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Observation and comparison of gas formation during holmium:YAG laser lithotripsy of cystine, uric acid, and calcium oxalate stones: a chromatographic and electron microscopic analysis

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Abstract

The primary aim of the present in vitro study is to analyze the chemical content of the bubbles occurring during the fragmentation of cystine stones with both the high-power and low-power holmium:YAG (Ho:YAG) lasers. The secondary aim is to discuss their clinical importance. Three types of human renal calculi calcium oxalate monohydrate (COM), cystine, and uric acid were fragmented with both low-power and high-power Ho:YAG lasers in separate experimental setups at room temperature, during which time it was observed whether gas was produced. After laser lithotripsy, a cloudy white gas was obtained, after the fragmentation of cystine stones only. A qualitative gas content analysis was performed with a gas chromatography–mass spectrometry (GC–MS) device. The fragments in the aqueous cystine calculi setup were dried and taken to the laboratory to be examined by scanning electron microscopy with energy dispersive X-ray spectroscopy (SEM–EDX) and X-ray diffraction analysis. No gas production was observed after fragmentation in the COM and uric acid stones. Free cystine, sulfur, thiophene, and hydrogen sulfide gas were produced by both low-power and high-power Ho:YAG laser lithotripsy of the cystine stones. In the SEM–EDX mapping analysis, a free cystine molecule containing 42.8% sulfur (S), 21% oxygen (O), 14.9% carbon (C), and 21% nitrogen (N) atoms was detected in the cystine stone experimental setup. The evidence obtained, which shows that hydrogen sulfide emerges in the gaseous environment during Ho:YAG laser fragmentation of cystine stones, indicates that caution is required to prevent the risk of in vivo production and toxicity.

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Acknowledgements

The authors thank Selçuk University Advanced Technology Research and Application Center for helping with experimental organization for the study.

Funding

No funding was received for conducting this study.

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Authors and Affiliations

  1. Department of Urology, Konya City Hospital, Akabe Street, 42020, Konya, Turkey

    Muzaffer Tansel Kılınç & Mehmet Serkan Özkent

  2. Department of Urology, School of Meram Medicine, Necmettin Erbakan University Medical Faculty, Konya, Turkey

    Yunus Emre Göger

Authors
  1. Muzaffer Tansel Kılınç
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  2. Mehmet Serkan Özkent
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Contributions

Writing—original draft (lead); conceptualization, formal analysis, visualization, resources: MTK; Resources, data curation, methodology: MSÖ; Supervision (lead); Conceptualization, formal analysis, visualization, resources, review and editing: YEG.

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Correspondence to Muzaffer Tansel Kılınç.

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Kılınç, M.T., Özkent, M.S. & Göger, Y.E. Observation and comparison of gas formation during holmium:YAG laser lithotripsy of cystine, uric acid, and calcium oxalate stones: a chromatographic and electron microscopic analysis. Urolithiasis 52, 23 (2024). https://doi.org/10.1007/s00240-023-01517-4

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