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Mosquera Seoane L. et al., 2023: Technological innovations in shock wave lithotripsy.

Mosquera Seoane L, Ortiz Salvador JB, Budia Alba A, Perez Fentes DA.
Servicio de Urología, Complexo Hospitalario Santiago de Compostela, Santiago de Compostela, La Coruña,España.
Servicio de Urología, Hospital Universitario y Politécnico La Fe, Valencia, Espana.
Servicio de Urología, Hospital Universitario y Politécnico La Fe, Valencia, Espana.

Abstract

Introduction: Since 1980, extracorporeal shock wave lithotripsy (SWL) has been employed in the treatment of urolithiasis, offering noninvasive alternatives to surgical techniques. In addition to being limited by the size and location of the stones, its efficacy is influenced by several factors. Despite the advancement of other surgical techniques, SWL could maintain its position with new improvements. Our objective is to review the existing literature on the latest advances in the extracorporeal treatment of lithiasis.

Material and methods: A non-systematic literature review was carried out from 2017 to 2023 to obtain 26 articles on three different emerging technologies in extracorporeal lithotripsy: Burst Wave Lithotripsy (BWL), Histotripsy, and Microbubble Lithotripsy (ML).

Results: The BWL uses sinusoidal bursts of US waves delivered at lower and higher frequencies than conventional SWL. Its mechanism of action generates a higher quality fragmentation (fine fragments) instead of generating tensile stresses for stone fracture resulting in larger fragments, as in traditional SWL. Studies in pigs and humans have shown effective fragmentation with a good safety profile. Based on High Intensity Focused Ultrasound (HIFU) technology, histotripsy fragments tissue through cavitation. Good in vitro results have been shown, but the formation of microbubbles between the stone and ultrasound waves hinders the progress of this technique. Microbubble Lithotripsy (ML) combines microbubbles and ultrasound for safe and effective stone fragmentation. In vitro and pig results are promising. This technique can help optimize treatments and reduce energy levels.

Conclusions: Technological innovation is not only being applied to endourological techniques, but also to ESWL. New techniques such as BWL, histotripsy and ML are promising, with good results in the research phase.

Actas Urol Esp (Engl Ed). 2023 Oct 17:S2173-5786(23)00120-8. doi: 10.1016/j.acuroe.2023.09.001. Online ahead of print. PMID: 37858618 Review. English, Spanish.

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Comments 1

Peter Alken on Monday, 06 May 2024 11:00

For those who are up to date with lithotripsy the paper does not add significant information.

Peter Alken

For those who are up to date with lithotripsy the paper does not add significant information. Peter Alken
Saturday, 13 July 2024