Kidney stone procedure "has the potential to be game changing"

https://komonews.com/news/local/uw-medicine-kidney-stone-breakthrough-procedure-treatment-nasa-mars-astronaut-research-patients-game-changer-seattle-clinical-trial-harborview-medical-center

by elorant • 3 years ago

239 100 3 years ago

komonews.com

donatj• 3 years ago

Oh nice. I had to have mine lasered and it was a big ordeal with tubes being placed ahead of time and later removed over as many appointment.

anonymousiam2• 3 years ago

Had my latest one lasered a few months ago. It all went well, except for the annoying stent that had to be removed a month later. IMHO, the laser approach to removing the stone (by obliterating it) is safer for the kidneys.

apetresc• 3 years ago

It will also give astronauts the go ahead they need from NASA to travel to Mars.

Wait, what? Everything else was worked out, but NASA just went "hold on, we can't go to Mars just yet until we figure out what to do if an astronaut gets kidney stones on the way"?

Did the writer just throw this in to make the procedure seem more hip and exciting?

chmod775• 3 years ago

It's a real issue in space:

Because space travel makes astronauts prone to kidney stones due, in part to bone demineralization from weightlessness, they are at increased risk. The NASA evidence base and publications note that astronauts have had more than 30 instances of kidney stones within two years of space travel. Medical assistance is a formidable challenge for those orbiting this planet or heading to other solar system destinations.

https://newsroom.uw.edu/news/keeping-kidney-stones-bay-durin...

Andrex• 3 years ago

I'm not even sure a free trip to space would be worth a kidney stone, personally.

bilsbie• 3 years ago

We really should be working on artificial gravity via spinning. It solves so many issues.

I know smaller craft can’t do this but we can always do a long tether with a counterweight.

(My personal pet idea is to go for super low gravity like .05G to start out to simplify things. You still get to walk around, go to the bathroom, spill liquids and clean up, cook, etc. )

bscphil• 3 years ago

The NASA evidence base and publications note that astronauts have had more than 30 instances of kidney stones within two years of space travel.

What does this mean? Surely the average astronaut doesn't pass 30 kidney stones every two years, that's more than one a month. So it's either over a specific two year period (for every astronaut in space at the time, probably a lot?) or it's for a specific number of astronauts. Confusing sentence.

at_a_remove• 3 years ago

The article has a bit in it "This technology is also making it possible for astronauts to travel to Mars, since astronauts are at a greater risk for developing kidney stones during space travel." And then a hyperlink to more information.

aristus• 3 years ago

As I understand it, it was not literally the last thing holding back. But NASA worries about everything and we have centuries of examples of remote missions failing because of medical problems that could not be solved in the field. Billions of dollars, tens of years, and a ship full of lives can't be risked on a 3mm pebble if it can possibly be prevented.

hanniabu• 3 years ago

we have centuries of examples of remote missions failing

decades*

letmevoteplease• 3 years ago

NASA currently considers kidney stones an unacceptable risk for a Mars mission that requires mitigation.[1] There are also about 10 other risks requiring mitigation, though.[1]

[1] https://humanresearchroadmap.nasa.gov/Risks/risk.aspx?i=81

[2] https://humanresearchroadmap.nasa.gov/Risks/

ghufran_syed• 3 years ago

NASA saying there is a “research gap” and that it “needs mitigation” is very different from it being an “unacceptable risk” which implies that no mission can happen until it happens. if there was a ship ready to go with a hab and propellant for the return trip sitting on mars, I can guarantee they would take the very next transfer window, kidney stone risk notwithstanding- particularly if the chinese or russians were about to do so and might get there first!

WirelessGigabit• 3 years ago

Maybe I'm not looking at the right terms but the appendix isn't on it. Is there a requirement for astronauts to have an appendectomy? Like researches in Antarctica.

joduplessis• 3 years ago

Not to the moon or the space station, but to Mars. Yes, next stop is Mars folks.

user568439• 3 years ago

Nice, but why this website trues to download a file automatically to my phone?

CodesInChaos• 3 years ago

Doesn't happen for me, but I'd guess it's a wrong mime-type on an ad-iframe.

soco• 3 years ago

Did you have the patience to wait for "saving preferences"? I gave up at around 74% whatever that means.

nharada• 3 years ago

Yeah it takes time to "save preferences" if you don't give it maximum permissions.

cromulent• 3 years ago

I’m used to accepting cookies, but after the download I checked the list of “required cookies”. Insane. I clicked on one privacy policy and was met with the same download and required cookies in order to read it.

Ecco• 3 years ago

The UW announcement is from 2022. I wonder why that article is posted now.

https://newsroom.uw.edu/news/ultrasound-promises-relief-thos...

xezzed2• 3 years ago

Well, isn't it called 'lithotripsy' and exists for quite a time?

apendleton• 3 years ago

This is "burst wave lithotripsy," compared to the somewhat-similar existing "shock wave lithotripsy." The new iteration apparently works more quickly and causes less pain, so can be performed while the patient is awake rather than requiring general anesthesia, which would make it practical to do it in, say, an ER or regular doctor's office. See https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10117400/#sec2t... for a comparison of the mechanisms.

bgm19752• 3 years ago

It also probably has the same caveat that shock wave lithotripsy does too, where if the stone travels below the pelvis, the procedure can’t be used.

xezzed2• 3 years ago

thanks)

__xor_eax_eax• 3 years ago

Ureteroscopy is another minimally invasive way to treat stones but often requires a temporary stent, which can be quite uncomfortable.

