Abstract
We present an overview of current and emerging lasers for Urology. We begin with an overview of the Holmium:YAG laser. The Ho:YAG laser is the gold standard lithotripsy modality for endoscopic lithotripsy, and compares favorably to standard electrocautery transurethral resection of the prostate for benign prostatic hyperplasia (BPH). Available laser technologies currently being studied include the frequency doubled double-pulse Nd:Yag (FREDDY) and high-powered potassium-titanyl-phosphate (KTP) lasers. The FREDDY laser presents an affordable and safe option for intracorporeal lithotripsy, but it does not fragment all stone compositions, and does not have soft tissue applications. The high power KTP laser shows promise in the ablative treatment of BPH. Initial experiments with the Erbium:YAG laser show it has improved efficiency of lithotripsy and more precise ablative and incisional properties compared to Ho:YAG, but the lack of adequate optical fibers limits its use in Urology. Thulium:YAG fiber lasers have also demonstrated tissue ablative and incision properties comparable to Ho:YAG. Lastly, compact size, portability, and low maintenance schedules of fiber lasers may allow them to shape the way lasers are used by urologists in the future.
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References
Jansen ED, van Leeuwen TG, Motamedi M, Borst C, Welch AJ (1994) Temperature dependence of the absorption coefficient of water for midinfrared laser radiation. Lasers Surg Med 14(3):258–268
Vassar GJ, Chan KF, Teichman JM, Glickman RD, Weintraub ST, Pfefer TJ, Welch AJ (1999) Holmium: YAG lithotripsy: photothermal mechanism. J Endourol 13(3):181–190
Sofer M, Watterson JD, Wollin TA, Nott L, Razvi H, Denstedt JD (2002) Holmium:YAG laser lithotripsy for upper tract urinary calculi in 598 patients. J Urol 167:31–34
Gilling PJ, Cass CB, Cresswell MD, Malcolm AR, Fraundorfer MR (1996) The use of the holmium laser in the treatment of benign prostatic hyperplasiaL. J Endourol 10:459–461
Westenberg A, Gilling P, Kennett K, Frampton C, Fraundorfer M (2004) Holmium laser resection of the prostate versus transurethral resection of the prostate: results of a randomized trial with 4-year minimum long-term followup. J Urol 172(2):616–619
Tan AH, Gilling PJ, Kennett KM, Frampton C, Westenberg AM, Fraundorfer MR (2003) A randomized trial comparing holmium laser enucleation of the prostate with transurethral resection of the prostate for the treatment of bladder outlet obstruction secondary to benign prostatic hyperplasia in large glands (40 to 200 grams). J Urol 170(4 Pt 1):1270–1274
Giddens JL, Grasso M (2000) Retrograde ureteroscopic endopyelotomy using the holmium:YAG laser. J Urol 164(5):1509–1512
Biyani CS, Cornford PA, Powell CS (2000) Ureteroscopic endopyelotomy with the Holmium:YAG laser. mid-term results. Eur Urol 38(2):139–143
Matsuoka K, Inoue M, Iida S, Tomiyasu K, Noda S (2002) Endoscopic antegrade laser incision in the treatment of urethral stricture. Urology 60(6):968–972
Watterson JD, Sofer M, Wollin TA, Nott L, Denstedt JD (2002) Holmium: YAG laser endoureterotomy for ureterointestinal strictures. J Urol 167(4):1692–1695
Singal RK, Denstedt JD, Razvi HA, Chun SS (1997) Holmium:YAG laser endoureterotomy for treatment of ureteral stricture. Urology 50(6):875–880
Jonler M, Lund L, Bisballe S (2004) Holmium:YAG laser vaporization of recurrent papillary tumours of the bladder under local anaesthesia. BJU Int 94(3):322–325
