PD54-10 FIRST REPORT OF COMMINUTION OF STONES IN HUMANS BY BURST WAVE LITHOTRIPSY

Abstract

You have accessJournal of UrologyStone Disease: Surgical Therapy IV (PD54)1 Sep 2021PD54-10 FIRST REPORT OF COMMINUTION OF STONES IN HUMANS BY BURST WAVE LITHOTRIPSY Jonathan D. Harper, James E. Lingeman, Ian Metzler, Peter Sunaryo, Robert M. Sweet, James C. Williams, Adam D. Maxwell, Jeff Thiel, Bryan W. Cunitz, Barbrina Dunmire, Michael R. Bailey, and Mathew D. Sorensen Jonathan D. HarperJonathan D. Harper More articles by this author , James E. LingemanJames E. Lingeman More articles by this author , Ian MetzlerIan Metzler More articles by this author , Peter SunaryoPeter Sunaryo More articles by this author , Robert M. SweetRobert M. Sweet More articles by this author , James C. WilliamsJames C. Williams More articles by this author , Adam D. MaxwellAdam D. Maxwell More articles by this author , Jeff ThielJeff Thiel More articles by this author , Bryan W. CunitzBryan W. Cunitz More articles by this author , Barbrina DunmireBarbrina Dunmire More articles by this author , Michael R. BaileyMichael R. Bailey More articles by this author , and Mathew D. SorensenMathew D. Sorensen More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002081.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: We report stone comminution in the first human subjects by burst wave lithotripsy (BWL), which is the transcutaneous application of focused, cyclic ultrasound pulses. METHODS: This is a prospective multi-institutional feasibility study recruiting subjects undergoing clinical ureteroscopy (URS) for at least one stone ≤ 12 mm on computed tomography (CT). During the planned URS, BWL is administered with a handheld probe, and any stone fragmentation and tissue injury are observed. Up to 3 stones can be treated, each for a maximum of 10 min to be respectful of operating room time. The primary effectiveness outcome is the volume percent comminution into fragments ≤ 2 mm, where fragment volume is determined by µCT of basketed fragments or image processing of the URS video using the laser fiber as a size reference. The primary safety outcome is independent, blinded grading of tissue injury from the video. RESULTS: Comminution data to date are from 6 female and 6 male subjects with an average BMI of 25 ± 5 kg/m2 and average age of 57 ± 15 years. Overall, 13 of 15 stones were comminuted with BWL (Table 1). In 8 of 15 cases, ≥ 85% of the stone was comminuted to fragments ≤ 2 mm in under 10 min. One stone in the distal ureter was 87% comminuted after 4 min before passing into the bladder. Seven stones were < 85% comminuted, potentially because of their size (> the beam width or < the acoustic wavelength), composition, structure, or the introduction of air by URS that shielded the stone from BWL. Figure 1 shows fragments from the 20% comminuted stone and tissue around the 99% comminuted stone. Only mild reddening with some hematuria was observed ureteroscopically. Included in the tissue observations were 2 additional BWL-treated subjects where the stone identified on CT was determined to be most likely submucosal on URS. For another additional BWL-treated subject, fragments were noted, but the URS video did not record for comminution or tissue measurement. CONCLUSIONS: The first study of BWL in human subjects resulted in an average of 63% comminution of stones into fragments ≤ 2 mm within a treatment time of only 10 min and with only mild tissue injury. Source of Funding: Work supported by NIH P01 DK043881 and K01 DK104854 © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e926-e927 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jonathan D. Harper More articles by this author James E. Lingeman More articles by this author Ian Metzler More articles by this author Peter Sunaryo More articles by this author Robert M. Sweet More articles by this author James C. Williams More articles by this author Adam D. Maxwell More articles by this author Jeff Thiel More articles by this author Bryan W. Cunitz More articles by this author Barbrina Dunmire More articles by this author Michael R. Bailey More articles by this author Mathew D. Sorensen More articles by this author Expand All Advertisement PDF downloadLoading ...