Lasers In Urology Research Articles

The Role of Lasers in Urology

The Role of Lasers in Urology

LASERS in Urology

No abstract available.

The first experience of laser lithotripsy in sialolithiasis

Relevance. The current limits of endoscopic removal of sialolithes are limited to 3-5mm, larger sialolithes require crushing, but an effective and safe technology has not yet been found. The solution to this problem is primarily related to the technologies of shock wave lithotripsy. Currently, various methods of lithotripsy using extracorporeal and intracorporeal sources are described in the literature. The positive experience of urological laser lithotripsy served as the basis for our study of the possibilities of using the thule laser device FiberLase U2 for the fragmentation of sialolithes. Materials and Methods. The study included 16 clinical observations of patients diagnosed with sialolithiasis who underwent sialoendoscopy with additional application of the technique of intra-c urrent crushing of the concretion with a thule laser device FiberLase U2 with subsequent extraction of fragments. Results and Discussion. Sialolithes were fragmented in all 16 clinical cases, regardless of shape and structure. Large fragments were removed using basket traps and endoscopic forceps. In 9 out of 16 observations, the operation ended with the complete removal of the stone and all its visible fragments (until the duct was completely cleaned). In 7 patients, fragments remained in the duct, which could not be removed. During the crushing process, we observed an undesirable effect of retrograde migration of the stone with a pulse impact, as well as the resulting suspension of small fragments and air bubbles complicated the visibility and the operation process. Also, in 3 cases, when the stone was destroyed, the laser beam hit the duct wall, which was accompanied by weak bleeding and for a while hindered endoscopic visibility and required active irrigation. Conclusion. At the first time, the technology of thule laser lithotripsy was used that made possible the destruction of sialolithes and remove stones larger than 5 mm. This approach expands the limits of endoscopic surgery of sialolithiasis. At the same time, there is a number of important problems that require further study and improvement of the method.

Thulium fiber laser in urology: physics made simple.

In this narrative review, we will focus on a novel thulium fiber laser's physical properties in terms of its clinical applicability. TFL has successfully moved forward from the preclinical trials into clinical practice and now is being widely used in clinics around the world. The available data suggest that the device effectively operates in soft tissues - benign prostate hyperplasia (BPH) and bladder tumors, as well as in lithotripsy. Also, the first promising results were obtained from laparoscopic surgery showing its possible applicability in the management of renal cell carcinoma. The constructional changes in fiber laser's design, lead to alteration of laser-tissue interactions, which resulted in clinical advantages of the device. Yet, the exact mechanism often is considered complex for understanding. With this work, we are aiming to build a bridge between biophysics and clinical practice and give a simple explanation of how the devices is working and why the knowledge of it is important for a clinician. The more effective wavelength (closer to the water absorption peak), favorable beam profile, different modes of action allowing to decrease carbonization on one hand and retropulsion on the other, all this makes TFL an evolution in urologic surgery. Further trials investigating on the possible pros and cons of the device are awaited.

Lasers in Urology – what has Survived of our Research Starting 1970

Lasers in Urology – what has Survived of our Research Starting 1970

The evolution of lasers in urology.

A very rapid development of laser technology lead to the fact that many of them have already replaced surgeons with their usual scalpel. Laser technology has taken a place among the methods of treatment of various urological diseases. The features of the physical effect of laser exposure make it possible to characterize laser surgery as safe for the patient and convenient for the doctor. Therefore, along with the improvement of old laser devices, also the development and testing of new ones is constantly carried out. Nowadays the most commonly used lasers in urology are Nd:YAG, Greenlight, diode, Ho:YAG, Tm:YAG lasers and novel thulium fiber laser (TFL). Laser technology is taking place among the recommended methods for the diagnosis and treatment of various urological diseases, such as benign prostatic hyperplasia, urolithiasis, and bladder tumors. The aim of our review was to talk about laser devices that have already taken a place in the arsenal of urologist and about the most interesting developments in the field of laser surgery.

The changing role of lasers in urologic surgery.

