Evaluation of synchronous twin pulse technique for shock wave lithotripsy: Determination of optimal parameters for in vitro stone fragmentation

Khaled Z. Sheir, Nasim Zabihi, David Lee, Joel M. Teichman, Jamil Rehman, Chandru Sundaram, Dirk Heimbach, Albrecht Hesse, Fernado Delvecchio, Pei Zhong, Glenn M. Preminger, Ralph V. Clayman

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Purpose: The Twinheads extracorporeal shock wave lithotriptor (THSWL) is composed of 2 identical shock wave generators and reflectors. One reflector is under the table and the other is over the table with a variable angle between the axes of the 2 reflectors. The 2 reflectors share a common second focal point, making it possible to deliver an almost synchronous twin pulse to the targeted stone. We studied the optimal parameters for in vitro stone fragmentation. Materials and Methods: Two types of 1 cm artificial stones were used, namely Bon(n)-stones of 3 compositions (75% calcium oxalate monohydrate [COM] plus 25% uric acid, struvite and cystine) and plaster of Paris. The parameters tested were shock wave number (100, 500 and 1,000), shock wave power (8, 11 and 14 kV) and angle between the reflector axes (67, 90 and 105 degrees). After the optimal parameters were determined we studied the disintegrative efficacy of THSWL for 3 types of human urinary calculi, including COM, calcium hydrogen phosphate (brushite) and cystine. Each stone received 1,000 twin shock waves at 14 kV with an angle of 90 degrees between the reflectors. All experiments were done using a rate of 60 twin shock waves per minute. Following lithotripsy stone fragments were processed and sized. The ratio of the weight of fragments greater than 2 mm-to-total weight of all fragments was calculated. Results: Optimal stone fragmentation results for THSWL were obtained with the maximum number of shock waves (1,000) and full power (14 kV). There was no significant statistical difference in fragment size or the ratio of fragments greater than 2 mm with the use of different angles except for cystine and plaster of Paris calculi, for which the right angle was most effective. At application of the optimal parameters to human stones THSWL produced small fragment size for COM and cystine stones, while brushite stones were not fragmented to the same extent. Conclusions: The efficacy of synchronous twin pulse technology improves as the number of shock waves and power increase. A 90-degree angle between the shock wave reflectors is advantageous for certain stones (that is cystine and plaster of Paris) but it is not a factor for other stone compositions. THSWL has satisfactory disintegrative efficacy for human stones, especially COM and cysteine calculi.

Original languageEnglish (US)
Pages (from-to)2190-2194
Number of pages5
JournalJournal of Urology
Volume170
Issue number6 I
DOIs
StatePublished - Dec 2003
Externally publishedYes

Fingerprint

Cystine
Lithotripsy
Calcium Oxalate
Calcium Sulfate
Calculi
Weights and Measures
Urinary Calculi
Uric Acid
Cysteine
In Vitro Techniques
Technology

Keywords

  • Biomedical
  • High-energy shock waves
  • Kidney
  • Kidney calculi
  • Lithotripsy
  • Technology assessment

ASJC Scopus subject areas

  • Urology

Cite this

Evaluation of synchronous twin pulse technique for shock wave lithotripsy : Determination of optimal parameters for in vitro stone fragmentation. / Sheir, Khaled Z.; Zabihi, Nasim; Lee, David; Teichman, Joel M.; Rehman, Jamil; Sundaram, Chandru; Heimbach, Dirk; Hesse, Albrecht; Delvecchio, Fernado; Zhong, Pei; Preminger, Glenn M.; Clayman, Ralph V.

In: Journal of Urology, Vol. 170, No. 6 I, 12.2003, p. 2190-2194.

