Renal injury during shock wave lithotripsy is significantly reduced by slowing the rate of shock wave delivery

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From: BJU International(Vol. 100, Issue 3)
Publisher: Wiley Subscription Services, Inc.
Document Type: Author abstract; Report
Length: 335 words

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Byline: Andrew P. Evan, James A. McAteer, Bret A. Connors, Philip M. Blomgren, James E. Lingeman (*) Keywords: shock wave lithotripsy; kidney; adverse effects; animal models Abstract: OBJECTIVE To assess the tissue protection afforded by simply reducing the rate of shock wave (SW) delivery, compared with studies in the pig in which SW lithotripsy (SWL)-induced vascular damage was significantly reduced by initiating treatment using low-amplitude SWs. MATERIALS AND METHODS Juvenile pigs (6-7 weeks old) were treated with an unmodified lithotripter (HM3, Dornier Medical Systems, Kennesaw, GA) at either 120 or 30 SW/min. Treatment was to one kidney per pig, with SWs (2000, 24 kV) directed to a lower-pole calyx. After treatment, parenchymal haemorrhage was determined morphometrically and expressed as percentage of functional renal volume (%FRV). RESULTS Kidneys treated at 120 SW/min had focal to extensive subcapsular haematomas. Parenchymal lesions were found only at the lower pole, but included regions within renal papillae and the cortex. Occasionally, damage extended across the full thickness of the kidney. The lesion in the pigs treated at 120 SW/min occupied a mean (sd) of 4.6 (1.7) %FRV. Kidneys of pigs treated at 30 SW/min showed no surface bleeding. Parenchymal haemorrhage was limited to papillae within the focal volume, and measured 0.08 (0.02) %FRV, a significant (P CONCLUSIONS Slowing the rate of delivery to 30 SW/min has a dramatic protective effect on the integrity of the kidney vasculature. This finding in our established pig model suggests a potential strategy to improve the safety of lithotripsy. As it was shown that a reduced SW rate also improves the efficiency of stone fragmentation, a slow rate appears to be a means to improve both the safety and efficacy of SWL. Author Affiliation: (*)Methodist Hospital Institute for Kidney Stone Disease, Indianapolis, Indiana, USA Article History: Accepted for publication 2 March 2007 Article note: Andrew P. Evan, Chancellor's Professor, Department of Anatomy and Cell Biology, Indiana University School of Medicine, 635 Barnhill Dr MS5035, Indianapolis, Indiana 46202-5120, USA. e-mail:

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Gale Document Number: GALE|A167005603