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Journal of Veterinary Internal Medicine Sep 2016In an age of advancing endoscopic and lithotripsy technologies, the management of urolithiasis poses a unique opportunity to advance compassionate veterinary care, not...
In an age of advancing endoscopic and lithotripsy technologies, the management of urolithiasis poses a unique opportunity to advance compassionate veterinary care, not only for patients with urolithiasis but for those with other urinary diseases as well. The following are consensus-derived, research and experience-supported, patient-centered recommendations for the treatment and prevention of uroliths in dogs and cats utilizing contemporary strategies. Ultimately, we hope that these recommendations will serve as a foundation for ongoing and future clinical research and inspiration for innovative problem solving.
Topics: Animals; Cat Diseases; Cats; Dog Diseases; Dogs; Lithotripsy; Practice Guidelines as Topic; Societies, Scientific; United States; Urolithiasis; Veterinary Medicine
PubMed: 27611724
DOI: 10.1111/jvim.14559 -
Journal of Ultrasound in Medicine :... Apr 2012Applications of ultrasound in medicine for therapeutic purposes have been accepted and beneficial uses of ultrasonic biological effects for many years. Low-power... (Review)
Review
Applications of ultrasound in medicine for therapeutic purposes have been accepted and beneficial uses of ultrasonic biological effects for many years. Low-power ultrasound of about 1 MHz has been widely applied since the 1950s for physical therapy in conditions such as tendinitis and bursitis. In the 1980s, high-pressure-amplitude shock waves came into use for mechanically resolving kidney stones, and "lithotripsy" rapidly replaced surgery as the most frequent treatment choice. The use of ultrasonic energy for therapy continues to expand, and approved applications now include uterine fibroid ablation, cataract removal (phacoemulsification), surgical tissue cutting and hemostasis, transdermal drug delivery, and bone fracture healing, among others. Undesirable bioeffects can occur, including burns from thermal-based therapies and severe hemorrhage from mechanical-based therapies (eg, lithotripsy). In all of these therapeutic applications of ultrasound bioeffects, standardization, ultrasound dosimetry, benefits assurance, and side-effect risk minimization must be carefully considered to ensure an optimal benefit to risk ratio for the patient. Therapeutic ultrasound typically has well-defined benefits and risks and therefore presents a manageable safety problem to the clinician. However, safety information can be scattered, confusing, or subject to commercial conflicts of interest. Of paramount importance for managing this problem is the communication of practical safety information by authoritative groups, such as the American Institute of Ultrasound in Medicine, to the medical ultrasound community. In this overview, the Bioeffects Committee of the American Institute of Ultrasound in Medicine outlines the wide range of therapeutic ultrasound methods, which are in clinical use or under study, and provides general guidance for ensuring therapeutic ultrasound safety.
Topics: Humans; Lithotripsy; Ultrasonic Therapy
PubMed: 22441920
DOI: 10.7863/jum.2012.31.4.623 -
Progress in Biophysics and Molecular... 2007Therapeutic applications of ultrasound predate its use in imaging. A range of biological effects can be induced by ultrasound, depending on the exposure levels used. At... (Review)
Review
Therapeutic applications of ultrasound predate its use in imaging. A range of biological effects can be induced by ultrasound, depending on the exposure levels used. At low levels, beneficial, reversible cellular effects may be produced, whereas at high intensities instantaneous cell death is sought. Therapy ultrasound can therefore be broadly divided into "low power" and "high power" applications. The "low power" group includes physiotherapy, fracture repair, sonophoresis, sonoporation and gene therapy, whereas the most common use of "high power" ultrasound in medicine is probably now high intensity focused ultrasound. Therapeutic effect through the intensity spectrum is obtained by both thermal and non-thermal interaction mechanisms. At low intensities, acoustic streaming is likely to be significant, but at higher levels, heating and acoustic cavitation will predominate. While useful therapeutic effects are now being demonstrated clinically, the mechanisms by which they occur are often not well understood.
Topics: Fractures, Bone; Genetic Therapy; Humans; Lithotripsy; Neoplasms; Phonophoresis; Thrombosis; Ultrasonic Therapy
PubMed: 16930682
DOI: 10.1016/j.pbiomolbio.2006.07.005 -
Endoscopy May 2019ESGE recommends offering stone extraction to all patients with common bile duct stones, symptomatic or not, who are fit enough to tolerate the intervention.Strong...
