title: Holmium: YAG lithotripsy: photothermal mechanism.
abstract: OBJECTIVE
  A series of experiments were conducted to test the hypothesis that the mechanism of holmium:YAG lithotripsy is photothermal.
  
  
  RESULTS
  To show that holmium:YAG lithotripsy requires direct absorption of optical energy, stone loss was compared for 150 J Ho:YAG lithotripsy of calcium oxalate monohydrate (COM) stones for hydrated stones irradiated in water (17+/-3 mg) and hydrated stones irradiated in air (25+/-9 mg) v dehydrated stones irradiated in air (40+/-12 mg) (P < 0.001). To show that Ho:YAG lithotripsy occurs prior to vapor bubble collapse, the dynamics of lithotripsy in water and vapor bubble formation were documented with video flash photography. Holmium:YAG lithotripsy began at 60 microsec, prior to vapor bubble collapse. To show that Ho:YAG lithotripsy is fundamentally related to stone temperature, cystine, and COM mass loss was compared for stones initially at room temperature (approximately 23 degrees C) v frozen stones ablated within 2 minutes after removal from the freezer. Cystine and COM mass losses were greater for stones starting at room temperature than cold (P < or = 0.05). To show that Ho:YAG lithotripsy involves a thermochemical reaction, composition analysis was done before and after lithotripsy. Postlithotripsy, COM yielded calcium carbonate; cystine yielded cysteine and free sulfur; calcium hydrogen phosphate dihydrate yielded calcium pyrophosphate; magnesium ammonium phosphate yielded ammonium carbonate and magnesium carbonate; and uric acid yielded cyanide. To show that Ho:YAG lithotripsy does not create significant shockwaves, pressure transients were measured during lithotripsy using needle hydrophones. Peak pressures were <2 bars.
  
  
  CONCLUSIONS
  The primary mechanism of Ho:YAG lithotripsy is photothermal. There are no significant photoacoustic effects.
authors.affiliation: Division of Urology, The University of Texas Health Science Center, San Antonio, USA.
authors.forename: G J
authors.initials: GJ
authors.lastname: Vassar
authors.forename: K F
authors.initials: KF
authors.lastname: Chan
authors.forename: J M
authors.initials: JM
authors.lastname: Teichman
authors.forename: R D
authors.initials: RD
authors.lastname: Glickman
authors.forename: S T
authors.initials: ST
authors.lastname: Weintraub
authors.forename: T J
authors.initials: TJ
authors.lastname: Pfefer
authors.forename: A J
authors.initials: AJ
authors.lastname: Welch
mesh_terms: D000704:Analysis of Variance; D002137:Calculi / Q000628:therapy*; D006695:Holmium; D006358:Hot Temperature; D006801:Humans; D017602:Lithotripsy, Laser / Q000379:methods*; D010777:Photochemistry; D011312:Pressure; D014741:Video Recording; D015019:Yttrium
chemical_list: D015019:Yttrium; D006695:Holmium