Focused ultrasound to expel calculi from the kidney

Safety and efficacy of a clinical prototype device

Jonathan D. Harper, Mathew D. Sorensen, Bryan W. Cunitz, Yak Nam Wang, Julianna Simon, Frank Starr, Marla Paun, Barbrina Dunmire, H. Denny Liggitt, Andrew P. Evan, James A. McAteer, Ryan S. Hsi, Michael R. Bailey

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

Purpose: Focused ultrasound has the potential to expel small stones or residual stone fragments from the kidney, or move obstructing stones to a nonobstructing location. We evaluated the efficacy and safety of ultrasonic propulsion in a live porcine model. Materials and Methods: Calcium oxalate monohydrate kidney stones and laboratory model stones (2 to 8 mm) were ureteroscopically implanted in the renal pelvicalyceal system of 12 kidneys in a total of 8 domestic swine. Transcutaneous ultrasonic propulsion was performed using an HDI C5-2 imaging transducer (ATL/Philips, Bothell, Washington) and the Verasonics® diagnostic ultrasound platform. Successful stone relocation was defined as stone movement from the calyx to the renal pelvis, ureteropelvic junction or proximal ureter. Efficacy and procedure time was determined. Three blinded experts evaluated histological injury to the kidney in the control, sham treatment and treatment arms. Results: All 26 stones were observed to move during treatment and 17 (65%) were relocated successfully to the renal pelvis (3), ureteropelvic junction (2) or ureter (12). Average ± SD successful procedure time was 14 ± 8 minutes and a mean of 23 ± 16 ultrasound bursts, each about 1 second in duration, were required. There was no evidence of gross or histological injury to the renal parenchyma in kidneys exposed to 20 bursts (1 second in duration at 33-second intervals) at the same output (2,400 W/cm2) used to push stones. Conclusions: Noninvasive transcutaneous ultrasonic propulsion is a safe, effective and time efficient means to relocate calyceal stones to the renal pelvis, ureteropelvic junction or ureter. This technology holds promise as a useful adjunct to surgical management for renal calculi.

Original languageEnglish (US)
Pages (from-to)1090-1095
Number of pages6
JournalJournal of Urology
Volume190
Issue number3
DOIs
StatePublished - Sep 1 2013

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Kidney Calculi
Kidney Pelvis
Kidney
Safety
Equipment and Supplies
Ureter
Ultrasonics
Swine
Calcium Oxalate
Wounds and Injuries
Transducers
Ultrasonography
Placebos
Technology
Therapeutics

All Science Journal Classification (ASJC) codes

  • Urology

Cite this

Harper, J. D., Sorensen, M. D., Cunitz, B. W., Wang, Y. N., Simon, J., Starr, F., ... Bailey, M. R. (2013). Focused ultrasound to expel calculi from the kidney: Safety and efficacy of a clinical prototype device. Journal of Urology, 190(3), 1090-1095. https://doi.org/10.1016/j.juro.2013.03.120
Harper, Jonathan D. ; Sorensen, Mathew D. ; Cunitz, Bryan W. ; Wang, Yak Nam ; Simon, Julianna ; Starr, Frank ; Paun, Marla ; Dunmire, Barbrina ; Liggitt, H. Denny ; Evan, Andrew P. ; McAteer, James A. ; Hsi, Ryan S. ; Bailey, Michael R. / Focused ultrasound to expel calculi from the kidney : Safety and efficacy of a clinical prototype device. In: Journal of Urology. 2013 ; Vol. 190, No. 3. pp. 1090-1095.
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abstract = "Purpose: Focused ultrasound has the potential to expel small stones or residual stone fragments from the kidney, or move obstructing stones to a nonobstructing location. We evaluated the efficacy and safety of ultrasonic propulsion in a live porcine model. Materials and Methods: Calcium oxalate monohydrate kidney stones and laboratory model stones (2 to 8 mm) were ureteroscopically implanted in the renal pelvicalyceal system of 12 kidneys in a total of 8 domestic swine. Transcutaneous ultrasonic propulsion was performed using an HDI C5-2 imaging transducer (ATL/Philips, Bothell, Washington) and the Verasonics{\circledR} diagnostic ultrasound platform. Successful stone relocation was defined as stone movement from the calyx to the renal pelvis, ureteropelvic junction or proximal ureter. Efficacy and procedure time was determined. Three blinded experts evaluated histological injury to the kidney in the control, sham treatment and treatment arms. Results: All 26 stones were observed to move during treatment and 17 (65{\%}) were relocated successfully to the renal pelvis (3), ureteropelvic junction (2) or ureter (12). Average ± SD successful procedure time was 14 ± 8 minutes and a mean of 23 ± 16 ultrasound bursts, each about 1 second in duration, were required. There was no evidence of gross or histological injury to the renal parenchyma in kidneys exposed to 20 bursts (1 second in duration at 33-second intervals) at the same output (2,400 W/cm2) used to push stones. Conclusions: Noninvasive transcutaneous ultrasonic propulsion is a safe, effective and time efficient means to relocate calyceal stones to the renal pelvis, ureteropelvic junction or ureter. This technology holds promise as a useful adjunct to surgical management for renal calculi.",
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Harper, JD, Sorensen, MD, Cunitz, BW, Wang, YN, Simon, J, Starr, F, Paun, M, Dunmire, B, Liggitt, HD, Evan, AP, McAteer, JA, Hsi, RS & Bailey, MR 2013, 'Focused ultrasound to expel calculi from the kidney: Safety and efficacy of a clinical prototype device', Journal of Urology, vol. 190, no. 3, pp. 1090-1095. https://doi.org/10.1016/j.juro.2013.03.120