Syed HA, Biyani CS, Bryan N, Brough SJ, Powell CS (2001) Holmium:YAG laser treatment of recurrent superficial bladder carcinoma: initial clinical experience. J Endourol 15(6):625–627
Teichman JM, Rao RD, Rogenes VJ, Harris JM (1997) Ureteroscopic management of ureteral calculi: electrohydraulic versus holmium:YAG lithotripsy. J Urol 158(4):1357–1361
Razvi HA, Denstedt JD, Chun SS, Sales JL (1996) Intracorporeal lithotripsy with the holmium:YAG laser. J Urol 156(3):912–914
Wu CF, Shee JJ, Lin WY, Lin CL, Chen CS (2004) Comparison between extracorporeal shock wave lithotripsy and semirigid ureterorenoscope with holmium:YAG laser lithotripsy for treating large proximal ureteral stones. J Urol 172(5 Pt 1):1899–1902
Lam JS, Greene TD, Gupta M (2002) Treatment of proximal ureteral calculi: holmium:YAG laser ureterolithotripsy versus extracorporeal shock wave lithotripsy. J Urol 167(5):1972–1976
Ilker Y, Ozgur A, Yazici C (2005) Treatment of ureteral stones using Holmium:YAG laser. Int Urol Nephrol 37(1):31–34
Albala DM, Assimos DG, Clayman RV, Denstedt JD, Grasso M, Gutierrez-Aceves J, Kahn RI, Leveillee RJ, Lingeman JE, Macaluso JN Jr, Munch LC, Nakada SY, Newman RC, Pearle MS, Preminger GM, Teichman J, Woods JR (2001) Lower pole I: a prospective randomized trial of extracorporeal shock wave lithotripsy and percutaneous nephrostolithotomy for lower pole nephrolithiasis-initial results [erratum appears in J Urol 2002 Apr;167(4):1805]. J Urol 166(6):2072–2080
Pearle MS, Lingeman JE, Leveillee R, Kuo R, Preminger GM, Nadler RB, Macaluso J, Monga M, Kumar U, Dushinski J, Albala DM, Wolf JS Jr, Assimos D, Fabrizio M, Munch LC, Nakada SY, Auge B, Honey J, Ogan K, Pattaras J, McDougall EM, Averch TD, Turk T, Pietrow P, Watkins S (2005) Prospective, randomized trial comparing shock wave lithotripsy and ureteroscopy for lower pole caliceal calculi 1 cm or less. J Urol 173(6):2005–2009
Lee H, Ryan RT, Teichman JM, Kim J, Choi B, Arakeri NV, Welch AJ (2003) Stone retropulsion during holmium:YAG lithotripsy. J Urol 169(3):881–885
Finley DS, Petersen J, Abdelshehid C, Ahlering M, Chou D, Borin J, Eichel L, McDougall E, Clayman RV (2005) Effect of holmium:YAG laser pulse width on lithotripsy retropulsion in vitro. J Endourol 19(8):1041–1044
Lee H, Kang HW, Teichman JM, Oh J, Welch AJ (2006) Urinary calculus fragmentation during Ho: YAG and Er:YAG lithotripsy. Lasers Surg Med 38(1):39–51
Lagerveld BW, Laguna MP, Debruyne FM, De La Rosette JJ (2005) Holmium:YAG laser for treatment of strictures of vesicourethral anastomosis after radical prostatectomy. J Endourol 19(4):497–501
Futao S, Wentong Z, Yan Z, Qingyu D, Aiwu L (2006) Application of endoscopic Ho:YAG laser incision technique treating urethral strictures and urethral atresias in pediatric patients. Pediatr Surg Int 22(6):514–518
el-Nahas AR, Shoma AM, Eraky I, el-Kenawy MR, el-Kappany HA (2006) Prospective, randomized comparison of ureteroscopic endopyelotomy using holmium:YAG laser and balloon catheter: J Urol 175(2):614–618; discussion 618
Pardalidis NP, Papatsoris AG, Kosmaoglou EV (2003) Endoscopic and laparoscopic treatment of ureteropelvic junction obstruction. J Urol 168:1937–1940
Jarrett TW, Chan DY, Charambura TC et al (2002) Laparoscopic pyeloplasty: the first 100 cases. J Urol 167:1253–1256
Baldwin DD, Dunbar JA, Wells N et al (2003) Single-center comparison of laparoscopic pyeloplasty, Acucise endopyelotomy, and open pyeloplasty. J Endourol 17:155–160
