title: Quantification of the Range of Motion of Kidney and Ureteral Stones During Shockwave Lithotripsy in Conscious Patients.
abstract: Effective shockwave lithotripsy requires accurate targeting of the stone throughout the course of treatment. Stone movement secondary to respiratory movement can make this more difficult. In vitro work has shown that stone motion outside the focal region reduces the efficacy of stone fragmentation; however, there are few clinical data on the degree of stone movement in patients during treatment. To investigate this, X-ray fluoroscopic images of the kidney and ureteral stones at the upper and lower limits of the normal respiratory cycle were acquired during shock wave lithotripsy of 58 conscious patients, and stone excursion was calculated from these images. In addition, the respiration rate and patient perceived pain were recorded during the course of the treatment. It was found that stone motion secondary to respiration was 7.7 ± 2.9 mm for kidney stones and 3.6 ± 2.1 mm for ureteral stones-less than has been reported in studies with anesthetized patients. There was no significant change of motion over the course of treatment although pain was found to increase. These data suggest that stone motion in conscious patients is less than in anesthetized patients. Furthermore, it suggests that lithotripters with focal regions of 8 mm or greater should not suffer from a marked drop in fragmentation efficiency due to stone motion.
authors.affiliation: 1 Oxford University Medical School , John Radcliffe Hospital, Oxford, United Kingdom .
authors.forename: Suzanne R
authors.initials: SR
authors.lastname: Harrogate
authors.affiliation: 1 Oxford University Medical School , John Radcliffe Hospital, Oxford, United Kingdom .
authors.forename: L M Shirley
authors.initials: LM
authors.lastname: Yick
authors.affiliation: 2 Department of Anatomy and Cell Biology, Indiana University School of Medicine , Indianapolis, Indiana.
authors.forename: James C
authors.initials: JC
authors.lastname: Williams
authors.affiliation: 3 Department of Engineering, Institute of Biomedical Engineering, University of Oxford , Oxford, United Kingdom .
authors.forename: Robin O
authors.initials: RO
authors.lastname: Cleveland
authors.affiliation: 4 Oxford Stone Group, Nuffield Department of Surgical Sciences, Department of Urology, University of Oxford, United Kingdom .
authors.forename: Benjamin W
authors.initials: BW
authors.lastname: Turney
mesh_terms: D015331:Cohort Studies; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D007668:Kidney / Q000000981:diagnostic imaging; D007669:Kidney Calculi / Q000000981:diagnostic imaging / Q000628:therapy*; D008096:Lithotripsy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009038:Motion; D009068:Movement; D010146:Pain; D012119:Respiration; D015656:Respiratory Mechanics; D014514:Ureteral Calculi / Q000000981:diagnostic imaging / Q000628:therapy*