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Independent assessment of a wide‐focus, low‐pressure electromagnetic lithotripter: absence of renal bioeffects in the pig
Author(s) -
Evan Andrew P.,
McAteer James A.,
Connors Bret A.,
Pishchalnikov Yuri A.,
Handa Rajash K.,
Blomgren Philip,
Willis Lynn R.,
Williams James C.,
Lingeman James E.,
Gao Sujuan
Publication year - 2008
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/j.1464-410x.2007.07231.x
Subject(s) - renal function , effective renal plasma flow , medicine , renal blood flow , kidney , urology , lithotripsy , renal injury , surgery
OBJECTIVE To assess the renal injury response in a pig model treated with a clinical dose of shock waves (SWs) delivered at a slow rate (27 SW/min) using a novel wide focal zone (18 mm), low acoustic pressure (<20 MPa) electromagnetic lithotripter (Xi Xin‐Eisenmenger, XX‐ES; Xi Xin Medical Instruments Co. Ltd., Suzhou, PRC). MATERIALS AND METHODS The left kidneys of anaesthetized female pigs were treated with 1500 SWs from either an unmodified electrohydraulic lithotripter (HM3, Dornier MedTech America, Inc., Kennesaw, GA, USA; 18 kV, 30 SW/min) or the XX‐ES (9.3 kV, 27 SW/min). Measures of renal function (glomerular filtration rate, GFR, and renal plasma flow) were collected before and after SW lithotripsy, and kidneys were harvested for histological quantification of vascular haemorrhage, expressed as a percentage of the functional renal volume (FRV). A fibre‐optic probe hydrophone was used to characterize the acoustic field, and the breakage of gypsum model stones was used to compare the function of the two lithotripters. RESULTS Kidneys treated with the XX‐ES showed no significant change in renal haemodynamic function and no detectable tissue injury. Pigs treated with the HM3 had a modest decline from baseline (≈ 20%) in both GFR ( P > 0.05) and renal plasma flow ( P = 0.064) in the treated kidney, but that was not significantly different from the control group. Although most HM3‐treated pigs showed no evidence of renal tissue injury, two had focal injury measuring 0.1% FRV, localized to the renal papillae. The width of the focal zone for the XX‐ES was ≈ 18 mm and that of the HM3 ≈ 8 mm. Peak positive pressures at settings used to treat pigs and break model stones were considerably lower for the XX‐ES (17 MPa at 9.3 kV) than for the HM3 (37 MPa at 18 kV). The XX‐ES required fewer SWs to break stones to completion than did the HM3, with a mean ( sd ) of 634 (42) and 831 (43) SWs, respectively ( P < 0.01). However, conditions were different for these tests because of differences in physical configuration of the two machines. CONCLUSION The absence of renal injury with the wide focal zone XX‐ES lithotripter operated at low shock pressure and a slow SW rate suggests that this lithotripter would be safe when used at the settings recommended for patient treatment. That the injury was also minimal using the Dornier HM3 lithotripter at a slow SW rate implies that the reduced tissue injury seen with these two machines was because they were operated at a slow SW rate. As recent studies have shown stone breakage to be improved when the focal zone is wider than the stone, a wide focal zone lithotripter operated at low pressure and slow rate has the features necessary to provide better stone breakage with less tissue injury.