Our group has introduced transcutaneous ultrasound to move kidney stones in order to expel small stones or relocate an obstructing stone to a nonobstructing location.
Human stones and metalized beads (2-8 mm) were implanted ureteroscopically in kidneys of eight domestic swine. Ultrasonic propulsion was performed using a diagnostic imaging transducer and a Verasonics ultrasound platform. Stone propulsion was visualized using fluoroscopy, ultrasound, and the ureteroscope. Successful stone movement was defined as relocating a stone to the renal pelvis, ureteropelvic junction (UPJ), or proximal ureter. Three blinded experts evaluated for histologic injury in control and treatment arms. All stones were moved. 65% (17/26) of stones/beads were moved the entire distance to the renal pelvis (3), UPJ (2), or ureter (12). Average successful procedure per stone required 14±8 min and 23±16 pushes. Each push averaged 0.9 s in duration. Mean interval between pushes was 41±13 s. No gross or histologic kidney damage was identified in six kidneys from exposure to 20 1-s pushes spaced by 33 s. Ultrasonic propulsion is effective with most stones being relocated to the renal pelvis, UPJ, or ureter. The procedure appears safe without evidence of injury. [Work supported by NIH DK43881, DK092197, and NSBRI through NASA NCC 9-58.].
Written by:
Bailey M, Wang YN, Simon JC, Cunitz BW, Harper JD, Hsi RS, Starr F, Paun M, Dunmire B, Sapozhnikov OA, Crum LA, Sorensen MD. Are you the author?
Ctr.Industrial and Medical Ultrasound, Appl. Phys. Lab., Univ. of Washington, 1013 NE 40th St., Seattle, WA.
Reference: J Acoust Soc Am. 2013 May;133(5):3279.
doi: 10.1121/1.4805345
PubMed Abstract
PMID: 23654704
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