Abstract
Purpose: Focused ultrasound has the potential to expel small stones or residual stone fragments from the kidney, or move obstructing stones to a nonobstructing location. We evaluated the efficacy and safety of ultrasonic propulsion in a live porcine model. Materials and Methods: Calcium oxalate monohydrate kidney stones and laboratory model stones (2 to 8 mm) were ureteroscopically implanted in the renal pelvicalyceal system of 12 kidneys in a total of 8 domestic swine. Transcutaneous ultrasonic propulsion was performed using an HDI C5-2 imaging transducer (ATL/Philips, Bothell, Washington) and the Verasonics® diagnostic ultrasound platform. Successful stone relocation was defined as stone movement from the calyx to the renal pelvis, ureteropelvic junction or proximal ureter. Efficacy and procedure time was determined. Three blinded experts evaluated histological injury to the kidney in the control, sham treatment and treatment arms. Results: All 26 stones were observed to move during treatment and 17 (65%) were relocated successfully to the renal pelvis (3), ureteropelvic junction (2) or ureter (12). Average ± SD successful procedure time was 14 ± 8 minutes and a mean of 23 ± 16 ultrasound bursts, each about 1 second in duration, were required. There was no evidence of gross or histological injury to the renal parenchyma in kidneys exposed to 20 bursts (1 second in duration at 33-second intervals) at the same output (2,400 W/cm2) used to push stones. Conclusions: Noninvasive transcutaneous ultrasonic propulsion is a safe, effective and time efficient means to relocate calyceal stones to the renal pelvis, ureteropelvic junction or ureter. This technology holds promise as a useful adjunct to surgical management for renal calculi.
| Original language | English |
|---|---|
| Pages (from-to) | 1090-1095 |
| Number of pages | 6 |
| Journal | Journal of Urology |
| Volume | 190 |
| Issue number | 3 |
| DOIs | |
| State | Published - Sep 2013 |
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Keywords
- kidney
- kidney calculi
- lithotripsy
- ultrasonography
- ureteroscopy
ASJC Scopus subject areas
- Urology
Cite this
Focused ultrasound to expel calculi from the kidney : Safety and efficacy of a clinical prototype device. / Harper, Jonathan D.; Sorensen, Mathew D.; Cunitz, Bryan W.; Wang, Yak Nam; Simon, Julianna C.; Starr, Frank; Paun, Marla; Dunmire, Barbrina; Liggitt, H. Denny; Evan, Andrew; McAteer, James A.; Hsi, Ryan S.; Bailey, Michael R.
In: Journal of Urology, Vol. 190, No. 3, 09.2013, p. 1090-1095.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Focused ultrasound to expel calculi from the kidney
T2 - Safety and efficacy of a clinical prototype device
AU - Harper, Jonathan D.
AU - Sorensen, Mathew D.
AU - Cunitz, Bryan W.
AU - Wang, Yak Nam
AU - Simon, Julianna C.
AU - Starr, Frank
AU - Paun, Marla
AU - Dunmire, Barbrina
AU - Liggitt, H. Denny
AU - Evan, Andrew
AU - McAteer, James A.
AU - Hsi, Ryan S.
AU - Bailey, Michael R.
PY - 2013/9
Y1 - 2013/9
N2 - Purpose: Focused ultrasound has the potential to expel small stones or residual stone fragments from the kidney, or move obstructing stones to a nonobstructing location. We evaluated the efficacy and safety of ultrasonic propulsion in a live porcine model. Materials and Methods: Calcium oxalate monohydrate kidney stones and laboratory model stones (2 to 8 mm) were ureteroscopically implanted in the renal pelvicalyceal system of 12 kidneys in a total of 8 domestic swine. Transcutaneous ultrasonic propulsion was performed using an HDI C5-2 imaging transducer (ATL/Philips, Bothell, Washington) and the Verasonics® diagnostic ultrasound platform. Successful stone relocation was defined as stone movement from the calyx to the renal pelvis, ureteropelvic junction or proximal ureter. Efficacy and procedure time was determined. Three blinded experts evaluated histological injury to the kidney in the control, sham treatment and treatment arms. Results: All 26 stones were observed to move during treatment and 17 (65%) were relocated successfully to the renal pelvis (3), ureteropelvic junction (2) or ureter (12). Average ± SD successful procedure time was 14 ± 8 minutes and a mean of 23 ± 16 ultrasound bursts, each about 1 second in duration, were required. There was no evidence of gross or histological injury to the renal parenchyma in kidneys exposed to 20 bursts (1 second in duration at 33-second intervals) at the same output (2,400 W/cm2) used to push stones. Conclusions: Noninvasive transcutaneous ultrasonic propulsion is a safe, effective and time efficient means to relocate calyceal stones to the renal pelvis, ureteropelvic junction or ureter. This technology holds promise as a useful adjunct to surgical management for renal calculi.
AB - Purpose: Focused ultrasound has the potential to expel small stones or residual stone fragments from the kidney, or move obstructing stones to a nonobstructing location. We evaluated the efficacy and safety of ultrasonic propulsion in a live porcine model. Materials and Methods: Calcium oxalate monohydrate kidney stones and laboratory model stones (2 to 8 mm) were ureteroscopically implanted in the renal pelvicalyceal system of 12 kidneys in a total of 8 domestic swine. Transcutaneous ultrasonic propulsion was performed using an HDI C5-2 imaging transducer (ATL/Philips, Bothell, Washington) and the Verasonics® diagnostic ultrasound platform. Successful stone relocation was defined as stone movement from the calyx to the renal pelvis, ureteropelvic junction or proximal ureter. Efficacy and procedure time was determined. Three blinded experts evaluated histological injury to the kidney in the control, sham treatment and treatment arms. Results: All 26 stones were observed to move during treatment and 17 (65%) were relocated successfully to the renal pelvis (3), ureteropelvic junction (2) or ureter (12). Average ± SD successful procedure time was 14 ± 8 minutes and a mean of 23 ± 16 ultrasound bursts, each about 1 second in duration, were required. There was no evidence of gross or histological injury to the renal parenchyma in kidneys exposed to 20 bursts (1 second in duration at 33-second intervals) at the same output (2,400 W/cm2) used to push stones. Conclusions: Noninvasive transcutaneous ultrasonic propulsion is a safe, effective and time efficient means to relocate calyceal stones to the renal pelvis, ureteropelvic junction or ureter. This technology holds promise as a useful adjunct to surgical management for renal calculi.
KW - kidney
KW - kidney calculi
KW - lithotripsy
KW - ultrasonography
KW - ureteroscopy
UR - http://www.scopus.com/inward/record.url?scp=84881479543&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84881479543&partnerID=8YFLogxK
U2 - 10.1016/j.juro.2013.03.120
DO - 10.1016/j.juro.2013.03.120
M3 - Article
C2 - 23583535
AN - SCOPUS:84881479543
VL - 190
SP - 1090
EP - 1095
JO - Journal of Urology
JF - Journal of Urology
SN - 0022-5347
IS - 3
ER -