Shock wave injury to the kidney in SWL: Review and perspective

James A. McAteer, Andrew P. Evan, Lynn R. Willis, Bret A. Connors, James C. Williams, Yuri A. Pishchalnikov, James E. Lingeman

Research output: Chapter in Book/Report/Conference proceedingConference contribution

6 Scopus citations

Abstract

Shock wave lithotripsy (SWL) is a first-line option for treatment for urinary calculi - particularly effective for the removal of uncomplicated stones from the upper urinary tract. The success of lithotripsy is tempered, however, by the occurrence of acute injury that has been reported to progress to long-term complications. SW trauma to the kidney is a vascular lesion characterized by parenchymal and subcapsular bleeding. The acute lesion is dose-dependent, and typically localized to the focal volume of the lithotripter. Cavitation has been implicated in vessel rupture, but SW-shear has the potential to be a primary mechanism for damage as well. Possible chronic adverse effects of SWL may include new-onset hypertension, development of diabetes, and exacerbation of stone disease. If acute trauma could be reduced, it seems likely that serious long-term effects could be minimized, or even eliminated. Reducing the dose of SW's needed for stone breakage is one option. Improved coupling improves stone breakage, and slowing SW rate significantly improves stone-free outcomes. Experiments with animals now show that treatment protocols can be designed to protect against tissue injury. Initiating treatment with low energy SW's dramatically reduces lesion size, and reducing the rate of SW delivery virtually eliminates SW trauma altogether. SWL stands to gain from new advances in technology, as lithotripters become safer and more effective. Perhaps the greatest progress will be made when we have determined the physical mechanisms of SW action both for stone breakage and tissue damage, and have better characterized the biological response to SW's - as this will provide the principles needed to achieve the best combination of safety and efficiency with whatever lithotripter is at hand.

Original languageEnglish (US)
Title of host publicationRENAL STONE DISEASE
Subtitle of host publication1st Annual International Urolithiasis Research Symposium
PublisherAmerican Institute of Physics Inc.
Pages287-301
Number of pages15
ISBN (Print)0735404062, 9780735404069
DOIs
StatePublished - 2007
Event1st Annual International Urolithiasis Research Symposium - Indianapolis, IN, United States
Duration: Nov 2 2006Nov 3 2006

Publication series

NameAIP Conference Proceedings
Volume900
ISSN (Print)0094-243X
ISSN (Electronic)1551-7616

Other

Other1st Annual International Urolithiasis Research Symposium
CountryUnited States
CityIndianapolis, IN
Period11/2/0611/3/06

Keywords

  • Animal models
  • Kidney
  • Kidney stones
  • Shock wave lithotripsy
  • Trauma

ASJC Scopus subject areas

  • Physics and Astronomy(all)

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  • Cite this

    McAteer, J. A., Evan, A. P., Willis, L. R., Connors, B. A., Williams, J. C., Pishchalnikov, Y. A., & Lingeman, J. E. (2007). Shock wave injury to the kidney in SWL: Review and perspective. In RENAL STONE DISEASE: 1st Annual International Urolithiasis Research Symposium (pp. 287-301). (AIP Conference Proceedings; Vol. 900). American Institute of Physics Inc.. https://doi.org/10.1063/1.2723588