Servicio de Urología, Complexo Hospitalario Santiago de Compostela, Santiago de Compostela, La Coruña,España.
Servicio de Urología, Hospital Universitario y Politécnico La Fe, Valencia, Espana.
Actas Urol Esp (Engl Ed). 2024 Jan-Feb;48(1):105-110. doi: 10.1016/j.acuroe.2023.09.001. Epub 2023 Oct 17.
Since 1980, extracorporeal shock wave lithotripsy (SWL) has been employed in the treatment of urolithiasis, offering noninvasive alternatives to surgical techniques. In addition to being limited by the size and location of the stones, its efficacy is influenced by several factors. Despite the advancement of other surgical techniques, SWL could maintain its position with new improvements. Our objective is to review the existing literature on the latest advances in the extracorporeal treatment of lithiasis.
A non-systematic literature review was carried out from 2017 to 2023 to obtain 26 articles on three different emerging technologies in extracorporeal lithotripsy: Burst Wave Lithotripsy (BWL), Histotripsy, and Microbubble Lithotripsy (ML).
The BWL uses sinusoidal bursts of US waves delivered at lower and higher frequencies than conventional SWL. Its mechanism of action generates a higher quality fragmentation (fine fragments) instead of generating tensile stresses for stone fracture resulting in larger fragments, as in traditional SWL. Studies in pigs and humans have shown effective fragmentation with a good safety profile. Based on High Intensity Focused Ultrasound (HIFU) technology, histotripsy fragments tissue through cavitation. Good in vitro results have been shown, but the formation of microbubbles between the stone and ultrasound waves hinders the progress of this technique. Microbubble Lithotripsy (ML) combines microbubbles and ultrasound for safe and effective stone fragmentation. In vitro and pig results are promising. This technique can help optimize treatments and reduce energy levels.
Technological innovation is not only being applied to endourological techniques, but also to ESWL. New techniques such as BWL, histotripsy and ML are promising, with good results in the research phase.
自 1980 年以来，体外冲击波碎石术（SWL）已被用于治疗尿路结石，为手术技术提供了非侵入性的替代方案。除了受到结石大小和位置的限制外，其疗效还受到多种因素的影响。尽管其他手术技术有所进步，但 SWL 通过新的改进仍能保持其地位。我们的目标是回顾关于体外结石治疗最新进展的现有文献。
进行了一次非系统性文献回顾，从 2017 年到 2023 年，获得了关于体外碎石术的三种新兴技术的 26 篇文章：爆裂波碎石术（BWL）、组织切除术和微泡碎石术（ML）。
BWL 使用比传统 SWL 更低和更高频率的正弦脉冲超声波。其作用机制产生更高质量的碎片（细小碎片），而不是像传统 SWL 那样产生拉伸应力使结石断裂导致更大的碎片。在猪和人类中的研究表明，该技术具有良好的安全性和有效的碎石效果。基于高强度聚焦超声（HIFU）技术，组织切除术通过空化作用使组织碎裂。已显示出良好的体外结果，但结石和超声波之间形成的微泡阻碍了该技术的进展。微泡碎石术（ML）将微泡和超声波结合起来，实现安全有效的碎石。体外和猪的结果很有前景。该技术可以帮助优化治疗并降低能量水平。
技术创新不仅应用于内镜技术，也应用于 ESWL。新技术如 BWL、组织切除术和 ML 很有前景，在研究阶段取得了良好的效果。
