Low-Power Holmium Laser for the Management of Urinary Tract Calculi, Strictures, and Tumors
- 1 June 2001
- journal article
- clinical trial
- Published by Mary Ann Liebert Inc in Journal of Endourology
- Vol. 15 (5), 529-532
- https://doi.org/10.1089/089277901750299348
Abstract
Background and Purpose: Introduction of the holmium laser has provided an indispensable tool for the management of urinary tract stones, strictures, and superficial urothelial tumors. While full-power holmium lasers are required for laser resection of the prostate, lower-power devices can be utilized for all cases of stone fragmentation and stricture incision and most cases of superficial urothelial tumors. Herein, we report our initial experience in utilizing a low-power holmium laser in our endourologic practice. Patients and Methods: Over a 6-month period, we have utilized both low-power (25 W) and full-power (80 W) holmium lasers to fragment urinary tract stones, incise ureteral or urethral strictures, and ablate superficial urothelial tumors. A series of 80 consecutive patients were assessed prospectively. Laser fibers with a diameter of 200 µm and 365 µm were employed with power settings of 6.4 to 10 W. Laser fiber size and power settings were similar for the low- and full-power devices. Results: Overall, 95% of the stones were completely fragmented, with a stone-free rate at 3 months of 92%. All strictures were incised, with a 91% patency rate at 3 months. Complete tumor ablation was attained in 70%, with a tumor-free rate of 60% at 3 months. Results were equivalent for the low- and full-power lasers. The 200-µm laser fiber allowed adequate access throughout the upper urinary tract during flexible ureteroscopy and flexible nephroscopy. The 365-µm laser fiber was employed via rigid and semirigid endoscopes. Conclusions: A low-power holmium laser supplies adequate fragmentation and incision power for virtually all endourologic cases. It also provides ablative power in most situations. The only current urologic application that cannot be performed with the low-power device is laser prostatic resection, which requires 60 to 80 W of power. The reduced-power holmium laser should be considered as a low-cost alternative for the management of urinary tract stones, strictures, and urothelial tumors, especially in centers where laser prostatic resection is not performed.Keywords
This publication has 12 references indexed in Scilit:
- Combined Antegrade and Retrograde Endoscopic Approach for the Management of Urinary Diversion-Associated PathologyJournal of Endourology, 2000
- Endoscopic management of upper urinary tract disease using a 200-μm holmium laser fiber: initial experience in japanUrology, 1999
- Impact of Holmium Laser Settings and Fiber Diameter on Stone Fragmentation and Endoscope Deflection*Journal of Endourology, 1998
- Use of ureteroscopy and holmium:YAG laser in patients with bleeding diathesesUrology, 1998
- Holmium: YAG laser endoureterotomy for treatment of ureteral strictureUrology, 1997
- INTRACORPOREAL LITHOTRIPSY: Instrumentation and DevelopmentUrologic Clinics of North America, 1997
- Holmium laser resection of the prostate: Preliminary results of a new method for the treatment of benign prostatic hyperplasiaUrology, 1996
- Soft-Tissue Applications of the Holmium:YAG Laser in UrologyJournal of Endourology, 1995
- Use of the holmium:YAG laser in urologyLasers in Surgery and Medicine, 1992
- Laser lithotripsy: A review of 20 years of research and clinical applicationsLasers in Surgery and Medicine, 1988