Holmium:YAG lithotripsy: Photothermal mechanism converts uric acid calculi to cyanide

Joel M.H. Teichman, George J. Vassar, Randolph D. Glickman, Cara M. Beserra, Stephen J. Cina, Ian M Thompson

Research output: Contribution to journalArticlepeer-review

34 Scopus citations

Abstract

Purpose: Holmium:YAG lithotripsy fragments stones through a photothermal mechanism. Uric acid when heated is known to be converted into cyanide. We test the hypothesis that holmium: YAG lithotripsy of uric acid calculi produces cyanide. Materials and Methods: Human calculi of known uric acid composition were irradiated with holmium:YAG energy in water. Stones received a total holmium:YAG energy of 0 (control), 0.1, 0.25, 0.5, 0.75, 1.0 or 1.25 kJ. The water in which lithotripsy was performed was analyzed for cyanide concentration. A graph was constructed to relate holmium:YAG energy to cyanide production. Results: Holmium:YAG lithotripsy of uric acid calculi in vitro produced cyanide consistently. Cyanide production correlated with total holmium:YAG energy (p<0.001). Conclusions: Holmium:YAG lithotripsy of uric acid calculi risks production of cyanide. This study raises significant safety issues.

Original languageEnglish (US)
Pages (from-to)320-324
Number of pages5
JournalJournal of Urology
Volume160
Issue number2
DOIs
StatePublished - Aug 1998

Keywords

  • Holmium
  • Lithotripsy, laser
  • Uric acid, calculi

ASJC Scopus subject areas

  • Urology

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