How Extracorporeal Shockwave Lithotripsy Works?
Extracorporeal shockwave lithotripsy is
probably the most commonly prescribed treatment for kidney stones. The
technique uses shockwaves to split up stones, so they can easily move across
the urinary tract. A lot of people can resume normal activities within a few
days. Complications of extracorporeal shockwave lithotripsy include blood in
the urine, bruising, and minor discomfort in the back or abdomen.
In extracorporeal shockwave lithotripsy,
shockwaves that are created outside the human body travel through your skin and
body tissues until they hit the denser kidney stones. Following the stones have
now been hit, they'll breakdown into sand-like particles that are easily passed
through the urinary tract in the urine.
What Does a Lithotripter Do?
The lithotripter attempts to split up the
stone with minimal collateral damage, by using an externally-applied, focused,
high-intensity acoustic pulse. The sedated or anesthetized patient lies down in
the apparatus'bed, with the back supported by way of a water-filled coupling
device placed at the degree of kidneys. A fluoroscopic x-ray imaging system or
an ultrasound imaging system is used to find the stone and aim the treatment.
The first generation lithotripter machine has a half ellipsoid-shaped piece that opens
toward the patient.
The acoustic pulse is generated at the
ellipsoidal focal point that is furthest from the in-patient and the stone
positioned at the contrary focal point receives the focused shock wave. The
treatment usually starts at the equipment's lowest power level, with a lengthy
gap between pulses, to be able to accustom the in-patient to the sensation. The
size of gap between pulses is also controlled to permit cavitation bubbles to
disperse, minimizing tissue damage.
Second and later generation machines use a
traditional lens to focus the shock wave. This functions just like a visual
lens, focusing the shock wave at the desired loci. The frequency of pulses are
still left at a slow rate for more efficient comminution of the stone and to
minimize morbidity, while the power levels are then gradually increased, to be
able to split up the stone.
The last power level usually is dependent
upon the patient's pain threshold and the observed success of stone breakage.
If the stone lies near a bone, this treatment may become more uncomfortable
because the shock waves can cause a delicate resonance in the bone which may be
felt by the patient.
The feeling of the treatment is likened to
a flexible band twanging off the skin. Alternatively, the in-patient might be
sedated throughout the procedure. This permits the power levels to be raised
quicker and a much higher pulse frequency, sometimes above 100 shocks per
minute.
The successive shock wave pressure pulses
end in direct shearing forces, as well as cavitation bubbles surrounding the
stone, which fragment the stones into smaller pieces that then can simply move
across the ureters or the cystic duct. The process takes about an hour. A
ureteral stent (a type of expandable hollow tube) works extremely well at the
discretion of the urologist. The stent provides for easier passage of the
stone, by relieving obstruction and through passive dilatation of the ureter.
How the Shockwaves are Created?
There are Three Different Ways to Generate the Shockwaves:
1) Electrohydraulic:
The initial method of shockwave generation was electrohydraulic, and thus the
shockwave is produced via spark-gap technology. In an electrohydraulic
generator, a high-voltage electrical current passes across a spark-gap electrode
located within a water-filled container. The discharge of energy produces a
vaporization bubble, which expands and immediately collapses, generating a
high-energy pressure wave.
2) Electromagnetic:
In an electromagnetic generator, a top voltage is put on an electromagnetic
coil, like the effect in a music loudspeaker. This coil, either directly or via
a secondary coil, induces high-frequency vibration in an adjacent metallic
membrane. This vibration is then used in a wave-propagating medium (often
water) to create shockwaves.
3) Piezoelectric:
The piezoelectric generator takes benefit of the piezoelectric effect.
Piezoelectric ceramics or crystals, emerge a water-filled container, are
stimulated via high-frequency electrical pulses. The alternating stress/strain
changes in the material create ultrasonic vibrations, causing the production of
a shockwave.
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