You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy and New Technology (I)1 Apr 20131974 ADVERSE EVENTS RESULTING FROM LASERS USED IN UROLOGY Abdulaziz Althunayan, Mohamed Elkoushy, Mostafa Elhilali, and Sero Andonian Abdulaziz AlthunayanAbdulaziz Althunayan Montreal, Canada More articles by this author , Mohamed ElkoushyMohamed Elkoushy Montreal, Canada More articles by this author , Mostafa ElhilaliMostafa Elhilali Montreal, Canada More articles by this author , and Sero AndonianSero Andonian Montreal, Canada More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2393AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Endourologic procedures such as prostate tissue ablation and lithotripsy use different types of lasers with different wavelengths such as Neodymium-Doped Yttrium Aluminum Garnet (Nd:YAG), Holmium: YAG (Ho:YAG) and Potassium Titanyl Phosphate (KTP) lasers with the following wavelengths 1064 nm, 2100 nm, and 532 nm, respectively. Currently, there is no data regarding adverse events (AEs) to patients or operators resulting from the use of these lasers. Therefore, the aim of the present study was to collate world reports of such AEs. METHODS The Manufacturer and User Facility Device Experience (MAUDE) database of the United States Food and Drug Administration (FDA) was searched using the term “Laser for gastro-urology use”. In addition, the Rockwell Laser Industries (RLI) Laser Accident Database was searched for the following types of lasers: Nd:YAG, Ho:YAG, and KTP. RESULTS Both databases were last accessed on October 1, 2012. Overall, there were 394 AEs (160 in FDA MAUDE database from 1992 to 2012 and 234 in RLI database from 1970 to 2005). Most of the AEs were related to generator failure or fiber tip breaking, especially with smaller laser fibers. While there were 20 AEs harming medical operators, 126 AEs resulted in harm for non-medical operators using Nd:YAG and KTP. Interestingly, all 131 AEs resulting in eye injuries were associated with the use of Nd:YAG and KTP lasers as a result of improper eye protection; none were reported with Ho:YAG. Most of the reported eye injuries resulted from non-medical laser uses. These eye injuries were serious ranging from mild corneal abrasions to total vision loss. Overall, there were 36 (9%) AEs resulting in patient harm including 7 (1.7%) mortalities; 3 deaths from ureteral perforation and retroperitoneal bleeding using the Ho:YAG laser (Between 2003 - 2005) and 4 deaths from air embolisms using the Nd:YAG laser (between 1987 - 1990). Two other patients with air embolisms from Nd:YAG laser survived. Other reported patient injuries included bladder or ureteral perforation resulting in urinary diversion in a patient, minor skin burns, internal burns, and bleeding. CONCLUSIONS Most of the AEs reported relate to equipment failure. There were no eye injuries reported with the use of Ho:YAG lasers. Caution must be exercised when using lasers in urology including wearing appropriate eye protection when using Nd:YAG and KTP lasers. AEs reported in FDA MAUDE (1992-2012) and RLI (1970-2005) databases Laser type Ho: YAG Ho: YAG Nd: YAG Nd: YAG KTP KTP Database FDA RLI FDA RLI FDA RLI No. of AEs 87 53 48 161 25 20 Generator or Fiber Failure 72 (83%) 48 (90%) 26 (54%) 30 (19%) 16 (64%) 0 Harm to operator (medical) 9 (10%) 2 (3.7%) 0 4 (2.5%) 5 (20%) 0 Harm to operator (non-medical) 0 0 0 109 (68%) 0 17 (85%) Eye injury 0 0 0 113 (70%) 1 (4.0%) 17 (85%) Harm to patient 6 (6.8%) 3 (5.6%) 2 (4.2%) 18 (11%) 4 (16%) 3 (15%) Death 3 (3.4%) 0 0 4 (2.5%) 0 0 © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e810 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Abdulaziz Althunayan Montreal, Canada More articles by this author Mohamed Elkoushy Montreal, Canada More articles by this author Mostafa Elhilali Montreal, Canada More articles by this author Sero Andonian Montreal, Canada More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...
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