Abstract
Since the early 1980s, extracorporeal shockwave lithotripsy (ESWL) has grown to be one of the primary techniques used for the clinical treatment of both kidney stone and gallstone disease. The mechanisms of soft-tissue damage and stone breakup in the fields of spark-gap, piezoelectric, and catheter lithotripters, as well as those of diagnostic and therapeutic ultrasound devices have been studied. The results are consistent with the hypothesis that transient acoustic cavitation is the primary mechanism responsible for the observed bioeffects, and plays a role as well in the breaking of the stone. Thresholds have been established for bioeffects in mouse kidney (less than 3–5 MPa peak positive pressure), chick embryos (less than 10 MPa), and Drosophila larvae (less than 1 MPa). The extremely low thresholds for lung hemorrhage in mice for 10 lithotripter pulses (1.5 MPa) and short pulses of diagnostic ultrasound (less than 1 MPa) suggest that gas-filled tissues within the body are especially susceptible to lithotripsy damage. The efficacy of gallstone lithotripsy depends critically upon the mechanical properties of the stones themselves. These properties influence which destruction mechanism−cavitation or stress fracture−is dominant.
Published Version
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