To summarize recent publications on the topic of laser in urology and explore new developments which may impact the future role of lasers in surgery. Ho: Yttrium-aluminium garnet (YAG) laser with Moses technology allows less retropulsion during a lithotripsy, yet its efficacy needs to be tested in clinical trials. Data on the efficacy of this device for benign prostatic obstruction treatment is also pending. A new promising generation of laser systems - thulium-fiber (Tm-fiber) lasers - has been introduced. Tm-fiber has already been shown to be effective and well tolerated in endoscopic enucleation of the prostate and has demonstrated favorable outcome compared with Ho:YAG in preclinical lithotripsy studies. However, more studies are needed to better understand the use of this novel technology and elucidate its role within the armamentarium of available technologies. Lasers remain an integral part of benign prostatic hyperplasia surgery and stone treatment and gain popularity in en-bloc resection of bladder cancer. Current efficacy of laser systems in prostate cancer ablation and their place in laparoscopy remain unclear, despite promising initial reports.

Lege artis eye coverage performed during gynecological/urological laser surgery. Results of asurvey of nursing experts

Intraoperative eye protection is generally important during surgery in patients under general anesthesia. There are, however, challenges that arise when alaser is used intraoperatively. In gynecological and urological diseases lasers are increasingly being used for treatment but alege artis eye cover or protection has not yet been investigated in the international literature. According to nursing experts, how is alege artis eye coverage performed during gynecological and urological laser surgery? In order to answer the research question, standardized expert interviews were carried out via telephone, direct face to face interviews and e‑mails with experts from specialized clinics in Austria. The results of a nonsystematic literature search formed the basis for the interview guidelines. In this study 11 experts agreed to participate in aqualitative survey. The result of the interviews recommended the use of skin-friendly plasters in combination with avitaminD eye ointment, special plasters/covers and/or laser safety goggles with avitaminD eye ointment and NaCl dressings. In addition to the direct protection of the eye, aperiodic intraoperative eyelid closure check must be performed. The findings from the expert interviews are to be understood as practice recommendations. Further research is needed in the future.

Role of lasers in urology.

Laser technology has long been a standard treatment for many diseases. In particular, laser treatment is considered the standard of care in various urological diseases. While originally primarily restricted to stone treatment, lasers have since evolved to play an important role even in the treatment of malignant diseases. In this review, we take a closer look at the history of lasers in urology and some implications for treatments today.

激光在泌尿外科中的应用进展

激光的使用贯穿于现代泌尿外科始终，激光设备的使用也愈发普遍。随着科学技术的发展，人们一直在探索激光的更多应用。在众多设备中，钬激光、半导体激光和铥激光是目前使用最多的工具。根据激光的波长、水吸收度、血红蛋白吸收度和穿透深度不同，激光可以用来凝固、汽化和剜除。在许多医疗中心，经过众多药物治疗无效的良性前列腺增生，激光常常被用作它的主要治疗手段。并且和传统开放手术、经尿道电切手术相比，激光具有更好的治疗效果。激光在泌尿系结石、尿道(输尿管)狭窄和膀胱肿瘤中的应用，让伴有基础疾病的高龄患者的手术方案变得更加安全，同时减少抗凝药治疗方案改变的烦恼。激光手术更加微创化，缩短住院时长、减少保留尿管时间，有时甚至可以完全避免尿管的置入。而且，在术后并发症和二次手术率方面，激光也具有明显改善。总之，随着激光设备间竞争的激烈化，设备花费和维修费用的下降，手术安全性能的提高，激光将会成为泌尿外科领域不可或缺的设备。 There has been a long time since the start of lasers in urology, and now it’s becoming more usual. With the development of science, people are exploring a new way. Among these devices available, holmium, diode and thulium lasers are the most popular. Lasers can be used for coagulation, vaporization and enucleation depending on the wavelength, the absorption by water and hemoglobin and the depth of penetration. Lasers play a key role when pharmacological treatment was useless for benign prostatic hyperplasia (BPH) patients in many medical centers. Compared with open or endoscopic operations, lasers have better therapeutic results. Treatment of older patient with multiple comorbidities has been made safe when lasers were used in the treatment of urolithiasis, urinary strictures and bladder tumors, and it can reduce the necessity to modify the anticoagulant drug treatment. Laser procedures are less invasive, shorter hospitalization time and guarantee a shorter bladder catheterization time, even eliminate the need for bladder catheterization completely. At the same time, it enables more stable outcomes and lower reoperation rate. However, with the increased competition between laser manufacturers, decreased purchase and maintenance costs, and increased operational safety, laser technology will become an indispensable tool in modern urology.

