Renal injury during shock wave lithotripsy is significantly reduced by slowing the rate of shock wave delivery

Andrew Evan, James A. McAteer, Bret A. Connors, Philip M. Blomgren, James E. Lingeman

Research output: Contribution to journalArticle

71 Citations (Scopus)

Abstract

OBJECTIVE: To assess the tissue protection afforded by simply reducing the rate of shock wave (SW) delivery, compared with studies in the pig in which SW lithotripsy (SWL)-induced vascular damage was significantly reduced by initiating treatment using low-amplitude SWs. MATERIALS AND METHODS: Juvenile pigs (6-7 weeks old) were treated with an unmodified lithotripter (HM3, Dornier Medical Systems, Kennesaw, GA) at either 120 or 30 SW/min. Treatment was to one kidney per pig, with SWs (2000, 24 kV) directed to a lower-pole calyx. After treatment, parenchymal haemorrhage was determined morphometrically and expressed as percentage of functional renal volume (%FRV). RESULTS: Kidneys treated at 120 SW/min had focal to extensive subcapsular haematomas. Parenchymal lesions were found only at the lower pole, but included regions within renal papillae and the cortex. Occasionally, damage extended across the full thickness of the kidney. The lesion in the pigs treated at 120 SW/min occupied a mean (sd) of 4.6 (1.7) %FRV. Kidneys of pigs treated at 30 SW/min showed no surface bleeding. Parenchymal haemorrhage was limited to papillae within the focal volume, and measured 0.08 (0.02) %FRV, a significant (P < 0.005) reduction in injury. CONCLUSIONS: Slowing the rate of delivery to 30 SW/min has a dramatic protective effect on the integrity of the kidney vasculature. This finding in our established pig model suggests a potential strategy to improve the safety of lithotripsy. As it was shown that a reduced SW rate also improves the efficiency of stone fragmentation, a slow rate appears to be a means to improve both the safety and efficacy of SWL.

Original languageEnglish
Pages (from-to)624-627
Number of pages4
JournalBJU International
Volume100
Issue number3
DOIs
StatePublished - Sep 2007

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Lithotripsy
Swine
Kidney
Wounds and Injuries
Hemorrhage
Safety
Hematoma
Blood Vessels
Therapeutics

Keywords

  • Adverse effects
  • Animal models
  • Kidney
  • Shock wave lithotripsy

ASJC Scopus subject areas

  • Urology

Cite this

Renal injury during shock wave lithotripsy is significantly reduced by slowing the rate of shock wave delivery. / Evan, Andrew; McAteer, James A.; Connors, Bret A.; Blomgren, Philip M.; Lingeman, James E.

In: BJU International, Vol. 100, No. 3, 09.2007, p. 624-627.

Research output: Contribution to journalArticle

Evan, Andrew ; McAteer, James A. ; Connors, Bret A. ; Blomgren, Philip M. ; Lingeman, James E. / Renal injury during shock wave lithotripsy is significantly reduced by slowing the rate of shock wave delivery. In: BJU International. 2007 ; Vol. 100, No. 3. pp. 624-627.
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abstract = "OBJECTIVE: To assess the tissue protection afforded by simply reducing the rate of shock wave (SW) delivery, compared with studies in the pig in which SW lithotripsy (SWL)-induced vascular damage was significantly reduced by initiating treatment using low-amplitude SWs. MATERIALS AND METHODS: Juvenile pigs (6-7 weeks old) were treated with an unmodified lithotripter (HM3, Dornier Medical Systems, Kennesaw, GA) at either 120 or 30 SW/min. Treatment was to one kidney per pig, with SWs (2000, 24 kV) directed to a lower-pole calyx. After treatment, parenchymal haemorrhage was determined morphometrically and expressed as percentage of functional renal volume ({\%}FRV). RESULTS: Kidneys treated at 120 SW/min had focal to extensive subcapsular haematomas. Parenchymal lesions were found only at the lower pole, but included regions within renal papillae and the cortex. Occasionally, damage extended across the full thickness of the kidney. The lesion in the pigs treated at 120 SW/min occupied a mean (sd) of 4.6 (1.7) {\%}FRV. Kidneys of pigs treated at 30 SW/min showed no surface bleeding. Parenchymal haemorrhage was limited to papillae within the focal volume, and measured 0.08 (0.02) {\%}FRV, a significant (P < 0.005) reduction in injury. CONCLUSIONS: Slowing the rate of delivery to 30 SW/min has a dramatic protective effect on the integrity of the kidney vasculature. This finding in our established pig model suggests a potential strategy to improve the safety of lithotripsy. As it was shown that a reduced SW rate also improves the efficiency of stone fragmentation, a slow rate appears to be a means to improve both the safety and efficacy of SWL.",
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AU - McAteer, James A.