Research output: Contribution to journalArticle

Sheir, KZ, Zabihi, N, Lee, D, Teichman, JM, Rehman, J, Sundaram, C, Heimbach, D, Hesse, A, Delvecchio, F, Zhong, P, Preminger, GM & Clayman, RV 2003, 'Evaluation of synchronous twin pulse technique for shock wave lithotripsy: Determination of optimal parameters for in vitro stone fragmentation', Journal of Urology, vol. 170, no. 6 I, pp. 2190-2194. https://doi.org/10.1097/01.ju.0000094188.69698.f8
Sheir, Khaled Z. ; Zabihi, Nasim ; Lee, David ; Teichman, Joel M. ; Rehman, Jamil ; Sundaram, Chandru ; Heimbach, Dirk ; Hesse, Albrecht ; Delvecchio, Fernado ; Zhong, Pei ; Preminger, Glenn M. ; Clayman, Ralph V. / Evaluation of synchronous twin pulse technique for shock wave lithotripsy : Determination of optimal parameters for in vitro stone fragmentation. In: Journal of Urology. 2003 ; Vol. 170, No. 6 I. pp. 2190-2194.
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abstract = "Purpose: The Twinheads extracorporeal shock wave lithotriptor (THSWL) is composed of 2 identical shock wave generators and reflectors. One reflector is under the table and the other is over the table with a variable angle between the axes of the 2 reflectors. The 2 reflectors share a common second focal point, making it possible to deliver an almost synchronous twin pulse to the targeted stone. We studied the optimal parameters for in vitro stone fragmentation. Materials and Methods: Two types of 1 cm artificial stones were used, namely Bon(n)-stones of 3 compositions (75{\%} calcium oxalate monohydrate [COM] plus 25{\%} uric acid, struvite and cystine) and plaster of Paris. The parameters tested were shock wave number (100, 500 and 1,000), shock wave power (8, 11 and 14 kV) and angle between the reflector axes (67, 90 and 105 degrees). After the optimal parameters were determined we studied the disintegrative efficacy of THSWL for 3 types of human urinary calculi, including COM, calcium hydrogen phosphate (brushite) and cystine. Each stone received 1,000 twin shock waves at 14 kV with an angle of 90 degrees between the reflectors. All experiments were done using a rate of 60 twin shock waves per minute. Following lithotripsy stone fragments were processed and sized. The ratio of the weight of fragments greater than 2 mm-to-total weight of all fragments was calculated. Results: Optimal stone fragmentation results for THSWL were obtained with the maximum number of shock waves (1,000) and full power (14 kV). There was no significant statistical difference in fragment size or the ratio of fragments greater than 2 mm with the use of different angles except for cystine and plaster of Paris calculi, for which the right angle was most effective. At application of the optimal parameters to human stones THSWL produced small fragment size for COM and cystine stones, while brushite stones were not fragmented to the same extent. Conclusions: The efficacy of synchronous twin pulse technology improves as the number of shock waves and power increase. A 90-degree angle between the shock wave reflectors is advantageous for certain stones (that is cystine and plaster of Paris) but it is not a factor for other stone compositions. THSWL has satisfactory disintegrative efficacy for human stones, especially COM and cysteine calculi.",
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author = "Sheir, {Khaled Z.} and Nasim Zabihi and David Lee and Teichman, {Joel M.} and Jamil Rehman and Chandru Sundaram and Dirk Heimbach and Albrecht Hesse and Fernado Delvecchio and Pei Zhong and Preminger, {Glenn M.} and Clayman, {Ralph V.}",
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T1 - Evaluation of synchronous twin pulse technique for shock wave lithotripsy

T2 - Determination of optimal parameters for in vitro stone fragmentation

AU - Sheir, Khaled Z.

AU - Zabihi, Nasim

AU - Lee, David

AU - Teichman, Joel M.

AU - Rehman, Jamil

AU - Sundaram, Chandru

AU - Heimbach, Dirk

AU - Hesse, Albrecht

AU - Delvecchio, Fernado

AU - Zhong, Pei

AU - Preminger, Glenn M.

AU - Clayman, Ralph V.

