[HN Gopher] Kidney stone procedure "has the potential to be game...
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Kidney stone procedure "has the potential to be game changing"
Author : elorant
Score : 209 points
Date : 2023-10-26 14:32 UTC (8 hours ago)
(HTM) web link (komonews.com)
(TXT) w3m dump (komonews.com)
| donatj wrote:
| Oh nice. I had to have mine lasered and it was a big ordeal with
| tubes being placed ahead of time and later removed over as many
| appointment.
| anonymousiam wrote:
| Had my latest one lasered a few months ago. It all went well,
| except for the annoying stent that had to be removed a month
| later. IMHO, the laser approach to removing the stone (by
| obliterating it) is safer for the kidneys.
| apetresc wrote:
| > It will also give astronauts the go ahead they need from NASA
| to travel to Mars.
|
| Wait, what? Everything else was worked out, but NASA just went
| "hold on, we can't go to Mars just yet until we figure out what
| to do if an astronaut gets kidney stones on the way"?
|
| Did the writer just throw this in to make the procedure seem more
| hip and exciting?
| chmod775 wrote:
| It's a real issue in space:
|
| > Because space travel makes astronauts prone to kidney stones
| due, in part to bone demineralization from weightlessness, they
| are at increased risk. The NASA evidence base and publications
| note that astronauts have had more than 30 instances of kidney
| stones within two years of space travel. Medical assistance is
| a formidable challenge for those orbiting this planet or
| heading to other solar system destinations.
|
| https://newsroom.uw.edu/news/keeping-kidney-stones-bay-durin...
| Andrex wrote:
| I'm not even sure a free trip to space would be worth a
| kidney stone, personally.
| bastardoperator wrote:
| Yeah, hard pass for me, no pun intended.
| sabellito wrote:
| The pun was very good though, you should've intended it.
| TrevorJ wrote:
| Best pun I have heard in ages.
| throwanem wrote:
| I mean if it was only blocking a ureter for ten minutes
| tops, then sure? Compared to what hydronephrosis feels
| like, merely voiding one isn't so much of a much, really.
| bilsbie wrote:
| We really should be working on artificial gravity via
| spinning. It solves so many issues.
|
| I know smaller craft can't do this but we can always do a
| long tether with a counterweight.
|
| (My personal pet idea is to go for super low gravity like
| .05G to start out to simplify things. You still get to walk
| around, go to the bathroom, spill liquids and clean up, cook,
| etc. )
| _Microft wrote:
| We have years of experience with both short and long-term
| missions in zero or micro gravity but we know a lot less
| about how low gravity affects the human body. We can hope
| that it is beneficial but what we actually need is a way to
| study it.
| simcop2387 wrote:
| And there's a very good chance that what we do know about
| zero/microgravity will still be beneficial with low
| gravity too. Definitely a reason to work on this even if
| we do ultimately wait until we have some kind of low
| gravity solution too.
| Lord-Jobo wrote:
| https://www.nasa.gov/podcasts/houston-we-have-a-
| podcast/arti...
|
| This podcast covers a lot of the status on international
| studies for artificial gravity.
|
| "Now we did try to fly a centrifuge on station around 2009
| or 2010. And again, it was the same international community
| and we put together an international proposal to do it on
| station. And it turns out after a lot of hemming and hawing
| and the U.S. was going to provide the crew and the
| integration, the Japanese were going to fly it and the
| Europeans were going to pay for the device and have it
| built, and flight certified. It turns out that the station
| really isn't designed for that much vibration. So instead
| of just having a person laying there, we were going to have
| a person with a cycle ergometer that would spin and do the
| ergometer. And that much vibration was bad for the station
| and it was decided that you would have to have a very
| expensive vibration isolation system that the Europeans
| weren't willing to pay for to be able to do it. So, we kind
| of lost the possibility of doing human centrifuge work on
| station at this time."
|
| So it looks like this is the current issue, and there is a
| large amount of work going into the physiological side of
| research to find out exactly what amounts and methods of
| artificial gravity achieve desired results.
| Teever wrote:
| This all stems from the fact that the current cost to
| orbit per kg is too impractical to build a space station
| that is designed to rotate.
| njarboe wrote:
| We really should be working on fusion powered rockets so we
| can just accelerate at .5g and get places quickly.
