Evaluation of 200 Mm, 365 Mm and 500 Mm Fibers of Laser Ho YAG in Transurethral Lithotripsy of Ureteral Stone

Introduction: At present, different Holmium: YAG laser caliber for endoscopic stone treatment are used, which includes 200, 365, 500 and 1000 Mm fiber. Currently there are not enough studies to compare the performance of these fibers. In this retrospective investigation the outcome of 200, 365 and 500 Mm fibers of Laser Ho YAG in Transurethral lithotripsy of ureteral stone evaluated.Methods: Seventy-four subjects with mean age of 35.3 ± 5.4 years old treated by endoscopic laser management from January 2016 to June 2017. The main purpose of investigation was to evaluation Mean Operation Time(MOT), Stone Free Rate (SFR) and complications of 200 Mm, 365 Mm and 500 Mm fibers of Laser Ho YAG in Transurethral lithotripsy.Results: MOT and SFR were significantly different in 500 Mm laser caliber (P = 0.046, P = 0.029, respectively). There was no remarkable difference between the three groups in this regard.Conclusion: Based upon our data, the clinical potency of the Ho: YAG laser was great in all three fiber calibers. The most important results of this comparison were the significantly higher SFR with increased laser caliber

Laser Application in Iran Urology: A Narrative Review

The usage of laser in medicine is not recent, and its history in urology goes back to 40 years ago. For the last 2 decades, common uses of laser have been treatments of subjects with urolithiasis, bladder tumors, benign prostatic enlargement, lesions of the genitalia and urinary tract strictures. To evaluate laser application in urology in Iran, we reviewed all of the Iranian literature on the topic. This study was designed to retrieve all studies on laser application in urology in Iran, regardless of publication status or language, covering years 1990–2017. Twenty-six articles were identified: 12 about urolithiasis, 8 about benign prostatic hyperplasia (BPH), 2 case reports, 1 paper about prostate cancer, 1 on female urethral stricture, 1 review and 1 basic sciences study. We conclude that the use of this technology has not yet found its position in Iran, especially in the field of urology. The main causes for it are the difficult accessibility and disturb of laser devices and its accessories, as well as the lack of adequate knowledge of the medical community about this modality

Flexible Ureterorenoscopy Versus Extracorporeal Shock Wave Lithotripsy for the Treatment of Renal Pelvis Stones of 10–20 mm in Obese Patients

Introduction: To compare outcomes of retrograde intrarenal surgery (RIRS) with extracorporeal shock wave lithotripsy (ESWL) as treatment of choice.Methods: A total number of 46 patients with renal pelvic stones 10-20 mm and body mass index (BMI) >30 randomized in two groups underwent RIRS and ESWL from 2011 to 2014 and followed for 3 months.Results: The patients mean ± SD age was 36.1 ± 13.1 years in ESWL and 33.2 ± 11.4 years in RIRS groups (P = .1) with comparable BMI in both groups (36.2 vs 38.1). In ESWL and RIRS groups, the operation time was 72.2 ± 21 vs 66.5 ± 19 minutes (P = .061), respectively. Stone free rate (SFR) at 3 months was 68% in ESWL group vs 90.4% in RIRS group (P = .019). The complication rate was 20% in ESWL group vs 14.2% in RIRS group (P = .211) but all of them were minor and managed conservatively.Conclusion: According to our study, RIRS procedure in comparison with ESWL is a safe and successful option of treatment for renal pelvis stone of 10-20 mm in obese people

Experience of 138 Transurethral Urethrotomy With Holmium:YAG Laser

Introduction: Many valid option modalities are available for the management of urethral stricture disease (USD), such as internal urethrotomy which has the success rates of 33%–60%. The aim of this study was to assess the outcome of holmium: YAG (Ho: YAG) laser urethrotomy (HLU).Methods: One hundred thirty-eight patients with urethral stricture with the mean age of 48±3.03 years old treated by HLU from March 2011 to August 2017. The main purpose of this investigation was to evaluate mean operation time, stricture recurrence rate and post-operation Qmax and complications of transurethral HLU.Results: The most common cause of USD was trauma in 82 (59.4%) patients. Mean laser operation time, mean hospital stay and mean postoperative duration of catheterization were 23.08 ± 9.1 minutes, 19.02 ± 10.7 hours and 10.3 ± 1.05 days respectively. The mean Qmax was 8.3 ± 2.07 mL/s before surgery and 16 ±3.1 mL/s afterward. At the end of 12 months follow-up, a total of 37 (26.8%) patients developed recurrence of the stricture. Patients with posterior, longer urethral strictures and previous history of interventions have more recurrence rate of the stricture.Conclusion: HLU is minimally invasive and seems to be an effective and safe management option for primary, short, urethral strictures. The hospital stay is remarkably short and complications are negligible

