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The commission of this article plunged me into doubt. First I should confess that I don’t find excuse to escape this part if somebody wants to minimally deepen in the knowledge of the biological effects of this energy source. Secondly, when we talk about results, we use terms made and defined by Physics. Often we have polemics about results, and what really happens is that we don’t reach agreements because we refer to different terms to explain the same observation; in conclusion we cannot understand each other because we do not know the adequate terms; for example, hypoxemia as oxygen deficit, which is true in an anemic patient as well as in a low oxygen saturation rate. In consequence, a good review of these concepts seems necessary to me. The third reason is the confusion that exists in our environment, I think sometimes of interest, about properties and effects of different types of laser. Only a minimal knowledge of physics will help us to state the scientific basis for understanding. The problems, nevertheless, accumulate due to the fact that the universe to which this article is directed is formed by urologists. What Physics education should we suppose they have? Superficial? Medium? Is it a collective with a uniform knowledge, being it whatever it is? The implication is clear. The article depth will depend on the answers to these questions. Nevertheless, the aim of the authors is to give a base enough to know what the laser is and how it acts. For that, the answer I gave to my questions is that the reader should understand the article and have enough base for, at least, reading critically the articles about laser published in urological journals.
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A laser, light amplification by stimulated emission of radiation, is a device able to transform other energies into electromagnetic radiation with emission of light beams of different wavelengths. They amplify the light and produce coherent light beams, the frequency of which varies from infrared to X ray. Stimulated emission, the process laser is based on, was described by A. Einstein in 1917, but it was not until the decade of the ‘60s when the first laser process was observed in a ruby crystal. Depending on the environment they use, lasers may be named as solid-state, gas, semiconductors or liquid.The possibility of uses for laser is almost unlimited, becoming a very valuable tool in biomedical sciences thanks to the various effects they produce when interacting with tissues (photovaporization, photodisruption, photocoagulation or photostimulation). For this reason, today, the use of lasers in the field of urology offers a wide range of possibilities, going from surgery for the treatment of obstruction, such as the fragmentation of a urinary stone or resection/ablation of prostatic tissue, to reconstructive surgery, such as tissue welding in vasovasostomy or urethral stenosis repair
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Though the primary role of lasers in urology hasalways been in the treatment of urolithiasis, there are severalother indications for their use. There are many different typesof lasers currently available, each with unique properties con-ducive to treating certain disorders. As such, it is critical thattoday’s urologist understands each laser’s characteristics inorder to optimize patient selection and treatment. The laserswhich are primarily used in urologic applications include thecarbon dioxide (CO 2 ) laser; the Neodymium:Yttrium-Aluminum-Garnet (Nd:YAG); the Potassium Titanyl Phosphate (KTP) laserand the Holmium:YAG (Ho:YAG) laser. This review focuses onthe unique characteristics of each of these lasers as well as theinstrumentation needed utilize and deploy these tools in theurinary tract
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INTRODUCTION: Optical urethrotomy was introduced by Sachse (1) in 1973 and it has a registered long-term recurrence rate of 75-80%. This stimulated the search for new therapies with less recurrences. Several types of láser were tried: Nd:YAG, KTP, Argon, Ho:YAG, diode,... Since the end of the ‘70s various types of láser are being used for the treatment of ureteral stenosis.OBJECTIVES: To describe the usefulness of the láser energy in the treatment of ureteral stenosis, mainly recurrent stenosis and to analyze the current experience with various types of láser (diode, nd:yag, holmium, argon,...)METHODS: We performed the systematic review of the bibliography, based on a medline search, and a detailed analysis of the selected articles.CONCLUSIONS: 1) the use of láser in the treatment of urethral stenosis is on the a valid, effective, and safe alternative option to optical urethrotomy, at least in the mid term; nevertheless, it has not demonstrated to date being better than that. 2)The election of treatment is surgeon dependent and, and no single technique has demonstrated to be clearly better than the others. 3) Prospective long-term studies with larger numbers of patients and longer follow-up are necessary . 4) láser technology is extensive and it is not available in all centers.