| wing-_-nuts wrote:
| Spin tha drum beltaloada!
| bsder wrote:
| Isn't size and speed the issue?
|
| For a 50m radius don't you need about 10 RPM (rotation once
| every 6 seconds!)? That's actually right at the maximum
| dimension of the ISS, no?
|
| And you're going to feel the gravity differential if you
| aren't _exactly_ on the rim.
|
| We'd have to get significantly better at building _much_
| bigger space structures before rotating them will be even
| remotely feasible.
| bscphil wrote:
| > The NASA evidence base and publications note that
| astronauts have had more than 30 instances of kidney stones
| within two years of space travel.
|
| What does this mean? Surely the _average_ astronaut doesn 't
| pass 30 kidney stones every two years, that's more than one a
| month. So it's either over a _specific_ two year period (for
| every astronaut in space at the time, probably a lot?) or it
| 's for a specific number of astronauts. Confusing sentence.
| tsimionescu wrote:
| I think they mean there have been 30 reported cases of an
| astronaut getting a kidney stone less than 2 years after
| their latest space flight.
|
| Given that astronauts are exceptionally physically fit
| individuals to start with, at least at the time of their
| space missions, this is probably quite significant evidence
| that space flight causes kidney stones.
| at_a_remove wrote:
| The article has a bit in it "This technology is also making it
| possible for astronauts to travel to Mars, since astronauts are
| at a greater risk for developing kidney stones during space
| travel." And then a hyperlink to more information.
| aristus wrote:
| As I understand it, it was not literally the last thing holding
| back. But NASA worries about _everything_ and we have centuries
| of examples of remote missions failing because of medical
| problems that could not be solved in the field. Billions of
| dollars, tens of years, and a ship full of lives can 't be
| risked on a 3mm pebble if it can possibly be prevented.
| hanniabu wrote:
| > we have centuries of examples of remote missions failing
|
| decades*
| ToValueFunfetti wrote:
| Depends on how broadly you define "remote missions"
| kstrauser wrote:
| I assume they're including sailing ships dealing with
| scurvy, and things like that. We haven't been in space very
| long, but we're a species of explorers.
| morkalork wrote:
| The Franklin Expedition of 1845 comes to mind. There were
| even theories about new-ish technology (tinned food)
| accidentally poisoning the crew with lead.
| letmevoteplease wrote:
| NASA currently considers kidney stones an unacceptable risk for
| a Mars mission that requires mitigation.[1] There are also
| about 10 other risks requiring mitigation, though.[1]
|
| [1] https://humanresearchroadmap.nasa.gov/Risks/risk.aspx?i=81
|
| [2] https://humanresearchroadmap.nasa.gov/Risks/
| ghufran_syed wrote:
| NASA saying there is a "research gap" and that it "needs
| mitigation" is very different from it being an "unacceptable
| risk" which implies that no mission can happen _until_ it
| happens. if there was a ship ready to go with a hab and
| propellant for the return trip sitting on mars, I can
| guarantee they would take the very next transfer window,
| kidney stone risk notwithstanding- particularly if the
| chinese or russians were about to do so and might get there
| first!
| hypercube33 wrote:
| I mean I just watched a bunch of documentaries about
| Challenger and Columbia...you're damn right they would
| rubber stamp it.
| bumby wrote:
| According to the method by which NASA measures risk, it is
| indeed an "unacceptable risk". The red 4x4 "LxC" box stands
| for "likelihood x consequence". So they consider it a high
| likelihood and a severe consequence. It's red because that
| puts it in the unacceptable category.
|
| If you look at the medical risk matrix it puts the
| likelihood between 60% - 80% and consequence at "loss time
| injury or illness per OSHA criteria" On a score of 1 (least
| risky) to 25 (most risky), a 4x4 scores 22.
|
| Now to your point about "guaranteeing" they would still go,
| they are allowed to waive these risks through a formal
| process. It tends to make managers squeamish though,
| because nobody wants to be the person who's signature is
| attached to a known risk that eventually causes a mishap.
|
| https://www.nasa.gov/wp-
| content/uploads/2015/10/s3001_guidel...
| WirelessGigabit wrote:
| Maybe I'm not looking at the right terms but the appendix
| isn't on it. Is there a requirement for astronauts to have an
| appendectomy? Like researches in Antarctica.
