title: Shock wave lithotripsy of stones implanted in the proximal ureter of the pig.
abstract: OBJECTIVE
  Ureteral stones can be difficult to treat with shock wave (SW) lithotripsy. A strategy for lithotripsy of proximal ureteral stones is to push them back into the renal pelvis prior to administering SWs. However, push-back is invasive and not always possible. Since there are few clues to suggest how best to treat ureteral stones with SWs in situ, we developed an animal model for research on lithotripsy for ureteral stones.
  
  
  METHODS
  Gypsum model stones were implanted bilaterally in the proximal ureter and renal calix of the pig via percutaneous access. Lithotripsy was performed using a HM3 lithotripter (Dornier Medical Systems, Marietta, Georgia) and stones at each location were treated with the same dose (400 SWs, 20 kV and 30 SWs per minute). Fragments were collected and the percent increase in projected surface area of the particles was determined.
  
  
  RESULTS
  The breakage (mean percent area increase) of stones implanted in the proximal ureter was significantly less than that of stones located in the renal calix treated with the same dose of shock waves (134% vs 327%, p <0.001). Also, stones that were fully confined by the ureter did not break as well as stones located at the ureteropelvic junction. This indicates that the physical environment surrounding a stone can have a significant effect on the efficiency of SW action.
  
  
  CONCLUSIONS
  The observation that stones implanted in the ureter showed decreased breakage compared with stones in the kidney is consistent with clinical experience. This finding is a valuable and even essential prerequisite for any experimental animal model system intended for the study of SW action in the breakage of ureteral stones.
authors.affiliation: Department of Surgery, Division of Urology, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Ryan F
authors.initials: RF
authors.lastname: Paterson
authors.forename: Samuel C
authors.initials: SC
authors.lastname: Kim
authors.forename: Ramsay L
authors.initials: RL
authors.lastname: Kuo
authors.forename: James E
authors.initials: JE
authors.lastname: Lingeman
authors.forename: Andrew P
authors.initials: AP
authors.lastname: Evan
authors.forename: Bret A
authors.initials: BA
authors.lastname: Connors
authors.forename: James C
authors.initials: JC
authors.lastname: Williams
authors.forename: James A
authors.initials: JA
authors.lastname: McAteer
mesh_terms: D000818:Animals; D002133:Calcium Sulfate / Q000737:chemistry; D004195:Disease Models, Animal; D005260:Female; D007670:Kidney Calices / Q000473:pathology; D007682:Kidney Pelvis / Q000473:pathology; D008096:Lithotripsy / Q000295:instrumentation / Q000379:methods*; D010316:Particle Size; D013499:Surface Properties; D013552:Swine; D014513:Ureter / Q000473:pathology; D014514:Ureteral Calculi / Q000473:pathology / Q000628:therapy*; D018666:Ureteroscopy
chemical_list: D002133:Calcium Sulfate