The term laser comes from English (light amplification by stimulated emission of radiation), which in English means “light amplified by stimulated emission of radiation”. In the field of urology, there are chemical elements that are frequently used, the two most famous being the Holmium laser and the Thulium laser. Both were discovered by Teodor Cleve. The first urological laser work on humans was described by Douglas in 1992, and since then, numerous works have been produced on this tool that has demonstrated its versatility and usefulness in numerous pathologies.
Laser for the treatment of urinary lithiasis
The prevalence of urinary lithiasis or stones is between 10 and 15% of the world’s population. Depending on their location and size, as well as the hardness of the lithiasis and the patient’s anatomy, there are different treatment methods. In some cases, expectant management can be chosen, through control of the renal lithiasis, or if they are at the level of the ureter, waiting for their spontaneous expulsion. If this is not achieved, extracorporeal lithotripsy – based on external waves that fragment or pulverize the lithiasis – can be used.
fragment or pulverize the lithiasis – or minimally invasive techniques such as ureterorenoscopy. Robotic surgery and laparoscopic techniques are used for complex cases, while open surgery has been practically relegated to the background.
In the case of endourological techniques, their main advantage is their low morbidity and rapid patient recovery. The laser is one of the most versatile energy sources for fragmenting or pulverizing lithiasis. The laser is transmitted by very small fibers of different calibers that reach complex locations. In addition, it can be modified to achieve a greater effect on the lithiasis depending on its hardness, either by fragmenting or pulverizing it. The effectiveness of the laser has been recognized by the different urological societies as the best tool for treating renal lithiasis.
Treatment of lower urinary tract symptoms
LUTS resulting from a benign growth of the prostate may require medical treatment, and in some situations surgical treatment. Surgical treatment is usually based on endoscopic surgery through the urethra, especially in prostates smaller than 60 grams. In cases of larger prostates, open surgery is usually chosen, and laparoscopy and robotic surgery are left for complex cases.
However, the laser has been shown to be effective in benign prostate growth in prostate sizes larger than those that can be covered by TUR. In addition, it minimizes bleeding and hospitalization time, as well as patient recovery.
Upper urinary tract tumor
This is a pathology with a very low prevalence, although it produces a great impact on those who suffer from it, since in many cases it requires the removal of the affected kidney and ureter.
However, in some cases it is possible to make an effective treatment with laser ablation, avoiding the removal and the potential renal failure that can be caused by these procedures. It is important, therefore, to differentiate between these tumors and kidney tumors that originate in the kidney.
Bladder tumor
Bladder tumors require removal. Usually, it is treated with endoscopic resection through monopolar or bipolar energy, achieving the removal of the tumor in fragments in order to later identify the lesion and its depth. In recent times, a new type of resection is being worked on, known as en bloc resection, removing the tumor in its entirety and not in fragments.
Urethral stricture
This is a narrowing at the level of the urine duct that communicates the bladder with the outside of the body. If this stricture has an impact on the patient’s health, it must be treated, and treatment is usually chosen according to its length and location.
If endoscopic treatment is used, it will be approached by means of an instrument called a urethromo, which must pass through the urethra, although in some cases it is contraindicated. In such cases, a urethrotomy with finer instruments and laser to cut the stricture should be chosen.
Ureteral stricture
Ureteral stricture is a narrowing in the ureter, the tube that connects the bladder and kidney. Depending on its size and location, it can be effectively treated with an endoscopic approach and by opening the stricture with a laser.
In conclusion, it can be said that the laser in urology is a very versatile tool that can be used to treat numerous pathologies. However, the selection of the cases to be treated with laser is very important, as well as the surgeon’s experience in order to achieve satisfactory results.
The laser by itself does not guarantee success, but a correct assessment and a good use are the ones that guarantee this success.
In Uros Associats, urologists in Barcelona we have a multidisciplinary team of experts in urological pathologies.