Ordnance gelatine as an in vitro tissue simulation scaffold for extracorporeal shock wave lithotripsy

In vitro shock wave lithotripsy (SWL) research is typically performed utilizing wet coupling lithotriptors with a mesh basket model. This model does not take into account shock wave energy attenuation through tissue. Models using dry coupling lithotriptors rely on immersion chambers and face similar limitations. Ordnance gelatin (OG) displays strength and viscous properties similar to human tissue and is therefore widely used for ballistic tissue injury research. We present our initial experience using an OG tissue simulating scaffold for dry coupling SWL research. Using 10% OG prepared in a disc-shaped mold (five stone wells/gel), we tested the model using a Modulith SLX-F2 lithotriptor and artificial stone phantoms. Following a test of concept run on an empty gel mold and a material integrity check for leakage, we shocked 60 stones (30 narrow focus [NF], 30 wide focus [WF]) in human pooled urine. Half were shocked using gels containing open-ended wells with the remainder closed-ended wells. Fragmentation coefficients (FC) were calculated across both foci and gel models. All gels successfully completed 5,000 shocks (1,000/well) without loss of gel integrity or fluid leakage. The mean FC using open-ended wells was 77.9 ± 7.6% NF and 74.4 ± 4.8% WF, and for closed wells 75.9 ± 8.0% NF and 67.1 ± 3.5% WF. The total model cost including the preparation of gels and begostones was assessed at approximately $1 per stone (Canadian). Ordnance gel serves as an excellent surrogate tissue shockwave scaffold providing an easily manufactured, reproducible and inexpensive model for dry coupling SWL research.