In order to test whether
shock wave fragmentation of human
gallstones increases their dissolution rates in a
bile acid-
lecithin solution, we carried out in vitro experiments. Stones comparable in size, weight and
cholesterol content (86%) from the same human gallbladder were disintegrated by
shock waves. A
glycoursodeoxycholic acid (GUDC)-
lecithin solution served as
solvent. After 10 days incubation in this
solvent, intact stones had lost only 4% of their
cholesterol. This value increased to 92% after disintegration of the stones by 300
shock wave discharges. Fragments with a size of less than 2 mm had lost 55% of their
cholesterol after day 1 and 99% after day 10. A large stone fragment cleaved off by
shock waves lost much more
cholesterol (42% after 10 days) than an intact untreated stone (4% after 10 days) comparable in size, weight and
cholesterol content. These data show that
shock wave
lithotripsy of
cholesterol gallstones considerably accelerates their dissolution rate in a GUDC-
lecithin solvent, the desirable fragment size being 2 mm or less. However, even large fragments may lose much more
cholesterol than comparable intact stones as a result of changes in surface structure as documented by scanning electron microscopy. The experiments favor the concept of a combined treatment of gallbladder stones by extracorporeally generated
shock waves and
bile salt therapy.