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AU - Blomgren, Philip M.

AU - Lingeman, James E.

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N2 - OBJECTIVE: To assess the tissue protection afforded by simply reducing the rate of shock wave (SW) delivery, compared with studies in the pig in which SW lithotripsy (SWL)-induced vascular damage was significantly reduced by initiating treatment using low-amplitude SWs. MATERIALS AND METHODS: Juvenile pigs (6-7 weeks old) were treated with an unmodified lithotripter (HM3, Dornier Medical Systems, Kennesaw, GA) at either 120 or 30 SW/min. Treatment was to one kidney per pig, with SWs (2000, 24 kV) directed to a lower-pole calyx. After treatment, parenchymal haemorrhage was determined morphometrically and expressed as percentage of functional renal volume (%FRV). RESULTS: Kidneys treated at 120 SW/min had focal to extensive subcapsular haematomas. Parenchymal lesions were found only at the lower pole, but included regions within renal papillae and the cortex. Occasionally, damage extended across the full thickness of the kidney. The lesion in the pigs treated at 120 SW/min occupied a mean (sd) of 4.6 (1.7) %FRV. Kidneys of pigs treated at 30 SW/min showed no surface bleeding. Parenchymal haemorrhage was limited to papillae within the focal volume, and measured 0.08 (0.02) %FRV, a significant (P < 0.005) reduction in injury. CONCLUSIONS: Slowing the rate of delivery to 30 SW/min has a dramatic protective effect on the integrity of the kidney vasculature. This finding in our established pig model suggests a potential strategy to improve the safety of lithotripsy. As it was shown that a reduced SW rate also improves the efficiency of stone fragmentation, a slow rate appears to be a means to improve both the safety and efficacy of SWL.

AB - OBJECTIVE: To assess the tissue protection afforded by simply reducing the rate of shock wave (SW) delivery, compared with studies in the pig in which SW lithotripsy (SWL)-induced vascular damage was significantly reduced by initiating treatment using low-amplitude SWs. MATERIALS AND METHODS: Juvenile pigs (6-7 weeks old) were treated with an unmodified lithotripter (HM3, Dornier Medical Systems, Kennesaw, GA) at either 120 or 30 SW/min. Treatment was to one kidney per pig, with SWs (2000, 24 kV) directed to a lower-pole calyx. After treatment, parenchymal haemorrhage was determined morphometrically and expressed as percentage of functional renal volume (%FRV). RESULTS: Kidneys treated at 120 SW/min had focal to extensive subcapsular haematomas. Parenchymal lesions were found only at the lower pole, but included regions within renal papillae and the cortex. Occasionally, damage extended across the full thickness of the kidney. The lesion in the pigs treated at 120 SW/min occupied a mean (sd) of 4.6 (1.7) %FRV. Kidneys of pigs treated at 30 SW/min showed no surface bleeding. Parenchymal haemorrhage was limited to papillae within the focal volume, and measured 0.08 (0.02) %FRV, a significant (P < 0.005) reduction in injury. CONCLUSIONS: Slowing the rate of delivery to 30 SW/min has a dramatic protective effect on the integrity of the kidney vasculature. This finding in our established pig model suggests a potential strategy to improve the safety of lithotripsy. As it was shown that a reduced SW rate also improves the efficiency of stone fragmentation, a slow rate appears to be a means to improve both the safety and efficacy of SWL.

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