ESGE recommends offering stone extraction to all patients with common bile duct stones, symptomatic or not, who are fit enough to tolerate the intervention.Strong recommendation, low quality evidence.ESGE recommends liver function tests and abdominal ultrasonography as the initial diagnostic steps for suspected common bile duct stones. Combining these tests defines the probability of having common bile duct stones.Strong recommendation, moderate quality evidence.ESGE recommends endoscopic ultrasonography or magnetic resonance cholangiopancreatography to diagnose common bile duct stones in patients with persistent clinical suspicion but insufficient evidence of stones on abdominal ultrasonography.Strong recommendation, moderate quality evidence.ESGE recommends the following timing for biliary drainage, preferably endoscopic, in patients with acute cholangitis, classified according to the 2018 revision of the Tokyo Guidelines:- severe, as soon as possible and within 12 hours for patients with septic shock- moderate, within 48 - 72 hours- mild, elective.Strong recommendation, low quality evidence.ESGE recommends endoscopic placement of a temporary biliary plastic stent in patients with irretrievable biliary stones that warrant biliary drainage.Strong recommendation, moderate quality of evidence.ESGE recommends limited sphincterotomy combined with endoscopic papillary large-balloon dilation as the first-line approach to remove difficult common bile duct stones. Strong recommendation, high quality evidence.ESGE recommends the use of cholangioscopy-assisted intraluminal lithotripsy (electrohydraulic or laser) as an effective and safe treatment of difficult bile duct stones.Strong recommendation, moderate quality evidence.ESGE recommends performing a laparoscopic cholecystectomy within 2 weeks from ERCP for patients treated for choledocholithiasis to reduce the conversion rate and the risk of recurrent biliary events. Strong recommendation, moderate quality evidence.
Topics: Cholecystectomy; Common Bile Duct; Endoscopy, Gastrointestinal; Endosonography; Europe; Gallstones; Humans; Lithotripsy; Patient Selection; Sphincterotomy, Endoscopic
PubMed: 30943551
DOI: 10.1055/a-0862-0346 -
Current Opinion in Urology Mar 2020Burst wave lithotripsy and ultrasonic propulsion of kidney stones are novel, noninvasive emerging technologies to separately or synergistically fragment and reposition... (Review)
Review
PURPOSE OF REVIEW
Burst wave lithotripsy and ultrasonic propulsion of kidney stones are novel, noninvasive emerging technologies to separately or synergistically fragment and reposition stones in an office setting. The purpose of this review is to discuss the latest refinements in technology, to update on testing of safety and efficacy, and to review future applications.
RECENT FINDINGS
Burst wave lithotripsy produced consistent, small passable fragments through transcutaneous applications in a porcine model, while producing minimal injury and clinical trials are now underway. A more efficient ultrasonic propulsion design that can also deliver burst wave lithotripsy effectively repositioned 95% of stones in 18 human participants (18 of 19 kidneys) and clinical trials continue. Acoustic tractor beam technology is an emerging technology with promising clinical applications through the manipulation of macroscopic objects.
SUMMARY
The goal of the reviewed work is an office-based system to image, fragment, and reposition urinary stones to facilitate their natural passage. The review highlights progress in establishing safety, effectiveness, and clinical benefit of these new technologies. The work is also anticipating challenges in clinical trials and developing the next generation of technology to improve on the technology as it is being commercialized today.
Topics: Acoustics; Animals; Disease Models, Animal; Humans; Kidney Calculi; Lithotripsy; Lithotripsy, Laser; Swine; Ultrasonic Therapy; Ultrasonography; Ureteroscopy; Urinary Calculi
PubMed: 31905177
DOI: 10.1097/MOU.0000000000000727 -
International Journal of Surgery... Dec 2016The advancements in the endourological armamentarium and the evolution of ureteroscopes with the advent of fiberoptic first and then digital technology, the introduction... (Review)
Review
The advancements in the endourological armamentarium and the evolution of ureteroscopes with the advent of fiberoptic first and then digital technology, the introduction of holmium laser lithotripters, together with the increasing number of requests for minimally invasive procedures has ameliorated outcomes, patients' safety and comfort, making the use of flexible ureteroscopy for urinary calculi increasingly attractive and widespread among urological community. Due to its high stone-free rates and low morbidity, flexible ureteroscopy has become a viable option for the treatment of renal stones. This review describes the contemporary ureteroscopic management of kidney stones.
Topics: Humans; Kidney Calculi; Lithotripsy; Patient Safety; Ureteroscopes; Ureteroscopy
PubMed: 27913238
DOI: 10.1016/j.ijsu.2016.11.130 -
BioMed Research International 2022Ureterorenoscopy (URS) is believed to be a safe and effective procedure for treating ureteral stones or ureteral strictures. Rapidly increasing intrarenal pressure...
