Presented by: Michael R. Bailey PhD
University of Washington

Introduction

Marine mammals may be susceptible to developing kidney stones, which can be challenging to treat surgically. Here, we describe the use of a new minimally invasive technology, burst wave lithotripsy (BWL) and ultrasonic propulsion to treat ureteral calculi in a 48-year-old female bottlenose dolphin (Tursiops truncatus) and to reduce renal stone burden in a 23-year-old male harbor seal (Phoca vitulina).

Materials

BWL and ultrasonic propulsion were delivered transcutaneously in sinusoidal ultrasound bursts to fragment and reposition stones, respectively for both cases. Targeting and monitoring were performed with real-time imaging integrated within the BWL system. The dolphin case received a 10-minute and a 20-minute BWL treatment conducted approximately 24 hours apart to treat two 8-10 mm partially obstructing right mid-ureteral stones, using oral sedation alone. For the harbor seal, while under general anesthesia, retrograde ureteroscopy attempts were unsuccessful because of ureteral tortuosity, and a 30-minute BWL treatment was targeted on one 10-mm right kidney stone cluster in attempt to reduce the renal stone burden.

Results

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In the dolphin case, the ureteral stones appeared to fragment, spread apart, and move with ultrasound propulsion.  On post-treatment days 1 and 9, the right ureteral calculi fragments shifted caudally to the ureteral orifice (UO), respectively. On day 10, the calculi fragments passed, and the hydroureter resolved. In the harbor seal, the stone cluster was observed to fragment and was not visible on the postoperative CT scan. The seal had gross hematuria and a day of behavior indicating stone passage but overall, an uneventful recovery.

Conclusion

New BWL and ultrasonic propulsion technologies successfully relieved ureteral stone obstruction in a geriatric dolphin and reduced renal stone burden in a geriatric harbor seal.

Funding

Work supported by The Mirage Hotel, SonoMotion, and NIH P01 DK043881.

Co-Authors

Arturo Holmes, MD
University of Washington

Ben Chew, MD
University of British Columbia

Robert Laughlin, DVM
The Mirage Hotel

Jean Buckley, MD
University of British Columbia

Erica Kiewice, BA
The Mirage Hotel

Michael Dancel, BS
The Mirage Hotel

David Blasko,
The Mirage Hotel

Victor Wong, MD
University of British Columbia

Abdulghafour Halawani, MD
King Abdulaziz University

Kyochul Koo, MD
Yonsei University College of Medicine

Doug Corl, PhD
SonoMotion

Paul Fasolo, MS
SonoMotion

Oren Levy, PhD
SonoMotion

Jeff Thiel, BS
University of Washington

Jammy Eichman, RVT
National Marine Mammal Foundation

Jennifer Meegan, DVM
National Marine Mammal Foundation

Martin Haulena, DVM
Vancouver Aquarium in British Columbia