"The ways we have to currently treat stones have some downsides," he said. "Most involve anesthesia."

In contrast to the shock waves used in ESWL, the BWL procedure uses "short harmonic bursts" of ultrasound energy, potentially enabling the stones to be broken up in a shorter procedure without the need for sedation or anesthesia. Pre-clinical studies supported the effectiveness of BWL in breaking experimental stones of varying size and composition, the study noted.

bgm19752• 3 years ago

Having had a Ureteroscopy procedure, I can say it sure as hell doesn’t feel minimally invasive. It (well, post-op until they remove the stint) was almost as unpleasant as the kidney stone.

vondur• 3 years ago

Ooh, this sounds good. I've had kidney stones a couple of times. It was not very fun.

8f2ab37a-ed6c• 3 years ago

Is this available anywhere outside of UW?

Giorgi• 3 years ago

Ultrasonic bursts? Is not that quite an old tech for stones?

lunarimiso• 3 years ago

I just, 2 days ago, starting to experience slight discomfort in the liver/kidney area. The feeling was very similar to how it was with my gallbladder. At least until it was removed. I am totally a ticking time bomb. So, yes.. please bring on even better treatments.

justanotheratom• 3 years ago

just FYI, AFAIK, kidney stone pain is sudden and unbearable, when the stone starts moving out of the kidney. Slight discomfort may not be a sign of kidney stone.

powersurge360• 3 years ago

Chronic stone former here, requiring surgical intervention a few times a year.

It definitely can be sudden and debilitating but for most of my teenage years I had mistaken the pain for ‘sleeping wrong’. Sometimes when I would bend over and then stand it would feel like someone had stapled my back together at the bend and I had to rip it out. It hurt, but not anything like what I expected. A couple of years later I wound up having a few stones that had grown to larger than an inch.

If you have unusual and unexpected pain it’s definitely worth getting checked out. I didn’t have health insurance at the time and since the pain was intermittent I never suspected anything serious and just chalked it up to sleeping in a poor posture or maybe not getting enough exercise to be limber. It almost killed me!

Turing_Machine• 3 years ago

It varies a lot depending on the size of the stone and its jaggedness.

I've unfortunately had several of them. Some passed with only mild discomfort. Others were excruciating... worst pain I've ever had.

Somewhere around here I have a glass bottle with my collection of stones.

RadixDLT• 3 years ago

get ready for some screams at night, your neighbors might think you are doing something different though

westurner2• 3 years ago

Still being run through clinical trials at UW Medicine, the procedure called _ burst wave lithotripsy _ uses an ultrasound wand and soundwaves to break apart the kidney stone
Ultrasonic propulsion is then used to move the stone fragments out, potentially giving patients relief in 10 minutes or less

(Edit)

"Fragmentation of Stones by Burst Wave Lithotripsy in the First 19 Humans" (2022) https://www.auajournals.org/doi/abs/10.1097/JU.0000000000002... gscholar citations: https://scholar.google.com/scholar?cites=4452238185664707620...

Lithotripsy: https://en.wikipedia.org/wiki/Lithotripsy

EWST: Extracorporeal shockwave therapy: https://en.wikipedia.org/wiki/Extracorporeal_shockwave_thera...

Could NIRS help with this targeted ultrasound procedure, too?

"Ultrasound-activated chemotherapy advances therapeutic potential in deep tumours" (2023) https://news.ycombinator.com/item?id=37885774#37885798 :

NIRS Near-Infrared Spectroscopy does not require contrast FWIU?

westurner2• 3 years ago

On reading brains with light, https://news.ycombinator.com/item?id=28399099#28400060 :

What about with realtime NIRS with an (inverse?) scattering matrix?

FWIU Openwater's technology portfolio includes targeted ultrasound with e.g. NIRS and LSI/LSCI: https://www.openwater.health/technology

One of their demo videos explains how inverting the scattering caused by the occluding body yields the mass-density at least (?). [Radio]Spectroscopy and quantum crystallography may have additional insight for tissue identification with low-cost NIRS sensor data?

Open fNIRS: https://openfnirs.org/

"Quantum light sees quantum sound: phonon/photon correlations" (2023) https://news.ycombinator.com/item?id=37793765 ; the photonic channel actually embeds the phononic field

anonymousiam2• 3 years ago

I've had conventional lithotripsy a few times, and I now have CKD. I have none of the typical CKD risk factors, and I suspect that the ultrasonic energy caused some damage. Unfortunately there is no way to know.

jjeaff2• 3 years ago

it could just be the stress that having kidney stones put on your kidneys in addition to the stress the ultrasonic waves impart. but also, probably the worst part of lithotripsy is that they usually use a strong x-ray to see what they are doing live. if they are slow in completing the procedure, you can end up being exposed to quite a lot of radiation.

