So there are some biological effects. If blood is not moving and you've just shock waved into a tank of blood, you would get hemolysis. Since the blood is constantly moving, very little of it is hemolyzed. There are surface skin hematomas and retroperitoneal hematomas that you'll see. We have rarely had a problem. In the now 15 years that I've been doing lithotripsy I have had to hospitalize one patient for bleeding and that was a patient who happened to be on aspirin and didn't let us know. Other than that I have not seen in my own personal experience anybody have any severe bleeding from this.
All of the patients will have some hematuria. Those patients will have cranberry-colored urine for 24 hours or so, so there is some bruising of the organ in and around where the shock waves are delivered. It's been studied in multiple studies. There does not seem to be any long lasting ill-effect on renal function, and I mentioned the hemoptysis in children because the lung is so close.
On the right you'll see a small hematoma here in the kidney ¾ these are animal kidneys, obviously, and this is a juvenile animal kidney and you can see the extent of damage is quite a bit more for the same energy application.