First Series Using Ultrasonic Propulsion and Burst Wave Lithotripsy to Treat Ureteral Stones

M Kennedy Hall, Jeff Thiel, Barbrina Dunmire, Patrick C Samson, Ross Kessler, Peter Sunaryo, Robert M Sweet, Ian S Metzler, Helena C Chang, Martin Gunn, Manjiri Dighe, Layla Anderson, Christina Popchoi, Ravi Managuli, Bryan W Cunitz, Barbara H Burke, Lisa Ding, Brianna Gutierrez, Ziyue Liu, Mathew D Sorensen, Hunter Wessells, Michael R Bailey, Jonathan D Harper, M Kennedy Hall, Jeff Thiel, Barbrina Dunmire, Patrick C Samson, Ross Kessler, Peter Sunaryo, Robert M Sweet, Ian S Metzler, Helena C Chang, Martin Gunn, Manjiri Dighe, Layla Anderson, Christina Popchoi, Ravi Managuli, Bryan W Cunitz, Barbara H Burke, Lisa Ding, Brianna Gutierrez, Ziyue Liu, Mathew D Sorensen, Hunter Wessells, Michael R Bailey, Jonathan D Harper

Abstract

Purpose: Our goal was to test transcutaneous focused ultrasound in the form of ultrasonic propulsion and burst wave lithotripsy to reposition ureteral stones and facilitate passage in awake subjects.

Materials and methods: Adult subjects with a diagnosed proximal or distal ureteral stone were prospectively recruited. Ultrasonic propulsion alone or with burst wave lithotripsy was administered by a handheld transducer to awake, unanesthetized subjects. Efficacy outcomes included stone motion, stone passage, and pain relief. Safety outcome was the reporting of associated anticipated or adverse events.

Results: Twenty-nine subjects received either ultrasonic propulsion alone (n = 16) or with burst wave lithotripsy bursts (n = 13), and stone motion was observed in 19 (66%). The stone passed in 18 (86%) of the 21 distal ureteral stone cases with at least 2 weeks follow-up in an average of 3.9±4.9 days post-procedure. Fragmentation was observed in 7 of the burst wave lithotripsy cases. All subjects tolerated the procedure with average pain scores (0-10) dropping from 2.1±2.3 to 1.6±2.0 (P = .03). Anticipated events were limited to hematuria on initial urination post-procedure and mild pain. In total, 7 subjects had associated discomfort with only 2.2% (18 of 820) propulsion bursts.

Conclusions: This study supports the efficacy and safety of using ultrasonic propulsion and burst wave lithotripsy in awake subjects to reposition and break ureteral stones to relieve pain and facilitate passage.

Keywords: calculi; lithotripsy; ultrasound; urolithiasis.

Conflict of interest statement

Conflict of Interest: MB, BC, BD, and MS have consulting agreements with and equity in SonoMotion, Inc., which has licensed this technology from the University of Washington for commercialization. RMS: American Urological Association, Elsevier Publishing (Campbells Urology). ISM: Bard BD, Perceus Inc. MD: Philips Medical Imaging, General Electric Healthcare.

Figures

Figure 1.
Figure 1.
Procedure diagrams of use in the ED or clinic as performed in this study (left) and as envisioned by our National Aeronautics and Space Administration sponsors for use in space travel (right). Courtesy of Carol Marinelli and Kim Reading.
Figure 2.
Figure 2.
Enrollment of subjects. BWL indicates burst wave lithotripsy.

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Source: PubMed

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