Do you have renal stone or enlarged prostate?

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 Do you have renal stone or enlarged prostate?

Do you have renal stone or enlarged prostate?

 

Do you have renal stone or enlarged prostate? Learn about the role of laser.

Holmium Laser in Urology

 

What is LASER?

We all are aware, LASER is an acronym for Light Amplification by Stimulated emission of Radiation. Laser has for long time fascinated both patients and Doctors. Today a lot of lasers are being used in the various Medical fields. Urology has also adapted a lot of lasers.

 

What is holmium laser?

Holmium laser is a solid-state laser with extensive utility in Urology. Holmium laser delivers laser light energy at a wavelength of 2140 nm via a flexible end firing quartz fiber. This energy is readily absorbed by water and has a minimal tissue absorption of only 0.4-mm. Due to this holmium laser has excellent cutting properties with unparalleled safety.

 

What are the other lasers used in Urology?

Many different lasers are used in Urology. It all started with Nd:YAG laser, now a lot of lasers like KTP laser, Thulium laser, Diode laser & Holmium laser are being used in Urology.

 

Why is holmium laser safe in Urinary system?

Urinary system extends from the kidney, two ureters, urinary bladder and the urethra (Urine outlet tube). As the laser fiber is flexible, using a flexible telescope it can be reached to any part of the urinary system. As the depth of penetration of the laser is 0.4 mm, it is safe for the urinary system.

 

What are the various roles of Holmium laser in Urology?

Holmium Laser is a new treatment modality in urology that has extensive role in the treatment of many urological ailments. It is used to fragment urinary calculi, enucleate enlarged prostate, excise urethral and ureteric strictures, ablate bladder tumors and for endopyelotomy for pelvi-ureteric junction obstruction.

 

Holmium laser for Urinary calculi.

Holmium laser is the best energy source to fragment urinary calculi especially the ureteric stones. The stone is powdered to very small pieces without the risk of pushback of the stones. Holmium energy can be delivered through flexible endoscopes and the hardest stones can be fragmented.

Advantages of Holmium laser over conventional stone fragmentation:

  • Safe.
  • Even the hardest stones powdered.
  • Flexible Ureteroscopy possible.
  • No pushback of stones
  • A day care procedure
  • Reduced need for double J stent.

 

Holmium laser for strictures.

Strictures are narrowing in the urinary passages. Strictures can happen in the ureter, bladder neck and urethra. Holmium laser excision of urethral and ureteric strictures is a simple day care procedure with good results in-patients with recurrent strictures. The results with holmium laser are expected to be better as the healing after holmium laser excision is by elastosis.

Pelvi-ureteric junction obstruction is a narrowing at the site where the ureter joins the kidney. This can be congenital (birth defect) or acquired (after operation). This obstruction can be treated by holmium laser using both retrograde and antegrade endoplelotomy.

Advantages of Holmium laser over conventional treatment:

  • Safe.
  • No bleeding.
  • May give better results.
  • Advantage in recurrent strictures.

 

Holmium laser for prostate enlargement.

One of the major indications of Holmium laser is its role in the management of Benign Enlargement of Prostate. Holmium Enucleation of Prostate (HoLEP) is indicated for patients with significant obstructing and symptomatic enlargement of prostate. The obstructing adenoma is enucleated completely transurethrally and pushed in the bladder. The adenoma tissue is morcellated removed. The advantages of HoLEP over the standard transurethral resection of Prostate (TURP) are-

  • Significantly reduced need for blood transfusion (<0>
  • No restriction on the size of prostate to be removed (Even prostates as large as 250 GMS can be enucleated)
  • Patients with cardiac pace makers, anticoagulants, and other medical risk factors can be treated.
  • No risk of TUR syndrome.
  • Smaller urethral catheter (18-20Fr) without traction for less than 24 hours in more than 90% patients.
  • Hospitalization for 36 hours.
  • Lesser risk of urethral stricture and bladder neck contracture.
  • Reduced risk of post prostatectomy impotence.
  • Holmium laser can treat associated strictures, stones or superficial bladder tumors.

 

Is Holmium laser an established technology?

Holmium laser is a multi-specialty laser with extensive role in management of urological aliments. One of the first holmium laser unit’s in India is installed at the R G Stone Urological Research Institute, Mumbai under the care of Dr. Pankaj N. Maheshwari (He was the chief Urologist of RG Stone then). Dr Maheshwari is extensively trained in Homlium laser at New York & at New Zealand and has a large personal experience of this technology. Over years, this technique has been widely used at RG Stone and at other institutes in India & Worldwide.

 

Other lasers

KTP laser is also being used for prostate enlargement. The major advantage of KTP laser is that it is blood less and nearly catheter less. Patient can go home in one day without a catheter. The only major problem with KTP laser is it is very expensive.

 

What the experts have to say about laser?

Dr. Peter Gilling, MD, Consulting Urologist at Tauranga Hospital, Tauranaga, New Zealand. (Dr Maheshwari has trained with Dr Gilling)                            

"The HoLRP (Holmium laser treatment of prostate) has replaced standard TURP completely and unreservedly in our hospital. There is nothing out there that has been shown to be better."

Dr. John Kabalin, MD, Scottsbluff Urology Associates, Scottsbluff, Nebraska, formerly Assistant Professor of Urology, Stanford University School of Medicine, and a recognized expert on surgical laser technology and applications                              "The Holmium laser represents the pinnacle of laser technology in urology as of 1998. This is the only operation for BPH that I am doing".

Dr. James Lingeman, MD, Director of Research, Methodist Hospital Institute for Kidney Stone Disease, Indianapolis, Indiana.                             

"I would envision that every significant urology department will have a Holmium laser at their disposal. It is a basic tool for stones and BPH, two of the most common conditions urologists treat".

 

 

Author:

Dr Pankaj N Maheshwari

Sr Consultant, Urology Fortis Hospital Mulund, Mumbai, India.

+91 88793 50085

[email protected] / [email protected]