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OBJECTIVES: The use of laser for endoscopic lithotripsy started in 1968 when Mulvaney tried a ruby laser without success; Later on, the CO2 laser and the Nd: YAG were tried. With the pulsed dye and alexandrite lasers energetic performances between 30 and 200 mJ are obtained, their capacity of fragmentation is not universal and is limited to small stones, generally ureteral stones, so that it has not been a therapeutic alternative for bladder lithiasis. The holmium laser generates energy pulses of 400-2500mJ, it is able to fragment every type of stone. The objective of this work is to analyze the results of endoscopic bladder lithotripsy with holmium-YAG laser.METHODS: In the period between 2006-2008 we treated 21 cases of bladder lithiasis, with a stone size between 1 and 4 cm in patients from 8-76 years, six women and 15 men, which correspond to: four cases of infantile lithiasis, 3 of uric acid, one case of cystine, seven cases of calcium oxalate and/or phosphate, five cases of bladder lithiasis growing around a double J catheter, and one case of lithiasis within an intravesical ureterocele. Treatment was performed with a 20W Dornier Medilas holmium-YAG equipment, applied using children/adult cystoscopes or 7-8.5 Ch ureteroscopes, both semirigid and flexible. Post operative control included KUB x-ray and ultrasound. We performed a study of lithogenic risk factors and stone fragments analysis.RESULTS: The 21 cases described are all secondary or type II bladder lithiasis. In all cases the absence of residual lithiasis was checked with imaging studies and the lithogenic risk factors were corrected with medical or surgical procedures.CONCLUSIONS: We consider that today bladder endoscopic lithotripsy with holmium laser is a therapeutic alternative. Despite there are multiple options for endoscopic treatment, transurethral lithotripsy with holmium laser offers good results with a low complication rate.
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Bladder cancer is one of the most frequents pathologies in urology. The introduction of the laser among the technical tools supposed a great advance, but the initial results with the first model failed with the expectations. Nevertheless, nowadays we have at our disposal a great variety of laser for urological use, with different functions and applications. We perform a review and try to assess the actual indications for its employment in the treatment of bladder cancer, as well as future applications.
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OBJECTIVES: The objective of this review is to provide an evidence-based update on laser surgery for BPH with a focus on comparing Greenlight Photoselective Vaporisation of the Prostate (PVP) to Holmium Laser Enucleation of the Prostate (HoLEP). METHODS: We reviewed all HoLEP and PVP papers identi-fied by a Pubmed search using the keywords: laser, prostate, BPH, holmium, HoLEP, PVP and greenlight. The published randomised trials investigating HoLEP and PVP are summarised. As there are no head to head randomised trials comparing HoLEP to PVP, we compare data from individual HoLEP and PVP papers. Data on multiple aspects of laser surgery for BPH are summarised and contrasted for the 2 procedures including: Perioperative management, subjective and objective measures of success, complications, sexual function, prostate volume reduction, durability, and surgery for men with large prostates and those in urinary retention.RESULTS/CONCLUSIONS: PVP and HoLEP are very different laser techniques. An important difference between the Greenlight laser and holmium and thulium is that its only urological application is prostate ablation. HoLEP is the most advanced laser technique currently available. In contrast to PVP, it has been rigorously evaluated in 8 randomised trials. It is a size independent procedure suitable for any prostate, and highly effective at treating urinary retention. HoLEP has been reported to be durable to periods up to 6 years. More tissue is removed with HoLEP than PVP, and this raises concerns regarding the long term durability of PVP for which there is no comparable data. The increase in HoLEP expertise world-wide and the development of lasers that are faster at ablating tissue and have other urological uses (eg thulium) may threaten the longevity of Greenlight PVP
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OBJECTIVES: Benign prostatic hyperplasia (BPH) affects a growing percentage of males over the age of 40 years, increasing with age. Currently, we have a new therapeutic tool available: the holmium laser.METHODS: We retrospectively collected data of 300 patients undergoing holmium laser enucleation of the prostate ( HoLEP) in our center.RESULTS: The results are: mean hospital stay 1,8 days (range 1-15 days, median 1,8); mean bladder catheter time 30.6 hours (range 12-312, median 30.3), total operative room time 75 minutes (range 38-150, median 71), maximal flow rate at six months 24.7 ml/sec. and 23.9 ml/sec. at 12 months. Surgical performance, number of grams resected per minute, is 0.48 for the whole group. We observed a variation in data from the first 20 cases, with worse results in this group.CONCLUSIONS: In our opinion holmium laser enucleation is an adequate method that the guarantees optimal results, comparable to those obtained with classic endoscopic and open surgical techniques, with a low rate of complications, which benefits the patient by diminishing the need for transfusions, catheterization time, and hospital stay; conversely, it has a learning curve of around 20 procedures, which may be associated with complications that may discourage the surgeon and stop the project of technique implementation in a center, having easy, accessible, established alternative procedures.
