Image not available

Fernández F et al, 2013: Out-of-Focus Low Pressure Pulse Pretreatment to the Whole Kidney to Reduce Renal Injury During Shockwave Lithotripsy: An In Vivo Study Using a Rabbit Model

Fernández F, Domínguez A, Castaño E, Loske AM
Centro de Física Aplicada y Tecnología Avanzada, Universidad Nacional Autónoma de México , Querétaro, Qro., México


Abstract

BACKGROUND AND PURPOSE: It is known that pretreating one renal pole with shockwaves generated at the minimum energy setting of an HM3 lithotripter reduces renal damage in pigs during shockwave lithotripsy; however, the minimum energy level to induce this effect is unknown. The purpose of this study was to analyze if exposing the whole kidney to low-energy-pressure pulses by positioning it out of focus protects the tissue from a clinical dose of shock waves.

MATERIALS AND METHODS: Seven rabbits were exposed to 250 shockwaves focused on the renal pelvis of the left kidney using a Piezolith 2300 lithotripter. A second group of seven rabbits received 50 prophylactic pressure pulses to the whole kidney at an out-of-focus position, followed by 250 shockwaves focused on the renal pelvis of the same kidney. The animals were sacrificed 1 week after shockwave treatment, and a bilateral nephrectomy was performed to compare tissue damage in both groups.

RESULTS: All shockwave-treated kidneys showed macro- and microhistologic changes. Capsular fibrosis, subcapsular hematoma, inflammation, and necrotic areas in the renal capsule were significantly less in kidneys that received the prophylactic treatment. No differences between both groups were observed for tissue damage in the renal cortex and the renal medulla.

CONCLUSIONS: Our preliminary experiment reveals that an out-of-focus pretreatment to the whole kidney reduces the damage to the renal capsule of rabbit kidneys during shockwave application. This protective effect may be extended to areas inside the kidney by adjusting the dose of the prophylactic pressure pulses.

J Endourol. 2013 Mar 26. [Epub ahead of print]
PMID:23373987 [PubMed - as supplied by publisher]

Rate this blog entry:
0
 

Comments 1

Peter Alken on Monday, 18 March 2013 07:12

The abstract reads like a small sensation. An interesting publication showing that there are still simple open questions for straight forward answers in the shock wave business. Reading the complete manuscript is a must for all companies and users. If the data are reproducible there could be a quick transfer into clinical use. The authors state:"This methodology ... could be easily implemented in any type of lithotripter" and "In this study, the dose of the prophylactic shockwaves was chosen based on previous tests (not published); however, it is reasonable to think that this dose of out-of-focus shockwaves is not the optimal dose. Further studies are needed to identify the dose to achieve the full renal protective response. This result will depend on the type of lithotripter. Because the pressure profile and the shape of the focal zone generated by different lithotripters is not the same, a specific treatment protocol is needed for each lithotripter model. Thorough pressure measurements would be needed before implementing this technique clinically."

Peter Alken

The abstract reads like a small sensation. An interesting publication showing that there are still simple open questions for straight forward answers in the shock wave business. Reading the complete manuscript is a must for all companies and users. If the data are reproducible there could be a quick transfer into clinical use. The authors state:"This methodology ... could be easily implemented in any type of lithotripter" and "In this study, the dose of the prophylactic shockwaves was chosen based on previous tests (not published); however, it is reasonable to think that this dose of out-of-focus shockwaves is not the optimal dose. Further studies are needed to identify the dose to achieve the full renal protective response. This result will depend on the type of lithotripter. Because the pressure profile and the shape of the focal zone generated by different lithotripters is not the same, a specific treatment protocol is needed for each lithotripter model. Thorough pressure measurements would be needed before implementing this technique clinically." Peter Alken
Guest
Monday, 21 August 2017
STORZ MEDICAL AG
Lohstampfestrasse 8
8274 Tägerwilen
Switzerland
Tel.: +41 (0)71 677 45 45
Fax: +41 (0)71 677 45 05

www.storzmedical.com
Personal data
Address
Contact data
Message