ISSN:1044-5471    

DOI:10.1089/clm.1998.16.1

年代:1998

数据来源: MAL

摘要:

ABSTRACTIntroduction and Objectives:The initial clinical experience with holmium laser energy applied for endoscopic lithotripsy was positive. The current study is presented as a contrast to the preliminary findings and as a means of defining the clinical usefulness of this specific laser lithotrite.Materials and Methods:Calculi were treated endoscopically with the holmium laser lithotriptor and data was gathered prospectively. The youngest patient in the series was a thirteen-month-old who underwent percutaneous therapy, while the youngest patient on whom a retrograde endoscopic procedure was performed was a six-year-old male patient with a proximal ureteral calculus. Low water density, quartz fiber delivery systems were developed and employed. Fiber diameters ranged from 200–1000 μm. The smaller fibers were employed most commonly through the actively deflectable, flexible endoscope to facilitate treatment with maximum deflection. Larger fibers, with their much larger vaporization bubbles, were used through rigid endoscopes to debulk large stone burdens.Results:A total of 210 patients with 249 calculi were treated. All major stone compositions were treated with minimal variation in laser efficiency. All but three of 109 ureteral calculi were treated in a retrograde fashion to completion (i.e., "stone free") in one sitting (97%). One-hundred thirteen renal stone burdens were treated with the holmium laser; 99 of these were treated solely in a retrograde fashion. Of the latter, 79 (80%) required only a single session. The combination of the actively deflectable, flexible ureteroscope and the 200-μm fiber facilitated treatment to completion of 38 of 45 lower-pole caliceal calculi (84%). The success of ureteropyeloscopic lithotripsy with the holmium laser for all intrarenal calculi, including staged or second sittings for large complex stone burdens, was 90%. Sixteen percutaneous procedures (13 renal and 3 ureteral calculi) employed the holmium laser as an endoscopic lithotrite. All 28 patients with large bladder calculi with a mean diameter of 41.8 mm were treated to completion in one sitting. Complications from holmium laser energy, including postoperative ureteral stricture disease, were not encountered in this series.Conclusions:Holmium laser energy is uniquely suited to treat urinary calculi safely regardless of stone size, location, or metabolic composition, and has particular efficacy in complex clinical presentati

ISSN:1044-5471    

DOI:10.1089/clm.1998.16.3

年代:1998

数据来源: MAL

摘要:

ABSTRACTObjective:To review the currently available data of photodynamic therapy (PDT) optical dosimetry for possible prostatic applications.Summary Background Data:PDT is a new cancer treatment modality often used as an alternative tumor treatment method. Recently, PDT has been suggested as an alternative therapy for prostatic carcinoma and BPH.Methods:PDT utilizes light and a preadministered photosensitizer drug to achieve localized tumor control. This article reviews currently available data on optical dosimetry of PDT in both human and canine prostates.Results:At 630 nm, a common wavelength used for Photofrin PDT, results indicate that light penetration is similar in cancerous and normal prostatic tissue. Because of limited light penetration, multiple fiber irradiation is necessary if eradicating the entire prostate gland is the ultimate goal. The available data also show that dynamic changes occur in light fluence rate distribution during PDT irradiation.Conclusions:PDT can be used to destroy prostatic tissue. Real-time optical dosimetry is necessary if accurate lesion volume control is desired.

ISSN:1044-5471    

DOI:10.1089/clm.1998.16.9

年代:1998

数据来源: MAL

摘要:

ABSTRACTObjective:To review the physics related to the holmium laser, its laser-tissue interactions, and its application to the treatment of urological diseases.Summary and Background Data:The holmium: YAG laser is a solid-state, pulsed laser that emits light at 2100 nm. It combines the qualities of the carbon dioxide and neodymium: YAG lasers providing both tissue cutting and coagulation in a single device. Since the holmium wavelength can be transmitted down optical fibers, it is especially suited for endoscopic surgery.Methods:The authors provide a review of the literature as it relates to the holmium laser and its application to urology.Results:The holmium wavelength is strongly absorbed by water. Tissue ablation occurs superficially, providing for precise incision with a thermal injury zone ranging from 0.5 to 1.0 mm. This level of coagulation is sufficient for adequate hemostasis. The most common urologic applications of the holmium laser that have been reported include incision of urethral and ureteral strictures; ablation of superficial transitional cell carcinoma; bladder neck incision and prostate resection; and lithotripsy of urinary calculi.Conclusions:The holmium:YAG laser is a multi-purpose, multi-specialty surgical laser. It has been shown to be safe and effective for multiple soft tissue applications and stone fragmentation. Its utilization in urology is anticipated to increase with time as a result of these features.

ISSN:1044-5471    

DOI:10.1089/clm.1998.16.13

年代:1998

数据来源: MAL

摘要:

