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Wong CHM, Ko ICH, Tang ESF, Yuen SKK, Leung DKW, Kong AWY, Chiu PKF, Teoh JYC, Ng CF. Risk factors of hematoma after SWL for renal calculi: analysis from RCTs and a literature review. Int Urol Nephrol 2024:10.1007/s11255-024-04205-3. [PMID: 39292362 DOI: 10.1007/s11255-024-04205-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2024] [Accepted: 09/11/2024] [Indexed: 09/19/2024]
Abstract
OBJECTIVE To identify risk factors of perinephric hematoma following extracorporeal shockwave lithotripsy (SWL) for renal calculi through combined analysis of two randomized controlled trials. PATIENTS AND METHODS This post-hoc analysis included adult patients with solitary renal calculi ranging from 5 to 15 mm, treated with SWL between 2016 and 2022. All patients received cross-sectional imaging (either non-contrast computer tomography scan or magnetic resonance imaging) two days post-SWL to assess the presence and severity of perinephric hematoma. RESULTS Among 573 patients analyzed, 173 (30.9%) developed perinephric hematoma by Day 2 post-SWL. Multivariate logistic regression identified higher total energy delivered (odds ratio [OR] = 1.533, p = 0.003), higher mean stone density (OR = 2.603, p = 0.01), higher maximal stone density (OR = 3.578, p = 0.03), and lower pole stone location (OR = 1.545, p = 0.029) were risk factors for the development of hematoma. Conversely, the stepwise ramping protocol was a protective factor for hematoma formation. (OR = 0.572, p = 0.042). CONCLUSIONS This study elucidates key factors influencing the risk of perinephric hematoma post-SWL, highlighting the importance of procedural adjustments such as the stepwise ramping protocol to reduce complications. These insights call for targeted patient and treatment strategy optimization to enhance SWL safety and efficacy.
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Affiliation(s)
- Chris Ho-Ming Wong
- Department of Surgery, SH Ho Urology Centre, The Chinese University of Hong Kong, Clinical Sciences Building, Prince of Wales, Hospital, New Territories, Hong Kong SAR
| | - Ivan Ching-Ho Ko
- Department of Surgery, SH Ho Urology Centre, The Chinese University of Hong Kong, Clinical Sciences Building, Prince of Wales, Hospital, New Territories, Hong Kong SAR
| | - Emmy Sui-Fan Tang
- Department of Surgery, SH Ho Urology Centre, The Chinese University of Hong Kong, Clinical Sciences Building, Prince of Wales, Hospital, New Territories, Hong Kong SAR
| | - Steffi Kar-Kei Yuen
- Department of Surgery, SH Ho Urology Centre, The Chinese University of Hong Kong, Clinical Sciences Building, Prince of Wales, Hospital, New Territories, Hong Kong SAR
| | - David Ka-Wai Leung
- Department of Surgery, SH Ho Urology Centre, The Chinese University of Hong Kong, Clinical Sciences Building, Prince of Wales, Hospital, New Territories, Hong Kong SAR
| | - Angel Wing-Yan Kong
- Department of Surgery, SH Ho Urology Centre, The Chinese University of Hong Kong, Clinical Sciences Building, Prince of Wales, Hospital, New Territories, Hong Kong SAR
| | - Peter Ka-Fung Chiu
- Department of Surgery, SH Ho Urology Centre, The Chinese University of Hong Kong, Clinical Sciences Building, Prince of Wales, Hospital, New Territories, Hong Kong SAR
| | - Jeremy Yuen-Chun Teoh
- Department of Surgery, SH Ho Urology Centre, The Chinese University of Hong Kong, Clinical Sciences Building, Prince of Wales, Hospital, New Territories, Hong Kong SAR
- Department of Urology, Medical University of Vienna, Vienna, Austria
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Chi Fai Ng
- Department of Surgery, SH Ho Urology Centre, The Chinese University of Hong Kong, Clinical Sciences Building, Prince of Wales, Hospital, New Territories, Hong Kong SAR.
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Zeng G, Zhu W, Somani B, Choong S, Straub M, Maroccolo MV, Kamal W, Ibrahim TAA, Cho A, Mazzon G, Chai CA, Ferretti S, Zhong W, Onal B, Mohamed O, Saulat S, Jurkiewicz B, Sezer A, Liu Y, Zeng T, Wang W, Gauhar V, Elderwy AA, Zaidi Z, Duvdevani M, Hamri SB, Kumar N, Kartalas-Goumas L, Gadzhiev N, Kraft K, Sepulveda F, Halinski A, Marietti S, Al-Anazi NAS, Santos LS, Vaddi CM, Jia J, Li J, Kuang X, Ye Z, Sarica K. International Alliance of Urolithiasis (IAU) guidelines on the management of pediatric urolithiasis. Urolithiasis 2024; 52:124. [PMID: 39230669 DOI: 10.1007/s00240-024-01621-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2024] [Accepted: 08/17/2024] [Indexed: 09/05/2024]
Abstract
The aim of this study was to construct the sixth in a series of guidelines on the treatment of urolithiasis by the International Alliance of Urolithiasis (IAU) that by providing a clinical framework for the management of pediatric patients with urolithiasis based on the best available published literature. All recommendations were summarized following a systematic review and assessment of literature in the PubMed database from January 1952 to December 2023. Each generated recommendation was graded using a modified GRADE methodology. Recommendations are agreed upon by Panel Members following review and discussion of the evidence. Guideline recommendations were developed that addressed the following topics: etiology, risk factors, clinical presentation and symptoms, diagnosis, conservative management, surgical interventions, prevention, and follow-up. Similarities in the treatment of primary stone episodes between children and adults, incorporating conservative management and advancements in technology for less invasive stone removal, are evident. Additionally, preventive strategies aiming to reduce recurrence rates, such as ensuring sufficient fluid intake, establishing well-planned dietary adjustments, and selective use pharmacologic therapies will also result in highly successful outcomes in pediatric stone patients. Depending on the severity of metabolic disorders and also anatomical abnormalities, a careful and close follow-up program should inevitably be planned in each pediatric patient to limit the risk of future recurrence rates.
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Affiliation(s)
- Guohua Zeng
- Department of Urology and Guangdong Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.
| | - Wei Zhu
- Department of Urology and Guangdong Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Bhaskar Somani
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK
| | - Simon Choong
- Institute of Urology, University College Hospitals of London, London, UK
| | - Michael Straub
- Department of Urology, Technical University Munich, Munich, Germany
| | | | - Wissam Kamal
- Department of Urology, King Fahd Hospital, Jeddah, Saudi Arabia
| | | | - Alexander Cho
- Great Ormond Street Hospital National Health Service Foundation Trust, London, UK
| | - Giorgio Mazzon
- Institute of Urology, University College Hospitals of London, London, UK
| | - Chu Ann Chai
- Department of Surgery Urology Unit, University Malaya, Kuala Lumpur, Malaysia
| | - Stefania Ferretti
- Department of Urology, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
| | - Wen Zhong
- Department of Urology and Guangdong Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Bulent Onal
- Department of Urology, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Omar Mohamed
- Department of Urology, Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - Sherjeel Saulat
- Department of Urology, Tabba Kidney Institute, Karachi, Pakistan
| | - Beata Jurkiewicz
- Paediatric Surgery Department, Warsaw Hospital for Children, Warsaw, Poland
| | - Ali Sezer
- Pediatric Urology Clinic, Konya City Hospital, Konya, Turkey
| | - Yang Liu
- Department of Urology and Guangdong Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Tao Zeng
- Department of Urology and Guangdong Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Wei Wang
- Department of Urology, Shanghai Public Health Clinical Center, Center of GRADE, Fudan University, Shanghai, China
| | - Vineet Gauhar
- Department of Urology, Ng Teng Fong General Hospital, The National University Health System, Singapore, 609606, Singapore
| | - Ahmad Abdelaziz Elderwy
- Assiut Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Asyut, Egypt
| | - Zafar Zaidi
- The Indus Hospital and Health Network, Karachi, Pakistan
| | | | - Saeed Bin Hamri
- Division of Urology, Department of Surgery, Ministry of the National Guard Health Affairs, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Nitesh Kumar
- Ford Hospital and Research Centre, Patna, 800027, India
| | | | - Nariman Gadzhiev
- Saint Petersburg State University Hospital, St. Petersburg, Russian Federation
| | - Kate Kraft
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Fabio Sepulveda
- Department of Urology, Federal University of Bahia, State Women's Hospital of Bahia, Salvador, Bahia, Brazil
| | - Adam Halinski
- Department of Paediatric Urology, PMC "Wisniowa Clinic", Zielona Gora, Poland
| | - Sarah Marietti
- University of California - San Diego, 200 West Arbor Drive MC 7897, San Diego, CA, 92103, USA
| | | | - Luiz Sergio Santos
- Department of Urology, Federal University of Parana, Curitiba, Paraná, Brazil
| | - Chandra Mohan Vaddi
- Preeti Urology and Kidney Hospital, 307, Remedy Hospital Lane, Mig1, Kphb Colony, Kukatpally, Hyderabad, Telangana, 500072, India
| | - Jianye Jia
- Department of Urology, Peking University International Hospital, Beijing, China
| | - Jun Li
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Xiaogen Kuang
- Department of Urology, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Zhangqun Ye
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kemal Sarica
- Department of Urology, Prof. Dr. Ilhan Varank Research and Training Hospital, Istanbul, Turkey.
- Department of Urology, Medical School, Biruni University, Istanbul, Turkey.
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Xu H, Liu B, Tang L. CT-based radiomics for predicting success of shock wave lithotripsy in ureteral stones larger than 1 cm. World J Urol 2024; 42:397. [PMID: 38985166 DOI: 10.1007/s00345-024-05111-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 03/05/2024] [Indexed: 07/11/2024] Open
Abstract
PURPOSE This study aims to investigate the predictive value of CT-based radiomics in determining the success of extracorporeal shock wave lithotripsy (SWL) treatment for ureteral stones larger than 10mm in adult patients. MATERIALS AND METHODS A total of 301 eligible patients (165/136 successful/unsuccessful) who underwent SWL were retrospectively evaluated and divided into a training cohort (n = 241) and a test cohort (n = 60) following an 8:2 ratio. Univariate analysis was performed to assess clinical characteristics for constructing a nomogram. Radiomics and conventional radiological characteristics of stones were evaluated. Following feature selection, radiomics and radiological models were constructed using logistic regression (LR), support vector machine (SVM), random forest (RF), K nearest neighbor (KNN), and XGBoost. The models' performance was compared using metrics such as the area under the receiver operating characteristic curve (AUC), precision, recall, accuracy, and F1 score. Finally, a nomogram was created incorporating the best image model signature and clinical predictors. RESULTS The SVM-based radiomics model showed superior predictive performance in both training and test cohorts (AUC: 0.956, 0.891, respectively). The nomogram, which combined SVM-based radiomics signature with proximal ureter diameter (PUD), demonstrated further improved predictive performance in the test cohort (AUC: 0.891 vs. 0.939, P = 0.166). CONCLUSIONS Integration of CT-derived radiomics and PUD showed excellent ability to predict SWL treatment success in patients with ureteral stones larger than 10mm, providing a promising approach for clinical decision-making.
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Affiliation(s)
- Huixin Xu
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, Jiangsu Province, China
| | - Bo Liu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, Jiangsu Province, China
| | - Lijun Tang
- Department of Nuclear Medicine, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, Jiangsu Province, China.
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Ng CF, Yee CH, Teoh JYC, Chiu PKF, Kong AWY, Lau BSY, Leung SCH, Wong KT, Chu WCW. Effect of Focal Zone Size on Treatment Outcomes and Renal Injury Following Extracorporeal Shockwave Lithotripsy of Renal Calculi: A Prospective Randomized Study. J Endourol 2024; 38:505-512. [PMID: 38482817 DOI: 10.1089/end.2023.0662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2024] Open
Abstract
Background: The narrower focal zone (FZ) size of modern lithotripter was considered as one of the factors that resulted in suboptimal treatment result of extracorporeal shockwave lithotripsy (SWL). Therefore, we investigate the efficacy and safety of standard narrow or extended (FZ) sizes in SWL for patients with renal stones. Materials and Methods: In this prospective study conducted between April 2018 and October 2022, patients with renal stones were randomized to receive SWL with either standard or extended FZ. Treatment was delivered using a Modulith SLX-F2 lithotripter with a maximum of 3000 shocks at 1.5 Hz. The primary outcome was treatment success 12 weeks after a single SWL session, defined as the absence of a stone or stone fragment <4 mm on computed tomography. Secondary outcomes included the incidence of perinephric hematoma, stone-free rate (SFR), and changes in the urinary levels of acute renal injury markers. Results: A total of 320 patients were recruited, and 276 patients were randomized into the two groups. The two groups had similar baseline parameters. The treatment success rate was significantly better for standard FZ (74.3%) than the extended FZ group (59.3%) (p = 0.009). Standard FZ also had a significantly better SFR (Grade-A, 36.8% vs 23.0%, p = 0.013) and less pain after treatment. Both groups had similar perinephric hematoma formation rates, unplanned hospital admission rates, and changes in urinary acute renal injury markers. Conclusions: The standard narrow FZ has better treatment efficacy and similar safety compared with the extended FZ during SWL for renal stones. This clinical trial has been registered in the public domain (CCRBCTR) under trial number CUHK_CCRB00510.
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Affiliation(s)
- Chi-Fai Ng
- Department of Surgery, SH Ho Urology Center, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Chi Hang Yee
- Department of Surgery, SH Ho Urology Center, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Jeremy Y C Teoh
- Department of Surgery, SH Ho Urology Center, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Peter K F Chiu
- Department of Surgery, SH Ho Urology Center, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Angel W Y Kong
- Department of Surgery, SH Ho Urology Center, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Becky S Y Lau
- Department of Surgery, SH Ho Urology Center, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Steven C H Leung
- Department of Surgery, SH Ho Urology Center, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Ka Tak Wong
- Department of Imaging and Intervention Radiology, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Winnie C W Chu
- Department of Imaging and Intervention Radiology, The Chinese University of Hong Kong, Shatin, Hong Kong
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5
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Patel R, Desai C, Acharya R, Raveshia D, Shah S, Panesar H, Patel N, Singh R. Five historical innovations that have shaped modern urological surgery. J Perioper Pract 2024; 34:154-163. [PMID: 38149615 DOI: 10.1177/17504589231214388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2023]
Abstract
Throughout history, many innovations have contributed to the development of modern urological surgery, improving patient outcomes and expanding the range of treatment options available to patients. This article explores five key historical innovations that have shaped modern urological surgery: External shockwave lithotripsy, transurethral resection of prostate, cystoscope, perioperative prostate-specific antigen and robotic surgery. The selection of innovations for inclusion in this article was meticulously determined through expert consensus and an extensive literature review. We will review the development, impact and significance of each innovation, highlighting their contributions to the field of urological surgery and their ongoing relevance in contemporary and perioperative practice.