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OBJECTIVES: To analyze safety and efficacy of KTP green laser photovaporization for the treatment of lower urinary tract obstruction caused by benign prostatic hyperplasia based on data from the medical literature.RESULTS: Most articles consulted emphasize its low complication rate, efficacy, and short learning curve. They have the limitation that most papers are not comparative, the number of patients included is low, and follow-up in many of them short.CONCLUSIONS: Prostatic vaporization with KTP laser is today an alternative to TUR, more in patients with comorbidities, due to its low complication rate. Nevertheless, we accept it is an expensive technology and more follow-up is required to confirm the results remain.
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It is more and more common to have patients in our clinics with the diagnosis of BPH and indication for surgery who present limitations due to their medications, age, associated morbidity or psychosocial conditions. Transurethral resection of the prostate, though it is the surgical standard of reference, is not free from complications such as reabsorption syndrome, bleeding, or even blood transfusion in a percentage of cases. Laser PVP may be a valid alternative in this subgroup of patients.We review our experience with this procedure, as well as the published articles on this topic, and describe technical recommendations we consider useful to avoid complications when possible during surgery or the immediate postoperative period.
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OBJECTIVES: The treatment of benign prostatic hyperplasia (BPH) with the Revolix® laser is effective. Its versatility enables 2 types of techniques: vaporresection and vaporization. Its chromophore target is water, like the holmium laser, with the difference that it may be used in both a continuous and pulsed mode. The continuous wave enables a precise cut and excellent hemostasis without diffusion to the neighbor tissues (0.2 mm penetration below the cut zone) with an excellent vision of the operative field. We report our experience after three years of treatment.METHODS: Revolix® (thulium) laser has a wavelength of 2013nm. 2 types of fibers, which reach a potency of up to 70 watts, are used to treat BPH. One frontal fiber for vaporresection and one fiber with side laser emission for vaporization. Both fibers may be combined to treat prostatic hypertrophy. Since the end of 2004 to March 2008 200 patients with BPH were treated. Prostate sizes varied from 20 to 120 g (mean 45 g). 99 patients underwent prostate vaporization, with sizes below 35 g, and 101 patients underwent vaporresection, with prostates over 35 g. Mean hospital time was 24 hours (range 1-4 hours). Mean catheterization time after laser treatment was 16 hours (range 12-72 hours). The efficacy of the treatment was evaluated with uroflowmetry, post void residual and evaluation of the symptoms with the IPSS questionnaire.RESULTS: The clinical results obtained after Revolix® laser are comparable to those obtained after transurethral resection of the prostate, KTP laser vaporization or holmium laser enucleation. We demonstrate an important improvement of symptoms, with a decrease over 50% in the IPSS score, a significant improvement in the uroflowmetry, and a marked decrease of post void residual. No blood transfusions were required. There were only 4 patients that presented post operative acute urinary retention, requiring catheterization for a few days; all of them achieved spontaneous voiding posteriorly. No patient presented urinary incontinence after treatment with the Revolix® laser.CONCLUSIONS: In our experience, the Revolix® laser has demonstrated being safe, easy to install, with low operative cost, and a very short learning curve.Its efficacy may be better demonstrated using vapor resection for big prostates and vaporization for smaller prostates (the smaller than 35 g). The reduction of prostatic tissue is intermediate with a slight post operative discomfort and a low complication rate.
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OBJECTIVES: The incidence of ureteral stenosis is frequent in our environment. Lately, due to the massive use of endourological techniques its incidence has increased.Etiology represents a decisive factor for the final result of treatment, but there are also common characteristics to all stenosis that influence very importantly the final success: time of evolution, length of the stenosis, side and function of the affected renal unit.Over the last years, the use of endourological techniques for the treatment of upper urinary tract stenosis, that substitute the traditional open technique, have increased. Holmium:YAG laser endoureterotomy presents advantages in comparison with other endourological techniques, because it enables a precise incision with direct vision of the ureteral stenosis. Moreover, with laser fibers ureteroscopes achieve a degree of flexibility/deflection that enables us to reach in most cases the stenotic area.At the time of incision of the ureteral wall, it should be complete, acting on all ureteral layers down to the periureteral fat, always having in mind the anatomic relationships of the ureter with neighbour structures, mainly vascular, to avoid injuries.Its effectiveness and easy management permits a high success rate, with resolution of the stenosis and a very low complication rate. After all the anterior, holmium laser retrograde endoureterotomy should be included as a first line treatment for benign ureteral stenosis.
