#AUA14 - Progress towards a practical protocol to minimize renal injury in extracorporeal shock wave lithotripsy - Session Highlights

ORLANDO, FL USA (UroToday.com) - The authors have previously demonstrated that a treatment dose of 2000 shock waves (SWs) produces a renal lesion and that this injury can be reduced:

(1) when SWs are delivered at a slower rate, or (2) when a priming dose of low-energy SWs is followed by a 3-4 minute pause. Although such protocols are effective at reducing injury, both of these modifications increase the required length of treatment time. Hence, the authors describe a new protocol offering renal protection and minimally increasing treatment time by using a 300 SW priming dose, with no pause.

auaSeven-week old juvenile pigs were first pretreated with 300 SWs at 12 kV (120 SWs/min), then treated after a 10 second pause with 2000 SWs at 24 kV, delivered to a lower pole calyx using a HM-3 lithotripter. Four hours later, the kidneys were fixed and processed for measuring the parenchymal lesion.

Six pigs were treated using the authors’ novel pause-less protocol, and were found to have lesions measuring 0.77±0.55% FRV (mean ± SE), compared to 3.31±1.06% FRV for a 2000 SWs dose at 24 kV. The results approached, but did not achieve, significance.

These preliminary data suggest that treatment with a pause-less protocol including 300 low-energy priming dose SWs shows promise in providing injury protection and short treatment length. These findings should undergo further study to determine whether the results are safely replicable in humans, before they can be adopted in the urology clinic.

Presented by Bret A. Connors, Ph.D at the American Urological Association (AUA) Annual Meeting - May 16 - 21, 2014 - Orlando, Florida USA

Indiana University School of Medicine, Indianapolis, IN USA

Written by Eric Ballon-Landa, BA, University of California (Irvine), and medical writer for UroToday.com