PY - 2003/12

Y1 - 2003/12

N2 - Purpose: The Twinheads extracorporeal shock wave lithotriptor (THSWL) is composed of 2 identical shock wave generators and reflectors. One reflector is under the table and the other is over the table with a variable angle between the axes of the 2 reflectors. The 2 reflectors share a common second focal point, making it possible to deliver an almost synchronous twin pulse to the targeted stone. We studied the optimal parameters for in vitro stone fragmentation. Materials and Methods: Two types of 1 cm artificial stones were used, namely Bon(n)-stones of 3 compositions (75% calcium oxalate monohydrate [COM] plus 25% uric acid, struvite and cystine) and plaster of Paris. The parameters tested were shock wave number (100, 500 and 1,000), shock wave power (8, 11 and 14 kV) and angle between the reflector axes (67, 90 and 105 degrees). After the optimal parameters were determined we studied the disintegrative efficacy of THSWL for 3 types of human urinary calculi, including COM, calcium hydrogen phosphate (brushite) and cystine. Each stone received 1,000 twin shock waves at 14 kV with an angle of 90 degrees between the reflectors. All experiments were done using a rate of 60 twin shock waves per minute. Following lithotripsy stone fragments were processed and sized. The ratio of the weight of fragments greater than 2 mm-to-total weight of all fragments was calculated. Results: Optimal stone fragmentation results for THSWL were obtained with the maximum number of shock waves (1,000) and full power (14 kV). There was no significant statistical difference in fragment size or the ratio of fragments greater than 2 mm with the use of different angles except for cystine and plaster of Paris calculi, for which the right angle was most effective. At application of the optimal parameters to human stones THSWL produced small fragment size for COM and cystine stones, while brushite stones were not fragmented to the same extent. Conclusions: The efficacy of synchronous twin pulse technology improves as the number of shock waves and power increase. A 90-degree angle between the shock wave reflectors is advantageous for certain stones (that is cystine and plaster of Paris) but it is not a factor for other stone compositions. THSWL has satisfactory disintegrative efficacy for human stones, especially COM and cysteine calculi.

AB - Purpose: The Twinheads extracorporeal shock wave lithotriptor (THSWL) is composed of 2 identical shock wave generators and reflectors. One reflector is under the table and the other is over the table with a variable angle between the axes of the 2 reflectors. The 2 reflectors share a common second focal point, making it possible to deliver an almost synchronous twin pulse to the targeted stone. We studied the optimal parameters for in vitro stone fragmentation. Materials and Methods: Two types of 1 cm artificial stones were used, namely Bon(n)-stones of 3 compositions (75% calcium oxalate monohydrate [COM] plus 25% uric acid, struvite and cystine) and plaster of Paris. The parameters tested were shock wave number (100, 500 and 1,000), shock wave power (8, 11 and 14 kV) and angle between the reflector axes (67, 90 and 105 degrees). After the optimal parameters were determined we studied the disintegrative efficacy of THSWL for 3 types of human urinary calculi, including COM, calcium hydrogen phosphate (brushite) and cystine. Each stone received 1,000 twin shock waves at 14 kV with an angle of 90 degrees between the reflectors. All experiments were done using a rate of 60 twin shock waves per minute. Following lithotripsy stone fragments were processed and sized. The ratio of the weight of fragments greater than 2 mm-to-total weight of all fragments was calculated. Results: Optimal stone fragmentation results for THSWL were obtained with the maximum number of shock waves (1,000) and full power (14 kV). There was no significant statistical difference in fragment size or the ratio of fragments greater than 2 mm with the use of different angles except for cystine and plaster of Paris calculi, for which the right angle was most effective. At application of the optimal parameters to human stones THSWL produced small fragment size for COM and cystine stones, while brushite stones were not fragmented to the same extent. Conclusions: The efficacy of synchronous twin pulse technology improves as the number of shock waves and power increase. A 90-degree angle between the shock wave reflectors is advantageous for certain stones (that is cystine and plaster of Paris) but it is not a factor for other stone compositions. THSWL has satisfactory disintegrative efficacy for human stones, especially COM and cysteine calculi.

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KW - High-energy shock waves

KW - Kidney

KW - Kidney calculi

KW - Lithotripsy

KW - Technology assessment

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