Aplication of Holmiun Laser in Urology

Abstract

Introduction: Laser is a technology of wide applications is in industry, investigation and biology, that transforms large quantities of energy into electromagnetic radiation that is then emitted as a light beam, which produces a photothermal or photoacustic effect. In the case of the Holmiun Laser whose wide wavelength (2120 nm) enables diverse procedures to be carried out, such as tissue ablation and cutting, lithotripsy, and tissue vaporization. Objective: To present different minimally invasive treatments with Holmium laser (New Star®, 18W model) in various urologic procedures done in the Country to the date. Material and methods: to present the first 10 cases of endourological surgery with Holmiun laser performed between July 2011 and December 2012 in Adventist Hospital of Asunción, such as PCNL, proximal and distal ureterolithotripsy, retrograde intrarenallithotripsy with flexible ureteroscope, internal urethrotomy, bladder neck restructuring for postoperative sclerosis, cystolithotripsy, all employing 18 Watt Holmium laser. Results: 1 patient underwent PCNL, 2 patient underwent intrarenal lithotripsy through flexible ureteroscopy, 6 cases of distal ureterolithotripsy, 1 case of cystolithotripsy. Among the patients who underwent uretrolithotripsy 2 of them required urethotomy and 1 cevicotomy with the same laser. Only in one case of distal ureteral stone, the laser lithotripsy had to be repeated. Treatment effectiveness was verified according to studies of choice for each pathology. In the patients that underwent lithotripsy plain abdominal x-rays were taken the patients that had urethral stricture and urethovesical stricture managed with laser urethrotomy , were followed up postoperatively with urethrograph and urethral calibration. All studies showed anatomic improvements. Conclusions: The Holmium laser has an excellent safety profile and efficacy. It can be employed in the entire urinary tract, and its generalized application during recent years for the management of obstructive urinary tract pathology and stone disease, in which it has become the gold standard. Endourology is a fundamental area of general urology, and the skillful use of laser technology is one of the greatest challenges in the professional training of the urologist which has allowed the use of flexible endoscope to reach the entire urinary tract.