MP18-07 ULTRASOUND TO REPOSITION AND ACCELERATE PASSAGE OF DISTAL URETERAL STONES

Abstract

You have accessJournal of UrologyStone Disease: Surgical Therapy II (MP18)1 Sep 2021MP18-07 ULTRASOUND TO REPOSITION AND ACCELERATE PASSAGE OF DISTAL URETERAL STONES M. Kennedy Hall, Jeff Thiel, Patrick C. Samson, Ross Kessler, Peter Sunaryo, Robert M. Sweet, Ian S. Metzler, Martin L. Gunn, Layla Anderson, Barbrina Dunmire, Christina Popchoi, Ravi Managuli, Bryan W. Cunitz, Barbara Burke, Adam D. Maxwell, Michael R. Bailey, Mathew D. Sorensen, Hunter Wessells, and Jonathan D. Harper M. Kennedy HallM. Kennedy Hall More articles by this author , Jeff ThielJeff Thiel More articles by this author , Patrick C. SamsonPatrick C. Samson More articles by this author , Ross KesslerRoss Kessler More articles by this author , Peter SunaryoPeter Sunaryo More articles by this author , Robert M. SweetRobert M. Sweet More articles by this author , Ian S. MetzlerIan S. Metzler More articles by this author , Martin L. GunnMartin L. Gunn More articles by this author , Layla AndersonLayla Anderson More articles by this author , Barbrina DunmireBarbrina Dunmire More articles by this author , Christina PopchoiChristina Popchoi More articles by this author , Ravi ManaguliRavi Managuli More articles by this author , Bryan W. CunitzBryan W. Cunitz More articles by this author , Barbara BurkeBarbara Burke More articles by this author , Adam D. MaxwellAdam D. Maxwell More articles by this author , Michael R. BaileyMichael R. Bailey More articles by this author , Mathew D. SorensenMathew D. Sorensen More articles by this author , Hunter WessellsHunter Wessells More articles by this author , and Jonathan D. HarperJonathan D. Harper More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002003.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The feasibility of ultrasonic propulsion and burst wave lithotripsy (BWL) to noninvasively reposition distal ureteral stones to facilitate passage and relieve pain was tested. METHODS: Patients presenting to the kidney stone clinic or emergency department (ED) with a distal ureteral stone were recruited after standard of care pain management. To attempt to move the stone, 10 subjects underwent ultrasonic propulsion (lower amplitude, longer duration bursts) alone, and 10 subjects also received intermittent BWL (higher amplitude, shorter duration bursts). All participants were awake without anesthesia and underwent:· a screening ultrasound to ensure the stone was visible· a pain assessment pre- and post-procedure · contact once a week for three weeks to assess for adverse events· follow-up imaging and chart review within 12 weeksSubjects were sub-categorized based on whether their stone was acute or chronic (≤10 days or >10 days from their ED visit, respectively). RESULTS: Demographic data and effectiveness outcomes are presented in Tables 1 and 2. Overall, 93% of acute stones passed in an average of 3.6 days post-procedure. There was no control group, but Table 2 includes published passage rates and times for potentially similar untreated groups as reference. Stone motion was observed in 16 of 20 cases, including a stone pushed into the bladder, ureteral jets were observed following propulsion bursts in 9 of 20 cases and fragmentation was observed in 3 of 10 BWL cases. Pain reduced post-procedure in 10 of 20 subjects, while pain increased in only one subject; although, the average score was low prior to treatment, and the average decrease was not statistically significant (p=0.13). Adverse events were limited to slight reddening of the skin (N=6), hematuria on only the initial urination post-procedure (BWL only, N=3), and a mild sensation, akin to a pinprick, on fewer than 10 of 620 propulsion bursts among 3 subjects. CONCLUSIONS: This feasibility study showed the potential for facilitating stone passage of distal ureteral stones and relieving pain with ultrasonic propulsion and BWL. Source of Funding: Work supported by NASA, NIH P01 DK043881, and NIH K01 DK104854 © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e320-e320 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information M. Kennedy Hall More articles by this author Jeff Thiel More articles by this author Patrick C. Samson More articles by this author Ross Kessler More articles by this author Peter Sunaryo More articles by this author Robert M. Sweet More articles by this author Ian S. Metzler More articles by this author Martin L. Gunn More articles by this author Layla Anderson More articles by this author Barbrina Dunmire More articles by this author Christina Popchoi More articles by this author Ravi Managuli More articles by this author Bryan W. Cunitz More articles by this author Barbara Burke More articles by this author Adam D. Maxwell More articles by this author Michael R. Bailey More articles by this author Mathew D. Sorensen More articles by this author Hunter Wessells More articles by this author Jonathan D. Harper More articles by this author Expand All Advertisement Loading ...