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April 23, 2019
Kidney Stones in Children

Kidney Stones Zapping Technology by NASA to Help Treat Astronauts With Stones

  • Astronauts more prone for kidney stones
  • Due to logistics reason, detection and treatment in space is not feasible
  • Burst Wave Lithotripsy (BWL) is compact and less heavy than conventional methods
  • BWL can be used for other problems too like stopping bleeds and bone strengthening in space

With so many dreams of stepping on to the Red planet, an astronaut undergoes
vigorous training and number of medical examinations including kidney and heart evaluation to be fit enough to be sent on to the space mission. But imagine an astronaut is sent on a mission to Mars and when he is ready to set foot on the Mars sand he develops kidney pain and kidney stone.

Kidney stone
or renal calculi is crystallization of minerals in the urine that slowly
enlarge to form stones. What usually leads to kidney stones is inadequate
hydration and sometimes due to recurrent urinary infections due to blockage or
abnormality in the urinary tract. This stone in the kidney when small does not
cause any symptoms. But the problem starts when it grows in size or gets
infected or enters the ureter and obstruct the urinary passage. Occasionally
the small stones will pass spontaneously or can be managed medically by asking
patients to drink plenty of fluids to push the stone out or using medicines to
make the ureters help them to get expelled. Most often these conservative
measures do not help and the patient may need surgical management.

‘The new technology of the Burst wave lithotripsy (BWL) uses smaller, more frequent bursts of ultrasound to break the kidney stone. BWL is also lighter, more compact and uses lesser energy which is suitable for usage in space.’


HURDLES IN KIDNEY STONE
MANAGEMENT IN SPACE – A BIG CHALLENGE

Either a shockwave lithotripsy is done where in the patient is made to lie down on a refrigerator like machine and large amounts of ultrasound waves are focused to break the stone or using an endoscopic approach and breaking the kidney or bladder stone using laser under direct vision.
However due to the technicality and size of the machines used in these
methods of treatment, this is not very feasible in outer space. Several data
from NASA suggests that the astronauts are very much prone to develop kidney
stones. And so if the astronaut does not pass the stone in the urine they might
cause various complications and they would need to be called back from the
mission to get treatment on Earth. One such incident has been recorded in NASA
ISS (international space station). But as far as Mass mission is concerned
sending back the person is not very possible.

And
another hurdle is in the detection of the kidney stone itself. The kidney
stones are generally detected using X-rays, ultra-sound and Computed tomography
scans. But due to the heaviness of the machinery involved it is not suitable
for space travel.

PORTABLE ULTRASOUND AND
BURSTWAVE LITHOTRIPSY- A STEP FORWARD

The
research team at the University of Washington’s Applied Physics Lab are working
to solve this difficult space scenario. The team is working on developing a
portable Ultrasound machine which will help to detect and disintegrate the
kidney stones without the need for surgery or large equipments. This research
is funded by the National Space Biomedical Research Institute.

This
technology focuses Ultrasound waves to detect the exact location of the stone
in the kidney or the ureter and then uses short bursts of sound energy to break
the stone into tiny pieces, small enough for the astronaut to pass in urine. “Originally
it was being experimented for use in blunt trauma where we can focus ultrasound
and stop bleeding,”
Michael Bailey, the principle investigator of the
research, said. “Then we realized that kidney stones were a bigger risk because bones
are de-mineralizing (in space more
rapidly) and that will increase the likelihood of stones and require treatment.”

This
technology will be very helpful in space missions especially for long distance
Mars mission that will take over a year to complete and where the astronaut
cannot be sent back very easily. The team has already developed the technology
to detect the location of the stone, the next process is to develop the
technology to break the stone, on which the researchers are working on
currently.

Based
on the mechanism of Shockwave lithotripsy, Adam Maxwell, an assistant professor
of Urology at UW has developed Burst
wave lithotripsy
  (BWL) which uses smaller, more frequent bursts of ultrasound to break
the stone. Anne Zwaschka, a student working with the team explained that the
difference between shock wave and burst wave lithotripsy is that the older
technique is like breaking the stone
with a hammer and in burst wave is like chiseling away the stone gradually
.
A big advantage with Burst wave is
regarding the equipment which is lighter, more compact and uses lesser energy
which is suitable for usage in space.

A NEW ERA IN SPACE MEDICINE – FURTHER TRIALS AND
EXTENDED USAGE OF BURST WAVE LITHOTRIPSY
  (BWL)

Now
that the challenge of focusing the wave has been crossed, soon the research
team will move on to testing BWL’s abilities, finding out its possible side
effects and drawbacks.  Eventually they
will start doing clinical trials. BWL can also be used in various other
problems faced by the astronauts in space like stopping bleeding, strengthening
bones or even performing ultrasound surgery, without breaking the patients’
skin.  Due to the flexibility of its
software, apps can also be developed to extend its functionality.

Similar
technology is being used in Swedish Medical Centre in Seattle to treat patients
with tremors without involving invasive and dangerous brain surgeries and also
in some medical centers in treatment of cancer
prostate with good results.

References :

  1. Kidney Stones in Adults – (https://www.niddk.nih.gov/health-information/health-topics/urologic-disease/kidney-stones-in-adults/Pages/facts.aspx)

Source: Medindia

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