Tissue damage from ultrasonic, pneumatic, and combination lithotripsy
Carl Sarkissian1, Yuqing Cui, Kevin Mohsenian
11 Glickman Urological and Kidney Institute, The Cleveland Clinic , Cleveland, Ohio.
Journal of Endourology
|August 2, 2014
Summary
Dual ultrasonic (DUS) lithotripsy poses a higher risk of urinary tract perforation compared to ultrasonic-only (US) and ultrasonic-pneumatic (US+P) modes. However, all lithotripsy modes demonstrated safety with forces under 400g and contact times of 5 seconds or less.
Area of Science:
- Urology
- Biomedical Engineering
- Materials Science
Background:
- Lithotripsy is a common procedure for breaking kidney stones.
- Different lithotripsy technologies exist, including ultrasonic, pneumatic, and dual ultrasonic (DUS) systems.
- Understanding the safety profile of these technologies on urinary tract tissues is crucial for minimizing iatrogenic injury.
Purpose of the Study:
- To comparatively evaluate the safety of ultrasonic-only (US), ultrasonic-pneumatic (US+P), and dual ultrasonic (DUS) lithotripsy probes on porcine urinary tract tissues.
- To determine the risk of probe perforation under varying forces and contact durations.
Main Methods:
- Utilized Swiss Lithoclast Ultra (US and US+P) and Gyrus ACMI Cyberwand (DUS) lithotripsy devices.
- Tested probes on fresh porcine ureter, bladder, and renal pelvis tissues.
- Applied vertical forces of 0, 400, or 700g for durations of 3 seconds, 5 seconds, or 3 minutes, or until perforation.
- Recorded perforation occurrence, time to perforation, and performed histological analysis for depth of damage.
Main Results:
- Dual ultrasonic (DUS) lithotripsy showed the highest perforation rate (26.4%), followed by ultrasonic-pneumatic (US+P) (13.7%), and ultrasonic-only (US) (8.5%).
- No perforations occurred with 0g probe force across all modes and tissues.
- The renal pelvis was significantly more resistant to perforation than the ureter or bladder.
- Forces exceeding 400g and contact durations longer than 5 seconds increased the risk of tissue damage.
Conclusions:
- Lithotripsy mode, tissue type, probe force, and contact duration significantly influence the risk of urinary tract perforation.
- All tested lithotripsy devices offer a reasonable safety margin for probe-tissue contact times of 3-5 seconds with forces up to 400g.
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