| extraduder_ire wrote:
| Returning from space in a hurry is a lot quicker than
| returning from Antarctica over winter. I don't know, but
| I've never heard of that being in their risk profile or
| requirements.
| Rebelgecko wrote:
| Can you abort while you're on the way to Mars?
| __s wrote:
| Looked up antarctica appendectomy:
| https://www.antarctica.gov.au/about-antarctica/people-in-
| ant...
|
| Only required for doctors staying over winter. Neat
| HideousKojima wrote:
| Probably because the Soviets famously had only one doctor
| at one of their stations and he happened to get
| appendicitis. Had to do his own appendectomy with two
| assistants to hold a mirror and light, and also what I
| assume were copious amounts of vodka.
| bumby wrote:
| From a non-NASA site:
|
| "NASA does not mandate astronauts to undergo an
| appendectomy before embarking on a mission. This decision
| stems from the understanding that the risks associated with
| surgery frequently outweigh the potential benefits."
|
| https://www.lunarsail.com/do-astronauts-have-their-
| appendix-...
| joduplessis wrote:
| Not to the moon or the space station, but to Mars. Yes, next
| stop is Mars folks.
| user568439 wrote:
| Nice, but why this website trues to download a file automatically
| to my phone?
| CodesInChaos wrote:
| Doesn't happen for me, but I'd guess it's a wrong mime-type on
| an ad-iframe.
| soco wrote:
| Did you have the patience to wait for "saving preferences"? I
| gave up at around 74% whatever that means.
| nharada wrote:
| Yeah it takes time to "save preferences" if you don't give it
| maximum permissions.
| cromulent wrote:
| I'm used to accepting cookies, but after the download I checked
| the list of "required cookies". Insane. I clicked on one
| privacy policy and was met with the same download and required
| cookies in order to read it.
| Ecco wrote:
| The UW announcement is from 2022. I wonder why that article is
| posted now.
|
| https://newsroom.uw.edu/news/ultrasound-promises-relief-thos...
| xezzed wrote:
| Well, isn't it called 'lithotripsy' and exists for quite a time?
| apendleton wrote:
| This is "burst wave lithotripsy," compared to the somewhat-
| similar existing "shock wave lithotripsy." The new iteration
| apparently works more quickly and causes less pain, so can be
| performed while the patient is awake rather than requiring
| general anesthesia, which would make it practical to do it in,
| say, an ER or regular doctor's office. See
| https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10117400/#sec2t...
| for a comparison of the mechanisms.
| bgm1975 wrote:
| It also probably has the same caveat that shock wave
| lithotripsy does too, where if the stone travels below the
| pelvis, the procedure can't be used.
| xezzed wrote:
| thanks)
| __xor_eax_eax wrote:
| > Ureteroscopy is another minimally invasive way to treat
| stones but often requires a temporary stent, which can be quite
| uncomfortable.
|
| "The ways we have to currently treat stones have some
| downsides," he said. "Most involve anesthesia."
|
| In contrast to the shock waves used in ESWL, the BWL procedure
| uses "short harmonic bursts" of ultrasound energy, potentially
| enabling the stones to be broken up in a shorter procedure
| without the need for sedation or anesthesia. Pre-clinical
| studies supported the effectiveness of BWL in breaking
| experimental stones of varying size and composition, the study
| noted.
| bgm1975 wrote:
| Having had a Ureteroscopy procedure, I can say it sure as
| hell doesn't feel minimally invasive. It (well, post-op until
| they remove the stint) was almost as unpleasant as the kidney
| stone.
| kasperset wrote:
| I can vouch for this having recently suffered from Kidney
| stone and the "treatment".
| vondur wrote:
| Ooh, this sounds good. I've had kidney stones a couple of times.
| It was not very fun.
| 8f2ab37a-ed6c wrote:
| Is this available anywhere outside of UW?
| Giorgi wrote:
| Ultrasonic bursts? Is not that quite an old tech for stones?
| lunarimiso wrote:
| I just, 2 days ago, starting to experience slight discomfort in
| the liver/kidney area. The feeling was very similar to how it was
| with my gallbladder. At least until it was removed. I am totally
| a ticking time bomb. So, yes.. please bring on even better
| treatments.
| justanotheratom wrote:
| just FYI, AFAIK, kidney stone pain is sudden and unbearable,
| when the stone starts moving out of the kidney. Slight
| discomfort may not be a sign of kidney stone.
