Do MT. et al., 2022: Clinical application of the therapeutic ultrasound in urologic disease: Part II of therapeutic ultrasound in urology.
Do MT, Ly TH, Choi MJ, Cho SY.
Department of Surgery, Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam.
Department of Urology, Seoul National University College of Medicine, Seoul, Korea.
Department of Urology, Cho Ray Hospital, Ho Chi Minh City, Viet Nam.
Department of Medicine, Jeju National University College of Medicine, Jeju, Korea.
Interdisciplinary Postgraduate Program in Biomedical Engineering, Jeju National University, Jeju, Korea.
Department of Urology, Seoul National University Hospital, Seoul, Korea.
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.
© The Korean Urological Association.
Investig Clin Urol. 2022 May 16. doi: 10.4111/icu.20220060. Online ahead of print. PMID: 35670002 Review. FREE ARTICLE
Comments 1
This review article summarizes the use of ultrasound therapy in urology. Only a minor part of the article deals with Li-ESWT and ESWL (SWL). The author has made a careful review of the current literature. Below I show some notations of particular interest.
It has been demonstrated that Li-ESWT can improve erectile dysfunction (ED).
The effect can be improved if combined with PDE5.
The effect of Li-ESWT is less good in patients with vascular causes of ED.
Standardized principles for Li-ESWT have not been established.
A literature summary of SWL results expressed as stone-free rates after 3 months are as follows:
Upper calyx 65-89 %
Middle calyx 67-86 %
Lower calyx 63-84 %
Renal pelvis 67-86 %
Upper ureter 75-84 %
Middle ureter 81-82 %
Distal ureter 77- 91 %
Reduced stone-free rates are seen with large stones, low calyx stones and multiple stones.
There is a world-wide trend from SWL to URS and the arguments are lower stone-free rates and higher re-treatment rates for SWL.
Recent advances in SWL are:
a. Optical control of coupling.
b. Pre-stenting?
c. Strategic modifications to reduce tissue injuries
d. External vibration /percussion
e. Enlarged focal size
f. Stone tracking systems
But the author’s comment is that it is uncertain to which extent these modifications can improve SWL in a way that increases the competition of SWL with endoscopic procedures, at least in terms of stone free rates.
The last part of this article deals with burst-wave lithotripsy (BWL) in combination with ultrasound propulsion. The clinical experience of this new technology is limited, but the author’s comment is that a combination of these two technologies might be the ”New hope for SWL”!
Hans-Göran Tiselius