Soulie M, Salomon L, Patard J et al (2001) Extraperitoneal laparoscopic pyeloplasty: a multicenter study of 55 procedures. J Urol 166:48–50
Tan BJ; Smith AD (2004) Ureteropelvic junction obstruction repair: when, how, what? Curr Opin Urol 14(2):55–59
Kuntz R, Lehrich K, Fayad A (2001) HoLEP vs open transvesical enucleation of prostates larger than 100 g: the first randomised prospective trial [Abstract]. In: Abstracts of the American Urological Association, Anaheim, 2001. J Urol 165(Suppl.):1208
El zayat EA, Elhilali MM (2006) Holmium laser enucleation of the prostate (HoLEP): the endourologic alternative to open prostatectomy. Eur Urol 49(1):87–91
El zayat E, Habib E, Elhilali M (2006) Holmium laser enucleation of the prostate in patients on anticoagulant therapy or with bleeding disorders. J Urol 175(4):1428–1432
Parr NJ, Loh CS, Desmond AD (1989) Transurethral resection of the prostate and bladder tumour without withdrawal of warfarin therapy. Br J Urol 64(6):623–625
Seki N, Mochida O, Kinukawa N, Sagiyama K, Nato S (2003) Holmium laser enucleation for prostatic adenoma: analysis of learning curve over the course of 70 consecutive cases. J Urol 170(5):1847–1850
McAllister WJ, Absalom MJ, Mir K et al (2000) Does endoscopic laser ablation of the prostate stand the test of time? Five-year results from a multicentre randomized controlled trial of endoscopic laser ablation against transurethral resection of the prostate. BJU Int 85:437–443
Anson KM, Watson GM, Shah TK, Barnes DG (1993) Laser prostatectomy: our initial experience of a technique in evolution. J Endourol 7:333–336
Martenson AC, De La Rosette JJ (1999) Interstitial laser coagulation in the treatment of benign prostatic hyperplasia using a diode laser system: results of an evolving technology. Prostate Cancer Prostatic Dis 2:148–154
Te AE, Malloy TR, Stein BS, Ulchaker JC, Nseyo UO, Hai MA, Malek RS (2004) Photoselective vaporization of the prostate for the treatment of benign prostatic hyperplasia: 12-month results from the first United States multicenter prospective trial. J Urol 172(4 Pt 1):1404–1408
Kuntzman RS, Malek RS, Barrett DM, Bostwick DG (1996) Potassium-titanyl-phosphate laser vaporization of the prostate: a comparative functional and pathologic study in canines. Urology 48:57
Bachmann A, Reich O, Wyler S, Ruszat R, Casella R, Gasser T, Hofstetter A, Sulser T (2004) The 80 W potassium-titanium-phosphate (KTP) laser vaporization of the prostate. Technique and 6 month follow-up after 70 procedures (German). Urologe (Ausg. A) 43(10):1262–1270
Malek RS, Kuntzman RS, Barrett DM (2000) High Power Potassium-titanyl-phosphate laser vaporization prostatectomy. J Urol 163(6):1730–1733
Bouchier-Hayes DM, Anderson P, Appledom SV et al (2005) A randomised trial comparing photo-vaporisation and trans-urethral resection of the prostate in patients with BPH (abstract). J Urol 173(Suppl 1555):42
Barber NJ, Muir GH (2004) High-power KTP laser prostatectomy: the new challenge to transurethral resection of the prostate. Curr Opin Urol 14(1):21–25
Reich O, Bachmann A, Siebels M et al (2005) High power (80 W) potassium-titanyl-phosphate laser vaporization of the prostate in 66 high risk patients. J Urol 173:158–160
Schmidlin F, Oswald M, Iselin C, Rohner S, Jichlinski P, Delacretaz G, Leisinger HJ, Graber P (1997) Vaporization of urethral stenosis using the KTP 532 laser (French). Ann Urol 31(1):38–42
