Categories: Urology

Lasers in Urology

It is hard to imagine that a narrow, one-way, moving, coherent, amplified beam of light fired by excited atoms is powerful enough to slice through steel. In 1917, Albert Einstein speculated that under certain conditions atoms could absorb light and be stimulated to shed their borrowed energy. Charles Townes coined the term laser (light amplification by stimulated emission of radiation) in 1951.

In the early days of lasers, it came as a surprise that these tools of light could be used for medicine since no one envisioned that they might be able to heal or otherwise improve people’s physical well-being. But doctors and medical researchers quickly began to see the possibilities, and the number of uses for medical lasers multiplied over the years.

Being faster and less invasive with high precision, lasers have penetrated most medical disciplines during the last half-century including dermatology, ophthalmology, dentistry, otolaryngology, gastroenterology, urology, gynecology, cardiology, neurosurgery, and orthopedics.

As a surgical tool, the laser is capable of three basic functions. When focused on a point it can cauterize deeply as it cuts, reducing the surgical trauma caused by a knife. It can vaporize the surface of a tissue. Or, through optical fibres, it can permit a doctor to see inside the body.

The laser light beam does not pose health risks to the patient or the medical team. Because the laser beam is so small and precise that it allows the healthcare providers to safely treat the tissue without injuring the surrounding area.

The Lasers used in the field of Urology are Holmium, Thullium, and KTP Lasers.

The Holmium laser has now been in clinical use in urology for several years. The indications for its use continue to expand, and now include lithotripsy (breaking the stone) and urothelial tumor ablation anywhere in the urinary tract, resection of the prostate, and incision of various urinary tract strictures. The 2100-nm wavelength provides the Holmium laser with a unique combination of vaporization and coagulation, allowing a precise cutting action when higher energy levels are applied. A shallow depth of penetration (< 0.5 mm) in water and tissue allows precise energy application and provides a margin of safety.

Fiber technology has also developed to allow an efficient and safe transfer of a continuously increasing energy output.

Holmium Laser Enucleation of Prostate (HoLEP) and Stone management is the main field of application today for the Ho: YAG laser. Using the pulsed energy release, the laser can be used like a chisel to enucleate enlarged prostatic tissue at the layer of the surgical pseudocapsule.

The benefits of Stone Management with Lasers are that it can treat all stone compositions, enables Stone-Dusting to minimize stone movement, reusable fibers, homeostasis, and >95% success with a single treatment. The effectiveness and safety of laser stone treatment have been proven in multiple studies regarding symptomatic stones in every location, failure of previous stone treatments, treatment of pregnant women, overweight/obese patients, and children of all ages.

Prostate laser surgery helps reduce urinary symptoms caused by enlarged prostate like frequent, urgent need to urinate, difficulty starting urination, slow (prolonged) urination, increased frequency of urination at night, stopping and starting again while urinating, the feeling of not able to completely empty the bladder.

Laser surgery offers several advantages over other methods of treating an Enlarged Prostate, such as transurethral resection of the prostate (TURP) and open prostatectomy. The advantages include a lower risk of bleeding. Laser surgery can be a good option for men who take medication to thin their blood or who have a bleeding disorder that does not allow their blood to clot normally.

There is a shorter hospital stay. Laser surgery can be done on an outpatient basis or with a shorter hospital stay. There is a quicker recovery. Recovery from laser surgery usually takes less time than recovery from TURP or open surgery.

Less long need for a urinary catheter.

The year 2020 marks the 60th anniversary of the laser. This technology has changed and evolved tremendously over the course of six decades, but there is still ample room for improvement. During the next 50 years we can expect for even more applications of this versatile technology to be imagined, tested, and eventually accepted.

Dr. Varun Sharma, Consultant Kidney Transplant – Adult & Urology, MMI Narayana Superspeciality Hospital, Raipur

Narayana Health

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