Holmium laser: treating urological pathologies with great precision

The Holmium laser is a very useful tool in Urology to make incisions in the narrow parts that can be formed for various reasons in the organs of the Excretory and Urinary System: urethra, ureter, pelvic-urethral junction and renal collecting system.

Advantages of the Holmium laser

The Holmium laser has three main advantages:

1. It has great precision in the control of the energy it releases.
2. Hemostasis (stop bleeding) of the most superficial blood vessels.
3. Very small area of thermal damage, which should limit damage to surrounding normal tissue.

In which pathologies can the Holmium laser be used?

The Holmium laser is very useful for making incisions and treating the following pathologies:

• Bladder neck obstruction. Sometimes small prostates with an elevated neck cause bladder neck obstruction. Only with one incision (at 6 o’clock, clockwise), or two bilateral incisions (at 5 and 7 o’clock, clockwise), it is possible to open the bladder neck to unblock it (BNI Bladder Neck Incision).
• Bladder neck stenosis. Sometimes, after treatment of Benign Prostatic Hyperplasia (BPH) (either endoscopic or open surgery), bladder neck stenosis may develop. It is usually treated by making an incision at 3 o’clock and 9 o’clock in the neck. As an alternative to scar tissue fibrous tissue can be completely resected with the Holmium laser.
• Ureteral stricture and HLEP Holmium Laser EndoPyelotomy; treatment of ureteropelvic junction strictures with Holmium laser. Since there are small diameter fibers that allow good irrigation and great SlimeLine™ bending capacity, strictures can be treated with flexible endoscopes in the ureter and kidneys (upper part). It is best to make the incision proximal to the stricture and finish it distal to it. In addition, obstruction of the urethropyelic junction can be incised with the Holmium laser, either endourologically, laparoscopically or percutaneously.
• ULI: Urethral Laser Incision (Urethral stricture). Access is made with a rigid endoscope, which may be a cystoscope, ureteroscope or resector modified to be used with fiber laser. If a cystoscope is used, the laser fiber must be stabilized through a ureteral catheter. Stricture cutting can be done retrograde, usually at 12 o’clock.