Ureterorenoscopy (URS) is believed to be a safe and effective procedure for treating ureteral stones or ureteral strictures. Rapidly increasing intrarenal pressure during URS may have a negative impact on the kidney, but its effect on renal function is not well known. The aim of this study was to evaluate whether URS balloon dilation or lithotripsy could cause acute kidney injury (AKI), which was evaluated using urine neutrophil gelatinase-associated lipocalin (NGAL), and renal tubular damage, which was evaluated using urine -glutathione S-transferase (GST) and GST. This prospective study included 207 patients with a mean age of 53.8 years between September 2012 and June 2013. Four groups were included: the ureteral stricture group (group 1), the ureteral stone group (group 2), and two control groups. URS increased urine NGAL (uNGAL) levels on days 1 and 14 in both groups, and only elevated uGST levels were noted on day 14 after URS lithotripsy (URS). On day 14, the difference between low-grade and high-grade hydronephrosis was significant in group 1 ( < 0.001) compared to that in group 2 ( = 0.150). Multivariate logistic regression analysis revealed that age, baseline estimated glomerular filtration rate (eGFR), and stone size > 1.0 cm were associated with the complete recovery of hydronephrosis after URS on day 14. Patients with ureteral stones with preserved renal function had more AKI than those with impaired renal function. However, there was no significant difference in URS-related AKI between the ≤1 cm and >1 cm subgroups. In addition, urine GST and GST levels were both significantly higher in the stone > 1 cm subgroup than in the ≤1 cm subgroup. In conclusion, URS laser lithotripsy and balloon dilatation resulted in AKI and renal tubular damage on day 14, although post-URS double-J (DBJ) stenting was performed in every patient.
Topics: Acute Kidney Injury; Dilatation; Glutathione Transferase; Humans; Hydronephrosis; Kidney Tubules, Distal; Lipocalin-2; Lithotripsy; Middle Aged; Prospective Studies; Retrospective Studies; Treatment Outcome; Ureteral Calculi; Ureteral Obstruction; Ureteroscopy
PubMed: 36158883
DOI: 10.1155/2022/5505969 -
Revista Da Associacao Medica Brasileira... 2015The use of certain technical principles and the selection of favorable cases can optimize the results of extracorporeal shock wave lithotripsy (ESWL). The aim of this... (Review)
Review
The use of certain technical principles and the selection of favorable cases can optimize the results of extracorporeal shock wave lithotripsy (ESWL). The aim of this study is to review how ESWL works, its indications and contraindications, predictive factors for success, and its complications. A search was conducted on the Pubmed® database between January 1984 and October 2013 using "shock wave lithotripsy" and "stone" as key-words. Only articles with a high level of evidence, in English, and conducted in humans, such as clinical trials or review/meta-analysis, were included. To optimize the search for the ESWL results, several technical factors including type of lithotripsy device, energy and frequency of pulses, coupling of the patient to the lithotriptor, location of the calculus, and type of anesthesia should be taken into consideration. Other factors related to the patient, stone size and density, skin to stone distance, anatomy of the excretory path, and kidney anomalies are also important. Antibiotic prophylaxis is not necessary, and routine double J stent placement before the procedure is not routinely recommended. Alpha-blockers, particularly tamsulosin, are useful for stones >10mm. Minor complications may occur following ESWL, which generally respond well to clinical interventions. The relationship between ESWL and hypertension/diabetes is not well established.
Topics: Clinical Trials as Topic; Humans; Lithotripsy; Treatment Outcome; Ureteral Calculi
PubMed: 25909212
DOI: 10.1590/1806-9282.61.01.065 -
Minerva Urologica E Nefrologica = the... Aug 2019Over the last four decades, extracorporeal shockwave lithotripsy (ESWL) has been used as an effective technique to treat kidney and ureteral stones. Nowadays, ESWL still... (Review)
Review
Over the last four decades, extracorporeal shockwave lithotripsy (ESWL) has been used as an effective technique to treat kidney and ureteral stones. Nowadays, ESWL still plays a role in stone treatment and is a primary treatment option in different guidelines. New technologies are now available to endourologists, but this procedure remains valid. This narrative review will shortly illustrate the history of ESWL and its clinical applications, limits, and specific uses.
Topics: Humans; Kidney Calculi; Lithotripsy; Ureteral Calculi
PubMed: 31086132
DOI: 10.23736/S0393-2249.19.03415-5 -
Urolithiasis Feb 2018It is well recognized that the popularity of extracorporeal shock wave lithotripsy (SWL), despite its non-invasive character, has decreased during recent years. This is... (Review)
Review
It is well recognized that the popularity of extracorporeal shock wave lithotripsy (SWL), despite its non-invasive character, has decreased during recent years. This is partly explained by the technological achievements in endoscopy and urologists' enthusiasm for such procedures. Another explanation is that many urologists have been insufficiently successful with SWL. The latter effect might to some extent be a result of the performance of the lithotripter used, but in too many cases, it is evident that the principles of how shock wave lithotripsy should be carried out are poorly applied. The purpose of this article is to emphasize some important aspects on how SWL best should be used. Based on decades of experience, it stands to reason that success with SWL does not come automatically and attention has to be paid to all details of this technique.
Topics: Humans; Kidney Calculi; Lithotripsy; Practice Guidelines as Topic
PubMed: 29177561
DOI: 10.1007/s00240-017-1020-z