2012, Number 2
Holmium laser use and application in endourology
Campos-Salcedo JG, Hernández-Martínez G, Terrazas-Ríos JL, Sedano-Lozano A, Castro-Marín M, López-Silvestre JC, Zapata-Villalba MA, Mendoza-Álvarez LA, Estrada-Carrasco CE, Paredes-Calva C, Rosas-Hernández H
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Language: Spanish
References: 12
Page: 72-78
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ABSTRACT
Introduction: Laser is a highly useful technologic advance that transforms large quantities of energy into electromagnetic radiation that is then emitted as a light beam, which produces a photothermal effect whose wide wavelength (2120 nm) enables diverse procedures to be carried out, such as tissue ablation and cutting, lithotripsy, and tissue vaporization.Objective: To present different minimally invasive treatments with Holmium laser (VersaPulse® LUMENIS 100W model) in various urologic diseases.
Material and methods: Diverse applications of Holmium laser in endourology are presented, such as endopyelotomy for treating ureteropelvic junction stricture, internal urethrotomy, bladder neck restructuring for postoperative sclerosis, cystolithotripsy, bladder tumor ablation, and enucleation of the prostate (HoLEP), all employing 100 Watt Holmium laser.
Results: Treatment effectiveness was verified according to studies of choice for each pathology. In the patient that underwent endopyelotomy, renal scintigram was carried out and showed kidney function improvement; retrograde urethrography and International Prostate Symptom Score were carried out in the patient that had urethral stricture managed with internal urethrotomy and in the patient with bladder neck fibrosis; plain abdominal x-rays were taken in the cystolithotripsy patient; and preoperative and postoperative uroflowmetry was used in the patient that underwent enucleation of the prostate (HoLEP). All studies showed both anatomic and functional improvement.
Discussion: Laser technology is a relatively new tool in the field of urology that has had a generalized application for nearly twenty years. Its advantages are the transmission of large quantities of energy through flexible fibers, a high degree of safety and effectiveness, and a low risk for damaging adjacent structures. Laser is used in multiple endourologic procedures that include lithotripsy, ablation, and prostate enucleation, enabling tumor resection in all of the urothelium, as well as the removal of large volumes of prostatic tissue through its enucleation.
Conclusions: Holmium laser has an excellent safety profile and flexibility and it is cost-effective, given that the same fiber can be used in various procedures. It can be employed in the entire urinary tract, and its generalized application over the last ten years has been in managing obstructive prostate pathology and stone disease, in which it has become the criterion standard. Endourology is a fundamental area of general urology, and the skillful use of laser technology is one of the greatest challenges in the professional training of the urologist.
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