Helfmann J (1992) Untersuchung der physikalischen Phanomene bei der Zertrummerung von Korperkonkrementen durch laserinduzierte Plasmen. In: Advances in laser medicine. Landsberg, Zurich: ecomed
Helfmann J, Muller G (2001) Laser lithotripsy: process overview. Med Laser Appl 16:30–37
Tischer CF, Koort H, Bazo A, Rasch R, Thiede C (2002) Clinical experiences with a new frequency-doubled double-pulse Nd:YAG Laser (FREDDY) for the treatment of urolithiasis. In: Proceedings of SPIE, vol 4609
Hochberger J, Bayer J, Tex S, Maiss J, Tschepe J, Hahn EG (1997) Frequenzverdoppelter Doppelpuls ND:YAG Laser (FREDDY) fur die Gallensteinlithotripsie—Praklinische und erste klinische Ergebnisse. Biomedizinische Technik “Laseranwendungen III” 442:330
Zorcher T, Hochberger J, Schrott KM et al (1999) In vitro study concerning the efficiency of the Frequency-doubled Double-Pulse Neodymium:YAG Laser (FREDDY) for Lithotripsy of Calculi in the Urinary tract. Lasers Surg Med 25(1):38–42
Delvecchio F, Zhu S, Weizer A, Silverstein A, Auge B, Pietrow P, Albala D, Zhong P, Preminger G (2001) In vitro fragmentation analysis of the FREDDY laser. Oral presentation at the WCE 2001, Bangkok
Bazo A, Chow WM, Coombs L, Barnes DG (2001) Freddy will crack it for you: a new device for urinary calculi lithotripsy. In: BAUS conference proceedings, section of Endourology, Sheffield, UK
Santa-Cruz RW, Leveillee RJ, Krongrad A (1998) Ex vivo comparison of four lithotripters commonly used in the ureter: what does it take to perforate? J Endourol 12(5):417–422
Harmon WJ, Sershon PD, Blute ML, Patterson DE, Segura JW (1997) Ureteroscopy: current practice and long-term complications. J Urol 157(1):28–32
Schafhauser W, Zorcher W et al (2000) Erste klinische Erfahrungen mit neuem frequenzverdoppeltem Doppelpuls Neodym:YAG Laser in der Therapie der Urolithiasis. Poster presentation at the DGU, Hamburg, Germany
Stark L, Carl P, Zauner R (2001) A new technique for Laser-Lithotripsy: FREDDY, the partially frequency-doubled double-Pulse Nd:YAG Laser. Poster presentation at the 1st int. consultation on Stone Disease, Paris
Dubosq F, Pasqui F, Girard F, Beley S, Lesaux N, Gattengno B, Thibault P, Traxer O (2006) Ednoscopic lithotripsy and the FREDDY laser: initial experience. J Endourol 20(5):296–299
Stark L, Car P (2001) First clinical experiences of laser lithotripsy using the partially frequency-doubled double-pulse neodymium:YAG laser (“FREDDY”) (abstract). J Urol 165:362A
Visuri SR, Walsh JT, Wigdor HA (1996) Erbium laser ablation of dentin hard tissue: effect of water cooling. Lasers Surg Med 18:294–300
Schlenk E, Profeta G, Nelson JS, Andrews JJ, Berns MW (1990) Laser assisted fixation of ear prostheses after stapedectomy. Lasers Surg Med 10:444–447
Pratisto H, Frenz M, Ith M, Romano V, Felix D, Grossenbacher R, Altermitt HJ, Weber HP (1996) Temperature and pressure effects during erbium stapedotomy. Lasers Surg Med 18:100–108
Dietlein TS, Jacobi PC, Krieglstein GK (1998) Erbium:YAG laser trabecular ablation (LTA) in the surgical treatment of glaucoma. Lasers Surg Med 23:104–110
Chan KF, Vargas G, Parker PJ, Teichman JMH, Glickman RD, McGuff HS, Welch AJ (2000) In vitro erbium:YAG laser lithotripsy. In: Proceedings of SPIE—the international society for optical engineering, vol 3914, pp 198–206
Chan KF, Hammer DX, Choi B, Teichman JMH, McGuff HS, Pratisto H, Jansen ED, Welch AJ (2000) Free electron laser lithotripsy: threshold radiant exposures. J Endourol 14:161–167