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Affiliation(s)
- Ravi Patel
- Department of Trauma and Orthopaedics, Shrewsbury and Telford Trust, The Princess Royal Hospital, Apley Castle, Telford, UK
- Department of Trauma and Orthopaedics, The Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, UK
| | - Chaitya Desai
- Department of Urology, Walsall Manor Hospital, Walsall Healthcare NHS Trust, Walsall, UK
| | - Radhika Acharya
- Department of Intensive Care, Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Dimit Raveshia
- Department of General Surgery, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Saumil Shah
- Department of Otolaryngology, The Princess Royal Hospital, Apley Castle, Telford, UK
| | - Harrypal Panesar
- Department of Otolaryngology, The Princess Royal Hospital, Apley Castle, Telford, UK
| | | | - Rohit Singh
- Department of Trauma and Orthopaedics, The Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, UK
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6
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Bahilo-Mateu P, Budia-Alba A. Extracorporeal shockwave lithotripsy in the management of urinary stones: New concepts and techniques to improve outcomes. Asian J Urol 2024; 11:143-148. [PMID: 38680578 PMCID: PMC11053317 DOI: 10.1016/j.ajur.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 11/07/2023] [Indexed: 05/01/2024] Open
Abstract
Objective Extracorporeal shockwave lithotripsy (SWL) currently plays an important role in the treatment of urinary tract lithiasis. The purpose of this article was to describe new concepts and procedural strategies that would improve results using SWL as a treatment for urolithiasis, thereby achieving better clinical practice. Methods A systematic review process was carried in PubMed/PMC from January 2003 to March 2023. A narrative synthesis of the most important aspects has been made. Results The important recommendations for the adequate selection of the candidate patient for treatment with SWL are summarized, as well as the new strategies for a better application of the technique. Aspects about intraoperative position, stone localization and monitoring, analgesic control, machine and energy settings, and measures aiming at reduced risk of complications are described. Conclusion To achieve the therapeutic goal of efficient stone disintegration without increasing the risk of complications, it is necessary to make an adequate selection of patients and to pay special attention to several important factors in the application of treatment. Technological development in later generation devices will help to improve current SWL results.
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Affiliation(s)
- Pilar Bahilo-Mateu
- Lithotripsy and Endourology Unit, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Alberto Budia-Alba
- Lithotripsy and Endourology Unit, La Fe University and Polytechnic Hospital, Valencia, Spain
- Lithotripsy and Endourology Unit, Urology Department, La Fe University and Polytechnic Hospital, Valencia, Spain
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7
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Medrano-Sánchez EM, Peña-Cantonero B, Candón-Ballester P, Blanco-Díaz M, Díaz-Mohedo E. Effectiveness of Low-Intensity Extracorporeal Shock Wave Therapy in Erectile Dysfunction: An Analysis of Sexual Function and Penile Hardness at Erection: An Umbrella Review. J Pers Med 2024; 14:177. [PMID: 38392610 PMCID: PMC10890328 DOI: 10.3390/jpm14020177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 01/10/2024] [Accepted: 01/29/2024] [Indexed: 02/24/2024] Open
Abstract
The present umbrella review of five systematic reviews and meta-analyses was conducted to investigate the effectiveness of Low-Intensity Extracorporeal Shock Wave Therapy (Li-ESWT) in the treatment of vascular origin Erectile Dysfunction (ED). A search was carried out in the databases of Pubmed, Scopus, Medline, Scielo and Embase. Participants were divided into two groups: an experimental group receiving Li-ESWT and a control group receiving simulated shock waves. The main variable of this study is ED, measured using the International Index of Erectile Function-Erectile Function (IIEF-EF) and the Erection Hardness Score (EHS) scale. The results showed a statistically significant increase in the mean IIEF-EF score in the experimental group. Overall, four out of five articles reported an increase in the EHS score in the Li-ESWT group compared to the placebo. Concerning the treatment parameters, better outcomes were observed with an energy density of 0.09 mJ/mm2 and the application of 1500-2000 pulses. Additionally, a follow-up of 6-12 months resulted in greater improvement in ED compared to 3 months, although more studies investigating follow-ups beyond 12 months are needed. Obtaining conclusive and clear results is challenging; however, everything indicates that Li-ESWT is an innovative therapeutic alternative for vascular-origin ED due to its low risk and improvement in erectile function.
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Affiliation(s)
- Esther M Medrano-Sánchez
- Research Group CTS305, Department of Physical Therapy, Faculty of Nursing, Physical Therapy and Podiatry, Universidad de Sevilla, 6, Avenzoar St., 41009 Sevilla, Spain
| | | | | | - María Blanco-Díaz
- Physiotherapy and Translational Research Group (FINTRA-RG), Institute of Health Research of the Principality of Asturias (ISPA), Faculty of Medicine and Health Sciences, Universidad de Oviedo, 33006 Oviedo, Spain
| | - Esther Díaz-Mohedo
- Department of Physical Therapy, Universidad de Málaga, Francisco Peñalosa Av., 29071 Málaga, Spain
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8
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AIUM Official Statement for the Statement on Biological Effects of Therapeutic Ultrasound. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:E68-E73. [PMID: 37584480 DOI: 10.1002/jum.16315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 07/28/2023] [Indexed: 08/17/2023]
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9
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Maxwell AD, Kim GW, Furrow E, Lulich JP, Torre M, MacConaghy B, Lynch E, Leotta DF, Wang YN, Borofsky MS, Bailey MR. Development of a burst wave lithotripsy system for noninvasive fragmentation of ureteroliths in pet cats. BMC Vet Res 2023; 19:141. [PMID: 37660015 PMCID: PMC10474658 DOI: 10.1186/s12917-023-03705-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 08/24/2023] [Indexed: 09/04/2023] Open
Abstract
BACKGROUND Upper urinary tract stones are increasingly prevalent in pet cats and are difficult to manage. Surgical procedures to address obstructing ureteroliths have short- and long-term complications, and medical therapies (e.g., fluid diuresis and smooth muscle relaxants) are infrequently effective. Burst wave lithotripsy is a non-invasive, ultrasound-guided, handheld focused ultrasound technology to disintegrate urinary stones, which is now undergoing human clinical trials in awake unanesthetized subjects. RESULTS In this study, we designed and performed in vitro testing of a modified burst wave lithotripsy system to noninvasively fragment stones in cats. The design accounted for differences in anatomic scale, acoustic window, skin-to-stone depth, and stone size. Prototypes were fabricated and tested in a benchtop model using 35 natural calcium oxalate monohydrate stones from cats. In an initial experiment, burst wave lithotripsy was performed using peak ultrasound pressures of 7.3 (n = 10), 8.0 (n = 5), or 8.9 MPa (n = 10) for up to 30 min. Fourteen of 25 stones fragmented to < 1 mm within the 30 min. In a second experiment, burst wave lithotripsy was performed using a second transducer and peak ultrasound pressure of 8.0 MPa (n = 10) for up to 50 min. In the second experiment, 9 of 10 stones fragmented to < 1 mm within the 50 min. Across both experiments, an average of 73-97% of stone mass could be reduced to fragments < 1 mm. A third experiment found negligible injury with in vivo exposure of kidneys and ureters in a porcine animal model. CONCLUSIONS These data support further evaluation of burst wave lithotripsy as a noninvasive intervention for obstructing ureteroliths in cats.
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Affiliation(s)
- Adam D Maxwell
- Department of Urology, University of Washington School of Medicine, Seattle, WA, USA
- Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, Seattle, WA, USA
| | - Ga Won Kim
- Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, Seattle, WA, USA
| | - Eva Furrow
- Department of Veterinary Clinical Sciences, University of Minnesota, St. Paul, MN, USA
| | - Jody P Lulich
- Department of Veterinary Clinical Sciences, University of Minnesota, St. Paul, MN, USA
| | - Marissa Torre
- Department of Veterinary Clinical Sciences, University of Minnesota, St. Paul, MN, USA
| | - Brian MacConaghy
- Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, Seattle, WA, USA
| | - Elizabeth Lynch
- Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, Seattle, WA, USA
| | - Daniel F Leotta
- Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, Seattle, WA, USA
| | - Yak-Nam Wang
- Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, Seattle, WA, USA
| | | | - Michael R Bailey
- Department of Urology, University of Washington School of Medicine, Seattle, WA, USA.
- Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, Seattle, WA, USA.
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10
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Hu C, Zhang QB, Wang F, Wang H, Zhou Y. The effect of extracorporeal shock wave on joint capsule fibrosis in rats with knee extension contracture: a preliminary study. Connect Tissue Res 2023; 64:469-478. [PMID: 37267052 DOI: 10.1080/03008207.2023.2217254] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 05/04/2023] [Indexed: 06/04/2023]
Abstract
The purpose of this study was to observe the therapeutic effect of extracorporeal shock wave (ESW) on extensional joint contracture of knee joint in rats and its mechanism on articular capsule fibrosis. Thirty-two SD rats were randomly divided into blank control, immobilization, natural recovery, and ESW intervention groups. Except for the control group, the left knee joints of other rats were fixed with external fixation brace for 4 weeks when they were fully extended to form joint contracture. The effect of intervention was assessed by evaluating joint contracture, total cell count and collagen deposition in joint capsule, and protein expression levels of TGF-β1, p-Smad2/3, Smad2/3, p-JNK, JNK, I and III collagen in joint capsule. ESW can effectively reduce arthrogenic contracture, improve the histopathological changes of anterior joint capsule, inhibit the high expression of target protein and the excessive activation of TGF-β1/Smad2/3/JNK signal pathway. Inhibition of excessive activation of TGF-β1/Smad2/3/JNK pathway may be one of the potential molecular mechanisms by which extracorporeal shock wave can play a role.
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Affiliation(s)
- Chao Hu
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
- Research Center for Translational Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Quan Bing Zhang
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
- Research Center for Translational Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Feng Wang
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
- Research Center for Translational Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Hua Wang
- Department of Toxicology, School of Public Health, Anhui Medical University, Hefei, China
| | - Yun Zhou
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
- Research Center for Translational Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
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11
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Vieiralves RR, Schuh MF, Favorito LA. Low-intensity extracorporeal shockwave therapy in the treatment of erectile dysfunction - a narrative review. Int Braz J Urol 2023; 49:428-440. [PMID: 36794846 PMCID: PMC10482445 DOI: 10.1590/s1677-5538.ibju.2023.9904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 04/02/2023] [Indexed: 02/17/2023] Open
Abstract
OBJECTIVES To provide an overview of low-intensity extracorporeal shockwave therapy (LIEST) for erectile dysfunction (ED), pointing out which concepts are already consolidated and which paths we still need to advance. MATERIALS AND METHODS We performed a narrative review of the literature on the role of shockwave therapies in erectile dysfunction, selecting publications in PUBMED, including only relevant clinical trials, systematic reviews and meta-analyses. RESULTS We found 11 studies (7 clinical trials, 3 systematic review and 1 meta-analysis) that evaluated the use of LIEST for the treatment of erectile dysfunction. One clinical trial evaluated the applicability in Peyronie's Disease and one other clinical trial evaluated the applicability after radical prostatectomy. CONCLUSIONS The literature presents little scientific evidence but suggests good results with the use of LIEST for ED. Despite a real optimism since it is a treatment modality capable of acting on the pathophysiology of ED, we must remain cautious, until a larger volume of higher quality studies allows us to establish which patient profile, type of energy and application protocol will achieve clinically satisfactory results.
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Affiliation(s)
- Rodrigo R. Vieiralves
- Universidade do Estado do Rio de Janeiro - UERJUnidade de Pesquisa UrogenitalRio de JaneiroRJBrasilUnidade de Pesquisa Urogenital - Universidade do Estado do Rio de Janeiro - UERJ, Rio de Janeiro, RJ, Brasil
| | - Mathias Ferreira Schuh
- Universidade do Estado do Rio de Janeiro - UERJUnidade de Pesquisa UrogenitalRio de JaneiroRJBrasilUnidade de Pesquisa Urogenital - Universidade do Estado do Rio de Janeiro - UERJ, Rio de Janeiro, RJ, Brasil
| | - Luciano Alves Favorito
- Universidade do Estado do Rio de Janeiro - UERJUnidade de Pesquisa UrogenitalRio de JaneiroRJBrasilUnidade de Pesquisa Urogenital - Universidade do Estado do Rio de Janeiro - UERJ, Rio de Janeiro, RJ, Brasil
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12
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Zeng G, Zhong W, Chaussy CG, Tiselius HG, Xu C, Turney B, Turk C, Tailly GG, Preminger GM, Akpinar H, Petrik A, Bernardo N, Wiseman O, Farahat Y, Budia A, Jones DK, Beltran Suarez E, De Marco F, Mazzon G, Lv J, Natchagande G, Guven S, Ibrahim TAA, Xu H, Xie L, Ye Z, Sarica K. International Alliance of Urolithiasis Guideline on Shockwave Lithotripsy. Eur Urol Focus 2023; 9:513-523. [PMID: 36435718 DOI: 10.1016/j.euf.2022.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 10/04/2022] [Accepted: 11/08/2022] [Indexed: 11/24/2022]
Abstract
Different international associations have proposed their own guidelines on urolithiasis. However, the focus is primarily on an overview of the principles of urolithiasis management rather than step-by-step technical details for the procedure. The International Alliance of Urolithiasis (IAU) is releasing a series of guidelines on the management of urolithiasis. The current guideline on shockwave lithotripsy (SWL) is the third in the IAU guidelines series and provides a clinical framework for urologists and technicians performing SWL. A total of 49 recommendations are summarized and graded, covering the following aspects: indications and contraindications; preoperative patient evaluation; preoperative medication; prestenting; intraoperative analgesia or anesthesia; intraoperative position; stone localization and monitoring; machine and energy settings; intraoperative lithotripsy strategies; auxiliary therapy following SWL; evaluation of stone clearance; complications; and quality of life. The recommendations, tips, and tricks regarding SWL procedures summarized here provide important and necessary guidance for urologists along with technicians performing SWL. PATIENT SUMMARY: For kidney and urinary stones of less than 20 mm in size, shockwave lithotripsy (SWL) is an approach in which the stone is treated with shockwaves applied to the skin, without the need for surgery. Our recommendations on technical aspects of the procedure provide guidance for urologists and technicians performing SWL.