| powersurge360 wrote:
| Chronic stone former here, requiring surgical intervention a
| few times a year.
|
| It definitely can be sudden and debilitating but for most of
| my teenage years I had mistaken the pain for 'sleeping
| wrong'. Sometimes when I would bend over and then stand it
| would feel like someone had stapled my back together at the
| bend and I had to rip it out. It hurt, but not anything like
| what I expected. A couple of years later I wound up having a
| few stones that had grown to larger than an inch.
|
| If you have unusual and unexpected pain it's definitely worth
| getting checked out. I didn't have health insurance at the
| time and since the pain was intermittent I never suspected
| anything serious and just chalked it up to sleeping in a poor
| posture or maybe not getting enough exercise to be limber. It
| almost killed me!
| Tade0 wrote:
| For a long time I had a fear of flying.
|
| After I passed stones I noticed something odd - no usual
| anxiety during takeoff and landing.
|
| It was the stones all this time.
| UberFly wrote:
| Strange. A mental thing or possible pain from sitting so
| long?
| Turing_Machine wrote:
| It varies a _lot_ depending on the size of the stone and its
| jaggedness.
|
| I've unfortunately had several of them. Some passed with only
| mild discomfort. Others were excruciating... worst pain I've
| ever had.
|
| Somewhere around here I have a glass bottle with my
| collection of stones.
| westurner wrote:
| > _Still being run through clinical trials at UW Medicine, the
| procedure called_ _ burst wave lithotripsy _ _uses an ultrasound
| wand and soundwaves to break apart the kidney stone_
|
| > _Ultrasonic propulsion is then used to move the stone fragments
| out, potentially giving patients relief in 10 minutes or less_
|
| (Edit)
|
| "Fragmentation of Stones by Burst Wave Lithotripsy in the First
| 19 Humans" (2022)
| https://www.auajournals.org/doi/abs/10.1097/JU.0000000000002...
| gscholar citations:
| https://scholar.google.com/scholar?cites=4452238185664707620...
|
| Lithotripsy: https://en.wikipedia.org/wiki/Lithotripsy
|
| EWST: Extracorporeal shockwave therapy:
| https://en.wikipedia.org/wiki/Extracorporeal_shockwave_thera...
|
| Could NIRS help with this targeted ultrasound procedure, too?
|
| "Ultrasound-activated chemotherapy advances therapeutic potential
| in deep tumours" (2023)
| https://news.ycombinator.com/item?id=37885774#37885798 :
|
| > _NIRS Near-Infrared Spectroscopy does not require contrast
| FWIU?_
| westurner wrote:
| On reading brains with light,
| https://news.ycombinator.com/item?id=28399099#28400060 :
|
| > _What about with realtime NIRS with an (inverse?) scattering
| matrix?_
|
| FWIU Openwater's technology portfolio includes targeted
| ultrasound with e.g. NIRS and LSI/LSCI:
| https://www.openwater.health/technology
|
| One of their demo videos explains how inverting the scattering
| caused by the occluding body yields the mass-density at least
| (?). [Radio]Spectroscopy and quantum crystallography may have
| additional insight for tissue identification with low-cost NIRS
| sensor data?
|
| Open fNIRS: https://openfnirs.org/
|
| "Quantum light sees quantum sound: phonon/photon correlations"
| (2023) https://news.ycombinator.com/item?id=37793765 ; the
| photonic channel actually embeds the phononic field
| anonymousiam wrote:
| I've had conventional lithotripsy a few times, and I now have
| CKD. I have none of the typical CKD risk factors, and I suspect
| that the ultrasonic energy caused some damage. Unfortunately
| there is no way to know.
| RCitronsBroker wrote:
| it may be good to know that we aren't talking about an entirely
| new process, shock(!) wave lithotripsy has been around for quite
| some time now. The "game-changer" is the introduction of burst
| wave lithotripsy, which apparently is less painful and thus
| possible to go through without general anaesthisia, which, don't
| get me wrong, is definitely an improvement. But I'm not sure I'd
| call it a game changer.
|
| I'm not convinced it's entirely painless as it's still the same
| "crush and drive out via ultrasound" idea. Combine this with the
| fact that just existing is excruciating with stones, i don't see
| a way around opioid analgesia. Additionally, the game hasn't
| changed in the regard of the human pelvis being great at keeping
| out ultrasound, so if your stones are out of reach that way,
| you're SOL.
