U.S. patent number 3,830,240 [Application Number 05/273,985] was granted by the patent office on 1974-08-20 for method and apparatus for disintegration of urinary calculi.
This patent grant is currently assigned to Blackstone Corporation. Invention is credited to John N. Antonevich, Roger Goodfriend.
United States Patent |
3,830,240 |
Antonevich , et al. |
August 20, 1974 |
METHOD AND APPARATUS FOR DISINTEGRATION OF URINARY CALCULI
Abstract
A method and apparatus are provided for disintegrating urinary
calculi by subjecting the urinary calculi to ultrasonic forces
transmitted transversely of a wave guide in a catheter.
Inventors: |
Antonevich; John N. (Jamestown,
NY), Goodfriend; Roger (Santa Clara, CA) |
Assignee: |
Blackstone Corporation
(Jamestown, NY)
|
Family
ID: |
23046284 |
Appl.
No.: |
05/273,985 |
Filed: |
July 21, 1972 |
Current U.S.
Class: |
606/128;
601/4 |
Current CPC
Class: |
A61B
17/22012 (20130101); A61B 2018/00982 (20130101); A61B
2017/320073 (20170801) |
Current International
Class: |
A61B
17/22 (20060101); A61B 17/32 (20060101); A61B
18/00 (20060101); A61b 017/22 () |
Field of
Search: |
;128/24A,328 |
References Cited
[Referenced By]
U.S. Patent Documents
Foreign Patent Documents
Primary Examiner: Pace; Channing L.
Attorney, Agent or Firm: Buell, Blenko & Ziesenheim
Claims
We claim:
1. 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 and ultrasonic means acting on the
coupling member to cause transverse vibration of the end thereof
adjacent the calculi.
2. An apparatus as claimed in claim 1 wherein the diameter of the
coupling member is less than two-thirds the diameter of the
lumen.
3. An apparatus as claimed in claim 1 wherein the coupling member
is a wire.
4. A method for fragmenting and drilling urinary calculi comprising
th steps of:
a. placing a catheter in a ureter containing a calculi to be
removed with one end abutting the calculi and the other end
free,
b. inserting a coupling member through the lumen of said catheter
until one end abuts the calculi while the other end extends out of
the free end of the catheter, said coupling member having a smaller
diameter than the lumen diameter,
c. subjecting the coupling member to ultrasonic vibrations such
that transverse vibrations are produced at the end abutting the
calculi, and
d. moving the coupling member into the catheter to cause it to
fragment and drill the calculi.
5. A method as claimed in claim 4 wherein the coupling member is a
wire whose diameter is less than two-thirds of the diameter of the
lumen of the catheter.
6. A method as claimed in claim 4 wherein a cystoscope is inserted
in the urinary tract to at least the bladder and the catheter is
inserted through the cystoscope into the bladder and from thence
into the ureter.
7. A method as claimed in claim 4 wherein flushing fluid is
introduced into the catheter whereby the catheter is irrigated with
fluid during fragmenting and drilling.
8. An apparatus as claimed in claim 1 wherein the coupling member
has a wave form adjacent the point when the ultrasonic means acts
upon it.
9. An apparatus as claimed in claim 1 wherein the coupling member
has a spiral form adjacent the end where the ultrasonic means acts
upon it.
10. An apparatus as claimed in claim 1 wherein the ultrasonic means
acts on the coupling member transversely to its length.
Description
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.
It is well known that the average number of hospital admissions for
removal of urinary calculi or stones is about 1 per 1,000 of
population per year. This means that there are in excess of 200,000
cases of urinary calculi requiring hospital care. Stones which are
quite small may in some cases be passed without hospitalization.
However, all stones and particularly larger stones, especially if
associated with obstruction or infection, must be removed from the
urinary tract to prevent renal damage. Stones which are lodged low
in the ureter may often be removed by manipulation using devices
which are passed through the ureter up to the stone where they
engage the stone for mechanical extraction. When the stone is high
in the ureter or remains in the kidney, then it must be removed
with open surgery in present practices.
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.
The idea of vibratory impact machining of urinary calculi is not
new. At least as early as 1946 proposals for vibratory impact
machining of stones obstructing urinary tracts were made.
Thereafter many investigators worked on techniques for ultrasonic
disintegration of such urinary calculi. Focused beam techniques on
distal stones were difficult to control and results were
questionable. Impact machining techniques by transmitting
longitudinal vibrations through wire wave guides were found to be
effective to some degree but much too slow to be practical.
Moreover, such methods were difficult to control and greatly
restricted in utility because of excessive heat generation along
the wave guide and the very large size of the wire used in order to
provide longitudinal vibration.
We have found that urinary calculi can be quickly fragmented or
drilled through if a wave guide or coupling member 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. We have found that with such an arrangement large
urinary calculi can be quickly fragmented and removed, usually in 2
to 60 seconds.
In the practice of our invention 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. Preferably 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. Preferably 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 and 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.
In the foregoing general description of our invention we have set
out certain objects, purposes and advantages. Other objects,
purposes and advantages will be apparent from a consideration of
the following description and the accompanying drawings in
which:
FIG. 1 illustrates the apparatus of this invention, partly in
section in place in a human urinary system for removing a
stone;
FIG. 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; and
FIG. 5 (a) through 5 (d) illustrates in side elevation several
embodiments of wave guide cutting and fragmenting ends.
Referring to the drawings we have illustrated a cystoscope 10
inserted through a urethra 11 into a bladder 12. A catheter 13 is
inserted through the cystoscope 10, the bladder 12 and into a
ureter 14 until its end contacts stone 15. At this point a wave
guide in the form of wire 16 is inserted through the catheter until
its end contacts the stone 15. The wire 16 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 16 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.
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.
We have found that coupling of 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 ratio of the guide (wire), this coupling will, above a
threshold ultrasonic displacement velocity lead to instability
resulting in conversion of longitudinal motion into transverse
motion of the guide, which is desired in the practice of this
invention. The same is true of the embodiment of 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. The connections
shown in FIGS. 2(c), 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(f)
converts the longitudinal motion of the transducer into transverse
motion.
In order to better control the position of the catheter and wave
guide at the distal point which may be 40 cm. from the transducer
we provide a control apparatus shown in the modification of FIG. 3.
In this embodiment those elements which are identical with elements
of FIG. 1 bear like reference numerals with the addition of a prime
sign. Referring to FIG. 3, the catheter 13' and wave guide 16' are
positioned at the stone 15' 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 gases 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.
In order to obtain the maximum efficiency while reducing the
likelihood of accidental penetration of 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.
We have also found that an expandable catheter aids in centering
the wire and in preventing accidental penetration of the ureter.
Such 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.
In the foregoing specification we have set out certain preferred
practices and embodiments of our invention, however the invention
may be otherwise practiced within the scope of the following
claims.
* * * * *