Using 300 Pretreatment Shock Waves in a Voltage Ramping Protocol Can Significantly Reduce Tissue Injury During...

Area of Science:

• Biomedical Engineering
• Nephrology
• Urology

Background:

• Shock wave lithotripsy (SWL) is a common procedure for kidney stone treatment.
• Pretreatment with low-energy shock waves (SWs) can reduce SWL-induced renal injury.
• Optimizing pretreatment protocols is crucial for clinical efficiency and patient outcomes.

Purpose of the Study:

• To determine if a reduced number of pretreatment SWs (300 SWs) can achieve similar renal lesion size reduction as a previously established protocol (500 SWs).
• To evaluate the efficacy of a 300 SW pretreatment regimen in minimizing hemorrhagic injury in porcine kidneys.

Main Methods:

• Fifteen female pigs underwent SWL targeting the left kidney with a 300 SWs (12 kV) pretreatment followed by a 2000 SWs (24 kV) clinical dose.
• Renal function and lesion size (% functional renal volume, FRV) were assessed before and after treatment.
• Results were compared to control groups receiving 500 SW pretreatment and no pretreatment.

Main Results:

• Glomerular filtration rate significantly decreased 1 hour post-lithotripsy in the 300 SW pretreatment group.
• The 300 SW pretreatment regimen significantly reduced hemorrhagic injury size to 0.8% ± 0.4% FRV.
• This reduction was comparable to the effect observed with 500 SW pretreatment.

Conclusions:

• A 300 SW pretreatment protocol, using a voltage ramping regimen, can effectively initiate a protective response in kidneys.
• This reduced pretreatment SW count significantly minimizes tissue injury in a lithotripsy model.
• The findings suggest a more time-efficient and potentially safer SWL pretreatment strategy.