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Affiliation(s)
- Guohua Zeng
- Department of Urology, First Affiliated Hospital of Guangzhou Medical University, Guangdong Key Laboratory of Urology, Guangzhou, China.
| | - Wen Zhong
- Department of Urology, First Affiliated Hospital of Guangzhou Medical University, Guangdong Key Laboratory of Urology, Guangzhou, China
| | - Christian G Chaussy
- University of Munich, Munich, Germany; University of Regensburg, Regensburg, Germany
| | - Hans Göran Tiselius
- Division of Urology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Changbao Xu
- The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ben Turney
- Department of Urology, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Christian Turk
- Department of Urology, Hospital of the Sisters of Charity, Vienna, Austria
| | | | - Glenn M Preminger
- Division of Urologic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Haluk Akpinar
- Department of Urology, Florence Nightingale Hospitals Group, Istanbul, Turkey
| | - Ales Petrik
- Department of Urology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Norberto Bernardo
- Department of Urology, Hospital de Clinicas Jose de San Martin, Buenos Aires, Argentina
| | - Oliver Wiseman
- Department of Urology, Cambridge University Hospitals, Cambridge, UK
| | - Yasser Farahat
- Department of Urology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Alberto Budia
- Department of Urology, La Fe Polytechnic University Hospital, Valencia, Spain
| | - David K Jones
- Department of Pharmacology, University of Michigan School of Medicine, Ann Arbor, MI, USA
| | - Edgar Beltran Suarez
- Department of Urology, Specialty Hospital La Raza, National Medical Center of the Mexican Institute of Social Security, Mexico City, Mexico
| | - Ferdinando De Marco
- Urology Division, Istituto Neurotraumatologico Italiano-Grottaferrata, Rome, Italy
| | - Giorgio Mazzon
- Department of Urology, San Bassiano Hospital, Vicenza, Italy
| | - Jianlin Lv
- Department of Urology, Jiangning Hospital, Nanjing Medical University, Nanjing, China
| | | | - Selcuk Guven
- Urology Department, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey
| | | | - Hanfeng Xu
- Department of Urology, First Affiliated Hospital of University of South China, Henyang, China
| | - Lei Xie
- Department of Urology, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, China
| | - Zhangqun Ye
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kemal Sarica
- Department of Urology, Biruni University Medical School, Istanbul, Turkey.
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13
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Zhang X, Ma Y. Global trends in research on extracorporeal shock wave therapy (ESWT) from 2000 to 2021. BMC Musculoskelet Disord 2023; 24:312. [PMID: 37081473 PMCID: PMC10116688 DOI: 10.1186/s12891-023-06407-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 04/07/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND This study intended to analyze the application of extracorporeal shock wave therapy in medicine and to evaluate the quality of related literature. METHODS All publications were extracted from 2000 to 2021 from the Web of Science Core Collection (WoSCC). The literature characteristics were depicted by VOSviewer (version 1.6.15) and the online bibliometric website ( http://bibliometric.com/ ). The future trends and hotspots were conducted by Bibliographic Item Co-occurrence Matrix Builder (version 2.0) and gCLUTO software. RESULTS We analyzed 1774 articles corresponding to the criteria for ESWT publications from 2000 to 2021. Most studies were conducted within the United States and China which besides have the most cooperation. The most published research institutions are Chang Gung University, Kaohsiung Chang Gung Memorial Hospital, and Kaohsiung Medical University. Six research hotspots were identified by keyword clustering analysis: Cluster0: The effects of ESWT on muscle spasticity; Cluster1: The application of ESWT in osteoarthritis (OA); Cluster2: Therapeutic effect of ESWT on tendon diseases; Cluster3: Early application of ESWT/ESWL in urolithiasis; Cluster4: The Role of angiogenesis in ESWT and the efficiency of ESWT for penile disease; Cluster5: The Special value of radial extracorporeal shock wave therapy (rESWT). CONCLUSIONS A comprehensive and systematic bibliometric analysis of ESWT was conducted in our study. We identified six ESWT-related research hotspots and predicted future research trends. With the gradual increase of research on ESWT, we find that ESWT is used more and more extensively, such in musculoskeletal disease, bone delay union, neurological injury, andrology disorders, lymphedema, and so on. In addition, the mechanism is not destructive damage, as initially thought, but a restorative treatment. Furthermore, delayed union, cellulite, burn, and diabetic foot ulcers may be the future direction of scientific study.
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Affiliation(s)
- Xinyu Zhang
- Department of Rehabilitation, The First Affiliated Hospital of China Medical University, 155 Nanjing Street, 110001, Shenyang, P.R. China
| | - Yuewen Ma
- Department of Rehabilitation, The First Affiliated Hospital of China Medical University, 155 Nanjing Street, 110001, Shenyang, P.R. China.
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14
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Ren Y, Yuan J, Xue Y, Zhang Y, Li S, Liu C, Liu Y. Advanced hydrogels: New expectation for the repair of organic erectile dysfunction. Mater Today Bio 2023; 19:100588. [PMID: 36896414 PMCID: PMC9988670 DOI: 10.1016/j.mtbio.2023.100588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/08/2023] [Accepted: 02/18/2023] [Indexed: 02/22/2023] Open
Abstract
Organic erectile dysfunction (ED) is a type of sexual disorder in men that is usually associated with illness, surgical injury, normal aging and has a high incidence across the globe. And the essence of penile erection is a neurovascular event regulated by a combination of factors. Nerve and vascular injury are the main causes of erectile dysfunction. Currently, the main treatment options for ED include phosphodiesterase type 5 inhibitors (PDE5Is), intracorporeal injections and vacuum erection devices (VEDs), which are ineffective. Therefore, it is essential to find an emerging, non-invasive and effective treatment for ED. The histopathological damage causing ED can be improved or even reversed with hydrogels, in contrast to current therapies. Hydrogels have many advantages, they can be synthesized from various raw materials with different properties, possess a definite composition, and have good biocompatibility and biodegradability. These advantages make hydrogels an effective drug carrier. In this review, we began with an overview of the underlying mechanisms of organic erectile dysfunction, discussed the dilemmas of existing treatments for ED, and described the unique advantages of hydrogel over other approaches. Then emphasizing the progress of research on hydrogels in the treatment of ED.
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Affiliation(s)
- Yan Ren
- School of Public Health, Zhejiang Chinese Medical University, Hangzhou, 310053, China.,CAS Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety & CAS Center for Excellence in Nanoscience, National Center for Nanoscience and Technology of China, Beijing, 100190, China
| | - Jing Yuan
- First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
| | - Yueguang Xue
- CAS Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety & CAS Center for Excellence in Nanoscience, National Center for Nanoscience and Technology of China, Beijing, 100190, China
| | - Yiming Zhang
- CAS Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety & CAS Center for Excellence in Nanoscience, National Center for Nanoscience and Technology of China, Beijing, 100190, China
| | - Shilin Li
- CAS Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety & CAS Center for Excellence in Nanoscience, National Center for Nanoscience and Technology of China, Beijing, 100190, China
| | - Cuiqing Liu
- School of Public Health, Zhejiang Chinese Medical University, Hangzhou, 310053, China
| | - Ying Liu
- CAS Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety & CAS Center for Excellence in Nanoscience, National Center for Nanoscience and Technology of China, Beijing, 100190, China.,GBA National Institute for Nanotechnology Innovation, Guangzhou, 510700, China
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15
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Xiao K, Zhou L, Zhu S, Lin L, Di X, Li H. Which frequency is better for pediatric shock wave lithotripsy? Low intermediate or high: A systematic review and meta-analysis. Front Surg 2023; 10:1063159. [PMID: 37009606 PMCID: PMC10050731 DOI: 10.3389/fsurg.2023.1063159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 02/13/2023] [Indexed: 03/17/2023] Open
Abstract
BackgroundTo explore the optimal frequency for pediatric extracorporeal shock wave lithotripsy (ESWL) in the treatment of upper urinary stones.MethodsA systematic literature search was undertaken using PubMed, Embase, Web of Science and Cochrane Central Register of Controlled Trials databases to identify eligible studies published before January 2023. Primary outcomes were perioperative efficacy parameters, including ESWL time, anesthesia time for ESWL sessions, success rates after each session, additional interventions needed, and treatment sessions per patient. Secondary outcomes were postoperative complications and efficiency quotient.ResultsFour controlled studies involving 263 pediatric patients were enrolled in our meta-analysis. In the comparison between the low-frequency and intermediate-frequency groups, we observed no significant difference as regards anesthesia time for ESWL session (WMD = −4.98, 95% CI −21.55∼11.58, p = 0.56), success rates after ESWL sessions (first session: OR = 0.02 95%CI −0.12∼0.17, p = 0.74; second session: OR = 1.04 95%CI 0.56∼1.90, p = 0.91; third session: OR = 1.62 95%CI 0.73∼3.60, p = 0.24), treatment sessions needed (WMD = 0.08 95%CI −0.21∼0.36, p = 0.60), additional interventions after ESWL (OR=0.99 95%CI 0.40∼2.47, p = 0.99) and rates of Clavien grade 2 complications (OR = 0.92 95%CI 0.18∼4.69, p = 0.92). However, the intermediate-frequency group may exhibit potential benefits in Clavien grade 1 complications. In the comparison between intermediate-frequency and high-frequency, the eligible studies exhibited higher success rates in the intermediate-frequency group after the first session, the second session and the third session. More sessions may be required in the high-frequency group. With respect to other perioperative, postoperative parameters and major complications, the results were similar.ConclusionsIntermediate-frequency and low-frequency had similar success rates and seemed to be the optimal frequency for pediatric ESWL. Nevertheless, future large-volume, well-designed RCTs are awaited to confirm and update the findings of this analysis.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/, identifier: CRD42022333646.
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Khavari M, Priyadarshi A, Morton J, Porfyrakis K, Pericleous K, Eskin D, Tzanakis I. Cavitation-induced shock wave behaviour in different liquids. ULTRASONICS SONOCHEMISTRY 2023; 94:106328. [PMID: 36801674 PMCID: PMC9975297 DOI: 10.1016/j.ultsonch.2023.106328] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 01/26/2023] [Accepted: 02/09/2023] [Indexed: 06/18/2023]
Abstract
This paper follows our earlier work where a strong high frequency pressure peak has been observed as a consequence of the formation of shock waves due to the collapse of cavitation bubbles in water, excited by an ultrasonic source at 24 kHz. We study here the effects of liquid physical properties on the shock wave characteristics by replacing water as the medium successively with ethanol, glycerol and finally a 1:1 ethanol-water solution. The pressure frequency spectra obtained in our experiments (from more than 1.5 million cavitation collapsing events) show that the expected prominent shockwave pressure peak was barely detected for ethanol and glycerol, particularly at low input powers, but was consistently observed for the 1:1 ethanol-water solution as well as in water, with a slight shift in peak frequency for the solution. We also report two distinct features of shock waves in raising the frequency peak at MHz (inherent) and contributing to the raising of sub-harmonics (periodic). Empirically constructed acoustic pressure maps revealed significantly higher overall pressure amplitudes for the ethanol-water solution than for other liquids. Furthermore, a qualitative analysis revealed that mist-like patterns are developed in ethanol-water solution leading to higher pressures.
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Affiliation(s)
- Mohammad Khavari
- School of Computing and Engineering, College of Science and Engineering, University of Derby, Derby DE22 3AW, United Kingdom; Faculty of Technology, Design and Environment, Oxford Brookes University, Oxford OX33 1HX, United Kingdom.
| | - Abhinav Priyadarshi
- Faculty of Technology, Design and Environment, Oxford Brookes University, Oxford OX33 1HX, United Kingdom
| | - Justin Morton
- Faculty of Technology, Design and Environment, Oxford Brookes University, Oxford OX33 1HX, United Kingdom
| | - Kyriakos Porfyrakis
- Faculty of Engineering and Science, University of Greenwich, Central Avenue, Chatham Maritime, Kent ME4 4TB, United Kingdom
| | - Koulis Pericleous
- Computational Science and Engineering Group, University of Greenwich, 30 Park Row, London SE10 9LS, United Kingdom
| | - Dmitry Eskin
- Brunel Centre for Advanced Solidification Technology, Brunel University London, Uxbridge UB8 3PH, United Kingdom
| | - Iakovos Tzanakis
- Faculty of Technology, Design and Environment, Oxford Brookes University, Oxford OX33 1HX, United Kingdom; Department of Materials, University of Oxford, Parks Rd, Oxford OX1 3PH, United Kingdom
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17
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Malinaric R, Mantica G, Martini M, Balzarini F, Mariano F, Marchi G, Tognoni P, Panarello D, Bottino P, Terrone C. The Lifetime History of the First Italian Public Extra-Corporeal Shock Wave Lithotripsy (ESWL) Lithotripter as a Mirror of the Evolution of Endourology over the Last Decade. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4127. [PMID: 36901138 PMCID: PMC10002114 DOI: 10.3390/ijerph20054127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 02/20/2023] [Accepted: 02/22/2023] [Indexed: 06/18/2023]
Abstract
Extracorporeal shockwave lithotripsy (ESWL) is the only non-invasive treatment for kidney stones. It does not require an operating room, anesthesia, or hospital stay. Its role evolved over the years and nowadays ESWL is slowly disappearing from many stone centers and urologic departments. We present the history and the role of ESWL treatment since its birth in 1959 and its development through the following years. We also present details of its application and impact on the first Italian stone center in 1985. ESWL has had different roles over the centuries: in the early years it was a great alternative to open surgery and percutaneous nephrolithotripsy (PCNL), then it had its decline with the introduction of the miniscopes. Currently, although ESWL is not considered a treatment of excellence, newer models are emerging. With the application of new technologies and artificial intelligence, this technique can become a good option alongside endourologic treatments.
