Photothermal laser lithotripsy of uric acid calculi: Clinical assessment of the effects of cyanide production

Joel M H Teichman, Paolo C. Champion, Randolph D. Glickman, Tim A. Wollin, John D. Denstedt

Research output: Chapter in Book/Report/Conference proceedingChapter

Abstract

The mechanism of holmium:YAG lithotripsy is photothermal. Holmium:YAG lithotripsy of uric acid calculi produces cyanide, which is a known, thermal decomposition product of uric acid. We review our experience with holmium:YAG lithotripsy of uric acid calculi to determine if there is any clinical evidence of cyanide toxicity. A retrospective analysis of all of our cases of holmium:YAG lithotripsy of uric acid calculi was done. Anesthetic and postoperative data were reviewed. A total of 18 patients with uric acid calculi were treated with holmium:YAG lithotripsy by ureteroscopy (5), retrograde nephroscopy (2), percutaneous nephrolithotomy (5) or cystolithotripsy (6). Total holmium:YAG irradiation ranged from 1.2 to 331 kJ. No patient had evidence of increased end-tidal carbon dioxide, changes in electrocardiogram or significant decrease in postoperative serum bicarbonate. An 84 year old woman had decreased diastolic pressure of 30 mm Hg while under general anesthesia. No cyanide related neurologic, cardiac or respiratory complications were noted. These data suggest no significant cyanide toxicity from holmium:YAG lithotripsy of uric acid calculi in typical clinical settings. More specific studies in animals are warranted to characterize the risk.

Original languageEnglish (US)
Title of host publicationProceedings of SPIE - The International Society for Optical Engineering
PublisherSociety of Photo-Optical Instrumentation Engineers
Pages210-214
Number of pages5
Volume3590
StatePublished - 1999
EventProceedings of the 1999 Lasers in Surgery: Advanced Characterization, Therapeutics, and Systems IX - San Jose, CA, USA
Duration: Jan 23 1999Jan 24 1999

Other

OtherProceedings of the 1999 Lasers in Surgery: Advanced Characterization, Therapeutics, and Systems IX
CitySan Jose, CA, USA
Period1/23/991/24/99

ASJC Scopus subject areas

  • Electrical and Electronic Engineering
  • Condensed Matter Physics

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