Investigations on stone fragmentation in different extracorporeal shock wave lithotripsy sound fields in vitro

Abstract

The mechanism of stone fragmentation in ESWL applications is still under investigation. Devices showing a wide focal area and comparably low focal pressure amplitudes have been reported to disintegrate stones more efficiently as current clinical devices with high amplitudes and small focal areas. From this the question is raised whether the underlying different physical mechanisms or treatment issues, like stone localization and movement, are responsible for these results. In this paper fragmentation experiments in vitro with different stone types (e.g., HMT and BegoStone, 15 mm diam.) under different sound fields are presented. A self focusing piezoelectric transducer with a small focal area and peak pressure amplitudes of up to 125 MPa is used. The number of pulses was counted until a complete fragmentation through a 2 mm wire mesh is reached. In order to simulate wide-focus low-pressure conditions, the stones were placed in the prefocal region. Fragmentation results are compared to the case of focal placement. Initial breakage occurs earlier in the prefocal region for the HMT stones, whereas complete fragmentation is reached significantly earlier in the focus for all stone types.