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Affiliation(s)
- Rafaela Malinaric
- IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy
- Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, 16132 Genova, Italy
| | - Guglielmo Mantica
- IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy
- Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, 16132 Genova, Italy
| | - Mariano Martini
- Department of Health Sciences, University of Genoa, 16132 Genova, Italy
| | | | - Federico Mariano
- IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy
- Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, 16132 Genova, Italy
| | - Giovanni Marchi
- IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy
- Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, 16132 Genova, Italy
| | - Piero Tognoni
- IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy
| | | | - Paolo Bottino
- IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy
| | - Carlo Terrone
- IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy
- Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, 16132 Genova, Italy
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Todorov LG, Sivaguru M, Krambeck AE, Lee MS, Lieske JC, Fouke BW. GeoBioMed perspectives on kidney stone recurrence from the reactive surface area of SWL-derived particles. Sci Rep 2022; 12:18371. [PMID: 36319741 PMCID: PMC9626463 DOI: 10.1038/s41598-022-23331-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 10/29/2022] [Indexed: 11/18/2022] Open
Abstract
Shock wave lithotripsy (SWL) is an effective and commonly applied clinical treatment for human kidney stones. Yet the success of SWL is counterbalanced by the risk of retained fragments causing recurrent stone formation, which may require retreatment. This study has applied GeoBioMed experimental and analytical approaches to determine the size frequency distribution, fracture patterns, and reactive surface area of SWL-derived particles within the context of their original crystal growth structure (crystalline architecture) as revealed by confocal autofluorescence (CAF) and super-resolution autofluorescence (SRAF) microscopy. Multiple calcium oxalate (CaOx) stones were removed from a Mayo Clinic patient using standard percutaneous nephrolithotomy (PCNL) and shock pulse lithotripsy (SPL). This produced approximately 4-12 mm-diameter PCNL-derived fragments that were experimentally treated ex vivo with SWL to form hundreds of smaller particles. Fractures propagated through the crystalline architecture of PCNL-derived fragments in a variety of geometric orientations to form rectangular, pointed, concentrically spalled, and irregular SWL-derived particles. Size frequency distributions ranged from fine silt (4-8 μm) to very fine pebbles (2-4 mm), according to the Wentworth grain size scale, with a mean size of fine sand (125-250 μm). Importantly, these SWL-derived particles are smaller than the 3-4 mm-diameter detection limit of clinical computed tomography (CT) techniques and can be retained on internal kidney membrane surfaces. This creates clinically undetectable crystallization seed points with extremely high reactive surface areas, which dramatically enhance the multiple events of crystallization and dissolution (diagenetic phase transitions) that may lead to the high rates of CaOx kidney stone recurrence after SWL treatment.
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Affiliation(s)
- Lauren G. Todorov
- grid.35403.310000 0004 1936 9991Department of Geology, University of Illinois at Urbana-Champaign, Urbana, IL USA ,grid.35403.310000 0004 1936 9991Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana-Champaign, Urbana, IL USA
| | - Mayandi Sivaguru
- grid.35403.310000 0004 1936 9991Cytometry and Microscopy to Omics Facility, Roy J. Carver Biotechnology Center, University of Illinois at Urbana-Champaign, Urbana, IL USA
| | - Amy E. Krambeck
- grid.66875.3a0000 0004 0459 167XDepartment of Urology, Mayo Clinic, Rochester, MN USA ,grid.16753.360000 0001 2299 3507Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - Matthew S. Lee
- grid.16753.360000 0001 2299 3507Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - John C. Lieske
- grid.66875.3a0000 0004 0459 167XDivision of Nephrology and Hypertension, Mayo Clinic, Rochester, MN USA ,grid.66875.3a0000 0004 0459 167XDepartment of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN USA
| | - Bruce W. Fouke
- grid.35403.310000 0004 1936 9991Department of Geology, University of Illinois at Urbana-Champaign, Urbana, IL USA ,grid.35403.310000 0004 1936 9991Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana-Champaign, Urbana, IL USA ,grid.35403.310000 0004 1936 9991Department of Biomedical and Translational Sciences, Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign, Urbana, IL USA ,grid.35403.310000 0004 1936 9991Roy J. Carver Biotechnology Center, University of Illinois at Urbana-Champaign, Urbana, IL USA ,grid.35403.310000 0004 1936 9991Department of Evolution, Ecology and Behavior, University of Illinois at Urbana-Champaign, Urbana, IL USA
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Yao F, Li K, Huang S, Cheng X, Jiang X. Furosemide improves the stone clearance rate of extracorporeal shockwave lithotripsy for kidney stones but not ureteral stones: a systematic review and meta-analysis. Ther Adv Urol 2022; 14:17562872221128473. [PMID: 36267107 PMCID: PMC9577065 DOI: 10.1177/17562872221128473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 09/07/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction We conducted a meta-analysis (MA) to investigate the effects of furosemide on the prognosis of extracorporeal shockwave lithotripsy (SWL) therapy to remove renal (RS) and ureteric stones (US). Methods We screened scientific databases including PubMed, Clinicalkey, Google Scholar, Medline, Embase, and Cochrane, from the date of establishment until March 2022, to search for randomized controlled trials evaluating SWL, in combination with furosemide (experimental group) or with SWL alone (control group), in treating RS or US. Our search terms included furosemide, extracorporeal SWL, and urolithiasis. For this MA, we employed the Cochrane Collaboration's RevMan version 5.3.0. Results Six trials, involving 1344 participants, with RS (n = 1097) and/or US (n = 247), met our predefined criteria. This included 137 proximal ureteral stones (PUSs), 35 mid-ureteral stones (MUS), and 75 distal ureteral stones (DUS). In case of RS, the experimental group exhibited significantly enhanced clearance, relative to controls (risk ratio [RR] = 1.16, 95% confidence interval [CI] = 1.07-1.25, p = 0.0002), yet there was no obvious difference in the PUS, MUS, and DUS (RR = 1.14, 95% CI = 0.97-1.33, p = 0.10; odds ratio [OR] = 1.26, 95% CI = 1.40-3.95, p = 0.69; RR = 1.21, 95% CI = 0.99-1.49, p = 0.06). There was also no marked difference between fragmentations in either group. Only reports of SWL treatment of RS provided adequate data on shocks, sessions, and complications for our analysis. Unfortunately, there was no significant alteration between the two groups. Conclusion According to our analysis, furosemide strongly accelerates the clearance rate of SWL-treated RS. However, it does not enhance the fragmentation rate. Given this evidence, we propose that furosemide does not significantly improve the efficacy of SWL therapy in removing US. Registration Our work is registered with PROSPERO (CRD42020204780).
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Affiliation(s)
- Feng Yao
- Department of Urology, People’s Hospital of
Chongqing Banan District, Chongqing, China
| | - Ke Li
- Department of Urology, People’s Hospital of
Chongqing Banan District, Chongqing, China
| | - ShiQuan Huang
- Department of Urology, People’s Hospital of
Chongqing Banan District, Chongqing, China
| | - XueSong Cheng
- Department of Urology, People’s Hospital of
Chongqing Banan District, Chongqing, China
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Tašič Muc B, Vella D, Lukač N, Kos M, Jezeršek M. Amplification of high-intensity pressure waves and cavitation in water using a multi-pulsed laser excitation and black-TiOx optoacoustic lens. BIOMEDICAL OPTICS EXPRESS 2022; 13:3993-4006. [PMID: 35991925 PMCID: PMC9352300 DOI: 10.1364/boe.460713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 05/28/2022] [Accepted: 06/02/2022] [Indexed: 06/15/2023]
Abstract
A method for amplification of high-intensity pressure waves generated with a multi-pulsed Nd:YAG laser coupled with a black-TiOx optoacoustic lens in the water is presented and characterized. The investigation was focused on determining how the multi-pulsed laser excitation with delays between 50 µs and 400 µs influences the dynamics of the bubbles formed by a laser-induced breakdown on the upper surface of the lens, the acoustic cavitation in the focal region of the lens, and the high-intensity pressure waves generation. A needle hydrophone and a high-speed camera were used to analyze the spatial distribution and time-dependent development of the above-mentioned phenomena. Our results show how different delays (td ) of the laser pulses influence optoacoustic dynamics. When td is equal to or greater than the bubble oscillation time, acoustic cavitation cloud size increases 10-fold after the fourth laser pulse, while the pressure amplitude increases by more than 75%. A quasi-deterministic creation of cavitation due to consecutive transient pressure waves is also discussed. This is relevant for localized ablative laser therapy.
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Affiliation(s)
- Blaž Tašič Muc
- Faculty of Mechanical Engineering, University of Ljubljana, Aškerčeva 6, Ljubljana, Slovenia
- Fotona d.o.o., Stegne 7, Ljubljana, Slovenia
| | - Daniele Vella
- Faculty of Mechanical Engineering, University of Ljubljana, Aškerčeva 6, Ljubljana, Slovenia
| | - Nejc Lukač
- Faculty of Mechanical Engineering, University of Ljubljana, Aškerčeva 6, Ljubljana, Slovenia
- Fotona d.o.o., Stegne 7, Ljubljana, Slovenia
| | - Matjaž Kos
- Faculty of Mechanical Engineering, University of Ljubljana, Aškerčeva 6, Ljubljana, Slovenia
| | - Matija Jezeršek
- Faculty of Mechanical Engineering, University of Ljubljana, Aškerčeva 6, Ljubljana, Slovenia
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Graber M, Nägele F, Hirsch J, Pölzl L, Schweiger V, Lechner S, Grimm M, Cooke JP, Gollmann-Tepeköylü C, Holfeld J. Cardiac Shockwave Therapy – A Novel Therapy for Ischemic Cardiomyopathy? Front Cardiovasc Med 2022; 9:875965. [PMID: 35647069 PMCID: PMC9133452 DOI: 10.3389/fcvm.2022.875965] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 04/12/2022] [Indexed: 11/14/2022] Open
Abstract
Over the past decades, shockwave therapy (SWT) has gained increasing interest as a therapeutic approach for regenerative medicine applications, such as healing of bone fractures and wounds. More recently, pre-clinical studies have elucidated potential mechanisms for the regenerative effects of SWT in myocardial ischemia. The mechanical stimulus of SWT may induce regenerative effects in ischemic tissue via growth factor release, modulation of inflammatory response, and angiogenesis. Activation of the innate immune system and stimulation of purinergic receptors by SWT appears to enhance vascularization and regeneration of injured tissue with functional improvement. Intriguingly, small single center studies suggest that SWT may improve angina, exercise tolerance, and hemodynamics in patients with ischemic heart disease. Thus, SWT may represent a promising technology to induce cardiac protection or repair in patients with ischemic heart disease.
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Affiliation(s)
- Michael Graber
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
- Department of Cardiovascular Sciences, Center for Cardiovascular Regeneration, Houston Methodist Research Institute, Houston, TX, United States
| | - Felix Nägele
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Jakob Hirsch
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Leo Pölzl
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
- Division of Clinical and Functional Anatomy, Medical University of Innsbruck, Innsbruck, Austria
| | - Victor Schweiger
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Sophia Lechner
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Michael Grimm
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - John P. Cooke
- Department of Cardiovascular Sciences, Center for Cardiovascular Regeneration, Houston Methodist Research Institute, Houston, TX, United States
| | | | - Johannes Holfeld
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
- *Correspondence: Johannes Holfeld,
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Harper JD, Lingeman JE, Sweet RM, Metzler IS, Sunaryo PL, Williams JC, Maxwell AD, Thiel J, Cunitz BW, Dunmire B, Bailey MR, Sorensen MD. Fragmentation of Stones by Burst Wave Lithotripsy in the First 19 Humans. J Urol 2022; 207:1067-1076. [PMID: 35311351 PMCID: PMC9078634 DOI: 10.1097/ju.0000000000002446] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE We report stone comminution in the first 19 human subjects by burst wave lithotripsy (BWL), which is the transcutaneous application of focused, cyclic ultrasound pulses. MATERIALS AND METHODS This was a prospective multi-institutional feasibility study recruiting subjects undergoing clinical ureteroscopy (URS) for at least 1 stone ≤12 mm as measured on computerized tomography. During the planned URS, either before or after ureteroscope insertion, BWL was administered with a handheld transducer, and any stone fragmentation and tissue injury were observed. Up to 3 stones per subject were targeted, each for a maximum of 10 minutes. The primary effectiveness outcome was the volume percent comminution of the stone into fragments ≤2 mm. The primary safety outcome was the independent, blinded visual scoring of tissue injury from the URS video. RESULTS Overall, median stone comminution was 90% (IQR 20, 100) of stone volume with 21 of 23 (91%) stones fragmented. Complete fragmentation (all fragments ≤2 mm) within 10 minutes of BWL occurred in 9 of 23 stones (39%). Of the 6 least comminuted stones, likely causative factors for decreased effectiveness included stones that were larger than the BWL beamwidth, smaller than the BWL wavelength or the introduction of air bubbles from the ureteroscope. Mild reddening of the papilla and hematuria emanating from the papilla were observed ureteroscopically. CONCLUSIONS The first study of BWL in human subjects resulted in a median of 90% comminution of the total stone volume into fragments ≤2 mm within 10 minutes of BWL exposure with only mild tissue injury.
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Affiliation(s)
- Jonathan D. Harper
- Department of Urology, University of Washington School of Medicine, Seattle, Washington
| | - James E. Lingeman
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Robert M. Sweet
- Department of Urology, University of Washington School of Medicine, Seattle, Washington
| | - Ian S. Metzler
- Department of Urology, University of Washington School of Medicine, Seattle, Washington
| | - Peter L. Sunaryo
- Department of Urology, University of Washington School of Medicine, Seattle, Washington
- Department of Urology, Northwest Permanente, Portland, Oregon
| | - James C. Williams
- Department of Anatomy, Cell Biology, and Physiology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Adam D. Maxwell
- Department of Urology, University of Washington School of Medicine, Seattle, Washington
- Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington,Seattle, Washington
| | - Jeff Thiel
- Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington,Seattle, Washington
| | - Bryan W. Cunitz
- Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington,Seattle, Washington
| | - Barbrina Dunmire
- Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington,Seattle, Washington
| | - Michael R. Bailey
- Department of Urology, University of Washington School of Medicine, Seattle, Washington
- Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington,Seattle, Washington
| | - Mathew D. Sorensen
- Department of Urology, University of Washington School of Medicine, Seattle, Washington
- Division of Urology, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
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23
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Chang HH, Lin YC, Li CC, Wu WJ, Liou WC, Lin YE, Huang KK, Chen WC. A clinical observational study of effectiveness of a solid coupling medium in extracorporeal shock wave lithotripsy. BMC Urol 2022; 22:56. [PMID: 35413871 PMCID: PMC9006431 DOI: 10.1186/s12894-022-01001-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 03/07/2022] [Indexed: 11/25/2022] Open
Abstract
This study aimed to investigate clinical effectiveness of stone disintegration by using isolation coupling pad (“icPad”) as coupling medium to reduce trapped air pockets during extracorporeal shock wave lithotripsy (ESWL). Patients underwent ESWL between Oct. 2017 and May 2018 were enrolled in this clinical observational study. An electromagnetic lithotripter (Dornier MedTech Europe GmbH Co., Germany) was used in this study. Patients were divided into icPad group P1, P2 and semi-gel group C by different coupling medium. The energy level and total number of shock wave (SW) for group P1 and C was set at level 2 and 3000 and group P2 at level 3 and 2500. The successful stone disintegration rate (SSDR) was determined to evaluate the treatment outcome. All patients were evaluated by KUB film and ultrasonography after 90 days. Complications during ESWL were recorded. A total of 300 patients satisfied the inclusion criteria. There were no significant differences in characteristics of patients and stone among three groups. The corresponding SSDRs for patients in group P1, P2 and C was 73.0%, 73.2% and 55.3%, respectively. The SSDR in group P1 was statistically higher than Group C. Comparing to semi-liquid gel, coupling medium using by icPad could achieve better treatment outcome of stone disintegration in ESWL.
