International Alliance of Urolithiasis Guideline on Shockwave Lithotripsy.

Different international associations have proposed their own guidelines on urolithiasis. However, the focus is primarily on an overview of the principles of urolithiasis management rather than step-by-step technical details for the procedure. The International Alliance of Urolithiasis (IAU) is releasing a series of guidelines on the management of urolithiasis.

How can and should we optimize extracorporeal shockwave lithotripsy?

It is well recognized that the popularity of extracorporeal shock wave lithotripsy (SWL), despite its non-invasive character, has decreased during recent years. This is partly explained by the technological achievements in endoscopy and urologists' enthusiasm for such procedures. Another explanation is that many urologists have been insufficiently successful with SWL.

High-Intensity Focused Ultrasound for the Treatment of Prostate Cancer: A Review.

Over the past 25 years, the average life expectancy for men has increased almost 4 years, and the age of prostate cancer detection has decreased an average of 10 years with diagnosis increasingly made at early-stage disease where curative therapy is possible. These changing trends in the age and extent of malignancy at diagnosis have revealed limitations in conventional curative therapies for prostate cancer, including a significant risk of aggressive cancer recurrence, and the risk of long-term genitourinary morbidity and its detrimental impact on patient's quality of life (QOL). Greater awareness of the shortcomings in radical prostatectomy, external radiotherapy, and brachytherapy has prompted the search for alternative curative therapies that offer comparable rates of cancer control and less treatment-related morbidity to better preserve QOL.

Salvage high-intensity focused ultrasound (HIFU) for locally recurrent prostate cancer after failed radiation therapy: Multi-institutional analysis of 418 patients.

Objective: To report the oncological outcome of salvage high-intensity focused ultrasound (S-HIFU) for locally recurrent prostate cancer after external beam radiotherapy (EBRT) from a multicentre database.

Patients And Methods: This retrospective study comprises patients from nine centres with local recurrent disease after EBRT treated with S-HIFU from 1995 to 2009. The biochemical failure-free survival (bFFS) rate was based on the 'Phoenix' definition (PSA nadir + 2 ng/mL).

First Clinical Experience with Extracorporeally Induced Destruction of Kidney Stones by Shock Waves.

We performed extracorporeally induced destruction of kidney stones on 72 patients. No complications have resulted from the tissue exposure to high energy shock waves. Clearance studies before and after the shock wave treatment indicate no changes in renal function.

Arguments for choosing extracorporeal shockwave lithotripsy for removal of urinary tract stones.

At a time when there is an almost unlimited enthusiasm and preference among urologists for endoscopic stone removal, we have found it essential to meet some of the frequently presented arguments on why extracorporeal shockwave lithotripsy (SWL) should not be used. We have based our considerations in this brief article on our 30-35 years' experience with the non-invasive or least invasive technique that SWL represents. Stone disintegration, requirement of repeated treatment sessions, the concern of residual fragments, complications and economic aspects are some points that are discussed.

Salvage ablative therapy in prostate cancer: international multidisciplinary consensus on trial design.

Introduction: Salvage ablative therapy (SAT) has been developed as a form of localized treatment for localized recurrence of prostate cancers following radiation therapy. To better address the utility of SAT, prospective clinical trials must address the aspects of accepted standards in the initial evaluation, treatment, follow-up, and outcomes in the oncology community. We undertook this study to achieve consensus on uniform standardized trial design for SAT trials.

Engineering Better Lithotripters.

Although shock wave lithotripsy (SWL) remains an excellent non-invasive method for active removal of stones from the ureter and kidney, its popularity has decreased during recent years and the arguments for choosing endoscopic procedures rather than the only non-invasive surgical procedure are usually based on the opinion that SWL results are inferior to those obtained with endoscopic methods. It is considered that slow technical progress has not sufficiently met the requirements of disintegration, reduced need of repeated treatments, shorter treatment duration and less negative effects on tissues. This article summarises some recently published articles that address these problems and have the aim of improving the function of lithotripters.

Antiplatelet and anticoagulative medication during shockwave lithotripsy.

Background And Purpose: Shockwave lithotripsy (SWL) is the gold standard treatment of patients with most renal and proximal ureteral calculi. Severe bleeding complications in SWL are extremely rare. Uncorrected bleeding diathesis might increase the risk and is considered to be an absolute contraindication for SWL.

Evolution and outcomes of 3 MHz high intensity focused ultrasound therapy for localized prostate cancer during 15 years.

Purpose: We describe the long-term cancer control and morbidity of high intensity focused ultrasound with neoadjuvant transurethral resection of the prostate, the risk of metastatic induction by transurethral prostate resection, and the evolution of high intensity focused ultrasound application and technology with time.

Materials And Methods: A prospective Harlaching high intensity focused ultrasound database was searched for patients with primary localized prostate cancer (T1-2, N0, M0, PSA at first diagnosis less than 50 ng/ml) and followup longer than 15 months. Those patients with previous long-term androgen deprivation therapy, locally advanced prostate cancer or any therapy influencing prostate specific antigen were excluded from study.

Aspects on how extracorporeal shockwave lithotripsy should be carried out in order to be maximally effective.

The present review summarizes the most important considerations and steps for an optimal result of extracorporeal shockwave lithotripsy. The relationship between shockwave path, geometry and anatomical conditions is of utmost importance. Selection of appropriate treatment variables in terms of shockwave number, power and frequency, is an important prerequisite for proper disintegration and prevention of complications.

Water-jet-aided transurethral dissection of urothelial carcinoma: a prospective clinical study.

Background And Purpose: The application of a water-jet dissector for mucosal elevation was shown to improve resection of lesions of the gastrointestinal tract. We present the first prospective clinical trial on the application of a combined water-jet dissector and needle-knife (HybridKnife) in transurethral dissection (TUD) of urothelial carcinoma of the bladder (UCB).

