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de Icaza-Herrera M et al, 2015: Combined short and long-delay tandem shock waves to improve shock wave lithotripsy according to the Gilmore-Akulichev theory.

de Icaza-Herrera M, Fernández F, Loske AM
Centro de Física Aplicada y Tecnología Avanzada, Universidad Nacional Autónoma de México, Boulevard Juriquilla 3001, Querétaro, Qro. 76230, Mexico.

Abstract

Extracorporeal shock wave lithotripsy is a common non-invasive treatment for urinary stones whose fragmentation is achieved mainly by acoustic cavitation and mechanical stress. A few years ago, in vitro and in vivo experimentation demonstrated that such fragmentation can be improved, without increasing tissue damage, by sending a second shock wave hundreds of microseconds after the previous wave. Later, numerical simulations revealed that if the second pulse had a longer full width at half maximum than a standard shock wave, cavitation could be enhanced significantly. On the other side, a theoretical study showed that stress inside the stone can be increased if two lithotripter shock waves hit the stone with a delay of only 20 μs. We used the Gilmore-Akulichev formulation to show that, in principle, both effects can be combined, that is, stress and cavitation could be increased using a pressure pulse with long full width at half maximum, which reaches the stone within hundreds of microseconds after two 20 μs-delayed initial shock waves. Implementing the suggested pressure profile into clinical devices could be feasible, especially with piezoelectric shock wave sources. 

Ultrasonics. 2015 Apr;58:53-9. doi: 10.1016/j.ultras.2014.12.002. Epub 2014 Dec 19.

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Comments 1

Othmar Wess on Monday, 22 June 2015 11:07

Cavitation plays an important role in extracorporeal shock wave lithotripsy. To achieve high fragmentation efficiency and low tissue lesions is a challenging objective. Direct impact of shock waves on brittle stones generates mechanical stress and different wave profiles may influence growth and collapse of cavitation bubbles. This paper proposes specific tandem shock waves to increase efficiency without affecting tissue lesions. There are many additional parameters affecting the overall success of shock wave lithotripsy. This is one which should be proven in clinical use.

Cavitation plays an important role in extracorporeal shock wave lithotripsy. To achieve high fragmentation efficiency and low tissue lesions is a challenging objective. Direct impact of shock waves on brittle stones generates mechanical stress and different wave profiles may influence growth and collapse of cavitation bubbles. This paper proposes specific tandem shock waves to increase efficiency without affecting tissue lesions. There are many additional parameters affecting the overall success of shock wave lithotripsy. This is one which should be proven in clinical use.
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