Focused ultrasound to expel calculi from the kidney : Safety and efficacy of a clinical prototype device. / Harper, Jonathan D.; Sorensen, Mathew D.; Cunitz, Bryan W.; Wang, Yak Nam; Simon, Julianna; Starr, Frank; Paun, Marla; Dunmire, Barbrina; Liggitt, H. Denny; Evan, Andrew P.; McAteer, James A.; Hsi, Ryan S.; Bailey, Michael R.

In: Journal of Urology, Vol. 190, No. 3, 01.09.2013, p. 1090-1095.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Focused ultrasound to expel calculi from the kidney

T2 - Safety and efficacy of a clinical prototype device

AU - Harper, Jonathan D.

AU - Sorensen, Mathew D.

AU - Cunitz, Bryan W.

AU - Wang, Yak Nam

AU - Simon, Julianna

AU - Starr, Frank

AU - Paun, Marla

AU - Dunmire, Barbrina

AU - Liggitt, H. Denny

AU - Evan, Andrew P.

AU - McAteer, James A.

AU - Hsi, Ryan S.

AU - Bailey, Michael R.

PY - 2013/9/1

Y1 - 2013/9/1

N2 - Purpose: Focused ultrasound has the potential to expel small stones or residual stone fragments from the kidney, or move obstructing stones to a nonobstructing location. We evaluated the efficacy and safety of ultrasonic propulsion in a live porcine model. Materials and Methods: Calcium oxalate monohydrate kidney stones and laboratory model stones (2 to 8 mm) were ureteroscopically implanted in the renal pelvicalyceal system of 12 kidneys in a total of 8 domestic swine. Transcutaneous ultrasonic propulsion was performed using an HDI C5-2 imaging transducer (ATL/Philips, Bothell, Washington) and the Verasonics® diagnostic ultrasound platform. Successful stone relocation was defined as stone movement from the calyx to the renal pelvis, ureteropelvic junction or proximal ureter. Efficacy and procedure time was determined. Three blinded experts evaluated histological injury to the kidney in the control, sham treatment and treatment arms. Results: All 26 stones were observed to move during treatment and 17 (65%) were relocated successfully to the renal pelvis (3), ureteropelvic junction (2) or ureter (12). Average ± SD successful procedure time was 14 ± 8 minutes and a mean of 23 ± 16 ultrasound bursts, each about 1 second in duration, were required. There was no evidence of gross or histological injury to the renal parenchyma in kidneys exposed to 20 bursts (1 second in duration at 33-second intervals) at the same output (2,400 W/cm2) used to push stones. Conclusions: Noninvasive transcutaneous ultrasonic propulsion is a safe, effective and time efficient means to relocate calyceal stones to the renal pelvis, ureteropelvic junction or ureter. This technology holds promise as a useful adjunct to surgical management for renal calculi.

AB - Purpose: Focused ultrasound has the potential to expel small stones or residual stone fragments from the kidney, or move obstructing stones to a nonobstructing location. We evaluated the efficacy and safety of ultrasonic propulsion in a live porcine model. Materials and Methods: Calcium oxalate monohydrate kidney stones and laboratory model stones (2 to 8 mm) were ureteroscopically implanted in the renal pelvicalyceal system of 12 kidneys in a total of 8 domestic swine. Transcutaneous ultrasonic propulsion was performed using an HDI C5-2 imaging transducer (ATL/Philips, Bothell, Washington) and the Verasonics® diagnostic ultrasound platform. Successful stone relocation was defined as stone movement from the calyx to the renal pelvis, ureteropelvic junction or proximal ureter. Efficacy and procedure time was determined. Three blinded experts evaluated histological injury to the kidney in the control, sham treatment and treatment arms. Results: All 26 stones were observed to move during treatment and 17 (65%) were relocated successfully to the renal pelvis (3), ureteropelvic junction (2) or ureter (12). Average ± SD successful procedure time was 14 ± 8 minutes and a mean of 23 ± 16 ultrasound bursts, each about 1 second in duration, were required. There was no evidence of gross or histological injury to the renal parenchyma in kidneys exposed to 20 bursts (1 second in duration at 33-second intervals) at the same output (2,400 W/cm2) used to push stones. Conclusions: Noninvasive transcutaneous ultrasonic propulsion is a safe, effective and time efficient means to relocate calyceal stones to the renal pelvis, ureteropelvic junction or ureter. This technology holds promise as a useful adjunct to surgical management for renal calculi.

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