Patients And Methods: Thirty separate urothelial tumors of the bladder in 17 unselected patients were elevated and dissected with the HybridKnife.

Transrectal high-intensity focused ultrasound for local treatment of prostate cancer: current role.

Attractivity of robotic high intensity focused ultrasound (HIFU) is based largely on the non-invasive, extremely precise nature of this high-tech robotic therapy as well as its clean, radiation free, surgical, but nevertheless, bloodless character. Today, in urological oncology, HIFU is used clinically as a therapeutic tool for the treatment of prostate cancer. Experimentally it is investigated for therapeutic use in kidney and breast cancer.

Robotic high-intensity focused ultrasound for prostate cancer: what have we learned in 15 years of clinical use?

High-intensity focused ultrasound (HIFU) is an emerging, noninvasive, local treatment of prostate cancer with 15 years of clinical experience, during which about 30,000 HIFU treatments have been performed worldwide. In this paper, we review relevant publications regarding the means by which new and old prostate cancer technologies are evaluated, the outcomes of HIFU by Ablatherm (EDAP TMS, Lyon, France), and the evolution currently underway regarding how prostate cancer is diagnosed and treated. We show the potential of HIFU to be used as local therapy for men with any stage of prostate cancer and how this additional therapeutic option can fit within the future armamentarium of a sequential multimodal therapy concept.

Shock wave technology and application: an update.

Context: The introduction of new lithotripters has increased problems associated with shock wave application. Recent studies concerning mechanisms of stone disintegration, shock wave focusing, coupling, and application have appeared that may address some of these problems.

Objective: To present a consensus with respect to the physics and techniques used by urologists, physicists, and representatives of European lithotripter companies.

Robot-assisted high-intensity focused ultrasound in focal therapy of prostate cancer.

In one-third of patients, prostate cancer (PCa) is monofocal. These patients can undergo focal high-intensity focused ultrasound (HIFU) therapy of the tumor without damage to surrounding structures and not compromising uro-oncologic safety. Robot-assisted HIFU coagulates the entire targeted volume within the prostate transrectally, in one session, without direct tumor contact and without adjuvant endourologic therapy.

High-intensity focused ultrasound in the management of prostate cancer.

The treatment of localized prostate cancer with high-intensity focused ultrasound (HIFU) has been researched since the 1990s and today the treatment is an actively used therapy for the disease. HIFU works in two ways to destroy tissue, namely thermal and mechanical effects. The most recent data on the Ablatherm HIFU device come from an international registry (@-Registry) and indicate a 5-year biochemical survival rate of 85%.

Survival benefit of radical prostatectomy in lymph node-positive patients with prostate cancer.

Background: Positive lymph node (LN) status is considered a systemic disease state. In prostate cancer, LN-positive diagnosis during pelvic LN dissection (PLND) potentially leads to the abandonment of radical prostatectomy (RP).

Objective: To compare the overall survival (OS) and relative survival (RS; as an estimate for cancer-specific survival) in LN-positive patients with or without RP.

Extracorporeal shockwave lithotripsy for lower pole calculi smaller than one centimeter.

Extracorporeal shockwave lithotripsy (ESWL) has revolutionized the treatment of urinary calculi and became the accepted standard therapy for the majority of stone patients. Only for stones located in the lower calix, ESWL displayed a limited efficacy. Since the stone-free rate seemed to be preferential, endoscopic maneuvers like percutaneous nephrolithotomy (PCNL) and retrograde intrarenal surgery (RIRS) have been proposed as the primary approach for this stone localization.

High-intensity focused ultrasound for prostate cancer: comparative definitions of biochemical failure.

Objectives: To compare the specificity and sensitivity of different definitions of biochemical failure in patients treated with high-intensity focused ultrasound (HIFU) for prostate cancer, to identify the most accurate predictor of clinical failure after HIFU.

Patients And Methods: Consecutively treated patients who underwent HIFU between October 1997 and July 2006 at two centres (Lyon, France; and Regensburg, Germany) were prospectively maintained within a central database and retrospectively reviewed for this study. Clinical failure was defined as a positive prostate biopsy after treatment, radiographic evidence of lymphatic or bony metastatic disease, or salvage treatment for prostate cancer (surgery, radiation, hormonal therapy or second HIFU).

Transrectal high-intensity focused ultrasound devices: a critical appraisal of the available evidence.

Developments in the technology applied to the field of minimally invasive surgery have led to the exploration of high-intensity focused ultrasound (HIFU) for the treatment of localized prostate cancer. Extensive research and continuous evolution have resulted in two commercially available HIFU devices: the Ablatherm and the Sonablate500. These devices are conceptually the same; however, specific technical differences exist.

First analysis of the long-term results with transrectal HIFU in patients with localised prostate cancer.

Objective: To evaluate the long-term efficacy of high-intensity focused ultrasound (HIFU) therapy for patients with localised prostate cancer.

Material And Methods: Patients included in this multicentre analysis had T1-T2 NxM0 prostate cancer, a PSA<15 ng/ml, and a Gleason score (GS) < or = 7, and were treated with prototypes or first-generation Ablatherm HIFU devices between October 1997 and August 2001. The Phoenix definition of biochemical failure was used (PSA nadir+2).

Technology insight: High-intensity focused ultrasound for urologic cancers.

The growing interest in high-intensity focused ultrasound (HIFU) technology is mainly due to its many potential applications as a minimally invasive therapy. It has been introduced to urologic oncology as a treatment for prostate and kidney cancers. While its application in the kidney is still at the clinical feasibility phase, HIFU technology is currently used in daily practice in Europe for the treatment of prostate cancer.