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Focused Ultrasound to Expel Calculi from the Kidney: Safety and Efficacy of a Clinical Prototype Device

2013; Lippincott Williams & Wilkins; Volume: 190; Issue: 3 Linguagem: Inglês

10.1016/j.juro.2013.03.120

1527-3792

Jonathan D. Harper, Mathew D. Sorensen, Bryan W. Cunitz, Yak-Nam Wang, Julianna C. Simon, Frank Starr, Marla Paun, Barbrina Dunmire, H. Denny Liggitt, Andrew P. Evan, James A. McAteer, Ryan S. Hsi, Michael R. Bailey,

Paleopathology and ancient diseases

No AccessJournal of UrologyInvestigative Urology1 Sep 2013Focused Ultrasound to Expel Calculi from the Kidney: Safety and Efficacy of a Clinical Prototype Device Jonathan D. Harper, Mathew D. Sorensen, Bryan W. Cunitz, Yak-Nam Wang, Julianna C. Simon, Frank Starr, Marla Paun, Barbrina Dunmire, H. Denny Liggitt, Andrew P. Evan, James A. McAteer, Ryan S. Hsi, and Michael R. Bailey Jonathan D. HarperJonathan D. Harper Department of Urology, School of Medicine, University of Washington, Seattle, Washington More articles by this author , Mathew D. SorensenMathew D. Sorensen Department of Urology, School of Medicine, University of Washington, Seattle, Washington Division of Urology, Department of Veteran Affairs Medical Center, Seattle, Washington More articles by this author , Bryan W. CunitzBryan W. Cunitz Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, Seattle, Washington More articles by this author , Yak-Nam WangYak-Nam Wang Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, Seattle, Washington More articles by this author , Julianna C. SimonJulianna C. Simon Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, Seattle, Washington More articles by this author , Frank StarrFrank Starr Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, Seattle, Washington More articles by this author , Marla PaunMarla Paun Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, Seattle, Washington More articles by this author , Barbrina DunmireBarbrina Dunmire Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, Seattle, Washington More articles by this author , H. Denny LiggittH. Denny Liggitt Department of Comparative Medicine, School of Medicine, University of Washington, Seattle, Washington More articles by this author , Andrew P. EvanAndrew P. Evan Department of Anatomy and Cell Biology, School of Medicine, Indiana University, Indianapolis, Indiana More articles by this author , James A. McAteerJames A. McAteer Department of Anatomy and Cell Biology, School of Medicine, Indiana University, Indianapolis, Indiana More articles by this author , Ryan S. HsiRyan S. Hsi Department of Urology, School of Medicine, University of Washington, Seattle, Washington Division of Urology, Department of Veteran Affairs Medical Center, Seattle, Washington More articles by this author , and Michael R. BaileyMichael R. Bailey Department of Urology, School of Medicine, University of Washington, Seattle, Washington More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.03.120AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail 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. References 1 : Prevalence of kidney stones in the United States. Eur Urol2012; 62: 160. Google Scholar 2 : The first kidney stone. Ann Intern Med1989; 111: 1006. Google Scholar 3 : Urologic Diseases in America Project: urolithiasis. J Urol2005; 173: 848. Link, Google Scholar 4 : International comparison of cost effectiveness of medical management strategies for nephrolithiasis. Urol Res2005; 33: 223. Google Scholar 5 : Extracorporeal shock wave lithotripsy for lower pole calculi: long-term radiographic and clinical outcome. J Urol1996; 156: 1572. Link, Google Scholar 6 : Clinical implications of clinically insignificant stone fragments after extracorporeal shock wave lithotripsy. J Urol1996; 155: 1186. 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Link, Google Scholar © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited ByAssimos D (2018) Re: Safety and Effectiveness of a Longer Focal Beam and Burst Duration in Ultrasonic Propulsion for Repositioning Urinary Stones and FragmentsJournal of Urology, VOL. 199, NO. 1, (21-23), Online publication date: 1-Jan-2018.Harper J, Cunitz B, Dunmire B, Lee F, Sorensen M, Hsi R, Thiel J, Wessells H, Lingeman J and Bailey M (2015) First in Human Clinical Trial of Ultrasonic Propulsion of Kidney StonesJournal of Urology, VOL. 195, NO. 4 Part 1, (956-964), Online publication date: 1-Apr-2016.Assimos D (2018) Re: Ultrasound Acoustic Shadow Width is an Accurate Predictor of Kidney Stone SizeJournal of Urology, VOL. 193, NO. 3, (900-900), Online publication date: 1-Mar-2015.Connors B, Evan A, Blomgren P, Hsi R, Harper J, Sorensen M, Wang Y, Simon J, Paun M, Starr F, Cunitz B, Bailey M and Lingeman J (2018) Comparison of Tissue Injury from Focused Ultrasonic Propulsion of Kidney Stones Versus Extracorporeal Shock Wave LithotripsyJournal of Urology, VOL. 191, NO. 1, (235-241), Online publication date: 1-Jan-2014.Eisner B (2018) Improvements in Minimally Invasive Stone Treatment: Experimental StudiesJournal of Urology, VOL. 190, NO. 3, (834-835), Online publication date: 1-Sep-2013. Volume 190Issue 3September 2013Page: 1090-1095 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.Keywordsultrasonographykidneyureteroscopylithotripsykidney calculiAcknowledgmentsWei Lu, John Kucewicz, Oleg Sapozhnikov, Anup Shah, Lisa Norton, Hunter Wessells, Lawrence Crum, Peter Kaczkowski, David Cronisier and James Lingeman provided assistance.MetricsAuthor Information Jonathan D. Harper Department of Urology, School of Medicine, University of Washington, Seattle, Washington More articles by this author Mathew D. Sorensen Department of Urology, School of Medicine, University of Washington, Seattle, Washington Division of Urology, Department of Veteran Affairs Medical Center, Seattle, Washington More articles by this author Bryan W. Cunitz Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, Seattle, Washington More articles by this author Yak-Nam Wang Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, Seattle, Washington More articles by this author Julianna C. Simon Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, Seattle, Washington More articles by this author Frank Starr Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, Seattle, Washington More articles by this author Marla Paun Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, Seattle, Washington More articles by this author Barbrina Dunmire Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, Seattle, Washington More articles by this author H. Denny Liggitt Department of Comparative Medicine, School of Medicine, University of Washington, Seattle, Washington More articles by this author Andrew P. Evan Department of Anatomy and Cell Biology, School of Medicine, Indiana University, Indianapolis, Indiana More articles by this author James A. McAteer Department of Anatomy and Cell Biology, School of Medicine, Indiana University, Indianapolis, Indiana More articles by this author Ryan S. Hsi Department of Urology, School of Medicine, University of Washington, Seattle, Washington Division of Urology, Department of Veteran Affairs Medical Center, Seattle, Washington More articles by this author Michael R. Bailey Department of Urology, School of Medicine, University of Washington, Seattle, Washington More articles by this author Expand All Advertisement PDF DownloadLoading ...