Re: Update on Lasers in Urology. Current Assessment on Holmium:yttrium-aluminum-garnet (Ho:YAG) Laser Lithotripter Settings and Laser Fibers

Re: Update on Lasers in Urology. Current Assessment on Holmium:yttrium-aluminum-garnet (Ho:YAG) Laser Lithotripter Settings and Laser Fibers

T. R. W. Herrmann and T. Bach (eds.): Editorial comment on “What is relevant for Lasers in Urology?”

T. R. W. Herrmann and T. Bach (eds.): Editorial comment on “What is relevant for Lasers in Urology?”

809 Intelligent lasers in urology – an experimental lithotripsy laser system with automated spectral real-time target identification

809 Intelligent lasers in urology – an experimental lithotripsy laser system with automated spectral real-time target identification

Adverse Events Resulting from Lasers Used in Urology

To collate world reports of adverse events (AEs) resulting from lasers used in urology. 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: neodymium-doped yttrium aluminum garnet (Nd:YAG), holmium:yttrium aluminum garnet (Ho:YAG), potassium titanyl phosphate (KTP), diode and thulium:YAG (Tm:YAG). Both databases were last accessed on October 1, 2012. Overall, there were 433 AEs; 166 in MAUDE database (1992-2012) and 267 in RLI database (1964-2005). Most of the AEs (198/433 or 46%) resulted from generator failure or fiber tip breaking. Whereas there were 20 (4.6%) AEs harming medical operators, there were 159 (37%) AEs harming nonmedical operators using Nd:YAG, KTP, and diode lasers. Eye injuries ranging from mild corneal abrasions to total vision loss were reported in 164 AEs with the use of Nd:YAG, KTP, and diode lasers. Overall, there were 36 (8.3%) AEs resulting in patient harm, including 7 (1.6%) mortalities, 3 deaths from ureteral perforation using the Ho:YAG laser, and 4 deaths from air emboli using the Nd:YAG laser. Other reported patient injuries included bladder perforation resulting in urinary diversion in a patient, in addition to minor skin burns, internal burns, and bleeding in others. There were no AEs reported with the use of Tm:YAG laser. 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, KTP, and diode lasers.

1974 ADVERSE EVENTS RESULTING FROM LASERS USED IN UROLOGY

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 ...

European Association of Urology Guidelines on Laser Technologies

ContextThe European Association of Urology (EAU) Guidelines Office has set up a guideline working panel to analyse the scientific evidence published in the world literature on lasers in urologic practice. ObjectiveReview the physical background and physiologic and technical aspects of the use of lasers in urology, as well as current clinical results from these new and evolving technologies, together with recommendations for the application of lasers in urology. The primary objective of this structured presentation of the current evidence base in this area is to assist clinicians in making informed choices regarding the use of lasers in their practice. Evidence acquisitionStructured literature searches using an expert consultant were designed for each section of this document. Searches were carried out in the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, and Medline and Embase on the Dialog/DataStar platform. The controlled terminology of the respective databases was used, and both Medical Subject Headings and EMTREE were analysed for relevant entry terms. One Cochrane review was identified. Evidence synthesisDepending on the date of publication, the evidence for different laser treatments is heterogeneous. The available evidence allows treatments to be classified as safe alternatives for the treatment of bladder outlet obstruction in different clinical scenarios, such as refractory urinary retention, anticoagulation, and antiplatelet medication. Laser treatment for bladder cancer should only be used in a clinical trial setting or for patients who are not suitable for conventional treatment due to comorbidities or other complications. For the treatment of urinary stones and retrograde endoureterotomy, lasers provide a standard tool to augment the endourologic procedure. ConclusionsIn benign prostatic obstruction (BPO), laser vaporisation, resection, or enucleation are alternative treatment options. The standard treatment for BPO remains transurethral resection of the prostate for small to moderate size prostates and open prostatectomy for large prostates. Laser energy is an optimal treatment method for disintegrating urinary stones. The use of lasers to treat bladder tumours and in laparoscopy remains investigational.

