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JU INSIGHT: First Series Using Ultrasonic Propulsion and Burst Wave Lithotripsy to Treat Ureteral Stones
By: M. Kennedy Hall, MD, MHS; Jeff Thiel, BS, RDMS; Barbrina Dunmire, MS; Patrick C. Samson, MD; Ross Kessler, MD; Peter Sunaryo, MD; Robert M. Sweet, MD, FACS, MAMSE; Ian S. Metzler, MD, MTM; Helena C. Chang, MD; Martin Gunn, MD, ChB; Manjiri Dighe, MD; Layla Anderson, BA; Christina Popchoi, BS, RDMS; Ravi Managuli, PhD, RDMS; Bryan W. Cunitz, MS; Barbara H. Burke, BS; Lisa Ding, PA-C; Brianna Gutierrez, PA-C; Ziyue Liu, PhD; Mathew D. Sorensen, MD, MS, FACS; Hunter Wessells, MD, FACS; Michael R. Bailey, PhD; Jonathan D. Harper, MD | Posted on: 01 Nov 2022
Kennedy Hall M, Thiel J, Dunmire B, et al. First series using ultrasonic propulsion and burst wave lithotripsy to treat ureteral stones. J Urol. 2022;208(5):1075-1082.
Study Need and Importance
Our goal was to test transcutaneous focused ultrasound in the form of ultrasonic propulsion and burst wave lithotripsy (BWL) to reposition ureteral stones and facilitate passage in awake subjects.
What We Found
Adult subjects with a diagnosed proximal or distal ureteral stone were prospectively recruited. Ultrasonic propulsion alone or with BWL was administered by a handheld transducer to awake, unanesthetized subjects. Twenty-nine subjects received either ultrasonic propulsion alone (n = 16) or with BWL bursts (n = 13), and stone motion was observed in 19 (66%), including 2 where the stone was repositioned into the bladder. The stone passed in 18 (86%) of the 21 distal ureteral stone cases with at least 2 weeks follow-up in an average of 3.9±4.9 days post-procedure (see Table). Fragmentation was observed in 7 of the BWL cases. All subjects tolerated the procedure with average pain scores (0-10) dropping from 2.1±2.3 to 1.6±2.0 (P = .03). Anticipated events were limited to hematuria on initial urination post-procedure and mild pain. In total, 7 subjects had associated discomfort in only 18 of 820 propulsion bursts.
Table. Efficacy Outcomes
| Propulsion Only | Propulsion+BWL | Total | |
|---|---|---|---|
| Analysis | |||
| No. pts | 16 | 13 | 29 |
| Stone motion, No. (%) | 11 (69) | 8 (62) | 19 (66) |
| Peristaltic motion | 6 (38) | 8 (62) | 14 (48) |
| Ureteric jets | 5 (31) | 4 (31) | 9 (31) |
| Echogenicity change/potential cavitation | 8 (50) | 9 (69) | 17 (59) |
| Subgroup Analysis | |||
| No. pts | 11 | 10 | 21 |
| Subjects passing stone, No. (%) | 11 (100) | 7 (70) | 18 (86) |
| Days to passage, mean±SD | 2.6±4.0 | 5.9±5.9 | 3.9±4.9 |
| Abbreviation: BWL, burst wave lithotripsy. | |||
Limitations
There was no control group for passage rate, although our subjects passed stones at a higher rate than might be expected. The AUA guidelines quote a stone passage rate of 54% for distal ureteral stones smaller than 10 mm based on meta-analyses of 1,205 subjects in 27 studies mostly following for 2 weeks after presentation.
Interpretation for Patient Care
This study supports the efficacy and safety of using ultrasonic propulsion and BWL to reposition and break ureteral stones, potentially relieving pain and facilitating passage in awake patients. This technology has the potential to provide an advantageous and patient-centered solution for the gap between expectant management and urological intervention for ureteral stones.
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