title: Assessment of renal injury with a clinical dual head lithotriptor delivering 240 shock waves per minute.
abstract: OBJECTIVE
  Lithotriptors with 2 treatment heads deliver shock waves along separate paths. Firing 1 head and then the other in alternating mode has been suggested as a strategy to treat stones twice as rapidly as with conventional shock wave lithotripsy. Because the shock wave rate is known to have a role in shock wave lithotripsy induced injury, and given that treatment using 2 separate shock wave sources exposes more renal tissue to shock wave energy than treatment with a conventional lithotriptor, we assessed renal trauma in pigs following treatment at rapid rate (240 shock waves per minute and 120 shock waves per minute per head) using a Duet lithotriptor (Direx Medical Systems, Petach Tikva, Israel) fired in alternating mode.
  
  
  METHODS
  Eight adult female pigs (Hardin Farms, Danville, Indiana) each were treated with sham shock wave lithotripsy or 2,400 shock waves delivered in alternating mode (1,200 shock waves per head, 120 shock waves per minute per head and 240 shock waves per minute overall at a power level of 10) to the lower renal pole. Renal functional parameters, including glomerular filtration rate and effective renal plasma flow, were determined before and 1 hour after shock wave lithotripsy. The kidneys were perfusion fixed in situ and the hemorrhagic lesion was quantified as a percent of functional renal volume.
  
  
  RESULTS
  Shock wave treatment resulted in no significant change in renal function and the response was similar to the functional response seen in sham shock wave treated animals. In 6 pigs treated with alternating mode the renal lesion was small at a mean +/- SEM of 0.22% +/- 0.09% of functional renal volume.
  
  
  CONCLUSIONS
  Kidney tissue and function were minimally affected by a clinical dose of shock waves delivered in alternating mode (120 shock waves per minute per head and 240 shock waves per minute overall) with a Duet lithotriptor. These observations decrease concern that dual head lithotripsy at a rapid rate is inherently dangerous.
authors.affiliation: Department of Anatomy and Cell Biology,Indiana University School of Medicine, Indianapolis, Indiana, USA.
authors.forename: Rajash K
authors.initials: RK
authors.lastname: Handa
authors.forename: James A
authors.initials: JA
authors.lastname: McAteer
authors.forename: Andrew P
authors.initials: AP
authors.lastname: Evan
authors.forename: Bret A
authors.initials: BA
authors.lastname: Connors
authors.forename: Yuri A
authors.initials: YA
authors.lastname: Pishchalnikov
authors.forename: Sujuan
authors.initials: S
authors.lastname: Gao
mesh_terms: D000704:Analysis of Variance; D000818:Animals; D004195:Disease Models, Animal; D004867:Equipment Design; D004869:Equipment Safety; D005260:Female; D007150:Immunohistochemistry; D007669:Kidney Calculi / Q000628:therapy; D007677:Kidney Function Tests; D007684:Kidney Tubules / Q000293:injuries* / Q000473:pathology; D008096:Lithotripsy / Q000009:adverse effects* / Q000295:instrumentation*; D008279:Magnetic Resonance Imaging; D011336:Probability; D011897:Random Allocation; D017595:Renal Plasma Flow; D012680:Sensitivity and Specificity; D013552:Swine