Rassweiler J, Köhrmann K U, Back W, Fröhner S, Raab M, Weber A, Kahmann F, Marlinghaus E, Jünemann K P, Alken P
Urologic Clinic, Klinikum Mannheim, Clinical Faculty of the University of Heidelberg, Germany.
World J Urol. 1993;11(1):43-53. doi: 10.1007/BF00182171.
Using the new electromagnetic shockwave source of the Modulith SL 20 shockwave-induced renal trauma was evaluated by acute and chronic studies in the the canine kidney model. In a further study the electromagnetic shockwave source of the Lithostar Plus Overhead module was tested. Overall, 92 kidneys were exposed to shock waves coupled either by water bath (Modulith lab type) or by water cushion (Modulith prototype, Lithostar Overhead) under ultrasound localization. The generator voltage ranged between 11 and 21 kV, the number of impulses between 25 and 2500. After application of 1500/2500 shocks the extent of the renal lesion depended strictly on the applied generator voltage and was classified into 4 grades: Grade 0, no macroscopic trauma detectable (at 11-12 kV); grade 1, petechial medullary bleeding (at 13 kV); grade 2, cortical hematoma (at 14-16 kV); and grade 3, perirenal hematoma (17-20 kV). Whereas at low and medium energy levels the number of shocks played only a minor role, at maximal generator voltage (20 kV) even 25 impulses induced a grade 2 and 600 shocks a grade 3 lesion, emphasizing the importance of shockwave limitation in the upper energy range. In shockwave-induced renal trauma a vascular lesion was predominant and cellular necrosis was secondary. Coupling with a water cushion resulted in a 15%-20% decrease in the disintegrative and traumatic effect, which was compensated for by increasing the generator voltage by 2 kV. Long-term studies showed complete restitution following grade 1 and 2 trauma, whereas after a grade 3 lesion a small segmental and capsular fibrosis without hyperplasia of the juxtaglomerular apparatus was observed. Based on the characteristic ultrasound pattern found in the first study, the threshold for induction of grade 1 lesion was investigated. With both lithotripters a wide range for induction of a grade 1 lesion (Modulith 234-411, Lithostar Plus 220-740) and also a significant overlapping with grade 0 and 2 lesions was seen at low energy settings (levels 2-4). In contrast, the range of shocks (Modulith 96-150, Lithostar Plus 90-142) and overlapping was minimal when high energy was used (levels 7-9). Finally, the disintegration-trauma coefficient combining the results obtained in a standard stone model with those of the canine kidney model was introduced.
使用Modulith SL 20的新型电磁冲击波源，通过对犬肾模型进行急性和慢性研究，评估冲击波诱发的肾损伤。在另一项研究中，对Lithostar Plus高架模块的电磁冲击波源进行了测试。总体而言，在超声定位下，92个肾脏通过水浴（Modulith实验室型）或水垫（Modulith原型，Lithostar高架）与冲击波耦合。发生器电压在11至21 kV之间，脉冲数在25至2500之间。施加1500/2500次冲击后，肾损伤的程度严格取决于所施加的发生器电压，并分为4级：0级，未检测到宏观损伤（11 - 12 kV）；1级，点状髓质出血（13 kV）；2级，皮质血肿（14 - 16 kV）；3级，肾周血肿（17 - 20 kV）。在低能量和中等能量水平时，冲击次数的作用较小，而在最大发生器电压（20 kV）时，即使25次脉冲也会导致2级损伤，600次冲击会导致3级损伤，这强调了在高能量范围内限制冲击波的重要性。在冲击波诱发的肾损伤中，血管损伤占主导，细胞坏死是次要的。与水垫耦合会使崩解和创伤效应降低15% - 20%，这可通过将发生器电压提高2 kV来补偿。长期研究表明，1级和2级创伤后可完全恢复，而3级损伤后可观察到小的节段性和包膜纤维化，且肾小球旁器无增生。基于第一项研究中发现的特征性超声模式，研究了诱发1级损伤的阈值。两种碎石机在低能量设置（2 - 4级）下，诱发1级损伤的范围较宽（Modulith为234 - 411，Lithostar Plus为220 - 740），并且与0级和2级损伤有明显重叠。相比之下，使用高能量（7 - 9级）时，冲击范围（Modulith为96 - 150，Lithostar Plus为90 - 142）和重叠最小。最后，引入了将标准结石模型和犬肾模型中获得的结果相结合的崩解 - 创伤系数。
