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Holmes AE, Chew BH, Laughlin R, Buckley J, Kiewice E, Dancel MJ, Blasko D, Wong VKF, Halawani A, Koo KC, Corl D, Fasolo P, Levy O, Thiel J, Bailey MR, Eichman J, Meegan JM, Haulena M. Application of novel burst wave lithotripsy and ultrasonic propulsion technology for the treatment of ureteral calculi in a bottlenose dolphin (Tursiops truncatus) and renal calculi in a harbor seal (Phoca vitulina). Urolithiasis 2024; 52:21. [PMID: 38189835 PMCID: PMC10774161 DOI: 10.1007/s00240-023-01515-6] [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: 10/12/2023] [Accepted: 11/29/2023] [Indexed: 01/09/2024]
Abstract
Marine mammals may develop kidney stones, which can be challenging to treat. We describe burst wave lithotripsy (BWL) and ultrasonic propulsion to treat ureteral calculi in a 48-year-old female bottlenose dolphin (Tursiops truncatus) and to reduce renal stone burden in a 23-year-old male harbor seal (Phoca vitulina). BWL and ultrasonic propulsion were delivered transcutaneously in sinusoidal ultrasound bursts to fragment and reposition stones. Targeting and monitoring were performed with real-time imaging integrated within the BWL system. Four dolphin stones were obtained and fragmented ex vivo. The dolphin case received a 10-min and a 20-min BWL treatment conducted approximately 24 h apart to treat two 8-10 mm partially obstructing right mid-ureteral stones, using oral sedation alone. For the harbor seal, while under general anesthesia, retrograde ureteroscopy attempts were unsuccessful because of ureteral tortuosity, and a 30-min BWL treatment was targeted on one 10-mm right kidney stone cluster. All 4 stones fragmented completely to < 2-mm fragments in < 20 min ex vivo. In the dolphin case, the ureteral stones appeared to fragment, spread apart, and move with ultrasonic propulsion. On post-treatment day 1, the ureteral calculi fragments shifted caudally reaching the ureteral orifice on day 9. On day 10, the calculi fragments passed, and the hydroureter resolved. In the harbor seal, the stone cluster was observed to fragment and was not visible on the post-operative computed tomography scan. The seal had gross hematuria and a day of behavior indicating stone passage but overall, an uneventful recovery. BWL and ultrasonic propulsion successfully relieved ureteral stone obstruction in a geriatric dolphin and reduced renal stone burden in a geriatric harbor seal.
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Affiliation(s)
- Arturo E Holmes
- Dept. of Urology, University of Washington School of Medicine, Seattle, WA, USA
| | - Ben H Chew
- Department of Urological Sciences, University of British Columbia, Stone Centre at Vancouver General Hospital, British Columbia, Vancouver, Canada
| | - Robert Laughlin
- The Mirage Hotel, Hard Rock International, Las Vegas, NV, USA
| | - Jean Buckley
- Department of Urological Sciences, University of British Columbia, Stone Centre at Vancouver General Hospital, British Columbia, Vancouver, Canada
| | - Erica Kiewice
- The Mirage Hotel, Hard Rock International, Las Vegas, NV, USA
| | | | - David Blasko
- The Mirage Hotel, Hard Rock International, Las Vegas, NV, USA
| | - Victor K F Wong
- Department of Urological Sciences, University of British Columbia, Stone Centre at Vancouver General Hospital, British Columbia, Vancouver, Canada
| | | | - Kyo Chul Koo
- Department of Urology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | | | | | | | - Jeff Thiel
- Ctr. for Industrial and Medical Ultrasound, Applied Physics Lab, Univ. of Washington, Washington, USA
| | - Michael R Bailey
- Dept. of Urology, University of Washington School of Medicine, Seattle, WA, USA.
- Ctr. for Industrial and Medical Ultrasound, Applied Physics Lab, Univ. of Washington, Washington, USA.
