Kidney damage and renal functional changes are minimized by waveform control that suppresses cavitation in shock wave lithotripsy

Andrew Evan, Lynn R. Willis, James A. McAteer, Michael R. Bailey, Bret A. Connors, Youzhi Shao, James E. Lingeman, James Williams, Naomi S. Fineberg, Lawrence A. Crum

Research output: Contribution to journalArticle

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Abstract

Purpose: In studies to understand better the role of cavitation in kidney trauma associated with shock wave lithotripsy we assessed structural and functional markers of kidney injury when animals were exposed to modified shock waves (pressure release reflector shock pulses) that suppress cavitation. Experiments were also performed in isolated red blood cells, an in vitro test system that is a sensitive indicator of cavitation mediated shock wave damage. Materials and Methods: We treated 6-week-old anesthetized pigs with shock wave lithotripsy using an unmodified HM3 lithotriptor (Dornier Medical Systems, Marietta, Georgia) fitted with its standard brass ellipsoidal reflector (rigid reflector) or with a pressure release reflector insert. The pressure release reflector transposes the compressive and tensile phases of the lithotriptor shock pulse without otherwise altering the positive pressure or negative pressure components of the shock wave. Thus, with the pressure release reflector the amplitude of the incident shock wave is not changed but cavitation in the acoustic field is stifled. The lower pole of the right kidney was treated with 2,000 shocks at 24 kV. Glomerular filtration rate, renal plasma flow and tubular extraction of para-aminohippurate were measured in the 2 kidneys 1 hour before and 1 and 4 hours after shock wave lithotripsy, followed by the removal of each kidney for morphological analysis. In vitro studies assessed shock wave induced lysis to red blood cells in response to rigid or pressure release reflector shock pulses. Results: Sham shock wave lithotripsy had no significant effect on kidney morphology, renal hemodynamics or para-aminohippurate extraction. Shock waves administered with the standard rigid reflector induced a characteristic morphological lesion and functional changes that included bilateral reduction in renal plasma flow, and unilateral reduction in the glomerular filtration rate and para-aminohippurate extraction. When the pressure release reflector was used, the morphological lesion was limited to hemorrhage of vasa recta vessels near the tips of renal papillae and the only change in kidney function was a decrease in the glomerular filtration rate at the 1 and 4-hour periods in shock wave treated kidneys. Red blood cell lysis in vitro was significantly lower with the pressure release reflector than with the rigid reflector. Conclusions: These data demonstrate that shock wave lithotripsy damage to the kidney is reduced when cavitation is suppressed. This finding supports the idea that cavitation has a prominent role in shock wave lithotripsy trauma.

Original languageEnglish
Pages (from-to)1556-1562
Number of pages7
JournalJournal of Urology
Volume168
Issue number4 I
StatePublished - Oct 2002

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Lithotripsy
Kidney
Pressure
Shock
Glomerular Filtration Rate
Renal Plasma Flow
Erythrocytes
Wounds and Injuries
Rectum
Acoustics
Swine
Hemodynamics
Hemorrhage

Keywords

  • Kidney
  • Kidney calculi
  • Lithotripsy
  • Swine
  • Wounds and injuries

ASJC Scopus subject areas

  • Urology

Cite this

Evan, A., Willis, L. R., McAteer, J. A., Bailey, M. R., Connors, B. A., Shao, Y., ... Crum, L. A. (2002). Kidney damage and renal functional changes are minimized by waveform control that suppresses cavitation in shock wave lithotripsy. Journal of Urology, 168(4 I), 1556-1562.

Kidney damage and renal functional changes are minimized by waveform control that suppresses cavitation in shock wave lithotripsy. / Evan, Andrew; Willis, Lynn R.; McAteer, James A.; Bailey, Michael R.; Connors, Bret A.; Shao, Youzhi; Lingeman, James E.; Williams, James; Fineberg, Naomi S.; Crum, Lawrence A.

In: Journal of Urology, Vol. 168, No. 4 I, 10.2002, p. 1556-1562.

Research output: Contribution to journalArticle

Evan, A, Willis, LR, McAteer, JA, Bailey, MR, Connors, BA, Shao, Y, Lingeman, JE, Williams, J, Fineberg, NS & Crum, LA 2002, 'Kidney damage and renal functional changes are minimized by waveform control that suppresses cavitation in shock wave lithotripsy', Journal of Urology, vol. 168, no. 4 I, pp. 1556-1562.
Evan, Andrew ; Willis, Lynn R. ; McAteer, James A. ; Bailey, Michael R. ; Connors, Bret A. ; Shao, Youzhi ; Lingeman, James E. ; Williams, James ; Fineberg, Naomi S. ; Crum, Lawrence A. / Kidney damage and renal functional changes are minimized by waveform control that suppresses cavitation in shock wave lithotripsy. In: Journal of Urology. 2002 ; Vol. 168, No. 4 I. pp. 1556-1562.
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AU - Willis, Lynn R.

AU - McAteer, James A.

AU - Bailey, Michael R.

AU - Connors, Bret A.

AU - Shao, Youzhi

AU - Lingeman, James E.

AU - Williams, James

AU - Fineberg, Naomi S.

AU - Crum, Lawrence A.

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N2 - Purpose: In studies to understand better the role of cavitation in kidney trauma associated with shock wave lithotripsy we assessed structural and functional markers of kidney injury when animals were exposed to modified shock waves (pressure release reflector shock pulses) that suppress cavitation. Experiments were also performed in isolated red blood cells, an in vitro test system that is a sensitive indicator of cavitation mediated shock wave damage. Materials and Methods: We treated 6-week-old anesthetized pigs with shock wave lithotripsy using an unmodified HM3 lithotriptor (Dornier Medical Systems, Marietta, Georgia) fitted with its standard brass ellipsoidal reflector (rigid reflector) or with a pressure release reflector insert. The pressure release reflector transposes the compressive and tensile phases of the lithotriptor shock pulse without otherwise altering the positive pressure or negative pressure components of the shock wave. Thus, with the pressure release reflector the amplitude of the incident shock wave is not changed but cavitation in the acoustic field is stifled. The lower pole of the right kidney was treated with 2,000 shocks at 24 kV. Glomerular filtration rate, renal plasma flow and tubular extraction of para-aminohippurate were measured in the 2 kidneys 1 hour before and 1 and 4 hours after shock wave lithotripsy, followed by the removal of each kidney for morphological analysis. In vitro studies assessed shock wave induced lysis to red blood cells in response to rigid or pressure release reflector shock pulses. Results: Sham shock wave lithotripsy had no significant effect on kidney morphology, renal hemodynamics or para-aminohippurate extraction. Shock waves administered with the standard rigid reflector induced a characteristic morphological lesion and functional changes that included bilateral reduction in renal plasma flow, and unilateral reduction in the glomerular filtration rate and para-aminohippurate extraction. When the pressure release reflector was used, the morphological lesion was limited to hemorrhage of vasa recta vessels near the tips of renal papillae and the only change in kidney function was a decrease in the glomerular filtration rate at the 1 and 4-hour periods in shock wave treated kidneys. Red blood cell lysis in vitro was significantly lower with the pressure release reflector than with the rigid reflector. Conclusions: These data demonstrate that shock wave lithotripsy damage to the kidney is reduced when cavitation is suppressed. This finding supports the idea that cavitation has a prominent role in shock wave lithotripsy trauma.

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