The word LASER derives from the English acronym (light amplification by stimulated emission of radiation), translated into Spanish means “Light amplified by stimulated radiation emission”. The concept of the laser was born with Albert Einstein’s theory in 1917 on the emission of energy by stimulating various chemical components.

In urology the two chemical elements that are most often used to stimulate energy are Holmio, whose name comes from the word “HOLMIA” (Latin word for Stockholm) and Tullium “THULE” (Greek word for Skadavia). Both discovered by Teodor Cleve.

The first report on the use of laser in urology in humans was described by Douglas in 1992 and since then several studies have identified the versatility of this very useful tool within the urological arsenal for the treatment of various pathologies.

Treatment of urinary lithiasis (stones):

The prevalence of lithiasis is around 10-15% of the world’s population. There are various methods of treatment, depending on the size, location and hardness of the lithiasis, as well as the anatomy of the patient’s urinary tract. In some cases you can opt for expectancy controlling renal lithiasis or if these are at the level of the ureter, waiting for the spontaneous expulsion of lithiasis, however, if this is not achieved, extracorporeal lithotripsy (external waves that pulverize or fragment lithiasis) or minimally invasive endourological techniques such as ureterorenoscopy or percutaneous nephrolithotomy can be assessed. leaving laparoscopic or robotic techniques for selected or complex cases, while the role of open surgery has currently been relegated, due to the benefits of minimally invasive techniques that offer less morbidity and great effectiveness.

In case of opting for endourological techniques, these have the advantage of low morbidity and rapid recovery by the patient, since very fine instruments are used to reach the lithiasis or lithiasis and through various sources of energy it is possible to fragment and / or pulverize them. Within the various energy sources the laser is the most versatile, since it is transmitted by very small fibers of different calibers, which can pass through the various work channels and be coupled to rigid and flexible instruments reaching complex locations, which cannot be achieved with other energy sources (mechanical or ultrasonic energy), In addition, the energy can be modified to achieve a better effect on the lithiasis according to its hardness, either by fragmenting it and then removing it with small baskets or pulverizing them to achieve spontaneous expulsion by the patient. The effectiveness of the laser has been recognized by various urology societies cataloging it as the best tool for the treatment of renal lithiasis.

Treatment of lower urinary tract symptoms (LUTS):

LUTS derived from benign prostate growth may require medical treatment and in certain situations may require surgical treatment, which classically consists of endoscopic surgery through the urethra (urethral resection with mono or bipolar energy) especially in prostates smaller than 60 grams in size and in some cases by open surgery (transvesical or retropubic adenomectomy) in prostates greater than 60 grams or with associated bladder lithiasis (bladder), leaving laparoscopic or robotic surgery for complex cases. However, the laser for the treatment of benign prostate growth was described by Gilling in 1998 and since then this technique has become popular and is applicable in prostate volumes higher than those that can be covered by TUR, demonstrating in various comparative studies with mono or bipolar energy resection and open surgery to reduce the time of need for bladder catheter after the procedure, Shorter hospitalization time, less bleeding. High satisfaction questionnaires in patients operated with this technique and lasting effects of symptom improvement, which makes it currently an effective and durable option for benign prostate growth requiring surgery.

Upper urinary tract tumor:

This disease has a very low prevalence between 5-10%, however, the impact it can produce in patients who suffer from it is very high, since it usually involves the removal of the affected kidney and ureter. However, in selected cases it is possible to perform effective treatment by laser ablation, avoiding removal and possible renal failure caused by these radical procedures. It is important to differentiate this type of tumor from those tumors of the kidney that originate in the tissue of the same, since the tumor of the pathways originates in the inner lining of the upper urinary tract.

Bladder tumor:

Bladder tumors are lesions that require removal, the most common method is endoscopic resection by monopolar or bipolar energy, which allows the removal in fragments of the tumor to perform the anatomopathological study and identify the type of lesion and depth of it. Recently a different type of resection called block resection is being studied, which removes the entire tumor in its entirety and not in fragments, which achieves a more accurate analysis of the surgical piece, being one of the tools studied the laser, with which the aforementioned block removal can be achieved, However, this procedure is still under study, so it is not yet standardized.

Urethral stenosis:

Urethral stenosis consists of a narrowing at the level of the urine duct that communicates the bladder with the outside, if the stenosis has an impact on the patient it is considered that it should be treated and the method with which it is performed is decided according to the location and length of it. In case of opting for endoscopic treatment, this is done by an instrument called urethrotome that carries a knife in order to cut the stenotic area, for its use it is required to pass this instrument through the urethra however in certain circumstances the passage of this instrument is contraindicated (for example patients with artificial sphincter due to incontinence), Therefore, urethrotomy can be performed with thinner instruments and using the laser to cut the stenosis.

Ureter stenosis:

Ureter stenosis is a narrowing in the ureter, which is a tube that connects the kidney to the bladder. Depending on the location and length of the same, it can be treated effectively by endoscopic approach for the opening of the stenosis with laser.

Conclusions:

The laser in urology is a versatile tool that allows us to perform the treatment of various pathologies in urology, however, it should be noted that it is very important to select the cases to be treated using this technology and the experience of the surgeon who uses it to achieve the desired results avoiding the possible complications of these treatments. This technology alone does not guarantee the success of the surgeries, it is necessary a correct assessment of the problem, the correct use of the instruments and tools and the experience of the team that assists you to correctly solve the problem

In Uros Associats we have a large staff trained and qualified in the use of laser for various urological pathologies, so, if you want an assessment of any urological problem, we will be happy to assist and guide you in order to help you.

Dr. Andres Koey Kanashiro Jet
Uros Associats