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Chen TT. et al., 2020: Burst wave lithotripsy and acoustic manipulation of stones

Chen TT, Samson PC, Sorensen MD, Bailey MR.
Department of Urology, University of Washington, Seattle, Washington.
Department of Urology, Weill Cornell Medicine, New York, New York.
Applied Physics Laboratory, Center for Industrial and Medical Ultrasound, University of Washington, Seattle, Washington, USA.

Abstract

PURPOSE OF REVIEW: Burst wave lithotripsy and ultrasonic propulsion of kidney stones are novel, noninvasive emerging technologies to separately or synergistically fragment and reposition stones in an office setting. The purpose of this review is to discuss the latest refinements in technology, to update on testing of safety and efficacy, and to review future applications.

RECENT FINDINGS: Burst wave lithotripsy produced consistent, small passable fragments through transcutaneous applications in a porcine model, while producing minimal injury and clinical trials are now underway. A more efficient ultrasonic propulsion design that can also deliver burst wave lithotripsy effectively repositioned 95% of stones in 18 human participants (18 of 19 kidneys) and clinical trials continue. Acoustic tractor beam technology is an emerging technology with promising clinical applications through the manipulation of macroscopic objects.

SUMMARY: The goal of the reviewed work is an office-based system to image, fragment, and reposition urinary stones to facilitate their natural passage. The review highlights progress in establishing safety, effectiveness, and clinical benefit of these new technologies. The work is also anticipating challenges in clinical trials and developing the next generation of technology to improve on the technology as it is being commercialized today.
Curr Opin Urol. 2020 Mar;30(2):149-156. doi: 10.1097/MOU.0000000000000727.

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Comments 1

Peter Alken on Thursday, July 02 2020 08:30

A look, not in the kitchen, but in the dining room of the group working on “… an office-based, handheld ultrasound device to target, detach, break, and reposition stones and stone fragments in the urinary space to facilitate natural clearance.” See also (1).
I remember discussing with Siemens 35 years ago about handheld ESWL devices when we cooperated with them on the Lithostar development (2). Sonography is a subjective imaging technique: what is seen and displayed heavily depends on the operator. It’s difficult to imagine that there will be a handheld ultrasound probe delivering images in a strict sequential fashion like a CT or MRI-scanner.

1 Ramesh S, Chen TT, Maxwell AD, Cunitz BW, Dunmire B, Thiel J, Williams JC , Jr, Gardner A, Liu Z, Metzler I, Harper JD, Sorensen MD, Bailey MR.
In Vitro Evaluation of Urinary Stone Comminution with a Clinical Burst Wave Lithotripsy System. J Endourol. 2020 Mar 20. doi: 10.1089/end.2019.0873

2 Wilbert DM, Reichenberger H, Noske E, Riedmiller H, Alken P, Hohenfellner R. New generation shock wave lithotripsy. J Urol. 1987;138(3):563–565. doi:10.1016/s0022-5347(17)43259-9

A look, not in the kitchen, but in the dining room of the group working on “… an office-based, handheld ultrasound device to target, detach, break, and reposition stones and stone fragments in the urinary space to facilitate natural clearance.” See also (1). I remember discussing with Siemens 35 years ago about handheld ESWL devices when we cooperated with them on the Lithostar development (2). Sonography is a subjective imaging technique: what is seen and displayed heavily depends on the operator. It’s difficult to imagine that there will be a handheld ultrasound probe delivering images in a strict sequential fashion like a CT or MRI-scanner. 1 Ramesh S, Chen TT, Maxwell AD, Cunitz BW, Dunmire B, Thiel J, Williams JC , Jr, Gardner A, Liu Z, Metzler I, Harper JD, Sorensen MD, Bailey MR. In Vitro Evaluation of Urinary Stone Comminution with a Clinical Burst Wave Lithotripsy System. J Endourol. 2020 Mar 20. doi: 10.1089/end.2019.0873 2 Wilbert DM, Reichenberger H, Noske E, Riedmiller H, Alken P, Hohenfellner R. New generation shock wave lithotripsy. J Urol. 1987;138(3):563–565. doi:10.1016/s0022-5347(17)43259-9
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