US3861391A - Apparatus for disintegration of urinary calculi - Google Patents
Apparatus for disintegration of urinary calculi Download PDFInfo
- Publication number
- US3861391A US3861391A US453063A US45306374A US3861391A US 3861391 A US3861391 A US 3861391A US 453063 A US453063 A US 453063A US 45306374 A US45306374 A US 45306374A US 3861391 A US3861391 A US 3861391A
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- US
- United States
- Prior art keywords
- catheter
- stone
- calculi
- coupling member
- wave guide
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Expired - Lifetime
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Classifications
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/22—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for
- A61B17/22004—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for using mechanical vibrations, e.g. ultrasonic shock waves
- A61B17/22012—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for using mechanical vibrations, e.g. ultrasonic shock waves in direct contact with, or very close to, the obstruction or concrement
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/32—Surgical cutting instruments
- A61B17/320068—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic
- A61B2017/320072—Working tips with special features, e.g. extending parts
- A61B2017/320073—Working tips with special features, e.g. extending parts probe
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B2018/00982—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body combined with or comprising means for visual or photographic inspections inside the body, e.g. endoscopes
Definitions
- This invention relates to methods and apparatus for disintegration of urinary calculi and particularly to an ultrasonic method and apparatus for fragmenting or drilling through urinary calculi.
- the present invention eliminates the need for surgical removal of urinary calculi and reduces the hazards of mechanical manipulation in removing stones from the urinary tract.
- urinary calculi can be quickly fragmented or drilled through if a wave guide is passed through the lumen of a catheter in the ureter so that both catheter and wave guide touch the calculi to be fragmented and the relative size of the wave guide with respect to the catheter in such that lateral motion of the wave guide within the catheter at the stone is possible.
- large urinary calculi can be quickly fragmented and removed, usually in 2 to 60 seconds.
- a catheter is passed cystoscopically to the side of the stone in the urinary tract, a wave guide is passed through the lumen of the catheter and both are made to contact the stone, the wave guide being of such size as to provide lateral motion of the guide within the catheter, an ultrasonic transducer is attached to the wave guide and energized setting the guide into longitudinal and transverse vibration thereby causing an impaction and scraping action of the free end of the guide on the stone resulting in fragmentation or drilling of the stone.
- the wave guide is a wire.
- the cutting area may be irrigated or cooled by passing flushing fluid through the catheter around the wave guide.
- the apparatus consists of hollow catheter means adapted to enter the ureter and contact the stone, wave guide means having a diameter smaller than the hollow portion of the catheter means ana adapted to pass through said hollow catheter means to contact the stone, and transducer means engaging the wave guide at the end opposite the stone and imparting both lateral and transverse motion to the wave guide at the end contacting the stone.
- FIG. I illustrates the apparatus of this invention, partly in section in place in a human urinary system for removing a stone
- FIGS. 2 (a) through 2 (f) illustrates fragmentarily several embodiments of coupling between transducer and wave guide
- FIG. 3 is a side elevational view of an apparatus for controlled fragmentation of stones
- FIG. 4 is a section through a connector for a catheter and wave guide for introducing flush solution into the catheter;
- FIGS. 5 (a) through 5 (d) illustrates in side elevation several embodiments of wave guide cutting and fragmentary ends.
- a cystoscope I0 inserted through a urethra 11 into a bladder 12.
- a catheter I3 is inserted through the cystoscope 10, the bladder 12 and into a ureter 14 until its end contacts stone 15.
- a wave guide in the form ofwire 16 is inserted through the catheter until its end contacts the stone 15.
- the wire I6 must be of substantially smaller diameter than the lumen diameter of the catheter, preferably less than two-thirds of the lumen diameter.
- the free end 16a of the wire I6 is attached to a transducer 17 by a set screw 18 or it may simply be abutted against the transducer with the transducer being urged toward the stone to put pressure on the wave guide.
- the cystoscope With the catheter and wave guide in fixed position against the stone, the cystoscope is moved to the position which provides the least amount of curvature in the catheter and wave guide.
- An X-ray picture of the urinary tract is preferably taken at this point to assure contact of the catheter and wave guide with the stone. At this point with contact assured the transducer is energized and the catheter and wave guide are both pushed gently toward the stone until the wave guide has moved a distance equal to the estimated thickness of the stone.
- the transducer 17 with the wire 16 can take various forms.
- the transducer can be directly mechanically connected as shown in FIG. 2(a) using a set screw or similar means. This is in general our preferred connection. Due to the high slenderness ration of the guide (wire), this coupling will, above a threshold ultrasonic displacement velocity lead to instability resulting in conversion of longitudi nal motion into transverse motion of the guide, which is desired in the practice of this invention.
- FIG. 2(b) where there is no mechanical attachment between the transducer and wire and coupling is achieved by the force pushing against the wire end to force the wire into contact with the stone.
