Abstract
The fragmentation mechanisms of gallstones exposed to both invitro and invivo lithotripsy with a Diasonics Therasonic piezoelectric litho- tripter were studied. Mechanical properties of stones, including air content, microhardness, acoustic attenuation, and shear and longitudinal wave speeds were measured and correlated with objective measures of fragmentation rates. These measures included the number of shocks to the development of the first crack, and the mass of the stone fragments larger than 3 mm in diameter remaining after 2000 shocks. The relationship of the volume of the surrounding liquid to the efficacy of litho- tripsy was studied for gallstones that were removed from the same patient. Finally, gallstones removed surgically from three patients who underwent lithotripsy and had incomplete fragmentation were examined under a scanning electron microscope for signs of damage. The results of these studies point to the combined roles of cavitation and stone properties as the principal determinants of gallstone breakup in lithotripsy.
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