Hall MK. et al., 2022: First Series Using Ultrasonic Propulsion and Burst Wave Lithotripsy to Treat Ureteral Stones.
Hall MK, Thiel J, Dunmire B, Samson PC, Kessler R, Sunaryo P, Sweet RM, Metzler IS, Chang HC, Gunn M, Dighe M, Anderson L, Popchoi C, Managuli R, Cunitz BW, Burke BH, Ding L, Gutierrez B, Liu Z, Sorensen MD, Wessells H, Bailey MR, Harper JD.
Department of Emergency Medicine, University of Washington School of Medicine, Seattle, Washington.
Department of Urology, University of Washington School of Medicine, Seattle, Washington.
Department of Radiology, University of Washington School of Medicine, Seattle, Washington.
Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, Seattle, Washington.
Institute of Translational Health Sciences, University of Washington, Seattle, Washington.
Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, Indiana.
Division of Urology, VA Puget Sound Health Care System, Seattle, Washington.
Abstract
Purpose: Our goal was to test transcutaneous focused ultrasound in the form of ultrasonic propulsion and burst wave lithotripsy to reposition ureteral stones and facilitate passage in awake subjects.
Materials and methods: Adult subjects with a diagnosed proximal or distal ureteral stone were prospectively recruited. Ultrasonic propulsion alone or with burst wave lithotripsy was administered by a handheld transducer to awake, unanesthetized subjects. Efficacy outcomes included stone motion, stone passage, and pain relief. Safety outcome was the reporting of associated anticipated or adverse events.
Results: Twenty-nine subjects received either ultrasonic propulsion alone (n = 16) or with burst wave lithotripsy bursts (n = 13), and stone motion was observed in 19 (66%). The stone passed in 18 (86%) of the 21 distal ureteral stone cases with at least 2 weeks follow-up in an average of 3.9±4.9 days post-procedure. Fragmentation was observed in 7 of the burst wave lithotripsy cases. All subjects tolerated the procedure with average pain scores (0-10) dropping from 2.1±2.3 to 1.6±2.0 (P = .03). Anticipated events were limited to hematuria on initial urination post-procedure and mild pain. In total, 7 subjects had associated discomfort with only 2.2% (18 of 820) propulsion bursts.
Conclusions: This study supports the efficacy and safety of using ultrasonic propulsion and burst wave lithotripsy in awake subjects to reposition and break ureteral stones to relieve pain and facilitate passage.
J Urol. 2022 Nov;208(5):1075-1082. doi: 10.1097/JU.0000000000002864. Epub 2022 Nov 1. PMID: 36205340.
Comments 1
Read it! Its an adventure! Goes by itself that this is a reviewer’s choice. Studying the article one gets a good impression how carefully and step-by-step the group is advancing not only to master the technique but also to find the right application.
The comment accompanying the article in the Journal of Urology (1) is in two ways typical: Different from German Urologists, US-Urologist do not master simple sonography, which is available since decades. As a result, the burden of slow progress due to problems caused by professional policies may be borne on the backs of patients.
“I personally do a lot of ultrasounds in my stone practice, but I would argue that most urologists are not experienced in ultrasound and would not likely be able to find and treat a ureteral stone, especially in an obese patient. If ultrasound training does not become a regular feature of urology training, we run the risk of this modality becoming yet another treatment urology has overtaken by other specialties like emergency department physicians or radiologists.”
1 Stern KL. Editorial Comment. J Urol. 2022 Nov;208(5):1082. doi: 10.1097/JU.0000000000002864.01. Epub 2022 Nov 1. PMID: 36205345.
Peter Alken