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Shock wave device changes kidney stone treatment

March 26, 2019 | Roy Rivenburg
Drs. Jaime Landman, Ralph Clayman, Ramy Yaacoub and Roshan Patel show off UCI Health’s new Dornier Gemini system to treat kidney stones
From left, Drs. Jaime Landman, Ralph Clayman, Ramy Yaacoub and Roshan Patel show off UCI Health’s new system for the noninvasive treatment of kidney stones.

Surrounded by high-voltage electrical boxes, foot-pedal controls and sleek computers, UCI Health’s new kidney stone pulverizer is both a step into the future and a blast from the past.

“It’s a thing of beauty,” says Dr. Jaime Landman, director of the UCI Health Center for Urological Care, after watching a demonstration of the device. Called the Gemini system, it could shift the way urinary tract stones are treated nationwide, he says.

The machine certainly figures to change UCI Health’s approach to the ailment, which currently affects about 10 percent of adults in the United States.

An incision-free treatment

After decades of pioneering minimally invasive surgical methods to remove the painful accretions of calcium and other minerals that can build up in the kidneys, UCI Health urologists now are turning to an older, incision-free remedy: electromagnetic shock waves.

Shock wave therapy for kidney stones sprang from a curious phenomenon involving supersonic jets and rainstorms. When water droplets collided with a plane approaching the sound barrier, they created shock waves that dented the aircraft’s metal surface.

Physicists at Dornier, a German aviation company, wondered if the concept could be adapted for medical use. The result was introduced in 1980: Dornier’s HM1 lithotripter (derived from Greek words meaning “stone crusher”), which had patients lowered into a tub of water and zapped with focused acoustic waves.

Early machine was cumbersome

While the technique worked well, the machine was cumbersome. As smaller, portable units were unveiled, the success rate dropped and side effects — including damage to surrounding tissue — climbed, partly because some operators lacked adequate training, according to medical journal reports.

For these reasons, shock wave treatments were rarely administered at UCI Health. The therapy was also only available inside a mobile surgery truck that visited various local hospitals.

Better imaging, stronger shock waves

Dornier’s new Gemini stone-busting system — souped up with more sophisticated imaging and punchier shock waves — promises to change all that.

Housed in a customized surgical suite at UCI Medical Center, it has the potential to disintegrate larger, harder and deeper stones than previous machines, says Dr. Ralph Clayman, a renowned kidney specialist, textbook author and surgical innovator who served as dean of UCI’s School of Medicine and founding chair of its urology department.

For patients who want their urethras to “remain a one-way street,” Clayman says, shock wave therapy offers a way to avoid scalpels, stents or endoscopic surgery, in which a thin tube is pushed up the urinary tract so that a tiny laser fiber can blast the stone.

Some risks with treatment

As with any medical procedure, shock wave treatments carry a few risks:

  • Lingering stone fragments occasionally cause infection, fever or obstructions requiring a second round of therapy later.
  • Most patients also temporarily experience blood in their urine, a result of the shock waves hitting nearby tissue.

Complications are often minor and rare, affecting 3 percent to 4 percent overall, says Dr. Ramy Yaacoub, a member of the UCI Health urology team.

It will take a year for UCI Health urologists to fully evaluate the Gemini’s effectiveness and publish their findings. If the device works as expected, “you’ll see a renaissance in shock wave therapy,” Clayman predicts. Many of the components of the device are already being used in Europe.

“As a university, our job is to be at the forefront and push the field forward,” he says.

Research into how stones form 

UCI Health researchers are also conducting clinical trials to learn whether certain foods or vitamins can reduce a person’s tendency to form kidney stones.

One promising candidate is coconut water, which in a recent small study on campus dramatically boosted the amount of crystal-dissolving citrate in urine, Clayman says. Other good sources of citrate include:

  • Orange juice
  • Diet 7UP®
  • Lemonade 

UCI Health also offers metabolic urine evaluations to determine the causes behind each patient’s stones and develop a personalized plan to counteract them. In general, UCI urologists recommend drinking 3 quarts of fluid per day (anything except dark colas) and eating a low-salt, Mediterranean-style diet.

Beyond that, “we have an array of techniques to deal with stones, and we have eliminated open surgery in 99 percent of cases,” Clayman says. “If someone recommends open surgery to remove a kidney stone, get a second opinion from us.”

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