Clinical Scorecard: Burst Wave Lithotripsy: A Transformative Approach Based on Insights from a Scoping Review
At a Glance
Category
Detail
Condition
Urolithiasis (urinary stones)
Key Mechanisms
Multi-cycle focused ultrasound pulses produce elastic waves and standing stress waves within stones causing discrete fragmentation with minimal cavitation
Target Population
Patients with urinary stones of various compositions and sizes, including calcium oxalate monohydrate, struvite, uric acid, and cystine stones
Care Setting
Any medical setting, including outpatient, without need for anesthesia or sedation
Key Highlights
BWL uses sinusoidal ultrasound bursts at low pressure amplitudes to fragment stones with minimal pain and complications.
Real-time ultrasound imaging enables continuous monitoring for precise targeting and cavitation mitigation.
BWL produces smaller stone fragments compared to shock wave lithotripsy and can be performed on awake patients without anesthesia.
Guideline-Based Recommendations
Diagnosis
Use real-time diagnostic ultrasound imaging integrated with BWL system for stone localization and monitoring during treatment.
Management
Apply BWL transcutaneously using a portable therapy transducer with ultrasound gel for stone fragmentation.
Tailor ultrasound frequency and pressure amplitude to stone size and composition to optimize fragmentation and minimize tissue damage.
Utilize ultrasonic propulsion technology via the same probe for repositioning stones as needed.
Monitoring & Follow-up
Continuously monitor treatment with diagnostic ultrasound imaging to ensure proper stone targeting and detect cavitation.
Adjust treatment parameters based on real-time imaging feedback to enhance safety and efficacy.
Risks
Minimized risk of tissue damage due to reduced cavitation compared to shock wave lithotripsy.
Potential for incomplete fragmentation in some cases; treatment duration and parameters may need adjustment.
Patient & Prescribing Data
Patients with urinary stones ranging from 1 mm to 7 mm, including various stone compositions
Higher ultrasound frequencies (up to 800 kHz) produce smaller fragments (<1 mm), while lower frequencies (around 170-390 kHz) produce larger fragments (3-4 mm), allowing controlled fragmentation tailored to clinical needs; treatment durations up to 30 minutes have shown high fragmentation rates.
Clinical Best Practices
Select ultrasound frequency and pressure amplitude based on stone size and composition to optimize fragmentation.
Use real-time ultrasound imaging for continuous monitoring and adjustment during treatment.
Perform BWL on awake patients without anesthesia to reduce procedural risks and increase accessibility.
Incorporate ultrasonic propulsion for stone repositioning to enhance treatment effectiveness.
Consider sequential fragmentation strategies using low and high frequencies to maximize stone comminution.
by Steffi Kar Kei Yuen, Vineet Gauhar, Chu Ann Chai, Connor M. Forbes, Victor K. F. Wong, Ryan F. Paterson, Ivan Ching Ho Ko, Joseph Li, Daniele Castellani, Ben H. Chew
