Department of Urology, Konya City Hospital, Akabe Street, Konya, 42020, Turkey.
Department of Urology, Necmettin Erbakan University Medical Faculty, Konya, Turkey.
Urolithiasis. 2024 Sep 6;52(1):125. doi: 10.1007/s00240-024-01625-9.
Laser lithotripsy mechanisms can cause the chemical decomposition of stone components and the emergence of different end products. However, the potentially toxic end products formed during thulium fiber laser (TFL) lithotripsy of cystine stones have not been sufficiently investigated. The aim of our in vitro study is to analyze the chemical content of the gas products formed during the fragmentation of cystine stone with TFL. Human renal calculi consisting of 100% pure cystine, calcium oxalate monohydrate, or uric acid were fragmented separately with TFL in experimental setups and observed for gas release. After the lithotripsy, only the cystine stones showed gas formation. Gas chromatography-mass spectrometry was used to analyze the gas qualitatively, and scanning electron microscopy with energy-dispersive X-ray spectroscopy (SEM-EDX) and X-ray diffraction was used to examine the dried cystine stone fragments. Fragmentation of the cystine stones released free cystine, sulfur, hydrogen sulfide, and carbon disulfide gas. The SEM-EDX and X-ray diffraction analyses revealed that the free cystine in the dried fragments contained 43.1% oxygen, 28.7% sulfur, 16.1% nitrogen, and 12.1% carbon atoms according to atomic weight. The detection of potentially toxic gases after lithotripsy of cystine stones with TFL indicates a risk of in vivo production. Awareness needs to be increased among healthcare professionals to prevent potential inhalation and systemic toxicity for patients and operating room personnel during TFL lithotripsy of cystine stones.
激光碎石机制可导致结石成分的化学分解，并产生不同的终产物。然而，钬光纤激光（TFL）碎石过程中胱氨酸结石形成的潜在有毒终产物尚未得到充分研究。我们的体外研究旨在分析 TFL 碎石过程中胱氨酸结石碎裂时形成的气体产物的化学含量。将由纯胱氨酸、一水草酸钙或尿酸组成的人肾结石分别用 TFL 在实验装置中进行碎石，并观察气体释放情况。碎石后，只有胱氨酸结石才会产生气体。使用气相色谱-质谱联用（GC-MS）对气体进行定性分析，并用扫描电子显微镜-能量色散 X 射线光谱（SEM-EDX）和 X 射线衍射分析干燥的胱氨酸结石碎片。胱氨酸结石的碎裂释放出游离胱氨酸、硫、硫化氢和二硫化碳气体。SEM-EDX 和 X 射线衍射分析表明，干燥碎片中的游离胱氨酸按原子量含有 43.1%的氧、28.7%的硫、16.1%的氮和 12.1%的碳原子。TFL 碎石后胱氨酸结石检测到潜在有毒气体表明存在体内产生的风险。需要提高医护人员的认识，以防止在 TFL 碎石治疗胱氨酸结石时患者和手术室人员潜在的吸入和全身毒性。
