U.S. patent number 3,785,382 [Application Number 05/252,752] was granted by the patent office on 1974-01-15 for device for destroying stones in the bladder, in the ureter, in the kidneys and the like.
This patent grant is currently assigned to Richard Wolf GmbH. Invention is credited to Heinz Schmidt-Kloiber, Stefan Schuy.
United States Patent |
3,785,382 |
Schmidt-Kloiber , et
al. |
January 15, 1974 |
DEVICE FOR DESTROYING STONES IN THE BLADDER, IN THE URETER, IN THE
KIDNEYS AND THE LIKE
Abstract
A device for destroying stones in the bladder, in the ureter, in
the kidneys and the like, comprising an elongated, flexible
lithotriptor insertable in conjunction with a cystoscope or a
special catheter through the urethra into the interior of the body
until such time when it comes into contact with the stone to be
destroyed, a driving mechanism comprising a chamber filled with a
liquid, a membrane closing the chamber and rigidly connected to the
lithotriptor, and imparting longitudinal mechanical vibrations to
same two electrodes inserted in the chamber in such a manner as to
provide electrical insulation, and a means which makes electric
flashovers between the electrodes possible inside the chamber.
Inventors: |
Schmidt-Kloiber; Heinz (Graz,
OE), Schuy; Stefan (Graz, OE) |
Assignee: |
Richard Wolf GmbH
(Knittlingen/Wurtt, DT)
|
Family
ID: |
3560804 |
Appl.
No.: |
05/252,752 |
Filed: |
May 12, 1972 |
Foreign Application Priority Data
|
|
|
|
|
May 14, 1971 [OE] |
|
|
A 4187/71 |
|
Current U.S.
Class: |
606/128;
60/531 |
Current CPC
Class: |
A61B
17/22022 (20130101); A61B 2017/922 (20130101); A61B
2017/22014 (20130101); A61B 17/22004 (20130101) |
Current International
Class: |
A61B
17/22 (20060101); A61B 17/92 (20060101); A61B
17/88 (20060101); A61b 017/22 () |
Field of
Search: |
;128/33R,328,356 ;60/25
;417/395 |
References Cited
[Referenced By]
U.S. Patent Documents
Primary Examiner: Truluck; Dalton L.
Claims
We claim:
1. A device for destroying stones in the bladder, in the ureter, in
the kidneys and the like, comprising a housing open on one side, a
cover plate mounted on the open side of the housing and having a
central crossbore, a membrane clamped between the cover plate and
the open side of the housing, said membrane defining a chamber
within the housing, said chamber being tightly closed and filled
with a liquid, an ureter catheter, one end of it fitted in said
crossbore of the cover plate, the other end of the catheter being
insertable through the urethra into the interior of the body, an
elongated flexible lithotriptor penetrating the catheter in
longitudinal direction, one end of the lithotriptor being rigidly
connected to the membrane, the other end of the lithotriptor
contacting the stone to be destroyed, two crossbores penetrating
the housing on opposite sides in transverse relation to the
catheter, two electrodes inserted in said crossbores of the housing
and electrically insulated from the housing, the inner ends of said
electrodes being opposed to each other at a distance, and
electrical means for the production of electric flashovers between
said inner ends of the electrodes.
2. A device according to claim 1, wherein a feed pipe and a drain
pipe are inserted in the chamber in such a manner as to protrude
into same, the feed pipe and the drain pipe each being closed at
its front end in the area of the chamber but provided with lateral
apertures.
3. A device according to claim 1, wherein said cover plate defines
an interior together with the side of the membrane facing away from
the chamber, the ureter catheter being connected to the interior, a
connecting pipe being provided on the cover plate for the supply of
rinsing liquid to the interior and consequently to the ureter
catheter.
Description
The present invention relates to a device for destroying stones in
the bladder, in the ureter, in the kidneys and the like, comprising
an elongated flexible lithotriptor insertable in conjunction with a
cystoscope or a special catheter through the urethra into the
interior of the body until such time when it comes into contact
with the stone to be destroyed, and connected with a driving
mechanism by means of which longitudinal mechanical vibrations are
imparted to the lithotriptor.
Conventional lithotriptors serve for the destruction of stones in
the urinary bladder exclusively. Such destruction was formerly
achieved either blindfold or with the use of endoscopes by purely
mechanical means. As a result, more or less serious lesions of the
mucuous membrane, haemorrhages and occasionally even perforations
did occur in the process.
Some improvement has been achieved after the so-called
electro-hydraulical lithotriptic method had become known. This
method takes advantage of the effect of hydraulic shock waves
produced by electric charges in a liquid dielectric medium. The
lithotriptor presents a probe comprising an insulated central and a
cylindrical external electrode or, in accordance with a recently
devised variety of design, two highly insulated electrodes arranged
side by side. However, this method is somewhat inconvenient
inasmuch as the diameter of the lithotriptor used for that purpose
cannot be less than 8 charr., and electric currents of as much as
several thousand volts and several hundred amperes have to be sent
through the ureter as far as close to the stone. During the
flashover, lesions of the mucuous membrane are liable to occur and
when a predetermined minimum distance is not attained, perforation
may result from coagulation of the bladder wall. Another drawback
of this method resides in the fact that it takes advantage of the
hydraulic wave produced by an electric discharge and can therefore,
be resorted to only provided there is a liquid between the stone
and the lithotriptor and a certain volume of liquid is available in
the area of the discharge. In view of the necessity of
accommodating two highly insulated electrodes, a liquid current as
well as lighting conduits and optical devices inside a common
shaft, it is not possible with the technology at present available,
to employ this method in the urethra.