| | - Jammy Eichman
- National Marine Mammal Foundation, San Diego, CA, USA
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Qiu M, Zhang T, Zhang Y, Liang T, Chen J, Gao H. Physical Techniques to Remove Residual Stone Fragments in the Urinary System. Urol Int 2023; 108:9-19. [PMID: 38008076 PMCID: PMC10836958 DOI: 10.1159/000535298] [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: 07/17/2023] [Accepted: 10/26/2023] [Indexed: 11/28/2023]
Abstract
BACKGROUND Although significant progress has been made in treatment techniques for renal and ureteral calculi, residual fragments (RF) persisting long after treatment pose a serious threat to patients' health. A variety of novel physical techniques and extraction devices are currently being developed to promote the removal of RF from the urinary system, and a series of in vivo experiments have demonstrated their safety and efficacy. SUMMARY External physical vibration lithecbole, magnetic extraction, biocompatible stone adhesive-based methods, and ultrasonic propulsion technologies are examples of innovative therapies that can promote the clearance of RF and improve the stone-free rate. In conclusion, the physical treatment of these RF needs to be optimized and improved. They are a promising technique for improving the efficiency of endovascular urology, and further in vivo studies are needed to confirm their safety and efficacy. KEY MESSAGES We have summarized the literature on removal of RF by physical methods in recent years, especially the new progress.
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Affiliation(s)
- Minhua Qiu
- Graduate School, Guangxi University of Chinese Medicine, Nanning, China
| | - Ting Zhang
- Graduate School, Guangxi University of Chinese Medicine, Nanning, China
- Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine, Nanning, China
| | - Yingying Zhang
- Graduate School, Guangxi University of Chinese Medicine, Nanning, China
- Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine, Nanning, China
| | - Taisheng Liang
- Graduate School, Guangxi University of Chinese Medicine, Nanning, China
- Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine, Nanning, China
| | - Jibing Chen
- Graduate School, Guangxi University of Chinese Medicine, Nanning, China
- Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine, Nanning, China
| | - Hongjun Gao
- Graduate School, Guangxi University of Chinese Medicine, Nanning, China
- Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine, Nanning, China
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Sorensen MD, Bailey MR, Harper JD. Reply to Wei Wang and Guowei Shi's Letter to the Editor re: Mathew D. Sorensen, Jonathan D. Harper, Michael S. Borofsky, et al. Removal of Small, Asymptomatic Kidney Stones and Incidence of Relapse. N Engl J Med 2022;387:506-13. Eur Urol 2023; 83:e80-e81. [PMID: 36526490 PMCID: PMC10037314 DOI: 10.1016/j.eururo.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 12/01/2022] [Indexed: 12/15/2022]
Affiliation(s)
- Mathew D Sorensen
- University of Washington, Seattle, WA, USA; VA Puget Sound Health Care System, Seattle, WA, USA
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4
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Microbubbles for human diagnosis and therapy. Biomaterials 2023; 294:122025. [PMID: 36716588 DOI: 10.1016/j.biomaterials.2023.122025] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 01/17/2023] [Accepted: 01/24/2023] [Indexed: 01/26/2023]
Abstract
Microbubbles (MBs) were observed for the first time in vivo as a curious consequence of quick saline injection during ultrasound (US) imaging of the aortic root, more than 50 years ago. From this serendipitous event, MBs are now widely used as contrast enhancers for US imaging. Their intrinsic properties described in this review, allow a multitude of designs, from shell to gas composition but also from grafting targeting agents to drug payload encapsulation. Indeed, the versatile MBs are deeply studied for their dual potential in imaging and therapy. As presented in this paper, new generations of MBs now opens perspectives for targeted molecular imaging along with the development of new US imaging systems. This review also presents an overview of the different therapeutic strategies with US and MBs for cancer, cardiovascular diseases, and inflammation. The overall aim is to overlap those fields in order to find similarities in the MBs application for treatment enhancement associated with US. To conclude, this review explores the new scales of MBs technologies with nanobubbles development, and along concurrent advances in the US imaging field. This review ends by discussing perspectives for the booming future uses of MBs.
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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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Raskolnikov D, Bailey MR, Harper JD. Recent Advances in the Science of Burst Wave Lithotripsy and Ultrasonic Propulsion. BME FRONTIERS 2022; 2022. [PMID: 37090444 PMCID: PMC10117400 DOI: 10.34133/2022/9847952] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Nephrolithiasis is a common, painful condition that requires surgery in many patients whose stones do not pass spontaneously. Recent technologic advances have enabled the use of ultrasonic propulsion to reposition stones within the urinary tract, either to relieve symptoms or facilitate treatment. Burst wave lithotripsy (BWL) has emerged as a noninvasive technique to fragment stones in awake patients without significant pain or renal injury. We review the preclinical and human studies that have explored the use of these two technologies. We envision that BWL will fill an unmet need for the noninvasive treatment of patients with nephrolithiasis.
