Shockwave Lithotripsy Program Project
Statement of the Problem and Main Goals of our Research Effort
When shock wave lithotripsy (SWL) was introduced in the mid-1980's it was accepted almost immediately. Growth in popularity was extremely rapid and was based in part on the perception that SWL was entirely safe. Now after nearly 12 years of clinical SWL, experience tells us differently. SWL may be very effective at breaking kidney stones, but it can also cause severe acute and chronic side effects.
Unfortunately, the rapid acceptance of SWL out-distanced efforts to determine objective criteria for safe clinical treatment. So, today, treatment protocols vary among clinical centers and it is only recently that clinical and basic research has begun to address the adverse effects associated with lithotripsy. Thus, very little is known about how shock waves (SW's) break stones, and there are few clues to help us understand the cause and effects of SWL-induced renal injury.
We pose four questions that are critical to understanding the adverse effects of lithotripsy. These questions define the focus of this Program Project.
o How do lithotripter shock waves break kidney stones?
o How do shock waves cause renal injury?
o What are the long-term consequences of shock wave injury to the kidney?
o What factors (renal and extrarenal) place patients at increased risk of injury?
We have created a coordinated, highly interactive, multidisciplinary, and collaborative approach to investigate the mechanisms of stone comminution and the biology of renal injury in SWL. The main goal of this research is to determine the physical mechanisms of stone comminution and the cause and consequences of SW-induced renal injury so that strategies can be devised to minimize or eliminate adverse effects while improving the efficacy of SWL.
Structural and Functional Changes due to Shockwave Lithotripsy