Abstract
Objectives
To measure, in an in vitro study, the number of shock waves to complete comminution
for 195 human stones, representing six major stone types. Not all renal calculi are
easily broken with shock wave lithotripsy. Different types of stones are thought to
have characteristic fragilities, and suggestions have been made in published reports
of variation in the fragility within some types of stones, but few quantitative data
are available.
Methods
Kidney stones classified by their dominant mineral content were broken in an unmodified
Dornier HM3 lithotripter or in a research lithotripter modeled after the HM3, and
the number of shock waves was counted for each stone until all fragments passed through
a sieve (3-mm-round or 2-mm-square holes).
Results
The mean ± SD number of shock waves to complete comminution was 400 ± 333 per gram
(n = 39) for uric acid; 965 ± 900 per gram (n = 75) for calcium oxalate monohydrate;
1134 ± 770 per gram (n = 21) for hydroxyapatite; 1138 ± 746 per gram (n = 13) for
struvite; 1681 ± 1363 per gram (n = 23) for brushite; and 5937 ± 6190 per gram (n
= 24) for cystine. The variation for these natural stones (83% ± 15% coefficient of
variation) was greater than that for artificial (eg, gypsum-based) stones (17% ± 8%).
Conclusions
The variability in stone fragility to shock waves is large, even within groups defined
by mineral composition. Thus, knowing the major composition of a stone may not allow
adequate prediction of its fragility in lithotripsy treatment. The variation in stone
structure could underlie the variation in stone fragility within type, but testing
of this hypothesis remains to be done.
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Article info
Publication history
Accepted:
January 24,
2003
Received:
October 31,
2002
Footnotes
☆This work was supported by NIH grants PO1 DK43881, RO1 DK55674; by a grant-in-aid from the National Kidney Foundation of Indiana; and by the Kidney Stone Research Fund, Methodist Hospital of Indiana Institute for Kidney Stone Disease.
Identification
Copyright
© 2003 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
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