RCitronsBroker• 3 years ago

it may be good to know that we aren’t talking about an entirely new process, shock(!) wave lithotripsy has been around for quite some time now. The "game-changer" is the introduction of burst wave lithotripsy, which apparently is less painful and thus possible to go through without general anaesthisia, which, don’t get me wrong, is definitely an improvement. But I’m not sure I’d call it a game changer.

I’m not convinced it’s entirely painless as it’s still the same "crush and drive out via ultrasound" idea. Combine this with the fact that just existing is excruciating with stones, i don’t see a way around opioid analgesia. Additionally, the game hasn’t changed in the regard of the human pelvis being great at keeping out ultrasound, so if your stones are out of reach that way, you’re SOL.

misja1112• 3 years ago

Shock or burst wave lithotripsy is not new either, but it is being improved all the time. So I guess that's what this article is about, just another recent improvement.

indigomm• 3 years ago

I've had lithotripsy and it certainly wasn't done under general anaesthetic. They just gave me painkillers and the procedure was fine. I was in and out very quickly - something like an hour or so.

misja1112• 3 years ago

I must be missing something. This kind of treatment is called lithotripsy and it is used already since the 80's. What is new here?

xutopia• 3 years ago

Burst waves rather than one signal.

jl2718• 3 years ago

Breakthrough? You could buy these machines on Alibaba years ago marketed for this purpose. I assume this means there was a cottage industry of private kidney stone treatment in Asia.

bawana• 3 years ago

I wonder if it helps impotence as ESWL seems to have been used iin this regard as well.https://healthcare.utah.edu/mens-health/conditions/erectile-....

anotheraccount9• 3 years ago

'Breakthrough'

oldbbsnickname• 3 years ago

I have 19 mm left and 14 mm right stones that I generally don't notice and don't have any pain.

ESWL seemed like a scam because there was no redness on back tissue and not a single grain or fragment was passed. I wonder if they set the machine to a high enough power or if they skipped the actual procedure while I was anesthetized.

I'm wondering if BWL would be any better where ESWL fails.

UberFly2• 3 years ago

They've been blasting with sound waves for a while. "Ultrasonic propulsion" though, that sounds cool.

RobRivera• 3 years ago

Kidney stone breakthrough...hehehe thats funny.

[Best read in Norm MacDonald's Burt Reynolds' voice]

mechhacker2• 3 years ago

I've broken bones, including a leg, and a kidney stone was the most painful thing I've experienced.

It was so painful it resulted in a blackout as it was moving through my innards and getting to my bladder. Anything to save myself from that non-invasively would be welcome. Thankfully, they have not returned as I think I know what triggers them for me.

anderber• 3 years ago

May I ask what triggered them for you? As someone prone to them, I'm curious if I'm doing everything possible to avoid these nasty things.

kabouseng• 3 years ago

Vitamin fizzy / soluble pills can cause it for some people.

mechhacker2• 3 years ago

I narrowed it down to grapefruit. At least that's what I suspect. I avoid them now.

PorterBHall• 3 years ago

If you get one, try to catch it and have it analyzed. I had a calcium oxalate stone. My urologist suggested adding some milk to my coffee (I had been drinking it black). Haven’t had another in 10 years.

astura• 3 years ago

You have to get your stones analyzed and they'll make suggestions based on what the composition is.

northernman• 3 years ago

I've had several kidney stones - usually at about one year intervals.

The first was the worst because you don't know what it is. Subsequent stones didn't seem to be as bad, since I knew I was going to survive.

The emerg doc told me that some ladies say the pain worse than childbirth.

mbajkowski2• 3 years ago

In the same boat, and agree that the first one was the worst because of the unknowns and associated pain.

That does not mean the later ones were less painful, but knowing what to expect, recognizing the symptoms early, and getting mentally ready go a long way. A well stocked medical cabinet with potent pain killers is a must, and I don't take long trips without them either.

Unfortunately, not all will pass naturally, depending on size and shape, so I'm looking forward to having this option available when needed.

galkk• 3 years ago

Hope that the ticking bomb in my right kidney (that was found during CT scan when the stone from my left kidney was coming out) can wait for the next year.

In all seriousness the article doesn't have anything about general availability and cost, alas. How soon it can be offered at your typical hospital instead of vicodin and lots of water?

xxpor3• 3 years ago

I was asked if I wanted to sign up in 2020, and said yes. No word back from the team though :(. I ended up getting the normal EWST, at UW Medicine.

I had a stone kicking around for 2 years that would cause pain off and on. Went to normal primary care, but they had no idea. We thought it was a gastro issue, since it felt like constipation (or so I thought). The problem was I was always fine when I actually went to see the doc. Until I finally went to the ER and they ordered a simple x-ray and found it :/

Kidney stone procedure "has the potential to be game changing"

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