ABSTRACTObjective:The authors review the current knowledge regarding the application of the Holmium: YAG laser for prostatectomy.Summary Background Data:Conventional surgical therapies for benign prostatic hyperplasia (BPH) are effective but associated with relatively high morbidity. Laser prostatectomy, using either Neodymium:YAG or potassium-titanyl-phosphate lasers, has emerged as a new and much safer operative approach to relieve symptoms of benign prostatic hyperplasia. However, these laser wavelengths possess key disadvantages that have limited their acceptability and dissemination in everyday urologic practice.Methods:The authors review their own extensive experience in the development and clinical application of Holmium:YAG laser technology for prostatectomy, as well as the published reports in the current medical literature now dealing with this subject.Results:In multiple clinical trials, Holmium:YAG laser resection of the prostate has proven efficacious in relieving symptomatic BPH. Both objective urodynamic measures of voiding outcomes and symptomatic improvement have been shown to be equivalent to standard electrocautery resection of the prostate. At the same time, these studies have demonstrated the superior safety and hemostasis of Holmium:YAG laser prostatectomy compared to electrocautery resection, similar to prior laser prostatectomy procedures. Unlike prior forms of laser prostatectomy, Holmium: YAG laser resection of the prostate acutely removes all obstructing prostate tissue, so that the postoperative catheterization requirement is typically only overnight and improvement in voiding is immediate. Current operative techniques and the latest technological developments to facilitate Holmium:YAG laser prostatectomy are described.Conclusions:Holmium:YAG laser prostatectomy combines the best features of prior laser prostatectomy technologies, including minimal complications and morbidity, with the efficacy and immediacy of voiding outcomes associated with conventional electrocautery resection of the prostate.

ISSN:1044-5471    

DOI:10.1089/clm.1998.16.21

年代:1998

数据来源: MAL

摘要:

ABSTRACTObjective:To describe the University of Florida experience with minimally invasive therapies in the surgical treatment of benign prostatic hyperplasia (BPH).Background Data:Typically, the standard surgical treatment for symptomatic benign prostatic hyperplasia (BPH) has been transurethral resection of the prostate (TURP). Due to the morbidity associated with TURP, several minimally invasive therapies, such as lasers, microwaves, high intensity focused ultrasound, and radiofrequency needle ablation, have been utilized to treat BPH.Methods:The authors review their experience, along with that of others, with various forms of heat therapy in the treatment of BPH.Results and Conclusions:Although high intensity focused ultrasound (HIFU), interstitial laser, and microwave procedures have been shown to be effective in the treatment of BPH, our experience has been with lasers, VaporTrode, and TUNA. We found that VaporTrode and TUNA currently offer several advantages over many of the other modalities.

ISSN:1044-5471    

DOI:10.1089/clm.1998.16.29

年代:1998

数据来源: MAL

摘要:

ABSTRACTBackground and Objective:Endoscopic urologic procedures for transurethral prostatectomy (TURP), external sphincterotomy (TURS), bladder neck incision, and incising strictures using diathermy have resulted in excessive bleeding and risk of hyponatremia. This presentation is a review of a methodology developed to evaluate the use of contact laser crystal firing Nd:YAG laser. Details of the technique are presented.Results:A review of 129 patients following laser TURS with 34% of these patients also needing TURP and 29% of patients also requiring TUIP has been done. Following contact laser endoscopic surgery, the catheter was removed in 24 hours. There was minimal to nil haemorrhage perioperatively and secondary haemorrhage was absent.Conclusion:The technique employing contact laser crystal provides an easy TURP, TURS, and stricture ablation. Followup indicates durable results.

ISSN:1044-5471    

DOI:10.1089/clm.1998.16.33

年代:1998

数据来源: MAL

摘要:

ABSTRACTPurpose:We describe our experience using the potassium titanyl phosphate (KTP)-532 laser in treating posterior urethral valves, ureteroceles, and urethral strictures in the pediatric patient.Methods:A retrospective chart review was performed from 1987 to 1997 on a total of 33 pediatric patients who underwent retrograde endoscopic treatment for posterior urethral valves (PUV), ureteroceles (UC), and urethral strictures using a KTP-532 laser.Results:Overall, our success rate was excellent in the treatment of valves and ureteroceles. With a mean follow-up of three years in the PUV group, no urethral strictures or micturation abnormalities were seen. The majority of ureteroceles were decompressed and only half of our patients required an additional procedure. Our experience with urethral strictures, however, was not as promising. All of these patients ultimately required open urethral reconstruction.Conclusion:The desirable thermal characteristics of the KTP laser, along with minimal complications and the availability of delicate pediatric endoscopic instruments have made this operation optimally suited for treating posterior urethral valves and ureteroceles in infants. However, the advantages for treating urethral strictures in children with the laser still remains to be established.

ISSN:1044-5471    

DOI:10.1089/clm.1998.16.39

年代:1998

数据来源: MAL

摘要:

ABSTRACTObjective:A review of the application of laser technology to vasectomy reversal surgery.Summary Background:Modern methods of vasectomy reversal that employ microsurgical techniques have resulted in a high reported success rate. However, the procedure is tedious and time consuming. Laser technology offers the possibility of simplifying the procedure and reducing operative time, with possibly even better results.Conclusions:Application of lasers in vasovasostomy for vasectomy reversal is still in its early development. Several animal and human studies have been conducted with mixed results. Continued clinical trials will be necessary to prove the benefit of the laser in this surgical setting.

ISSN:1044-5471    

DOI:10.1089/clm.1998.16.45

年代:1998

数据来源: MAL

摘要:

ABSTRACTUrology is a surgical specialty that relies heavily on the endoscopic approach for diagnosis and treatment of disease. Electrosurgical instruments have been the standard vehicle for endoscopic tumor ablation. Over the last 30 years a number of investigators have explored the use of the medical laser as either an alternative or an adjunct to standard electrosurgical techniques. The development of small caliber flexible and rigid endoscopics has facilitated access to the entire genitourinary system from the tip of the papilla to the urethral meatus. Medical lasers, by virtue of delivering energy through small flexible fibers, are ideally suited for endoscopic application. In addition, the potential for very limited and precise distribution of laser energy in targeted tissue is clinically appealing for endoscopic applications. In this article, we review the use of thermal lasers in urologic oncology.

ISSN:1044-5471    

DOI:10.1089/clm.1998.16.49

年代:1998

数据来源: MAL