Another method which has been tried time and time again, and which
recently turned out to be partly successful, is called the
supersonic lithotriptic method. The sound energy is supplied by a
magnetostrictive or piezoelectric transducer connected to a
high-frequency generator. Via an intermediate piece the transducer
excites an amplitude transformer which is so designed as to step up
the supersonic amplitude. Connected thereto is a cylindrical
workhead serving as a probe and preferably ending in a
calice-shaped tip designed so as to prevent the drillhead from
bogging down. By the high-frequency motions produced by the tip of
the probe the stone is eventually pierced through, provided a
certain amount of pressure is also applied. Moreover, provision has
to be made for a liquid layer to improve the effect of coupling.
Apart from these shortcomings, the temperature of the working probe
rises in the process so that its diameter cannot be less than a few
millimeters. It is therefore, difficult to employ this method in
the ureter. Yet another drawback stems from the necessity of
continuously tuning this system since the natural vibration of the
probe varies as a function of length and of the surrounding
medium.
It is the object of the present invention to provide a device by
means of which stones in the bladder, in the ureter and in the
kidneys can be destroyed without any risk whatsoever for the
patient.
According to the invention, the driving element comprises a chamber
filled with a liquid and closed by means of a membrane rigidly
connected to the lithotriptor, two electrodes being inserted in the
chamber in such a manner as to provide electric insulation.
Electric flashovers of short duration can be released by means of
the electrodes. This arrangement makes it possible to use a long,
thin and flexible lithotriptor inserted through the urethra into
the bladder or into the ureter by means of an endoscope having an
appropriate aperture and a suitable steering means until such time
when it comes into contact with the stone to be destroyed. Since no
high-voltage lines are introduced in the patient's body, this
method can be said to be reliable, easily and precisely applicable
without the least risk for the patient. The hydraulic wave produced
by means of the electric flashover does not directly affect the
stone, but acts upon a membrane which transmits its motion to a
long thin wire. The transducer supplies motion amplitudes of up to
1 millimeter. Since the pulses are of the shortest duration
possible, it is not necessary to particularly modulate the length
of the lithotriptor irrespective of whether the probe is operated
in air, water or any other medium.
To ensure a continuous exchange of liquid, the chamber is
preferably provided with a feed pipe and a drain pipe protruding
into same, both pipes being closed at their front ends and provided
with lateral apertures. Preferably the lithotriptor is guided
within a thin ureter catheter connected to the interior of a cover
plate located on the side of the membrane opposite the chamber, the
rinsing liquid being supplied to the interior via a connecting
pipe.
Further details of the invention will become apparent from the
following description of a proven embodiment of the invention with
reference to the accompanying drawing wherein
FIG. 1 is an axial cross-sectional view, and
FIG. 2 a horizontal cross-sectional view on line II--II of FIG.
1.
A long, thin and flexible lithotriptor 4 with a workhead 4' is
connected to a membrane 3 forming the termination of a rigid
chamber 1 filled with water. By the release of electric flashovers
of extremely short duration via two opposite electrodes 6
introduced through insulating bushes 8 with special electrode heads
7, hydraulic shock waves are produced in the chamber by means of
vaporization in the area of the arc, causing deformation of the
membrane 3 for a short period of time. When coupled to an
appropriately selected lithotriptor these membrane deformations can
be transformed into longitudinal vibrations in the lithotriptor. In
order to keep the conductivity increase of the liquid due to
electrochemical and photochemical reactions as low as possible, the
liquid in the chamber is continuously exchanged through the feed
and drain pipes 9, 9'. The feed and drain pipes are closed at their
front ends and provided with lateral apertures 10 so as to preclude
the direct escape of pressure waves.
The membrane 3 rests on a gasket 11 inserted in the planished front
end of the chamber 1, tightly closing the same after it has been
clamped down by means of a cover plate 2 of particular design and a
clamping ring 5. In order to avoid disruption of the connection
between the lithotriptor and the membrane as a result of buckling,
the cover plate is provided with a cylindrical guiding means for
the lithotriptor.
For the destruction of stones in the ureter, the lithotriptor 4 is
guided inside a thin ureter catheter 12 which on the one hand,
serves as a means for centering the lithotriptor, and on the other
hand as a means for supplying the workhead with liquid between the
catheter and the lithotriptor. The ureter catheter is fixed in the
guiding portion of the cover plate. The rinsing liquid can be
introduced into the interior 14 of the cover plate 2 through a
connecting pipe 13 on the cover plate.
* * * * *