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OBJECTIVES: Ureteral-intestinal anastomosis represent an important problem in patients undergoing radical cystectomy with urinary diversion using intestinal segments, either small or large intestine. With the incorporation of laser technology in urology, new therapeutic possibilities have been opened for the section of these ureteral intestinal stenosis. Various types of laser had been employed to perform the incision, Nd:YAG, KTP:YAG, Ho:YAG, Er:YAG, and Th:YAG. The experience is limited in terms of use and results don’t give clear therapeutic orientation. The section of ureteral-intestinal stenosis with laser has advantages and disadvantages, but the application of this energy source with various techniques of endoscopic section, such as the Lovaco`s technique of endoluminal invagination and endoureterotomy gives satisfactory results in the short-midterm.
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Ureteropyelic junction obstruction (UPJO) is the most frequent congenital anomaly of the upper urinary tract. Until some years ago, the treatment of first choice was open pyeloplasty, but the development of endoscopic surgery and the clinical improvement on instruments, enables the treatment in a minimally invasive fashion, offering the advantages of shorter operative time, less morbidity, reduction of post operative analgesic requirements, shorter hospital stay, and shorter convalescence period. Retrograde endopyelotomy represents the natural evolution of the minimally invasive surgical treatment of the UPJO by eliminating the need of a percutaneous renal tract and its possible complications. It may be performed in three ways: semirigid ureteroscope and electrocautery, cold knife or laser incision; flexible ureteroscope and electrocautery or laser incision; and under x-ray control with the Acucise™ cutting balloon catheter. Currently, the development of smaller ureterorenoscopes (semirigid and flexible) and the use of safer and more effective energy sources, such as holmium:YAG laser, have improved the results of this technique. We present the technique step-by-step and a bibliographic review.
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Upper urinary tract urothelial tumors reflect a small but growing number of urologic malignancies. The application of progressive endoscopic therapies including ureteroscopic and percutaneous nephroscopic resection and topical chemotherapy have found success, defined as the preservation of the renal unit without malignant progression, in those with low grade lesions. Careful and meticulous diagnostic endoscopy with tissue sampling and cytologic evaluation is key to directing treatment and counseling patients with regard to the risk of recurrence and progression. It is the population with a low grade lesion and negative cytology that are most commonly selected for endsoscopic resection. Those with high grade lesions who opt for endoscopic resection are counseled that this therapy is palliative and can often control local symptoms but is infrequently curative. Surveillance endoscopy post endoscopic resection and topical chemotherapy is essential. With growing surgical experience and improved instrumentation, the complications associated with these and other endoscopic procedures is acceptably low
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Transitional cell carcinoma of the upper urinary tract (UUT-TCC) is relatively uncommon, accounting for 2–5% of all urothelial tumors. Its incidence appears to be increasing as a result of progress in imaging, endoscopy, and improved survival from bladder cancer. Renal pelvis tumors represent 10% of all renal cancers. Pyelic neoplasms occur at a rate twice to four times the incidence of tumors in the ureter, where the common site is the distal tract (about 70%). One third of UUT-TCC are multifocal, and about 1% are simultaneous and bilateral.The two alternative endoscopic approaches for lesions localized in the renal collecting system are the ureteroscopic retrograde one and the percutaneous anterograde one. The treatment choice is addressed by some criteria: lesion size, location, and multifocality. Small accessible lesions <l cm are preferably treated ureteroscopically, maintainig the integrity of the urinary tract.The introduction of lasers represented a big step in the diagnosis and endoscopic treatment of upper urinary tract tumors. A successful laser treatment is defined by the careful selection of the patients affected by urinary tract lesions. Usually, only patients affected by low grade and papillary lesion should be treated endoscopically with laser. Patients with high gradeand invasive lesions should rather be submitted to surgicalprocedure. Actually, the urologist has a wide choice in laser technology (Holmium laser, Thulium laser). For a correct and safe treatment of ureteral and pyelic lesions with lasers it is mandatory to respect some technical advises. First of all, anadequate access for a good vision of ureter and renal pelvis is imperative. In fact, the urologist should always work in safety, with an optimal control of the instrumentation. Then, it is importantto define the laser type and its energy level. The development in laser technology (i.e. small and flexible laser fibers) allowsalso a radical, safe and minimally invasive treatment ofurothelial lesions using flexible ureteroscopes. Of course it is mandatory to evaluate the grade and stage of the tumors by means of the ureteroscopic biopsies: invasive tumors must be treated by immediate nephroureterectomy while the endoscopictreatment should be reserved to those patients with a solitary kidney, renal failure, bilateral tumors, severe comorbities or affected by a solitary tumors with <15 mm in diameter and of low-grade/stage.
