Mp29-11 Feasibility of Burst Wave Lithotripsy and Ultrasonic Propulsion to Expel Small, Asymptomatic, Renal Stones

You have accessJournal of UrologyStone Disease: Surgical Therapy (Including ESWL) III (MP29)1 May 2024MP29-11 FEASIBILITY OF BURST WAVE LITHOTRIPSY AND ULTRASONIC PROPULSION TO EXPEL SMALL, ASYMPTOMATIC, RENAL STONES Arturo E. Holmes, Mathew D. Sorensen, Barbrina Dunmire, Jeff Thiel, Barbara H. Burke, Christina Popchoi, John C. Kucewicz, Yak-Nam Wang, Stephanie Totten, Adam D. Maxwell, M. Kennedy Hall, James E. Lingeman, Alana C. Desai, Branda Levchak, Claire C. Yang, Michael R. Bailey, and Jonathan D. Harper Arturo E. HolmesArturo E. Holmes , Mathew D. SorensenMathew D. Sorensen , Barbrina DunmireBarbrina Dunmire , Jeff ThielJeff Thiel , Barbara H. BurkeBarbara H. Burke , Christina PopchoiChristina Popchoi , John C. KucewiczJohn C. Kucewicz , Yak-Nam WangYak-Nam Wang , Stephanie TottenStephanie Totten , Adam D. MaxwellAdam D. Maxwell , M. Kennedy HallM. Kennedy Hall , James E. LingemanJames E. Lingeman , Alana C. DesaiAlana C. Desai , Branda LevchakBranda Levchak , Claire C. YangClaire C. Yang , Michael R. BaileyMichael R. Bailey , and Jonathan D. HarperJonathan D. Harper View All Author Informationhttps://doi.org/10.1097/01.JU.0001008680.67760.37.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The feasibility of burst wave lithotripsy (BWL) and ultrasonic propulsion to noninvasively fragment and expel small, asymptomatic, renal stones in awake subjects is being tested. A previous randomized control trial reported that removal of secondary, small, asymptomatic renal stones during surgery for a primary stone reduced relapse by 82% (Sorensen et al., NEJM, 2022;387:506-13). Our objective was to treat small asymptomatic stones with BWL and ultrasonic propulsion in a clinic-based setting without anesthesia. METHODS: Participants with up to three, 2-7 mm stones in one kidney seen on computerized tomography (CT) within 90 days were consented and screened to assure targetability with the ultrasound device. Untreated infection or inability to hold anticoagulation were exclusions. Transcutaneous ultrasound imaging with BWL therapy to break stones and ultrasonic propulsion to reposition fragments were applied to awake subjects for a 30-minute total exposure under continuous cardiac monitoring. Pain was assessed immediately before and after the procedure. Postoperative urine samples were graded on a published hematuria score (0-10). Participants were asked to strain their urine and they were contacted weekly for 3 weeks to assess for adverse events (AEs) and fragment passage. The primary outcome was stone free on CT 90 days post procedure. Secondary outcomes included change in stone volume, fragment passage, and AEs. RESULTS: Thirteen participants have been enrolled; 4 failed screening because no stones were seen (2), stones were too large (1), and the individual chose bilateral surgery instead (1). Nine participants with 11 stones received the research procedure: all tolerated treatment. Seven participants have received follow-up CT to date, 2 were stone free with 3 stones completely cleared. Mean reduction in stone volume was 70±25%. Video recordings of the research procedures showed stone fragmentation and repositioning. Six of 9 provided photographs of passed fragments. AEs were mild and self-resolving and included: hematuria (6, average score 2.0±1.6), renal colic (1), back pain (3), urinary urgency (1), and change in urinary frequency (1). One participant with a history of urinary tract infections was given antibiotics post procedure despite a negative urinalysis. All pain scores were zero, except one 2, which the participant attributed to positioning. CONCLUSIONS: It is feasible to remove small, asymptomatic, renal stones noninvasively in awake participants with only mild transient AEs. BWL and ultrasonic propulsion may in the not-too-distant future offer a way to prophylactically remove small stones before they require an emergency department visit or surgery. Source of Funding: Work supported by NIH NIDDK P01 DK043881 © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e485 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Arturo E. Holmes More articles by this author Mathew D. Sorensen More articles by this author Barbrina Dunmire More articles by this author Jeff Thiel More articles by this author Barbara H. Burke More articles by this author Christina Popchoi More articles by this author John C. Kucewicz More articles by this author Yak-Nam Wang More articles by this author Stephanie Totten More articles by this author Adam D. Maxwell More articles by this author M. Kennedy Hall More articles by this author James E. Lingeman More articles by this author Alana C. Desai More articles by this author Branda Levchak More articles by this author Claire C. Yang More articles by this author Michael R. Bailey More articles by this author Jonathan D. Harper More articles by this author Expand All Advertisement PDF downloadLoading ...