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Affiliation(s)
- Hao-Han Chang
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yu-Chih Lin
- Division of General Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Ching-Chia Li
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wen-Jeng Wu
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wen-Chin Liou
- Department of Surgery, St. Joseph Hospital, Kaohsiung, Taiwan
| | - Yusen Eason Lin
- Graduate Institute of Human Resource and Knowledge Management, National Kaohsiung Normal University, Kaohsiung, Taiwan.,CleanWave Medical Co., LTD, Kaohsiung, Taiwan
| | - Kuo-Kuang Huang
- Department of Pharmacy and Master Program, Tajen University, No. 20, Weixin Rd., Yanpu Township, Pingtung County, 90741, Taiwan
| | - Wei-Chuan Chen
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan. .,Department of Pharmacy and Master Program, Tajen University, No. 20, Weixin Rd., Yanpu Township, Pingtung County, 90741, Taiwan. .,Division of Urology, Department of Urology, Kaohsiung Veterans General Hospital, No. 386, Dazhong 1st Rd., Zuoying Dist., Kaohsiung City, 813414, Taiwan.
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24
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Yao H, Wang X, Liu H, Sun F, Tang G, Bao X, Wu J, Zhou Z, Ma J. Systematic Review and Meta-Analysis of 16 Randomized Controlled Trials of Clinical Outcomes of Low-Intensity Extracorporeal Shock Wave Therapy in Treating Erectile Dysfunction. Am J Mens Health 2022; 16:15579883221087532. [PMID: 35319291 PMCID: PMC8949743 DOI: 10.1177/15579883221087532] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 01/23/2022] [Accepted: 02/25/2022] [Indexed: 12/29/2022] Open
Abstract
We conducted a meta-analysis to evaluate the efficacy of low-intensity extracorporeal shock wave therapy (LI-ESWT) in the treatment of erectile dysfunction (ED). From July 2011 to June 2021, we finally selected 16 randomized controlled trials (RCTs) including 1,064 participants to evaluate the efficacy of LI-ESWT in the treatment of ED from PubMed, EMBASE, and Cochrane databases. The data are analyzed by Review Manager Version 5.4. Fifteen articles mentioned International Index of Erectile Function (IIEF), in the follow-up of 1 month (mean difference [MD] = 3.18, 95% confidence interval [CI] = [1.38, 4.98], p = .0005), 3 months (MD = 3.01, 95% CI = [2.04, 3.98], p < .00001), and 6 months (MD = 3.20, 95% CI = [2.49, 3.92], p < .00001). After treatment, the improvement of IIEF in the LI-ESWT group was better than that in the control group. Besides, eight of the 16 trials provided data on the proportion of patients with baseline Erectile Hardness Score (EHS) ≤ 2 improved to EHS ≥ 3. The LI-ESWT group was also significantly better than the placebo group (odds ratio [OR] = 5.07, 95% CI = [1.78, 14.44], p = .002). The positive response rate of Questions 2 and 3 of the Sexual Encounter Profile (SEP) was not statistically significant (SEP2: OR = 1.27, 95% CI = [0.70, 2.30], p = .43; SEP3: OR = 4.24, 95% CI = [0.67, 26.83], p = .13). The results of this meta-analysis suggest that treatment plans with an energy density of 0.09 mJ/mm2 and pulses number of 1,500 to 2,000 are more beneficial to IIEF in ED patients. In addition, IIEF improvement was more pronounced in patients with moderate ED after extracorporeal shockwave therapy.
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Affiliation(s)
- Huibao Yao
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
| | - Xiaofeng Wang
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
| | - Hongquan Liu
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
| | - Fengze Sun
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
| | - Gonglin Tang
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
| | - Xingjun Bao
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
| | - Jitao Wu
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
| | - Zhongbao Zhou
- Department of Urology, Beijing TianTan Hospital, Capital Medical University, Fengtai District, Beijing, China
| | - Jian Ma
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
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25
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Cheng YH, Tsai NC, Chen YJ, Weng PL, Chang YC, Cheng JH, Ko JY, Kang HY, Lan KC. Extracorporeal Shock Wave Therapy Combined with Platelet-Rich Plasma during Preventive and Therapeutic Stages of Intrauterine Adhesion in a Rat Model. Biomedicines 2022; 10:biomedicines10020476. [PMID: 35203684 PMCID: PMC8962268 DOI: 10.3390/biomedicines10020476] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 02/15/2022] [Accepted: 02/15/2022] [Indexed: 11/16/2022] Open
Abstract
Intrauterine adhesion (IUA) is caused by artificial endometrial damage during intrauterine cavity surgery. The typical phenotype involves loss of spontaneous endometrium recovery and angiogenesis. Undesirable symptoms include abnormal menstruation and infertility; therefore, prevention and early treatment of IUA remain crucial issues. Extracorporeal shockwave therapy (ESWT) major proposed therapeutic mechanisms include neovascularization, tissue regeneration, and fibrosis. We examined the effects of ESWT and/or platelet-rich plasma (PRP) during preventive and therapeutic stages of IUA by inducing intrauterine mechanical injury in rats. PRP alone, or combined with ESWT, were detected an increased number of endometrial glands, elevated vascular endothelial growth factor protein expression (hematoxylin-eosin staining and immunohistochemistry), and reduced fibrosis rate (Masson trichrome staining). mRNA expression levels of nuclear factor-kappa B, tumor necrosis factor-α, transforming growth factor-β, interleukin (IL)-6, collagen type I alpha 1, and fibronectin were reduced during two stages. However, PRP alone, or ESWT combined with PRP transplantation, not only increased the mRNA levels of vascular endothelial growth factor (VEGF) and progesterone receptor (PR) during the preventive stage but also increased PR, insulin-like growth factor 1 (IGF-1), and IL-4 during the therapeutic stage. These findings revealed that these two treatments inhibited endometrial fibrosis and inflammatory markers, thereby inhibiting the occurrence and development of intrauterine adhesions.
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Affiliation(s)
- Yin-Hua Cheng
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan; (Y.-H.C.); (Y.-J.C.); (P.-L.W.); (Y.-C.C.); (H.-Y.K.)
| | - Ni-Chin Tsai
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan;
- Department of Obstetrics and Gynecology, Pingtung Christian Hospital, Pingtung 900, Taiwan
| | - Yun-Ju Chen
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan; (Y.-H.C.); (Y.-J.C.); (P.-L.W.); (Y.-C.C.); (H.-Y.K.)
| | - Pei-Ling Weng
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan; (Y.-H.C.); (Y.-J.C.); (P.-L.W.); (Y.-C.C.); (H.-Y.K.)
| | - Yun-Chiao Chang
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan; (Y.-H.C.); (Y.-J.C.); (P.-L.W.); (Y.-C.C.); (H.-Y.K.)
| | - Jai-Hong Cheng
- Center for Shockwave Medicine and Tissue Engineering, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan; (J.-H.C.); (J.-Y.K.)
- Medical Research, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan
- Department of Leisure and Sports Management, Cheng Shiu University, Kaohsiung 833, Taiwan
| | - Jih-Yang Ko
- Center for Shockwave Medicine and Tissue Engineering, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan; (J.-H.C.); (J.-Y.K.)
- Department of Orthopedic Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan
| | - Hong-Yo Kang
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan; (Y.-H.C.); (Y.-J.C.); (P.-L.W.); (Y.-C.C.); (H.-Y.K.)
- Center for Menopause and Reproductive Medicine Research, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan
| | - Kuo-Chung Lan
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan; (Y.-H.C.); (Y.-J.C.); (P.-L.W.); (Y.-C.C.); (H.-Y.K.)
- Center for Menopause and Reproductive Medicine Research, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan
- Department of Obstetrics and Gynecology, Jen-Ai Hospital, Taichung 412, Taiwan
- Correspondence: ; Tel.: +886-7-7317123-8654; Fax: +886-7-7322915
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26
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Shi L, Yang X, Wang P, Ma X, Li D, Wu X, Gao F, Sun W. Quantitative Magnetic Resonance Imaging of Femoral Head Articular Cartilage Change in Patients with Hip Osteonecrosis Treated with Extracorporeal Shock Wave Therapy. Int J Clin Pract 2022; 2022:8609868. [PMID: 35814305 PMCID: PMC9208945 DOI: 10.1155/2022/8609868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 05/15/2022] [Accepted: 05/23/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Multiple reports have demonstrated the therapeutic potential of extracorporeal shock wave (ESWT) in osteonecrosis of the femoral head (ONFH). However, few studies reported the changes in hip articular cartilage after the intervention. This study aimed to investigate the effect of ESWT on femoral head cartilage using a novel technique, quantitative T2-mapping magnetic resonance imaging. METHODS A total of 143 eligible patients with unilateral early-stage ONFH were randomized into the ESWT group and control group. Seventy-three patients in the ESWT group received two sessions of ESWT with oral drug treatment, while seventy patients in the control group received oral drug treatment only. The visual analog pain scale (VAS) and Harris hip score (HHS) at 3-month, 6-month, and 12-month follow-up were used as the clinical evaluation index. The radiological evaluation index used the T2 mapping values, necrotic size, and China-Japan Friendship Hospital (CJFH) classification. RESULTS A total of 143 patients (62 females and 81 males) were finally included, and the characteristics before treatment were comparable between the two groups. At the last follow-up (12 months), the T2 values and ΔT2 changes in the ESWT group were all smaller than those in the control group (p=0.042; p=0.039), while the CJFH classification of ONFH and necrotic lesion size were not statistically significant. At 3 months and 6 months, the VAS in the ESWT group was lower than that in the control group (p=0.021; p=0.046) and the HHS in the ESWT group was higher (p=0.028; p=0.039). However, there were no significant differences in the VAS and HHS at 12 months between the ESWT and control groups. CONCLUSIONS The results of the current study indicated that, based on drug treatment, ESWT is an effective treatment method for nontraumatic ONFH, which could result in significant pain relief and function restoration. Furthermore, it could delay the injury of femoral head cartilage during the progression of ONFH.
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Affiliation(s)
- Lijun Shi
- Department of Orthopedic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Xu Yang
- Department of Orthopedics, Peking University China-Japan Friendship Clinical Hospital, Beijing 100029, China
| | - Peixu Wang
- Department of Orthopedic Surgery, Centre for Osteonecrosis and Joint-Preserving & Reconstruction, China-Japan Friendship Hospital, Beijing 100029, China
| | - Xiangwei Ma
- Department of Rehabilitation Medicine, China-Japan Friendship Hospital, Beijing 100029, China
| | - Dan Li
- Department of Pediatrics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, Henan, China
| | - Xinjie Wu
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm 171 76, Sweden
| | - Fuqiang Gao
- Department of Orthopedic Surgery, Centre for Osteonecrosis and Joint-Preserving & Reconstruction, China-Japan Friendship Hospital, Beijing 100029, China
| | - Wei Sun
- Department of Orthopedic Surgery, Centre for Osteonecrosis and Joint-Preserving & Reconstruction, China-Japan Friendship Hospital, Beijing 100029, China
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Herout R, Baunacke M, Groeben C, Aksoy C, Volkmer B, Schmidt M, Eisenmenger N, Koch R, Oehlschläger S, Thomas C, Huber J. Contemporary treatment trends for upper urinary tract stones in a total population analysis in Germany from 2006 to 2019: will shock wave lithotripsy become extinct? World J Urol 2022; 40:185-191. [PMID: 34453580 PMCID: PMC8813696 DOI: 10.1007/s00345-021-03818-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 08/20/2021] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To describe the change in upper urinary tract stone management in Germany over a 14-year period. METHODS Using remote data processing we analyzed the nationwide German billing data from 2006 to 2019. To analyze the clinics' case numbers and regional trends, we used the reimbursement.INFO tool based on standardized quality reports of all German hospitals. To also cover shock wave lithotripsy (SWL) as an outpatient procedure, we analyzed the research database of the Institute for Applied Health Research with a representative anonymous sample of 4 million insured persons. RESULTS The number of inpatient interventional therapies for upper tract urolithiasis in Germany increased from 70,099 cases in 2006 to 94,815 cases in 2019 (trend p < 0.0001). In-hospital SWL declined from 41,687 cases in 2006 to 10,724 cases in 2019 (decline of 74%; trend p < 0.0001). The percentage of SWL as an outpatient procedure increased between 2013 and 2018 from 36 to 46% of all performed SWL, while total SWL case numbers declined. Contrarily, the number of ureteroscopies increased from 32,203 cases in 2006 to 78,125 cases in 2019 (increase of 143%; trend p < 0.0001). The number of percutaneous nephrolithotomy also increased from 1673 cases in 2006 to 8937 in 2019 (increase of 434%; trend p < 0.0001). CONCLUSION We observed an increase in interventional therapy for upper tract urolithiasis in Germany with a dramatic shift from SWL to endoscopic/percutaneous treatment. These changes may be attributed to enormous technological advances of the endoscopic armamentarium and to reimbursement issues.
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Affiliation(s)
- Roman Herout
- Department of Urology, University Hospital Carl Gustav Carus, TU Dresden, Fetscherstraße 74, 01307, Dresden, Germany.
| | - Martin Baunacke
- Department of Urology, University Hospital Carl Gustav Carus, TU Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Christer Groeben
- Department of Urology, University Hospital Carl Gustav Carus, TU Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Cem Aksoy
- Department of Urology, University Hospital Carl Gustav Carus, TU Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Björn Volkmer
- Department of Urology, Klinikum Kassel, Kassel, Germany
| | | | | | - Rainer Koch
- Department of Urology, University Hospital Carl Gustav Carus, TU Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Sven Oehlschläger
- Department of Urology, University Hospital Carl Gustav Carus, TU Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Christian Thomas
- Department of Urology, University Hospital Carl Gustav Carus, TU Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Johannes Huber
- Department of Urology, University Hospital Carl Gustav Carus, TU Dresden, Fetscherstraße 74, 01307, Dresden, Germany
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Pricop C, Ivanuta M, Radavoi GD, Toma CV, Cumpanaş A, Jinga V, Bacalbaşa N, Puia D. Determining whether previous SWL for ureteric stones influences the results of ureteroscopy as the second-line treatment: A clinical study. Exp Ther Med 2021; 23:38. [PMID: 34849153 DOI: 10.3892/etm.2021.10960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 09/20/2021] [Indexed: 11/06/2022] Open
Abstract
The purpose of the study was to establish whether shock wave lithotripsy (SWL) is a potential harmful first-line treatment for ureteric stones where ureteroscopy (URS) is necessary as a second-line treatment. Medical records of patients with ureteric stones who underwent either URS as the only therapy applied or SWL followed by URS over two years were retrospectively evaluated. In total, 158 patients were included: 79 patients in Group A (no SWL) and 79 in Group B (prior SWL before URS). There was no difference in major complications, Group A had higher stone-free rates, Group B had higher rates of ureteral edema and similar intraoperative ureteral lesions. In conclusion, the failure of SWL for lumbar or pelvic ureteral lithiasis does not appear to have a negative effect on the rate of intraoperative complications or the success rate of semi-rigid retrograde URS for this category of calculi, with the same safety profile as first-line endourological intervention.
