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Holmium:YAG lithotripsy of uric acid calculi
J M Teichman1, P C Champion, T A Wollin
1Division of Urology, University of Texas Health Science Center, San Antonio, USA.
Purpose:
Holmium:YAG lithotripsy of uric acid calculi produces cyanide. We review our experience with holmium:YAG lithotripsy of uric acid calculi to determine if there is any clinical evidence of cyanide toxicity.
Materials And Methods:
A retrospective analysis of all of our cases of holmium:YAG lithotripsy of uric acid calculi was done. Anesthetic and postoperative data were reviewed.
Results:
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). No patient had 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 neurological, cardiac or respiratory complications were noted.
Conclusions:
There were no obvious cyanide related complications from holmium:YAG lithotripsy of uric acid calculi. These data suggest no significant cyanide toxicity from holmium:YAG lithotripsy of uric acid calculi in typical clinical settings. Animal studies are warranted to characterize the risk.