Guía clínica de la Asociación Europea de Urología sobre tecnologías láser

ContextThe European Association of Urology (EAU) Guidelines Office has set up a guideline working panel to analyse the scientific evidence published in the world literature on lasers in urologic practice. ObjectiveReview the physical background and physiologic and technical aspects of the use of lasers in urology, as well as current clinical results from these new and evolving technologies, together with recommendations for the application of lasers in urology. The primary objective of this structured presentation of the current evidence base in this area is to assist clinicians in making informed choices regarding the use of lasers in their practice. Evidence acquisitionStructured literature searches using an expert consultant were designed for each section of this document. Searches were carried out in the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, and Medline and Embase on the Dialog/DataStar platform. The controlled terminology of the respective databases was used, and both Medical Subject Headings and EMTREE were analysed for relevant entry terms. One Cochrane review was identified. Evidence synthesisDepending on the date of publication, the evidence for different laser treatments is heterogeneous. The available evidence allows treatments to be classified as safe alternatives for the treatment of bladder outlet obstruction in different clinical scenarios, such as refractory urinary retention, anticoagulation, and antiplatelet medication. Laser treatment for bladder cancer should only be used in a clinical trial setting or for patients who are not suitable for conventional treatment due to comorbidities or other complications. For the treatment of urinary stones and retrograde endoureterotomy, lasers provide a standard tool to augment the endourologic procedure. ConclusionsIn benign prostatic obstruction (BPO), laser vaporisation, resection, or enucleation are alternative treatment options. The standard treatment for BPO remains transurethral resection of the prostate for small to moderate size prostates and open prostatectomy for large prostates. Laser energy is an optimal treatment method for disintegrating urinary stones. The use of lasers to treat bladder tumours and in laparoscopy remains investigational.

Laser nun auch in der organerhaltenden Nierenchirurgie?

Kidney surgery is subject to continuous change. Partial nephrectomy is the prevailing method for small and medium-sized tumours and proven to be superior to radical nephrectomy. The conventional technique usually includes clamping the renal vessels. The duration of the ischaemia caused determines the outcome of the remaining renal function. The shorter the ischaemic time the more likely the renal function will be preserved. Thus, new techniques are needed to abandon renal vessel clamping. Essential is a combination of good cutting abilities and assured haemostasis. To date, the commonly used techniques for cutting in partial nephrectomy only partially fulfil these requirements. Establishment of laser in urology offers a new surgical technique that combines both. In spite of the still limited data on laser use in kidney surgery, this method can be assessed favourably. Laser offers a possibility of both open and laparoscopic partial nephrectomy avoiding renal vessel clamping without additional risks or complications.

Learning Curve and Training Simulation in Urological Laser Performances

Learning Curve and Training Simulation in Urological Laser Performances

The evolution of lasers in urology

The world's first laser was developed by Theodore Maiman in 1960. Over the course of the past five decades, this technology has evolved into a highly specialized entity, also finding a niche market in the field of urology. Lasers obtained from various lasing mediums producing amplified light of different wavelengths have been tested for urological applications. Today, these lasers are most commonly used in the surgical management of benign prostatic hyperplasia and as intracorporeal lithotripters. Other uses include ablation of various urologic tumors and incising strictures of the upper- and lower urinary tract. A continuous process of evolution of this technology is taking place, resulting in surgical lasers becoming ever safer, more effective, and more affordable.