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Affiliation(s)
- Cătălin Pricop
- Department of Urology, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iași, Romania.,Department of Urology, 'C. I. Parhon' Hospital, 700503 Iași, Romania
| | - Marius Ivanuta
- Department of Urology, 'C. I. Parhon' Hospital, 700503 Iași, Romania
| | - George Daniel Radavoi
- Department of Urology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Urology, 'Prof. Dr. Theodor Burghele' Clinical Hospital, 050653 Bucharest, Romania
| | - Cristian-Valentin Toma
- Department of Urology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Urology, 'Prof. Dr. Theodor Burghele' Clinical Hospital, 050653 Bucharest, Romania
| | - Alin Cumpanaş
- Department of Urology, 'Victor Babeş' University of Medicine and Pharmacy, 300041 Timișoara, Romania.,Department of Urology, 'Pius Brînzeu' County Emergency Clinical Hospital Timiş, 300723 Timișoara, Romania
| | - Viorel Jinga
- Department of Urology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Urology, 'Prof. Dr. Theodor Burghele' Clinical Hospital, 050653 Bucharest, Romania
| | - Nicolae Bacalbaşa
- Department of Urology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Visceral Surgery, Center of Excellence in Translational Medicine, 'Fundeni' Clinical Institute, 022328 Bucharest, Romania
| | - Dragoş Puia
- Department of Urology, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iași, Romania.,Department of Urology, 'C. I. Parhon' Hospital, 700503 Iași, Romania
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Sapozhnikov OA, Maxwell AD, Bailey MR. Maximizing mechanical stress in small urinary stones during burst wave lithotripsy. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2021; 150:4203. [PMID: 34972267 PMCID: PMC8664414 DOI: 10.1121/10.0008902] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 11/04/2021] [Accepted: 11/09/2021] [Indexed: 06/14/2023]
Abstract
Unlike shock wave lithotripsy, burst wave lithotripsy (BWL) uses tone bursts, consisting of many periods of a sinusoidal wave. In this work, an analytical theoretical approach to modeling mechanical stresses in a spherical stone was developed to assess the dependence of frequency and stone size on stress generated in the stone. The analytical model for spherical stones is compared against a finite-difference model used to calculate stress in nonspherical stones. It is shown that at low frequencies, when the wavelength is much greater than the diameter of the stone, the maximum principal stress is approximately equal to the pressure amplitude of the incident wave. With increasing frequency, when the diameter of the stone begins to exceed about half the wavelength in the surrounding liquid (the exact condition depends on the material of the stone), the maximum stress increases and can be more than six times greater than the incident pressure. These results suggest that the BWL frequency should be elevated for small stones to improve the likelihood and rate of fragmentation.
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Affiliation(s)
- Oleg A Sapozhnikov
- Physics Faculty, Moscow State University, Leninskie Gory, Moscow 119991, Russia
| | - Adam D Maxwell
- Department of Urology, University of Washington School of Medicine, Seattle, Washington 98195, USA
| | - Michael R Bailey
- Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, 1013 NE 40th Street, Seattle, Washington 98105, USA
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Lee JY, Andonian S, Bhojani N, Bjazevic J, Chew BH, De S, Elmansy H, Lantz-Powers AG, Pace KT, Schuler TD, Singal RK, Wang P, Ordon M. Canadian Urological Association guideline: Management of ureteral calculi - Abridged version. Can Urol Assoc J 2021; 15:383-393. [PMID: 34847343 PMCID: PMC8631858 DOI: 10.5489/cuaj.7652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Jason Y. Lee
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Sero Andonian
- Division of Urology, Department of Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - Naeem Bhojani
- Department of Urology, Université de Montréal, Montreal, QC, Canada
| | - Jennifer Bjazevic
- Division of Urology, Department of Surgery, Western University, London, ON, Canada
| | - Ben H. Chew
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Shubha De
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Hazem Elmansy
- Urology, Northern Ontario School of Medicine, Thunder Bay, ON, Canada
| | | | - Kenneth T. Pace
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Trevor D. Schuler
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Rajiv K. Singal
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Peter Wang
- London Health Sciences Centre, Western University, London, ON, Canada
| | - Michael Ordon
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
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Lee JY, Andonian S, Bhojani N, Bjazevic J, Chew BH, De S, Elmansy H, Lantz-Powers AG, Pace KT, Schuler TD, Singal RK, Wang P, Ordon M. Canadian Urological Association guideline: Management of ureteral calculi - Full-text. Can Urol Assoc J 2021; 15:E676-E690. [PMID: 34464257 PMCID: PMC8631842 DOI: 10.5489/cuaj.7581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Jason Y. Lee
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Sero Andonian
- Division of Urology, Department of Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - Naeem Bhojani
- Department of Urology, Université de Montréal, Montreal, QC, Canada
| | - Jennifer Bjazevic
- Division of Urology, Department of Surgery, Western University, London, ON, Canada
| | - Ben H. Chew
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Shubha De
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Hazem Elmansy
- Urology, Northern Ontario School of Medicine, Thunder Bay, ON, Canada
| | | | - Kenneth T. Pace
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Trevor D. Schuler
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Rajiv K. Singal
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Peter Wang
- London Health Sciences Centre, Western University, London, ON, Canada
| | - Michael Ordon
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
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Sarica K, Ferhat M, Ohara R, Parmar S. Importance of precise imaging for stone identification during shockwave lithotripsy: a critical evaluation of "OptiVision" as a post-processing radiography imaging modality. Urolithiasis 2021; 50:87-93. [PMID: 34528109 DOI: 10.1007/s00240-021-01284-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 08/29/2021] [Indexed: 11/26/2022]
Abstract
To evaluate the efficacy of a unique imaging software "OptiVision" on the confidence of stone identification using X-ray imaging during shockwave lithotripsy. A total of 57 patients with solitary radio-opaque kidney stones sized < 15 mm were included and evaluated with appropriate radiological imaging and laboratory studies before undergoing shockwave lithotripsy (SWL). The size of the stones was measured on KUB and CT images using maximal stone diameters. All patients were evaluated with radiography on the Dornier Delta III immediately before SWL and at the end of the SWL session with fluoroscopy, a snapshot image, and the OptiVision modality (applied over the acquired snapshot image without additional radiation exposure) for precise identification of the stone. All images obtained with these three different imaging modalities (fluoroscopy, snapshot, and OptiVision) were comparatively evaluated for confidence levels in stone identification using a five-point Likert scale (1 = poor diagnostic confidence, 5 = excellent diagnostic confidence). These confidence levels were also used to differentiate between stones and bony structures using these same imaging modalities. Results were evaluated for statistical significance regarding their impact on the precise identification of renal stones. A total of 57 patients with solitary stones were evaluated using flouroscopy, snapshot, and OptiVision images before and after SWL to ascertain the efficacy of these 3 imaging modalities on the precise identification of the calculi. Stone sizes ranged from 4 to 15 mm, with a mean of 8.30 mm in the longest dimension. Evaluation of the findings demonstrated that while the pre- and post-SWL confidence of fluoroscopic stone identification was from 29.51 to 31.15%, the values using snapshot ranged from 31.15 to 39.34%. Pre- and post-SWL confidence of stone identification with OptiVision post-processing imaging was approximately 89%. In the majority of cases (n = 43), the use of OptiVision image processing enabled urologists to identify the stone with a higher level of confidence rating than the use of both fluoroscopy (n = 0) and snapshot (n = 0) image processing tools. While a rating level of 4 or higher was given in 89% of images obtained by OptiVision during the pre- and post-SWL phase, this value was only 37% (4 or more points) using fluoroscopy and Snapshot image processing techniques. For all the radiography image processing tools, the distribution of the Likert score differed significantly among the OptiVision, fluoroscopy, and snapshot imaging modalities (p < 0.001). Precise and reliable identification of stone(s) located in the kidney is essential in delivering shock waves to the desired focal point and achieving higher stone-free rates. Our findings demonstrated that using the specially designed imaging modality OptiVision was significantly helpful in identifying and localizing stones with high-quality images before SWL for effective stone disintegration during this procedure.
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Affiliation(s)
- Kemal Sarica
- Department of Urology, Biruni University, Medical School, Bahcelievler Medicana Hospital, Istanbul, Turkey
| | - Mehmet Ferhat
- Urology Clinic, Medicana Bahcelievler Hospital, Istanbul, Turkey.
| | - Rei Ohara
- Department of Urology, Musashino Yohwakai Hospital, Tokyo, Japan
| | - Sameer Parmar
- Global Clinical Application Manager, Dornier MedTech, Wessling, Germany
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Sides MB, Johnston SL, Sirek A, Lee PH, Blue RS, Antonsen EL, Basner M, Douglas GL, Epstein A, Flynn-Evans EE, Gallagher MB, Hayes J, Lee SMC, Lockley SW, Monseur B, Nelson NG, Sargsyan A, Smith SM, Stenger MB, Stepanek J, Zwart SR. Bellagio II Report: Terrestrial Applications of Space Medicine Research. Aerosp Med Hum Perform 2021; 92:650-669. [PMID: 34503618 DOI: 10.3357/amhp.5843.2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
AbstractINTRODUCTION: For over 50 yr, investigators have studied the physiological adaptations of the human system during short- and long-duration spaceflight exposures. Much of the knowledge gained in developing health countermeasures for astronauts onboard the International Space Station demonstrate terrestrial applications. To date, a systematic process for translating these space applications to terrestrial human health has yet to be defined.METHODS: In the summer of 2017, a team of 38 international scientists launched the Bellagio ll Summit Initiative. The goals of the Summit were: 1) To identify space medicine findings and countermeasures with highest probability for future terrestrial applications; and 2) To develop a roadmap for translation of these countermeasures to future terrestrial application. The team reviewed public domain literature, NASA databases, and evidence books within the framework of the five-stage National Institutes of Health (NIH) translation science model, and the NASA two-stage translation model. Teams then analyzed and discussed interdisciplinary findings to determine the most significant evidence-based countermeasures sufficiently developed for terrestrial application.RESULTS: Teams identified published human spaceflight research and applied translational science models to define mature products for terrestrial clinical practice.CONCLUSIONS: The Bellagio ll Summit identified a snapshot of space medicine research and mature science with the highest probability of translation and developed a Roadmap of terrestrial application from space medicine-derived countermeasures. These evidence-based findings can provide guidance regarding the terrestrial applications of best practices, countermeasures, and clinical protocols currently used in spaceflight.Sides MB, Johnston SL III, Sirek A, Lee PH, Blue RS, Antonsen EL, Basner M, Douglas GL, Epstein A, Flynn-Evans EE, Gallagher MB, Hayes J, Lee SMC, Lockley SW, Monseur B, Nelson NG, Sargsyan A, Smith SM, Stenger MB, Stepanek J, Zwart SR; Bellagio II Team. Bellagio II report: terrestrial applications of space medicine research. Aerosp Med Hum Perform. 2021; 92(8):650669.
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Rassweiler J, Rieker P, Pecha R, Dressel M, Rassweiler-Seyfried MCC. In-vitro comparison of two electromagnetic shock-wave generators: low-pressure-wide focus versus high-pressure small focus - the impact on initial stone fragmentation and final stone comminution. J Endourol 2021; 36:266-272. [PMID: 34314251 DOI: 10.1089/end.2021.0416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
CONTEXT Recently developed concepts for higher efficacy ESWL with low-pressure wide focus systems resulting in finer fragmentation of the calculi. OBJECTIVE To compare two different electromagnetic shock wave sources (low-pressure wide focus (XL) versus high-pressure small focus (SL)) by sound-field measurements and in-vitro fragmentation. EVIDENCE ACQUISITION The CS-2012A XX-ES lithotripter (self-focusing electromagnetic shock-wave generator with concave spherical curved electrical coil; Xinin Lithotripter = XL) was compared to the Siemens Lithoskop (= SL) (electromagnetic generator with a flat electric coil with an acoustical lens). Different sound-field measurements were performed using a fiber-optic hydrophone. Measurements at three different power settings (XL: 8.0kV, 9.3kV and 10.3kV; SL: Level 1, 5 and 8). 10 ATS-stones and 15 BegoStones (9.3 kV, Level 3) with a frequency of 90/minute (SL) and 20/minute (XL). Number of impulses to the first crack and for complete stone comminution (residual fragments <2mm) were documented. RESULTS The median number of shock waves for the first crack in ATS-stones with the XL was 12 (10-14), with the SL 7 (6-9). Complete disintegration was accomplished after 815 (782-824) shock waves with XL, 702 (688-712) with SL. The difference was not statistically significant. The median number of shock waves to produce the first crack in BegoStones was 524 (504-542) with XL and only 151 (137-161) with SL. Numbers of shock waves for complete disintegration did not differ significantly (XL:2518 vs SL:2287). Using a wide focus with low pressure shows more homogeneous disintegration. CONCLUSION Two stone models showed significant differences regarding form and time of the initial fragmentation. Impulses for stone comminution did not differ significantly. The advantages of a low-pressure wide focus-system include minimal trauma and a homogeneous fragment size but is more time consuming. High-pressure small focus systems are clinically effective.
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Affiliation(s)
- Jens Rassweiler
- Klinikum Heilbronn, Dept. of Urology, Am Gesundbrunnen 20-24, Heilbronn, Germany, 74078.,Germany;
| | - Philip Rieker
- SLK-Kliniken, University of Heidelberg, Urology, Heilbronn, Germany;
| | - Rainer Pecha
- University of Stuttgart, 9149, Institute of Physics,, Stuttgart, Baden-Württemberg, Germany;
| | - Martin Dressel
- University of Stuttgart, 9149, Insitute of Physics, Stuttgart, Baden-Württemberg, Germany;
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35
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Drug Delivery by Ultrasound-Responsive Nanocarriers for Cancer Treatment. Pharmaceutics 2021; 13:pharmaceutics13081135. [PMID: 34452096 PMCID: PMC8397943 DOI: 10.3390/pharmaceutics13081135] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 06/28/2021] [Accepted: 06/29/2021] [Indexed: 12/13/2022] Open
Abstract
Conventional cancer chemotherapies often exhibit insufficient therapeutic outcomes and dose-limiting toxicity. Therefore, there is a need for novel therapeutics and formulations with higher efficacy, improved safety, and more favorable toxicological profiles. This has promoted the development of nanomedicines, including systems for drug delivery, but also for imaging and diagnostics. Nanoparticles loaded with drugs can be designed to overcome several biological barriers to improving efficiency and reducing toxicity. In addition, stimuli-responsive nanocarriers are able to release their payload on demand at the tumor tissue site, preventing premature drug loss. This review focuses on ultrasound-triggered drug delivery by nanocarriers as a versatile, cost-efficient, non-invasive technique for improving tissue specificity and tissue penetration, and for achieving high drug concentrations at their intended site of action. It highlights aspects relevant for ultrasound-mediated drug delivery, including ultrasound parameters and resulting biological effects. Then, concepts in ultrasound-mediated drug delivery are introduced and a comprehensive overview of several types of nanoparticles used for this purpose is given. This includes an in-depth compilation of the literature on the various in vivo ultrasound-responsive drug delivery systems. Finally, toxicological and safety considerations regarding ultrasound-mediated drug delivery with nanocarriers are discussed.
