechanical Engineering and Materials Science
pubs.organisational-group Pratt School of Engineering
pubs.organisational-group School of Medicine
pubs.organisational-group Surgery
pubs.organisational-group Surgery, Urology
pubs.publication-status Published
pubs.volume 25
dc.identifier.eissn 1557-900X

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