title: Fragmentation of urinary calculi in vitro by burst wave lithotripsy.
abstract: OBJECTIVE
  We developed a new method of lithotripsy that uses short, broadly focused bursts of ultrasound rather than shock waves to fragment stones. We investigated the characteristics of stone comminution by burst wave lithotripsy in vitro.
  
  
  METHODS
  Artificial and natural stones (mean ± SD size 8.2 ± 3.0 mm, range 5 to 15) were treated with ultrasound bursts using a focused transducer in a water bath. Stones were exposed to bursts with focal pressure amplitude of 6.5 MPa or less at a 200 Hz burst repetition rate until completely fragmented. Ultrasound frequencies of 170, 285 and 800 kHz were applied using 3 transducers, respectively. Time to fragmentation for each stone type was recorded and fragment size distribution was measured by sieving.
  
  
  RESULTS
  Stones exposed to ultrasound bursts were fragmented at focal pressure amplitudes of 2.8 MPa or greater at 170 kHz. Fractures appeared along the stone surface, resulting in fragments that separated at the surface nearest to the transducer until the stone was disintegrated. All natural and artificial stones were fragmented at the highest focal pressure of 6.5 MPa with a mean treatment duration of 36 seconds for uric acid stones to 14.7 minutes for cystine stones. At a frequency of 170 kHz the largest artificial stone fragments were less than 4 mm. Exposure at 285 and 800 kHz produced only fragments less than 2 mm and less than 1 mm, respectively.
  
  
  CONCLUSIONS
  Stone comminution with burst wave lithotripsy is feasible as a potential noninvasive treatment method for nephrolithiasis. Adjusting the fundamental ultrasound frequency allows for stone fragment size to be controlled.
authors.affiliation: Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, Seattle, Washington. Electronic address: amax38@u.washington.edu.
authors.forename: Adam D
authors.initials: AD
authors.lastname: Maxwell
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: Wayne
authors.initials: W
authors.lastname: Kreider
authors.affiliation: Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, Seattle, Washington; Department of Acoustics, Physics Faculty, Moscow State University, Moscow, Russia.
authors.forename: Oleg A
authors.initials: OA
authors.lastname: Sapozhnikov
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: 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: Department of Urology, School of Medicine, University of Washington, Seattle, Washington; Division of Urology, Department of Veteran Affairs Medical Center, Seattle, Washington.
authors.forename: Mathew D
authors.initials: MD
authors.lastname: Sorensen
mesh_terms: D006801:Humans; D066298:In Vitro Techniques; D008096:Lithotripsy / Q000379:methods*; D014545:Urinary Calculi / Q000628:therapy*
keywords: kidney; lithotripsy; nephrolithiasis; sound; ultrasonic therapy
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