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Affiliation(s)
- Dima Raskolnikov
- Department of Urology, University of Washington School of Medicine, 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
| | - Jonathan D. Harper
- Department of Urology, University of Washington School of Medicine, Seattle, WA, USA
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7
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Do MT, Ly TH, Choi MJ, Cho SY. Clinical application of the therapeutic ultrasound in urologic disease: Part II of the therapeutic ultrasound in urology. Investig Clin Urol 2022; 63:394-406. [PMID: 35670002 PMCID: PMC9262482 DOI: 10.4111/icu.20220060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 03/14/2022] [Accepted: 03/17/2022] [Indexed: 11/18/2022] Open
Abstract
This article aimed to review the clinical application and evidence of the therapeutic ultrasound in detail for urological diseases such as prostate cancer, kidney tumor, erectile dysfunction, and urolithiasis. We searched for articles about high-intensity focused ultrasound (HIFU), extracorporeal shock wave therapy, ultrasound lithotripsy, and extracorporeal shockwave lithotripsy (ESWL) in the MEDLINE and Embase. HIFU may be indicated as a primary treatment for low- or intermediate-risk prostate cancer, and salvage therapy for local recurrence as a promising way to address the limitations of current standard therapies. The application of HIFU in treating kidney tumors has scarcely been reported with unsatisfactory results. Evidence indicates that low-intensity shockwave therapy improves subjective and objective erectile function in patients with erectile dysfunction. Regarding the application of ultrasound in stone management, the novel combination of ultrasound lithotripsy and other energy sources in a single probe promises to be a game-changer in efficiently disintegrating large kidney stones in percutaneous nephrolithotomy. ESWL is losing its role in managing upper urinary tract calculi worldwide. The burst-wave lithotripsy and ultrasound propulsion could be the new hope to regain its position in the lithotripsy field. According to our investigations and reviews, cavitation bubbles of the therapeutic ultrasound are actively being used in the field of urology. Although clinical evidence has been accumulated in urological diseases such as prostate cancer, kidney tumor, erectile dysfunction, and lithotripsy, further development is needed to be a game-changer in treating these diseases.
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Affiliation(s)
- Minh-Tung Do
- Department of Surgery, Hai Phong University of Medicine and Pharmacy, Hai Phong, Viet Nam
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - Tam Hoai Ly
- Department of Urology, Cho Ray Hospital, Ho Chi Minh City, Viet Nam
| | - Min Joo Choi
- Department of Medicine, Jeju National University College of Medicine, Jeju, Korea
| | - Sung Yong Cho
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
- Department of Urology, Seoul National University Hospital, Seoul, Korea
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8
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Yang T, Song R, Meng X, Wei H, Jiang X, Yuan X, Liu X, Jiao Z, Liu J, Shi H. A single center study that evaluates the preclinical use of a newly developed software and moving bed system to facilitate the spontaneous excretion of residual fragments after primary stone treatment (RIRS or PCNL). World J Urol 2021; 40:585-591. [PMID: 34687345 PMCID: PMC8921061 DOI: 10.1007/s00345-021-03863-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 10/07/2021] [Indexed: 11/27/2022] Open
Abstract
Purpose We developed a Postural Drainage Lithotripsy System (PDLS) that uses the patient's computed tomography urography (CTU) data to reconstruct the three-dimensional figure of the renal pelvis, provides an individualized inversion and overturning angle and uses gravity to remove residual fragments (RFs). The purpose of this study was to investigate PDLS in the treatment of renal RFs. Methods A stone with a diameter of 4.0 mm was placed in the upper, middle, and lower calyx of the renal model. A total of 60 trials were applied to 20 renal models. The movement trajectory, passage rate, and postural drainage angle of calculi during the treatment of PDLS were observed. Results All of the stones in 60 trials were observed to move during treatment, and 53/60 (88%) were relocated successfully to the renal pelvis. The passage rate of the upper calyx was 14/20 (70%), that of the middle calyx was 20/20 (100%), and that of the lower calyx was 19/20 (95%). Conclusions PDLS can provide individualized inversion and reversal angles and remove stones from the renal model. More clinical trials are needed to verify the above view and evaluate its efficacy. Supplementary Information The online version contains supplementary material available at 10.1007/s00345-021-03863-7.