- 2(6), 2(d) and 2(e) provide indirect conversion of the transducer motion into combined longitudinal and transverse, longitudinal and transverse torsional and longitudinal and transverse ellipsoidal motion respectively at the free end of the wire when it contacts the stone.
- the connection shown at 2(j) converts the longitudinal motion of the transducer into transverse motion.
- the catheter 13' and wave guide 16' are positioned at the stone as described in connection with FIG. 1 above.
- the exposed ends of the catheter and wire guide are fixed in a T-connector 20 provided with an O-ring 21 to seal around the catheter 13 without collapsing the catheter end.
- a puncturable rubber diaphragm 22 is placed at the opposite end of the T and the wire 16 is passed therethrough.
- a viscous grease such as silicon vacuum grease seals the puncture in the diaphragm through which the wire passes so that gasses or liquids may be pumped through the side arm of the T to cool or flush the stone area.
- the T member 20 is fixed in a clamp 24 mounted on a tilting base 25 which carries a slide 26 on which is mounted transducer assembly 17'.
- the slide 26 is controlled by micrometer feed 27 to apply pressure through the transducer 17', the wire 16' to the stone 15'.
- the micrometer 27 allows a fixed controlled feed of wire against the stone and reduces the chance of the wire going through the stone and accidentally penetrating the ureter.
- the wire end illustrated in FIG. 5 have been used by us with success. These ends are designed to center the wire end in the catheter to prevent by-passing the stone. In addition, some of these ends by rotation after drilling through the stone can be used to reverse drill and thus create a better chance of breaking the stone or they may be used to pull the stone out of the ureter.
- an expandable catheter aids in centering the wire and in preventing accidental penetration of the ureter.
- a catheter can be provided with a double wall construction, the outer wall being relatively thin and elastic and enlarged by introducing air or gas between the two walls after the catheter is placed in contact with the stone.
- An apparatus for fragmenting and drilling urinary calculi comprising a catheter adapted to be inserted into a ureter to abut the calculi to be removed, a coupling member extending lengthwise of the lumen of said catheter and having a diameter less than the diameter of said lumen whereby said coupling member may vibrate transversely within the catheter, ultrasonic means acting on the coupling member to cause trans verse vibration of the end thereof adjacent the calculi, and means engaging the end of the catheter remote from the calculi whereby said end is immobilized relatively to the ultrasonic means and the ultrasonic means is mounted on a slide movable at a controlled rate to and from said catheter.
Abstract
Description
Claims (6)
Priority Applications (1)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US453063A US3861391A (en) | 1972-07-02 | 1974-03-20 | Apparatus for disintegration of urinary calculi |
Applications Claiming Priority (2)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US00273985A US3830240A (en) | 1972-07-02 | 1972-07-02 | Method and apparatus for disintegration of urinary calculi |
US453063A US3861391A (en) | 1972-07-02 | 1974-03-20 | Apparatus for disintegration of urinary calculi |
Publications (1)
Publication Number | Publication Date |
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US3861391A true US3861391A (en) | 1975-01-21 |
Family
ID=26956539
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
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US453063A Expired - Lifetime US3861391A (en) | 1972-07-02 | 1974-03-20 | Apparatus for disintegration of urinary calculi |
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US (1) | US3861391A (en) |
Cited By (111)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US4192294A (en) * | 1977-10-11 | 1980-03-11 | Gekhman Boris S | Method of removing concretions from the ureter |
US4474180A (en) * | 1982-05-13 | 1984-10-02 | The United States Of America As Represented By The Administrator Of The National Aeronautics And Space Administration | Apparatus for disintegrating kidney stones |
US4589415A (en) * | 1984-08-31 | 1986-05-20 | Haaga John R | Method and system for fragmenting kidney stones |
US4684369A (en) * | 1982-04-14 | 1987-08-04 | Wildemeersch Dirk A A | Instrument for suprapubic drainage of the bladder, inserted through the urethra |
EP0243458A1 (en) * | 1985-10-15 | 1987-11-04 | Greenfeld Albert R | Ultrasonic self-cleaning catheter system. |
US4870953A (en) * | 1987-11-13 | 1989-10-03 | Donmicheal T Anthony | Intravascular ultrasonic catheter/probe and method for treating intravascular blockage |
WO1990001300A1 (en) * | 1988-08-05 | 1990-02-22 | Sonic Needle Corporation | Ultrasonic device for applying cavitation forces |
US4989588A (en) * | 1986-03-10 | 1991-02-05 | Olympus Optical Co., Ltd. | Medical treatment device utilizing ultrasonic wave |
US5047043A (en) * | 1986-03-11 | 1991-09-10 | Olympus Optical Co., Ltd. | Resecting device for living organism tissue utilizing ultrasonic vibrations |
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US5154722A (en) * | 1988-05-05 | 1992-10-13 | Circon Corporation | Electrohydraulic probe having a controlled discharge path |
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Cited By (210)
Publication number | Priority date | Publication date | Assignee | Title |
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