Chan KF, Lee H, Teichman JMH, Kamerer A, McGuff HS, Welch AJ (2002) Erbium:YAG laser lithotripsy. J Urol 168:436–441
Teichman JMH, Chan KF, Cecconi PP, Corbin NS, Kamerer AD, Glickman RD, Welch AJ (2001) Erbium:Yag versus Holmium:Yag. J Urol 165:876–879
Kang HK, Lee H, Teichman JH, Welch AJ (2005) Comparison of urinary calculus fragmentation during Ho:YAG and Er:YAG lithotripsy. In: Proceedings of SPIE, vol 5686, pp 159–170
Jovanovic S, Schonfeld U, Prapavat V et al (1997) Effects of pulsed laser systems on stapes footplate. Lasers Surg Med 21:341
Jelinkova H, Kohler O, Nemec M, Koranda P, Siulc J, Drlik P, Miyagi M, Shi YW, Matsuura Y, Kokta MR (2004) Hrabal Interaction of mid-infrared laser radiation with soft ureter tissue. In: Proceedings of SPIE, vol 5610, pp 18–23
Varkarakis IM, Inagaki T, Allafa ME, Chan TY, Rogers CG, Wright EJ, Fried NM (2005) Erbium vs. Holmium laser incision of the urethra and bladder neck. In: Proceedings of SPIE, vol 5686, pp 171–175
Chaney CA, Yang Y, Fried NM (2004) Assembly and testing of Germanium/Silica Optical fibers for flexible endoscopic delivery of Erbium:YAG laser radiation. In: Proceedings of SPIE, vol 5317, pp 1–8
Iwai K, Shi Y, Matsuura Y, Miyagi M (2002) Rugged hollow fiber for the infrared and its use in laser lithotripsy. In: Proceedings of SPIE, vol 4916, pp 115–119
Kay SL, Oz MC, Haber M, Blitzer A, Treat MR, Trokel SL (1992) Soft tissue effects of the THC:YAG laser on canine vocal cords. Otolaryngol Head Neck Surg 107(3):438–443
Silkiss RZ, Axelrod RN, Iwach AG, Vassiliadis A, Hennings DR (1992) Transcanalicular THC:YAG dacryocystorhinostomy. Ophthalmic Surg 23(5):351–353
Silkiss RZ (1993) THC:YAG nasolacrimal duct recanalization. Ophthalmic Surg 24(11):772–774
Devos D, Creac’h C, Laureau E, Bourriez JL, Guieu JD (2000) Thulium laser evoked potentials. Normative values for the arms and legs (French). Neurophysiol Clin 30(5):313–322
Theisen D, Ott V, Bern HW, Danick V, Keller R, Brinkmann R (2003) Cw high power IR-laser at 2microns for minimally invasive surgery. In: Proceedings of SPIE, vol 5142, pp 96–100
El-Sherif AF, King TA (2003) Soft and hard tissue ablation with short-pulse high peak power and continuous thulium-silica fiber lasers. Lasers Med Sci 18(3):139–147
Rink K, Delacretaz G, Salathe RP (1995) Fragmentation process of current laser lithotriptors. Lasers Surg Med 16(2):134–146
Fried NM (2005) High-power laser vaporization of the canine prostate using a 110 W Thulium fiber laser at 1.91 microns. Lasers Surg Med 36(1):52–56
Fried NM, Murray KE (2005) High-power thulium fiber laser ablation of urinary tissues at 1.94 microm. J Endourol 19(1):25–31
Wollin TA, Denstedt JD (1998) The holmium laser in urology. J Clin Laser Med Surg 16(1):13–20
Fried NM (2005) Thulium fiber laser lithotripsy: an in vitro analysis of stone fragmentation using a modulated 110-watt Thulium fiber laser at 1.94 microns. Lasers Surg Med 37(1):53–58
Xia SJ, Zhang YN, Lu J, Sun XW, Zhang J, Zhu YY, Li WG (2005) Thulium laser resection of prostate-tangerine technique in treatment of benign prostate hyperplasia (Chinese). Zhonghua Yi Xue Za Zhi 30;85(45):3225–3228
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Marks, A.J., Teichman, J.M.H. Lasers in clinical urology: state of the art and new horizons. World J Urol 25, 227–233 (2007). https://doi.org/10.1007/s00345-007-0163-x
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DOI: https://doi.org/10.1007/s00345-007-0163-x