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Affiliation(s)
- Tao Yang
- Department of Urology, Wujin Hospital Affiliated with Jiangsu University, Changzhou, 213004, China.,Department of Urology, The Wujin Clinical College of Xuzhou Medical University, Changzhou, 213004, China
| | - Rijin Song
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Xianghu Meng
- Department of Urology, Wujin Hospital Affiliated with Jiangsu University, Changzhou, 213004, China.,Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Hanping Wei
- Department of Urology, Wujin Hospital Affiliated with Jiangsu University, Changzhou, 213004, China.,Department of Urology, The Wujin Clinical College of Xuzhou Medical University, Changzhou, 213004, China
| | - Xinying Jiang
- Department of Urology, Wujin Hospital Affiliated with Jiangsu University, Changzhou, 213004, China.,Department of Urology, The Wujin Clinical College of Xuzhou Medical University, Changzhou, 213004, China
| | - Xiaoliang Yuan
- Department of Urology, Wujin Hospital Affiliated with Jiangsu University, Changzhou, 213004, China.,Department of Urology, The Wujin Clinical College of Xuzhou Medical University, Changzhou, 213004, China
| | - Xiaowu Liu
- Department of Urology, Wujin Hospital Affiliated with Jiangsu University, Changzhou, 213004, China.,Department of Urology, The Wujin Clinical College of Xuzhou Medical University, Changzhou, 213004, China
| | - Zhimin Jiao
- Department of Urology, Wujin Hospital Affiliated with Jiangsu University, Changzhou, 213004, China.,Department of Urology, The Wujin Clinical College of Xuzhou Medical University, Changzhou, 213004, China
| | - Jun Liu
- Department of Urology, The 940th Hospital of PLA Joint Logistics Support Force, Lanzhou, 730050, China
| | - Honglei Shi
- Department of Urology, Wujin Hospital Affiliated with Jiangsu University, Changzhou, 213004, China. .,Department of Urology, The Wujin Clinical College of Xuzhou Medical University, Changzhou, 213004, China.
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Harper JD, Metzler I, Hall MK, Chen TT, Maxwell AD, Cunitz BW, Dunmire B, Thiel J, Williams JC, Bailey MR, Sorensen MD. First In-Human Burst Wave Lithotripsy for Kidney Stone Comminution: Initial Two Case Studies. J Endourol 2021; 35:506-511. [PMID: 32940089 PMCID: PMC8080914 DOI: 10.1089/end.2020.0725] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: To test the effectiveness (Participant A) and tolerability (Participant B) of urinary stone comminution in the first-in-human trial of a new technology, burst-wave lithotripsy (BWL). Materials and Methods: An investigational BWL and ultrasonic propulsion system was used to target a 7-mm kidney stone in the operating room before ureteroscopy (Participant A). The same system was used to target a 7.5 mm ureterovesical junction stone in clinic without anesthesia (Participant B). Results: For Participant A, a ureteroscope inserted after 9 minutes of BWL observed fragmentation of the stone to <2 mm fragments. Participant B tolerated the procedure without pain from BWL, required no anesthesia, and passed the stone on day 15. Conclusions: The first-in-human tests of BWL pulses were successful in that a renal stone was comminuted in <10 minutes, and BWL was also tolerated by an awake subject for a distal ureteral stone. Clinical Trial NCT03873259 and NCT02028559.
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Affiliation(s)
- Jonathan D. Harper
- Department of Urology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Ian Metzler
- Department of Urology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Michael Kennedy Hall
- Department of Emergency Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Tony T. Chen
- Department of Urology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Adam D. Maxwell
- Department of Urology, University of Washington School of Medicine, Seattle, Washington, USA
- Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, Seattle, Washington, USA
| | - Bryan W. Cunitz
- Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, Seattle, Washington, USA
| | - Barbrina Dunmire
- Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, Seattle, Washington, USA
| | - Jeff Thiel
- Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, Seattle, Washington, USA
| | - James C. Williams
- Department of Anatomy, Cell Biology & Physiology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Michael R. Bailey
- Department of Urology, University of Washington School of Medicine, Seattle, Washington, USA
- Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, Seattle, Washington, USA
| | - Mathew D. Sorensen
- Department of Urology, University of Washington School of Medicine, Seattle, Washington, USA
- Division of Urology, VA Puget Sound Health Care System, Seattle, Washington, USA
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10
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Hall MK, Samson PC, Kessler R, Lehnhardt K, Easter B, Thiel J, Wessells H, Bailey MR, Harper JD. Pearl-unjammed: the Seattle stone maneuver for ureteropelvic junction urolithiasis. J Am Coll Emerg Physicians Open 2020; 1:252-256. [PMID: 32613205 PMCID: PMC7329006 DOI: 10.1002/emp2.12047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Renal colic encounters are common; in the United States alone, they represent greater than one million annual emergency department (ED) visits. Most of these stones are managed conservatively with a trial of passage. However, some lead to repeat colic episodes, secondary ED visits, increased anxiety, and increased cost. Of the 5%-10% of symptomatic stones that become lodged at the ureteropelvic junction and are larger than 5 mm, most require operative intervention. In the process of executing a NASA-funded study of ultrasonic repositioning of kidney stones, the subject was administered fluid to dilate the collecting system, placed in Trendelenburg bed positioning, and rolled to both sides. During this process a symptomatic, obstructing 9-mm ureteropelvic junction stone moved back into the kidney's lower pole/infundibulum and symptoms were immediately resolved. The patient remained asymptomatic for a period of 5 weeks at which point elective intervention was scheduled. This case demonstrates that ureteropelvic junction stones may be repositioned in a non-invasive manner, turning a stone that requires urgent intervention into one that can be managed electively.