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Bajaj M, Smith R, Rice M, Zargar-Shoshtari K. Predictors of success following extracorporeal shock-wave lithotripsy in a contemporary cohort. Urol Ann 2021; 13:282-287. [PMID: 34421266 PMCID: PMC8343291 DOI: 10.4103/ua.ua_155_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Accepted: 08/25/2020] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES The objectives of this study are to determine the predictors of success following extracorporeal shock-wave lithotripsy (ESWL) in a contemporary cohort at a high-volume stone center. METHODS We conducted a retrospective review all patients who underwent an elective ESWL within our institution over a 24-month period (January 2014 to December 2015). Data on patient demographics, stone variables, and inpatient treatment outcomes were evaluated.The presence of residual stone fragments larger than 4 mm on follow-up imaging was considered to be treatment failure. Using this threshold, clinically relevant variables between the treatment success and failure groups were identified. Multivariable logistic regression analyses (MVA) of clinically relevant variables were used to determine the independent factors predicting ESWL success. RESULTS Of 446 study eligible patients, 421 patients had complete follow-up data and were included in the analysis. Treatment was successful in 72.2% of patients in this study. Stone size, number of shocks delivered, and maximum treatment intensity were statistically different in the two groups. In a MVA where stone size, location, density, presence of ureteric stent, skin-stone distance (SSD), number of shocks, and maximum shock intensity were included, only stone size of <10 mm (odds ratio [OR] 3.4 [95% confidence interval [CI]: 1.98-5.84]) and SSD <15 cm (OR: 0.133, [95% CI: 0.027-0.65]) were the independent predictor of ESWL success. CONCLUSION We have demonstrated "real world" outcomes with high-volume use of ESWL. In our experience that with diligent patient selection, ESWL remains an effective tool for the management of upper tract calculi.
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Affiliation(s)
- Mohit Bajaj
- Department of Urology, Auckland City Hospital, Auckland, New Zealand
| | - Russell Smith
- Department of Urology, Auckland City Hospital, Auckland, New Zealand
| | - Michael Rice
- Department of Urology, Auckland City Hospital, Auckland, New Zealand
| | - Kamran Zargar-Shoshtari
- Department of Urology, Auckland City Hospital, Auckland, New Zealand
- Department of Urology, Counties Manukau Health, Auckland, New Zealand
- Department of Surgery, University of Auckland, Auckland, New Zealand
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de Oliveira PS, Ziegelmann MJ. Low-intensity shock wave therapy for the treatment of vasculogenic erectile dysfunction: a narrative review of technical considerations and treatment outcomes. Transl Androl Urol 2021; 10:2617-2628. [PMID: 34295748 PMCID: PMC8261418 DOI: 10.21037/tau-20-1286] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 12/31/2020] [Indexed: 12/27/2022] Open
Abstract
Erectile dysfunction (ED) impacts a significant portion of the aging male population. Standard treatments such as oral medications, intracavernosal injections, intraurethral suppositories, vacuum erection aids, and penile prosthesis placement have stood the test of time. Recently, there has been a growing interest in the concept of regenerative medicine with the goal of restoring or renewing functional tissue. Low intensity shock wave therapy (LiSWT) is one example of a regenerative therapy. A strong body of basic science data suggests that shockwaves, when applied to local tissue, will encourage blood vessel and nerve regeneration. Clinical evidence supports the use of LiSWT to treat conditions ranging from ischemic heart disease, musculoskeletal injuries, and even chronic non-healing wounds. LiSWT is also being used to treat male sexual dysfunction conditions such as Peyronie's Disease and ED. The first studied application of LiSWT for ED was published in 2010. Since then multiple randomized, sham-controlled trials have sought to evaluate outcomes for this novel therapy in men with vasculogenic ED. Additionally, several meta-analyses are available with pooled data suggesting that LiSWT results in a significantly greater improvement in erectile function relative to sham-control. Despite these promising findings, the current body of literature is marred by significant heterogeneity relating to treatment protocols, patient populations, and follow-up duration. Further work is necessary to determine optimal device technologies, patient characteristics, and treatment duration prior to considering LiSWT as standard of care for men with ED.
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Affiliation(s)
- Pedro Simoes de Oliveira
- Department of Urology, Centro Hospitalar Universitário Lisboa Norte, Hospital de Santa Maria, Lisbon, Portugal.,Centro Cardiovascular da Universidade de Lisboa, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
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38
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Kereiakes DJ, Virmani R, Hokama JY, Illindala U, Mena-Hurtado C, Holden A, Hill JM, Lyden SP, Ali ZA. Principles of Intravascular Lithotripsy for Calcific Plaque Modification. JACC Cardiovasc Interv 2021; 14:1275-1292. [PMID: 34167671 DOI: 10.1016/j.jcin.2021.03.036] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 02/23/2021] [Accepted: 03/16/2021] [Indexed: 01/14/2023]
Abstract
A significant proportion of lesions treated with transcatheter interventions in the coronary and peripheral vascular beds exhibit moderate to severe calcific plaques known to portend lower procedural success rates, increased peri-procedural adverse events, and unfavorable clinical outcomes compared with noncalcific plaques. Adapted from lithotripsy technology used for treatment of ureterorenal calculi, intravascular lithotripsy (IVL) is a novel technique for the treatment of severely calcific plaque lesions that uses acoustic shockwaves in a balloon-based delivery system. Shockwaves induce calcium fractures, which facilitate stent expansion and luminal gain. In this review, the authors summarize the physics, preclinical and clinical data on IVL use in the coronary and peripheral vasculature, and future directions of IVL in transcatheter cardiovascular therapies.
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Affiliation(s)
- Dean J Kereiakes
- The Christ Hospital and Lindner Research Center, Cincinnati, Ohio, USA.
| | - Renu Virmani
- Cardiovascular Pathology Institute, Gaithersburg, Maryland, USA
| | | | | | - Carlos Mena-Hurtado
- Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut, USA
| | | | | | | | - Ziad A Ali
- Columbia University Medical Center, New York, New York, USA
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Chen Z, Zeng DD, Seltzer RGN, Hamilton BD. Automated Generation of Personalized Shock Wave Lithotripsy Protocols: Treatment Planning Using Deep Learning. JMIR Med Inform 2021; 9:e24721. [PMID: 33973862 PMCID: PMC8150413 DOI: 10.2196/24721] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 12/31/2020] [Accepted: 04/11/2021] [Indexed: 12/23/2022] Open
Abstract
Background Though shock wave lithotripsy (SWL) has developed to be one of the most common treatment approaches for nephrolithiasis in recent decades, its treatment planning is often a trial-and-error process based on physicians’ subjective judgement. Physicians’ inexperience with this modality can lead to low-quality treatment and unnecessary risks to patients. Objective To improve the quality and consistency of shock wave lithotripsy treatment, we aimed to develop a deep learning model for generating the next treatment step by previous steps and preoperative patient characteristics and to produce personalized SWL treatment plans in a step-by-step protocol based on the deep learning model. Methods We developed a deep learning model to generate the optimal power level, shock rate, and number of shocks in the next step, given previous treatment steps encoded by long short-term memory neural networks and preoperative patient characteristics. We constructed a next-step data set (N=8583) from top practices of renal SWL treatments recorded in the International Stone Registry. Then, we trained the deep learning model and baseline models (linear regression, logistic regression, random forest, and support vector machine) with 90% of the samples and validated them with the remaining samples. Results The deep learning models for generating the next treatment steps outperformed the baseline models (accuracy = 98.8%, F1 = 98.0% for power levels; accuracy = 98.1%, F1 = 96.0% for shock rates; root mean squared error = 207, mean absolute error = 121 for numbers of shocks). The hypothesis testing showed no significant difference between steps generated by our model and the top practices (P=.480 for power levels; P=.782 for shock rates; P=.727 for numbers of shocks). Conclusions The high performance of our deep learning approach shows its treatment planning capability on par with top physicians. To the best of our knowledge, our framework is the first effort to implement automated planning of SWL treatment via deep learning. It is a promising technique in assisting treatment planning and physician training at low cost.
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Affiliation(s)
- Zhipeng Chen
- Shenzhen Artificial Intelligence and Data Science Institute (Longhua), Longhua, Shenzhen, China
| | - Daniel D Zeng
- The State Key Laboratory of Management and Control for Complex Systems, Institute of Automation, Chinese Academy of Sciences, Beijing, China
| | - Ryan G N Seltzer
- Translational Analytics and Statistics, Tucson, AZ, United States
| | - Blake D Hamilton
- School of Medicine, University of Utah, Salt Lake City, UT, United States
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40
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Ochoa A, Guillot-Tantay C, Misrai V, Rouprêt M. [Low-intensity extracorporeal shock wave therapy for erectile dysfunction: A systematic review]. Prog Urol 2021; 31:506-518. [PMID: 33941461 DOI: 10.1016/j.purol.2020.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 08/13/2020] [Accepted: 11/10/2020] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Our purpose was to assess the efficacy of low intensity extracorporeal shock waves (SW) for the treatment of organic erectile dysfunction (ED). METHODS A systematic review of the literature published between 2000 and 2020 was conducted using the PRISMA methodology. We used Medline data with the following key words (MesH): "extracorporeal shock wave therapy"; "erectile dysfunction"; "sexuality". RESULTS Nineteen articles were selected: thirteen randomised controlled trial and six meta-analyses. Most of them studied vascular etiology. Low intensity SW is beneficial ED is evaluated by the IIEF, EHS scores and penile hemodynamic. CONCLUSION SW may have a theoretical impact on the vascular etiology of organic DE. Their use in this context is supported by the European Society of urology and the European Society of sexual medecine. However, there are discrepancies in current data to establish a protocol to follow in daily practice.
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Affiliation(s)
- A Ochoa
- Sorbonne université, GRC 5 onco-urologie prédictive, Assistance publique-Hôpitaux de Paris, hôpital La Pitié Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - C Guillot-Tantay
- Sorbonne université, GRC 5 onco-urologie prédictive, Assistance publique-Hôpitaux de Paris, hôpital La Pitié Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - V Misrai
- Service d'urologie, Clinique Pasteur, Toulouse, France
| | - M Rouprêt
- Sorbonne université, GRC 5 onco-urologie prédictive, Assistance publique-Hôpitaux de Paris, hôpital La Pitié Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
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Kaygisiz O, Cicek MC, Mert A, Akesen S, Sarandol E, Kilicarslan H. Which frequency is better for pediatric shock wave lithotripsy? Intermediate or low: a prospective randomized study. World J Urol 2021; 39:3963-3969. [PMID: 33890144 DOI: 10.1007/s00345-021-03696-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 04/08/2021] [Indexed: 10/21/2022] Open
Abstract
PURPOSE Shock wave lithotripsy (SWL) is the first option in the treatment of pediatric kidney stones; however, optimal frequency is still uncertain. The aim of this study was to compare low frequency [60 shocks per minute (SWs/min)] and intermediate frequency [90 SWs/min] in terms of lithotripsy success, complications, cardiac arrhythmia, anesthesia time, secondary procedures, and efficiency quotient (EQ) in children. METHODS Seventy-eight consecutive children who received SWL for radiopaque renal stones between July 2016 and January 2020 were randomly divided into two groups: Group 60 (SWL frequency: 60 SWs/min) and Group 90 (SWL frequency: 90 SWs/min). After exclusion (remaining 71 children), Group 60 (n = 38) and Group 90 (n = 33) were compared using univariate analysis. RESULTS The median age of children (37 girls, 34 boys) was 5 (1-16) years. Patient demographics and stone features were similar between the groups. Success rate after the last SWL session was 81.6% (n = 31) for Group 60 and 87.9% (n = 29) for Group 90 (p = 0.527). Stone-free rate after the first, second, and third sessions was 42.1%, 18.4%, and 21.1% for Group 60 and 48.5%, 27.3%, and 12.1% for Group 90, respectively. Additional treatment rate was similar between the groups. In Group 60, the EQ was 57.83, and it was 64.07 in Group 90. Median total anesthesia time was significantly longer in Group 60 (74.5 min) than in Group 90 (32 min; p < 0.001). CONCLUSION Intermediate frequency and low-frequency pediatric SWL have similar success rates; however, intermediate-frequency SWL has a shorter anesthesia time.
