title: Comparison of tissue injury from focused ultrasonic propulsion of kidney stones versus extracorporeal shock wave lithotripsy.
abstract: OBJECTIVE
  Focused ultrasonic propulsion is a new noninvasive technique designed to move kidney stones and stone fragments out of the urinary collecting system. However, to our knowledge the extent of tissue injury associated with this technique is not known. We quantitated the amount of tissue injury produced by focused ultrasonic propulsion under simulated clinical treatment conditions and under conditions of higher power or continuous duty cycles. We compared those results to extracorporeal shock wave lithotripsy injury.
  
  
  METHODS
  A human calcium oxalate monohydrate stone and/or nickel beads were implanted by ureteroscopy in 3 kidneys of live pigs weighing 45 to 55 kg and repositioned using focused ultrasonic propulsion. Additional pig kidneys were exposed to extracorporeal shock wave lithotripsy level pulse intensity or continuous ultrasound exposure 10 minutes in duration using an ultrasound probe transcutaneously or on the kidney. These kidneys were compared to 6 treated with an unmodified Dornier HM3 lithotripter (Dornier Medical Systems, Kennesaw, Georgia) using 2,400 shocks at 120 shock waves per minute and 24 kV. Histological analysis was performed to assess the volume of hemorrhagic tissue injury created by each technique according to the percent of functional renal volume.
  
  
  RESULTS
  Extracorporeal shock wave lithotripsy produced a mean ± SEM lesion of 1.56% ± 0.45% of functional renal volume. Ultrasonic propulsion produced no detectable lesion with simulated clinical treatment. A lesion of 0.46% ± 0.37% or 1.15% ± 0.49% of functional renal volume was produced when excessive treatment parameters were used with the ultrasound probe placed on the kidney.
  
  
  CONCLUSIONS
  Focused ultrasonic propulsion produced no detectable morphological injury to the renal parenchyma when using clinical treatment parameters but produced injury comparable in size to that of extracorporeal shock wave lithotripsy when using excessive treatment parameters.
authors.affiliation: Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, Indiana. Electronic address: bconnors@iupui.edu.
authors.forename: Bret A
authors.initials: BA
authors.lastname: Connors
authors.affiliation: Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, Indiana.
authors.forename: Andrew P
authors.initials: AP
authors.lastname: Evan
authors.affiliation: Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, Indiana.
authors.forename: Philip M
authors.initials: PM
authors.lastname: Blomgren
authors.affiliation: Department of Urology, School of Medicine, University of Washington, Seattle, Washington.
authors.forename: Ryan S
authors.initials: RS
authors.lastname: Hsi
authors.affiliation: Department of Urology, School of Medicine, University of Washington, Seattle, Washington.
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Harper
authors.affiliation: Department of Urology, School of Medicine, University of Washington, Seattle, Washington.
authors.forename: Mathew D
authors.initials: MD
authors.lastname: Sorensen
authors.affiliation: Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, Seattle, Washington.
authors.forename: Yak-Nam
authors.initials: YN
authors.lastname: Wang
authors.affiliation: Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, Seattle, Washington.
authors.forename: Julianna C
authors.initials: JC
authors.lastname: Simon
authors.affiliation: Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, Seattle, Washington.
authors.forename: Marla
authors.initials: M
authors.lastname: Paun
authors.affiliation: Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, Seattle, Washington.
authors.forename: Frank
authors.initials: F
authors.lastname: Starr
authors.affiliation: Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, Seattle, Washington.
authors.forename: Bryan W
authors.initials: BW
authors.lastname: Cunitz
authors.affiliation: Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, Seattle, Washington.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Bailey
authors.affiliation: Methodist Hospital Institute for Kidney Stone Disease, Indianapolis, Indiana.
authors.forename: James E
authors.initials: JE
authors.lastname: Lingeman
mesh_terms: D000818:Animals; D004195:Disease Models, Animal; D005260:Female; D006801:Humans; D007668:Kidney / Q000293:injuries* / Q000473:pathology; D007669:Kidney Calculi / Q000628:therapy*; D007674:Kidney Diseases / Q000209:etiology / Q000473:pathology*; D008096:Lithotripsy / Q000009:adverse effects*; D013552:Swine; D014464:Ultrasonic Therapy / Q000009:adverse effects*
keywords: SPPA; SW; SWL; extracorporeal SW lithotripsy; high-intensity focused ultrasound ablation; iatrogenic disease; kidney; lithotripsy; nephrolithiasis; p+; peak positive pressure; shock wave; spatial peak pulse average
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