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OBJECTIVES: To evaluate the contribution of laser, mainly holmium laser, to the endourological treatment of ureteral lithiasis.METHODS: We analyze our experience in 154 endourological treatments of ureteral lithiasis with holmium laser performed in our Unit from June 2005 to December 2007.RESULTS: Stone fragmentation was achieved in 100% of the cases. The use of long jaw forceps associated with the holmium laser enabled us to reach a stone free rate of 91%.CONCLUSIONS: The treatment of ureteral lithiasis has benefit from the development of endoscopic procedures, being the holmium laser the energy source of choice nowadays. The fragmentation rate was 100%. Complications were rare and never important.
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OBJECTIVES: The non negligible number of residual stones after extracorporeal lithotripsy is leading to a revision of the indications of percutaneous nephrolithotomy (PCNL). The laser, managed with flexible nephroscopes, plays an important role in this field. Pulsed Nd: YAG, dye and alexandrite lasers have given way to the holmium:yag laser in the endourological treatment of urinary lithiasis.METHODS: More than one lithotripter are often required for percutaneous nephrolithotomy of great volume stones, and ballistic and electrokinetic lithotripters are generally preferred due to their high performance. The best indications for Holmium laser is the treatment of caliceal stones far from the pelvis, only accessible through flexible nephroscopes. Midi and minipercs, renal lithiasis in children and some earthy calculi, of low consistency, are also good indications for it.Depending on the anatomical characteristics of the kidney and localization, number, size and hardness of the stone 200,365, or 500 nanometer fibers may be employed. Due to the fact that the laser drills a hole in the stone like if it is a thermal barrier, it may break in different ways: applying the quartz fiber in between the layers, drilling all the interior before breaking the surface, or drilling multiple points to weaken it and creating broad fracture lines. To accelerate the breaking process one can choose to use larger fibers or to modify the settings of the equipment increasing the potency, although this has some potential risk for the kidney.RESULTS: The theoretical 100% of good results is reduced due to multiple technical and anatomical factors: size, number, localization, and hardness of the stone, as well as the possibility of reaching and seeing the calculus and being able to place the tip of the fiber against it.CONCLUSIONS: Although the holmium laser develops an excellent role at the time of avoiding leaving residual calculi or diminishing the number of them, sometimes the electrohydraulic lithotripsy is more effective.
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There is controversy yet about which is the best treatment modality for lithiasis of the lower calyx. The range of lithiasis clearance of the stones localized in the lower calyx will depend on various factors such as size, composition of the stone, type of lithotripter employed, type of urinary transport, and anatomy of the lower calyx. The role of flexible ureteros-copy in the treatment of intrarenal pathology has experimented a dramatic evolution, impulsed by the improvements in design of flexible ureterscopes, their degree of deflection, and better quality of image, in the great diversification of small calibre accessory instruments, and the use of the holmium laser for lithotripsy. Its development makes possible to offer it as a therapeutic option for the failures of extracorporeal lithotripsy in stones smaller than 1 cm and as first-line treatment for stones smaller than 1 cm in size if they are cystine stones or they have an attenuation level over 1000 HU; also in obese patients or those with coagulation problems.
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During the last decade there has been a rapiddevelopment in flexible nephroscopy, flexible ureterorenosco-py, laser lithotripsy and instruments for stone manipulation.We are going to review the use of Laser in the management oflithiasis in differents situations.Efforts should be made to minimize renal injury, and laser playa significant role in patients with urolithiasis and horseshoekidneys, chronic renal failure, neurological patients
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OBJECTIVES: Lithiasic pathology continues being very prevalent in our environment. There are multiple approaches and treatments to solve it in current urology.Lately, endourological techniques have suffered a spectacular advance which has permitted to increase their success rates, diminishing also their comorbidity very much. Nevertheless, despite all improvements we still face a series of complications that may reduce the success of the procedure. Among all of them, we emphasize stone retropulsion during endoscopic lithotripsy, because it appears in an important number of procedures and, it does not only diminish the range of stone free patients, but also is associated with a longer surgical time, and occasionally will make necessary the employment of additional procedures that increase cost and treatment morbidity.To reduce the incidence of this retropulsion classical manoeuvres have been employed: antitrendelenburg, decrease of the intensity of the irrigaton flow, modification of laser parameters, or pneumatic balloons. Currently, we have other more effective mechanisms to combat it, among them: the devices that occlude the ureteral lumen, and nitinol baskets/forceps.Adequate selection of the stone extraction device may be definitive for completion of the ureterorenoscopic procedure with success, and in the programmed time. The election of an inadequate device may make the procedure impossible or cause iatrogenic damage to the urinary tract.For all it, specific instruments to entrap and extract stones (baskets and ureteral lumen occlusion devices) is an armamentarium that every endourologist should be familiar with.