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Affiliation(s)
- Onur Kaygisiz
- Department of Urology, Faculty of Medicine, Bursa Uludag University, Nilufer, Bursa, Turkey.
| | - Mehmet Cagatay Cicek
- Department of Urology, Faculty of Medicine, Bursa Uludag University, Nilufer, Bursa, Turkey
| | - Ahmet Mert
- Urology Clinic, Serik State Hospital, Turkish Ministry of Health, Serik, Antalya, Turkey
| | - Selcan Akesen
- Department of Anesthesiology, Faculty of Medicine, Bursa Uludag University, Nilufer, Bursa, Turkey
| | - Emre Sarandol
- Department of Biochemistry, Faculty of Medicine, Bursa Uludag University, Nilufer, Bursa, Turkey
| | - Hakan Kilicarslan
- Department of Urology, Faculty of Medicine, Bursa Uludag University, Nilufer, Bursa, Turkey
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Fawzy AM, Abdelkafy AA, Elahawy MM, Abdelgawad AH, Hasanein MGS, Abdelgawad AT, Magdi Ali M, Fathelbab TK, Galal EM. Contralateral Coupling During Extracorporeal Shockwave Lithotripsy for Stones in Ectopic Kidney: Is It Feasible? J Endourol 2021; 35:1090-1096. [PMID: 33544033 DOI: 10.1089/end.2020.1064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: Extracorporeal shockwave lithotripsy (SWL) results in a lower stone-free rate (SFR) for ectopic kidneys when using the standard technique, directing the shock wave from the same side of the stone; however, this may not be the optimal approach when the ectopic kidney is located more medial and anterior than the normally positioned kidney. Thus, contralateral coupling where waves come from the opposite direction may result in a better outcome. We tested the feasibility and outcome of contralateral coupling during SWL for stone in ectopic kidney. Materials and Methods: We prospectively recruited 20 patients with simple renal ectopia, who presented with renal stones that were amenable for SWL in the period between 2014 and 2018 at outpatient clinic of urology department, Minia University. Patients received SWL in Private Nile SWL Center were included to benefit from the ability of the electromagnetic SWL lithotripter. We did SWL in a supine position, and then contralateral coupling was performed from the opposite side of the affected kidney, rather than using the standard ipsilateral coupling approach. The SFR and various pre-, intra-, and postprocedural SWL variables were assessed, including stone characteristics, body habitus, shock wave numbers, and auxiliary measures. Count and percentages were calculated. Results: The mean stone radius was 14.7 mm with a mean S.T.O.N.E. (size, topography, obstructions, number of stones, and evaluation of HUs) of 9.6 points. Effective SWL was achieved in 80% of cases, 65% of them were stone free with effective single SWL session in 56% of cases. Hematuria, infection, and obstruction occurred in 50%, 20%, and 15% cases, respectively. One case required ureteral stent insertion. Conclusions: SWL applied through contralateral coupling is feasible, with comparable safety profile to the standard ipsilateral approach. Better SFR was achieved with the contralateral approach, in fewer sessions. However, the recruitment of more cases is necessary.
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Affiliation(s)
- Ahmed M Fawzy
- Faculty of Medicine, Minia Urology and Nephrology University Hospital, Minia University, Minia, Egypt.,Nile SWL Center, Minia, Egypt
| | - Amr Abdelhameed Abdelkafy
- Faculty of Medicine, Minia Urology and Nephrology University Hospital, Minia University, Minia, Egypt
| | - Mamdouh Mohamed Elahawy
- Faculty of Medicine, Minia Urology and Nephrology University Hospital, Minia University, Minia, Egypt
| | - Ahmed Hakeem Abdelgawad
- Faculty of Medicine, Minia Urology and Nephrology University Hospital, Minia University, Minia, Egypt
| | - Mohammed G S Hasanein
- Faculty of Medicine, Minia Urology and Nephrology University Hospital, Minia University, Minia, Egypt.,Nile SWL Center, Minia, Egypt
| | - Asmaa Taha Abdelgawad
- Faculty of Medicine, Minia Urology and Nephrology University Hospital, Minia University, Minia, Egypt
| | - Mostafa Magdi Ali
- Department of Urology, School of Medicine, Minia University, Minia, Egypt
| | - Tarek Khalaf Fathelbab
- Faculty of Medicine, Minia Urology and Nephrology University Hospital, Minia University, Minia, Egypt.,Nile SWL Center, Minia, Egypt
| | - Ehab Mohamed Galal
- Faculty of Medicine, Minia Urology and Nephrology University Hospital, Minia University, Minia, Egypt
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Ortac M, Özmez A, Cilesiz NC, Demirelli E, Kadıoğlu A. The impact of extracorporeal shock wave therapy for the treatment of young patients with vasculogenic mild erectile dysfunction: A prospective randomized single-blind, sham controlled study. Andrology 2021; 9:1571-1578. [PMID: 33780173 DOI: 10.1111/andr.13007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 03/16/2021] [Accepted: 03/19/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Low-intensity extracorporeal shock wave therapy (ESWT) for the treatment of vasculogenic erectile dysfunction (ED) has emerged as a promising method directly targeting the underlying pathophysiology of the disease. OBJECTIVES To compare outcomes in ED patients after ESWT and placebo treatment. MATERIALS AND METHODS Prospective randomized placebo-controlled single-blinded trial on 66 patients with mild ED. The study comprised a 4-week washout phase, a 4-week treatment phase, and a 48-week follow-up. Inclusion criteria included age between 18 and 75 years and diagnosis of mild ED (IIEF-EF score = 17-25) being made at least six months prior to study inclusion and being confirmed by Penile Doppler ultrasonography (US) at baseline examination. Efficacy endpoints were changes from baseline in patient-reported outcomes of erectile function (International Index of Erectile Function domain scores [IIEF-EF]), as well as erection hardness and duration (Sexual Encounter Profile diary [SEP] and Global Assessment Questions [GAQ]). Safety was assessed throughout the study. RESULTS A total of 66 enrolled patients were allocated to ESWT (n = 44) or placebo (n = 22). Mean age of ESWT and placebo group was 42.32 ± 9.88 and 39.86 ± 11.64 (p = 0.374), respectively. Mean baseline IIEF-EF scores of ESWT group and placebo were 20.32 ± 2.32 and 19.68 ± 1.55 respectively (p = 0.34). At 3-months follow-up, mean IIEF-EF scores were significantly higher in ESWT patients than in placebo patients (23.10 ± 2.82 vs. 20.95 ± 2.19, p = 0.003), and IIEF-EF scores of ESWT patients remained high during the 6 months (22.67 ± 3.35 vs. 19.82 ± 1.56) follow-up. The percentage of patients reporting both successful penetration (SEP2) and intercourse (SEP3) in more than 50% of attempts was significantly higher in ESWT-treated patients than in placebo patients (p = 0.001). A minimal clinically important difference between the IIEF = EF baseline and 3-months follow-up was found in 74% of ESWT and 36% of placebo. No serious adverse events were reported. DISCUSSION AND CONCLUSION ESWT significantly improved the erectile function of relatively young patients with vasculogenic mild ED when compared to placebo and the beneficial effect of this treatment up to 6 months. These findings suggest that ESWT could be a useful treatment option in vasculogenic ED.
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Affiliation(s)
- Mazhar Ortac
- Urology Department, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Abdulkadir Özmez
- Urology Department, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Nusret Can Cilesiz
- Urology Department, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Erhan Demirelli
- Urology Department, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ateş Kadıoğlu
- Urology Department, Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Lee W, Weisholtz DS, Strangman GE, Yoo SS. Safety Review and Perspectives of Transcranial Focused Ultrasound Brain Stimulation. BRAIN & NEUROREHABILITATION 2021; 14:e4. [PMID: 36742103 PMCID: PMC9879416 DOI: 10.12786/bn.2021.14.e4] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 02/17/2021] [Accepted: 03/04/2021] [Indexed: 11/08/2022] Open
Abstract
Ultrasound is an important theragnostic modality in modern medicine. Technical advancement of both acoustic focusing and transcranial delivery have enabled administration of ultrasound waves to localized brain areas with few millimeters of spatial specificity and penetration depth sufficient to reach the thalamus. Transcranial focused ultrasound (tFUS) given at a low acoustic intensity has been shown to increase or suppress the excitability of region-specific brain areas. The neuromodulatory effects can outlast the sonication, suggesting the possibility of inducing neural plasticity needed for neurorehabilitation. Increasing numbers of studies have shown the efficacy and excellent safety profile of the technique, yet comparisons among the safety-related parameters have not been compiled. This review aims to provide safety information and perspectives of tFUS brain stimulation. First, the acoustic parameters most relevant to thermal/mechanical tissue damage are discussed along with regulated parameters for existing ultrasound therapies/diagnostic imaging. Subsequently, the parameters used in studies of large animals, non-human primates, and humans are surveyed and summarized in terms of the acoustic intensity and the mechanical index. The pulse-mode operation and the use of low ultrasound frequency for tFUS-mediated brain stimulation warrant the establishment of new safety guidelines/recommendations for the use of the technique among healthy volunteers, with additional cautionary requirements for its clinical translation.
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Affiliation(s)
- Wonhye Lee
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Daniel S. Weisholtz
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Gary E. Strangman
- Neural Systems Group, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
- Center for Space Medicine, Baylor College of Medicine, Houston, TX, USA
- Translational Research Institute, Houston, TX, USA
| | - Seung-Schik Yoo
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Li G, Man L. Low-intensity extracorporeal shock wave therapy for male chronic pelvic pain syndrome: a systematic review and meta-analysis. Transl Androl Urol 2021; 10:1202-1211. [PMID: 33850755 PMCID: PMC8039608 DOI: 10.21037/tau-20-1423] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background A systematic review of the evidence was conducted to evaluate the efficacy of low-intensity extracorporeal shock wave therapy (LI-ESWT) for patients with chronic pelvic pain syndrome (CPPS). Methods A comprehensive search was undertaken of the Cochrane Register, PubMed, and Embase databases for controlled trials that evaluated patients with CPPS who were treated with LI-ESWT and that were published before August 2019. The National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) was the most frequently used tool to evaluate the treatment efficacy of LI-ESWT. The NIH-CPSI comprises subscales for pain [using a visual analog scale (VAS)], urinary function, and quality of life (QoL). Results Six studies analyzing 317 patients were published from 2009 to 2019. The overall meta-analysis of the data indicated that LI-ESWT demonstrated efficacy in the treatment of CPPS at 12 weeks [risk difference (RD): 0.46; 95% confidence interval (CI), 0.28–0.63; P<0.00001]. The studies were divided into 3 groups based on time after LI-ESWT (1, 12, and 24 weeks) and were compared in total NIH-CPSI scores, QoL, VAS scores, and urinary symptoms. The total NIH-CPSI scores, QoL, VAS scores, and urinary symptom scores improved significantly at 12 weeks after LI-ESWT (P<0.05), but not at 1 week or 24 weeks (P>0.05). Conclusions Based on these studies, LI-ESWT may transiently improve the total NIH-CPSI scores, QoL, pain scores, and urinary symptom scores of patients with CPPS. Future research may elucidate the mechanisms underlying the effects of LI-ESWT on CPPS. Well-designed and long-term multicenter randomized controlled trials are urgently needed to estimate the real potential and ultimate use of these devices in patients with CPPS.
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Affiliation(s)
- Guizhong Li
- Department of Urology, Beijing Jishuitan Hospital, Beijing, China
| | - Libo Man
- Department of Urology, Beijing Jishuitan Hospital, Beijing, China
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Rassweiler JJ, Rassweiler-Seyfried MC. Therapieverfahren – extrakorporale Stoßwellentherapie. Urolithiasis 2021. [DOI: 10.1007/978-3-662-62454-8_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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47
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[Stone therapy-use and limitations of the guidelines]. Urologe A 2020; 59:1498-1503. [PMID: 33237370 DOI: 10.1007/s00120-020-01394-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Increase of medical knowledge, technical innovation together with a demographic change, and increase of stone incidence in daily practice challenges guideline preparation and clinical studies. Increasing interdisciplinary collaboration in stone treatment can also be demonstrated in the number of affiliated professional and working groups in the current guideline update. The following case illustrates treatment options in a symptomatic patient harbouring bilateral stones and metabolic risk factors. Decision guidance for treatment and recurrence prevention measures are presented on the basis of expert opinion and available published evidence.
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A review of ultrasound-mediated microbubbles technology for cancer therapy: a vehicle for chemotherapeutic drug delivery. JOURNAL OF RADIOTHERAPY IN PRACTICE 2020. [DOI: 10.1017/s1460396919000633] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
AbstractBackground:The unique behaviour of microbubbles under ultrasound acoustic pressure makes them useful agents for drug and gene delivery. Several studies have demonstrated the potential application of microbubbles as a non-invasive, safe and effective technique for targeted delivery of drugs and genes. The drugs can be incorporated into the microbubbles in several different approaches and then carried to the site of interest where it can be released by destruction of the microbubbles using ultrasound to achieve the required therapeutic effect.Methods:The objective of this article is to report on a review of the recent advances of ultrasound-mediated microbubbles as a vehicle for delivering drugs and genes and its potential application for the treatment of cancer.Conclusion:Ultrasound-mediated microbubble technology has the potential to significantly improve chemotherapy drug delivery to treatment sites with minimal side effects. Moreover, the technology can induce temporary and reversible changes in the permeability of cells and vessels, thereby allowing for drug delivery in a spatially localised region which can improve the efficiency of drugs with poor bioavailability due to their poor absorption, rapid metabolism and rapid systemic elimination.
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Ochoa A, Guillot-Tantay C, Faix A, Misrai V, Rouprêt M. Traitement de la maladie de Lapeyronie par ondes de choc extracorporelles. Prog Urol 2020; 30:488-499. [DOI: 10.1016/j.purol.2020.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 03/31/2020] [Accepted: 04/03/2020] [Indexed: 12/01/2022]
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Lajoinie G, Visscher M, Blazejewski E, Veldhuis G, Versluis M. Three-phase vaporization theory for laser-activated microcapsules. PHOTOACOUSTICS 2020; 19:100185. [PMID: 32775197 PMCID: PMC7399189 DOI: 10.1016/j.pacs.2020.100185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 04/15/2020] [Accepted: 04/22/2020] [Indexed: 06/11/2023]
Abstract
Precision control of vaporization, both in space and time, is critical for numerous applications, including medical imaging and therapy, catalysis and energy conversion, and it can be greatly improved through the use of micro- or nano-sized light absorbers. Ultimately, optimization of these applications also requires a fundamental understanding of the vaporization process. Upon laser irradiation, polymeric microcapsules containing a dye can vaporize, leading to the growth of a vapor bubble that emits a strong acoustic signature. Here, we compare laser-activated capsules containing either a volatile or a non-volatile oil core. We theoretically explore the vaporization of the capsules based on a three-phase thermodynamics model, that accounts for the partial vaporization of both the surrounding fluid and the oil core as well as for the interaction between heat transfer and microbubble growth. The model is compared to ultra-high-speed imaging experiments, where we record the cavitation events. Theory and experiments are in convincing agreement.
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Affiliation(s)
- Guillaume Lajoinie
- Physics of Fluids Group, Technical Medical (TechMed) Center and MESA+ Institute for Nanotechnology, University of Twente, P.O. Box 217, 7500 AE Enschede, The Netherlands
| | - Mirjam Visscher
- Physics of Fluids Group, Technical Medical (TechMed) Center and MESA+ Institute for Nanotechnology, University of Twente, P.O. Box 217, 7500 AE Enschede, The Netherlands
- Department of Biomedical Engineering, Thorax Center, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Emilie Blazejewski
- Nanomi Monosphere Technology, Zutphenstraat 51, 7575 EJ Oldenzaal, The Netherlands
| | - Gert Veldhuis
- Nanomi Monosphere Technology, Zutphenstraat 51, 7575 EJ Oldenzaal, The Netherlands
| | - Michel Versluis
- Physics of Fluids Group, Technical Medical (TechMed) Center and MESA+ Institute for Nanotechnology, University of Twente, P.O. Box 217, 7500 AE Enschede, The Netherlands
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