Strategies for Improved Shock Wave Lithotripsy

在我们的上一个资助期间，我们已经帮助碎石社区认识到SWL不良反应的严重性，并且我们对理解涉及结石粉碎和组织损伤的冲击波作用的物理声学机制做出了重大贡献。然而，从我们在这一领域的角度来看，我们看到仍有许多工作需要完成。特别是，泌尿外科社区现在面临着一个新的困境，因为碎石术并没有变得更好，碎石机本身已经成为一个危险因素。我们的多学科科学家/临床医生团队是解决这些问题的理想选择。本更新提案制定了四个互动协作项目的计划，以实现以下目标。我们将： 1.识别和隔离增加SWL不良反应风险的因素。 2.定义导致长期肾损伤的SW组织反应。 3.制定治疗策略（保护机制），以减少碎石术期间遭受的肾损伤。 4.建立安全有效SWL的SW参数（速率、电压、数量）选择标准。 5.评价第三代电磁碎石机的有效性和安全性，作为确定如何改善这些器械的SWL的一步。 6.开发实时成像和空化检测，使泌尿科医生能够在SWL期间监测组织损伤和结石粉碎。 7.测试软件输送（双脉冲碎石术）中的新概念，用于空化控制，以增强结石破碎并最大限度地减少组织损伤。 8.确定SWL中结石失效的机制，以便可以完善碎石机波形，实现有效的结石破碎。 9.建立计算模型，模拟冲击波作用的关键特征（虚拟碎石机），并允许对系统性改善SWL进行相关预测。 我们的主要目标是改进冲击波碎石术-使碎石术对所有患者更安全，更有效。

During our last funding period, we have helped the lithotripsy community recognize the severity of SWL adverse effects, and we have made a significant contribution to the understanding of the physical acoustic mechanisms of shock wave action involved in stone comminufion and tissue injury. However, from our perspective in this field we see there is still much that needs to be accomplished. In particular, the urology community is now faced with a new dilemma, in that lithotripsy is not getting better and the lithotripter itself has become a risk factor. Our multidisplanary team of scientist/clinicians is ideally situated to address these issues. The present renewal proposal has developed a plan of four interactive, collaborative projects to achieve the following goals. We will: 1. Identify and isolate factors that increase the risk of adverse effects in SWL. 2. Define the tissue response to SW's that leads to long-term renal damage. 3. Develop treatment strategies (protective mechanisms) that reduce the renal trauma suffered during lithotripsy. 4. Establish criteria for the selection of SW parameters (rate, voltage, number) for safe and effective SWL. 5. Evaluate the efficacy and safety of 3rd generation electromagnetic lithotripters, as a step toward determining how to improve SWL performed with these devices. 6. Develop real-time imaging and cavitation detection to allow the urologist to monitor tissue damage and stone comminution during SWL. 7. Test a new concept in SW delivery (dual pulse lithotripsy) for cavitation control to enhance stone breakage and minimize tissue injury. 8. Determine the mechanics of stone failure in SWL so that the lithotripter waveform can be perfected for efficient stone breakage. 9. Establish computational models that will simulate the critical features of shock wave action (the virtual lithotripter) and allow relevant predictions for systematic improvement of SWL. Our main goal is to improve shock wave lithotripsy - to make lithotripsy safer and more efficient for all patients.