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Affiliation(s)
- M Kennedy Hall
- Department of Emergency Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Patrick C Samson
- Department of Urology, Weill Medical College of Cornell University, New York, New York
| | - Ross Kessler
- Department of Emergency Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Kris Lehnhardt
- Department of Emergency Medicine and Center for Space Medicine, Baylor College of Medicine, Houston, Texas.,Exploration Medical Capability, Human Research Program, NASA Johnson Space Center, Houston, Texas
| | - Benjamin Easter
- Exploration Medical Capability, Human Research Program, NASA Johnson Space Center, Houston, Texas.,Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Jeff Thiel
- Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, Seattle, Washington
| | - Hunter Wessells
- Department of Urology, University of Washington School of Medicine, Seattle, Washington
| | - Michael R Bailey
- Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, Seattle, Washington.,Department of Urology, University of Washington School of Medicine, Seattle, Washington
| | - Jonathan D Harper
- Department of Urology, University of Washington School of Medicine, Seattle, Washington
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11
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In-Office Ultrasound Facilitates Timely Clinical Care at a Multidisciplinary Kidney Stone Center. UROLOGY PRACTICE 2020; 7:167-173. [PMID: 32613031 DOI: 10.1097/upj.0000000000000082] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Introduction A considerable publication record exists comparing sensitivity and specificity of radiological ultrasound (including point of care ultrasound) to computerized tomography for stone disease. However, the practical application of in-office ultrasound to support the growing number of kidney stone centers around the world represents a nuanced topic that is ripe for study and discussion. Methods We provide a descriptive analysis of how in-office ultrasound is being used as an adjunct to clinical care based on our experience during 50 days in clinic at an institutionally affiliated, multidisciplinary kidney stone center. Clinic subjects gave consent and underwent ultrasound as part of research studies. Ultrasonograms were shared with and verified by the treating physician before the patient was discharged from care. We counted the number of times research imaging altered the care plan. Results Of the 60 patients enrolled the clinician used the information obtained from the studies in 20 (33%) to determine the course of clinical care that resulted in a change in treatment or process. Conclusions Ultrasound has the potential to be a cost-effective and valuable tool that can provide more efficient workflow within a kidney stone center or urology clinic.
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12
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Abstract
PURPOSE OF REVIEW Burst wave lithotripsy and ultrasonic propulsion of kidney stones are novel, noninvasive emerging technologies to separately or synergistically fragment and reposition stones in an office setting. The purpose of this review is to discuss the latest refinements in technology, to update on testing of safety and efficacy, and to review future applications. RECENT FINDINGS Burst wave lithotripsy produced consistent, small passable fragments through transcutaneous applications in a porcine model, while producing minimal injury and clinical trials are now underway. A more efficient ultrasonic propulsion design that can also deliver burst wave lithotripsy effectively repositioned 95% of stones in 18 human participants (18 of 19 kidneys) and clinical trials continue. Acoustic tractor beam technology is an emerging technology with promising clinical applications through the manipulation of macroscopic objects. SUMMARY The goal of the reviewed work is an office-based system to image, fragment, and reposition urinary stones to facilitate their natural passage. The review highlights progress in establishing safety, effectiveness, and clinical benefit of these new technologies. The work is also anticipating challenges in clinical trials and developing the next generation of technology to improve on the technology as it is being commercialized today.
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Affiliation(s)
- Tony T. Chen
- Department of Urology, University of Washington, Seattle, WA, USA
| | | | | | - Michael R. Bailey
- Department of Urology, University of Washington, Seattle, WA, USA
- Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, Seattle, WA, USA
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