| misja111 wrote:
| Shock or burst wave lithotripsy is not new either, but it is
| being improved all the time. So I guess that's what this
| article is about, just another recent improvement.
| indigomm wrote:
| I've had lithotripsy and it certainly wasn't done under general
| anaesthetic. They just gave me painkillers and the procedure
| was fine. I was in and out very quickly - something like an
| hour or so.
| misja111 wrote:
| I must be missing something. This kind of treatment is called
| lithotripsy and it is used already since the 80's. What is new
| here?
| xutopia wrote:
| Burst waves rather than one signal.
| jl2718 wrote:
| Breakthrough? You could buy these machines on Alibaba years ago
| marketed for this purpose. I assume this means there was a
| cottage industry of private kidney stone treatment in Asia.
| bawana wrote:
| I wonder if it helps impotence as ESWL seems to have been used
| iin this regard as well.https://healthcare.utah.edu/mens-
| health/conditions/erectile-....
| anotheraccount9 wrote:
| 'Breakthrough'
| oldbbsnickname wrote:
| I have 19 mm left and 14 mm right stones that I generally don't
| notice and don't have any pain.
|
| ESWL seemed like a scam because there was no redness on back
| tissue and not a single grain or fragment was passed. I wonder if
| they set the machine to a high enough power or if they skipped
| the actual procedure while I was anesthetized.
|
| I'm wondering if BWL would be any better where ESWL fails.
| UberFly wrote:
| They've been blasting with sound waves for a while. "Ultrasonic
| propulsion" though, that sounds cool.
| RobRivera wrote:
| Kidney stone breakthrough...hehehe thats funny.
|
| [Best read in Norm MacDonald's Burt Reynolds' voice]
| mechhacker wrote:
| I've broken bones, including a leg, and a kidney stone was the
| most painful thing I've experienced.
|
| It was so painful it resulted in a blackout as it was moving
| through my innards and getting to my bladder. Anything to save
| myself from that non-invasively would be welcome. Thankfully,
| they have not returned as I think I know what triggers them for
| me.
| anderber wrote:
| May I ask what triggered them for you? As someone prone to
| them, I'm curious if I'm doing everything possible to avoid
| these nasty things.
| kabouseng wrote:
| Vitamin fizzy / soluble pills can cause it for some people.
| mechhacker wrote:
| I narrowed it down to grapefruit. At least that's what I
| suspect. I avoid them now.
| xxpor wrote:
| grapefruits should usually help, as they're high in citric
| acid.
| 131012 wrote:
| most citrus fruits help to reduce kidney stones, but not
| grapefruit. grapefruit has different weird interaction
| with medication and does increase risk of kidney stones,
| contrary to other citrus fruits.
|
| https://www.webmd.com/diet/foods-high-in-oxalates
| xxpor wrote:
| I don't know what to believe any more because that
| article says kale is a low oxalate food, but
| https://blog.swedish.org/swedish-blog/kale-causes-kidney-
| sto... says the opposite (and was on the list I got at
| discharge)
| northernman wrote:
| I've had several kidney stones - usually at about one year
| intervals.
|
| The first was the worst because you don't know what it is.
| Subsequent stones didn't seem to be as bad, since I knew I was
| going to survive.
|
| The emerg doc told me that some ladies say the pain worse than
| childbirth.
| galkk wrote:
| Hope that the ticking bomb in my right kidney (that was found
| during CT scan when the stone from my _left_ kidney was coming
| out) can wait for the next year.
|
| In all seriousness the article doesn't have anything about
| general availability and cost, alas. How soon it can be offered
| at your typical hospital instead of vicodin and lots of water?
| xxpor wrote:
| I was asked if I wanted to sign up in 2020, and said yes. No word
| back from the team though :(. I ended up getting the normal EWST,
| at UW Medicine.
|
| I had a stone kicking around for 2 years that would cause pain
| off and on. Went to normal primary care, but they had no idea. We
| thought it was a gastro issue, since it felt like constipation
| (or so I thought). The problem was I was always fine when I
| actually went to see the doc. Until I finally went to the ER and
| they ordered a simple x-ray and found it :/
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