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OBJECTIVE: Partial nephrectomy is a technique that requires extensive manipulation and control of the renal vessels. In this paper we will evaluate the contribution of Revolix® laser to the minimally invasive and nephron sparing renal surgery over the years 2005-2008.METHODS: We have used the Revolix® laser (Thulium), with a wavelength of 2013 nm in the infrared (invisible) spectrum, which can work in a continue or pulsed manner. Its chromophore target is water. Two different techniques may be employed: vaporization (side firing fiber) or vaporresection (frontal fiber). In all cases we used the frontal fiber (rigifib, flexifib and percufib), for vaporresection between 12 and 15 watts.
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In this paper we analyze the complications of various applications of laser in urology. The search of a minor aggression trying to diminish complications have lead the de-velopment of the use of this energy in the most frequent urolo-gic pathologies. Its use in the fragmentation of ureteral stones has modified the therapeutic algorithms. In prostatic diseases we analyze the various options from enucleation (HoLEP) to green laser photovaporization, reviewing the bibliographic re-ferences and comparing them with our experience. There are other therapeutic applications that use this energy as a cutting instruments for urethral, ureteral, ureteropyelic junction stenosis, or bladder neck section.
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Photodynamic Therapy (FDT) is a minimally in-vasive therapeutic modality extraordinarily useful. In urology, FDT is very useful and may be applied through endoscopes or directly, with excellent results obtained for the diagnosis and treatment of bladder tumors, in the treatment of prostate cancer and its recurrences, and in the treatment of dermatological premalignant lesions and carcinomas of the penis.FDT is founded on the use of photosensitizing products which selectively accumulate in tumor tissues. The irradiation of these tissues with a proper wavelength light (generally in the red region of the visible spectrum λ ≥ 600nm) produces the forma-tion of oxygen reactive species with cytotoxic effects leading to selective death of neoplastic cells, and tumor regression. The main advantage of FDT is the restriction of cellular da-mage to the irradiation area, with the associated decrease of secondary effects on healthy tissues near the tumor, on the contrary to what happen with other conventional therapies for some tumors of the urinary tract. Moreover, FDT may be used in combination with radiotherapy and chemotherapy.
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The use of laser applications in urology has undergone significant advances and is now used in a wide variety of procedures. Improvements in types of lasers, the wavelength of energy used, optical fiber delivery systems, pre-cision of laser applications and cost reduction have served to further improve laser technology and extend the potential applications. The different types of lasers available at the pre-sent time appear to be an alternative treatment modality with excellent cosmetic and functional results and low morbidity in the treatment of benign, pre-malignant and malignant lesions in the genital area. The objective of this article is to provide an update on the most important clinical and experimental advan-cements therapeutic applications of lasers in genital lesions.
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The use of laser technology in the field of urolo-gic surgery has experienced great advances over the past 20 years. Since the beginning of this century robotic technology has landed in a determined manner in our specialty and every day will be more and more indications on what is going to have a final deployment. The current combination of laser and surgical robots, can be focused on two distinct areas, but possibly complementary, the use of lasers to guide the surgical procedure, what we might call “landmarks and structures recognition” or “positioning” and laser use because of its ablative ability minimizing blood loss and increasing the resection accuracy. This paper reviews most recent articles and contributions on the combination of these two technologies.
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We review the current trends and new perspectives of the use of laser in urology, analyzing different fields in which this energy has been used.In lithotripsy, the laser has modified the therapeutic algorithms for ureteral lithiasis. Moreover, the possibility of using laser with flexible ureteroscopes is enabling the performance of intracorporeal in situ renal lithotripsy. New lasers such as Erbium:yag, more effective and more innocuous than holmium are currently under development. The research in new fibers, more flexible, economic and long-lasting is the next challenge in this field.In BPH, although the KTP laser has obtained and extraordinary diffusion for a certain type of prostate volume, new lasers such as thulium and diode, are in competition with holmium laser in the field of prostatic enucleation due to their precise cut.The application of laser in photodynamic therapy for urological cancers and tissue welding are currently new promising objectives of research.