Surgical Management of Vesical Stones in Children: A Comparison Between Open cystolithotomy, Percutaneous Cystolithotomy and Transurethral Cystolithotripsy with Holmium-YAG Laser

Introduction: Bladder stone in children is rare but is more common in developing countries. In recent years, the urologists have trend to minimal invasive approaches. The aim of this study, was to compare the outcomes of surgical bladder stone management in our single tertiary center.Methods and materials: The 159 children younger than 18 years with vesical stones treated during January 2000 to January 2015 in Shohada e Tajrish hospital, Tehran, Iran that 146 subjects entered to the study. According to type of intervention, patients stratified to three groups. First group was included 80 patient’s that open cystolithotomy(OCL) was done for them, second group, 39 patients who underwent percutaneous cystolithotomy(PCCL)and third group,27 patients who treated by transurethral cystolithotripsy with holmium-YAG laser(TULL). Demographic data, operation time, hospital stay, and post operation complications were extracted and compared between groups.Results: Mean age was 8.3±5.1 years (8.6±5.1, 6±4.2 years for boys and girls, respectively). Mean stone size was 2.76±1.07 cm that was not significant between three groups but it was larger in OCL group. Mean operative time was 29.15(±7.12) min that in separate, mean operative time in TULL was significantly higher than PCCL and OCL respectively (36.3±5.97, 30.54±5.27 and 26.06±6.32 min/P:0.000). Mean hospital stay in OCL group was 3.55±1 day that was higher than PCCL and TULL groups significantly (P=0.000).Conclusion: based on our study, Ho:YAG lithotripsy is a safe with high success rate minimally invasive management method for children bladder calculi if proper equipment was available and done in expert hands

Direct Vision Internal Urethrotomy with Application of Holmium: YAG Laser

INTRODUCTION: Male urethral stricture is a complicated urologic disease that could be successfully treated using internal urethrotomy. Laser internal urethrotomy has been used in many cases with favorable outcome in many studies. Holmium: YAG laser with its incisional properties on tissue is one of the laser types applied for internal urethrotomy.METHODS: We present a 19 year-old male with history of aortic valve stenosis and metallic aortic valvoplasty on prescription of oral anti-coagulant therapy (Warfarin) who was a candidate for internal urethrotomy due to bulbar urethral stricture. Holmium laser core-through urethrotomy was performed for him.RESULTS: Internal urethrotomy was done using the ablative 50-watt Holmium: YAG laser 2140 nm (manufactured by the Atomic Energy Organization of Iran [AEOI]). No complication was observed intra- and post-operatively. After 6 months of followup no evidence of urethral stricture was observed.CONCLUSION: According to our study, Ho-YAG laser core through urethrotomy is a safe and effective procedure. It is a less invasive alternative to more complex urethroplasty procedures for patients with post-traumatic urethral stricture with high risk of urethral bleeding due to anti-coagulant therap

Is Holmium Laser an Appropriate Modality to Treat Genital Warts?

Introduction: Genital warts in young adults aged 18-28 years are very common. Several approaches are routinely used in the treatment of warts, viz., medical treatment (podophyllin and trichloroacetic acid), conventional surgery (excision or electrocautery), cryotherapy, and laser treatment. Because of high recurrence rates after treatment, complications and long duration of treatment, newer modalities have been developed. One of these newer methods is laser, which has been used in several urologic diseases. However, there are only a few studies about use of Holmium laser for treatment of genital warts. This retrospective study compared the success rate of Holmium laser with other available treatments for genital warts.Methods: Between October 2011 and May 2016, 142 patients with genital warts attended the urology clinics at Shohada-e-Tajrish hospital in Tehran, Iran. Out of these, a total of 101 patients were included in this study consisting of 42, 39, 11 and 9 patients treated with cryotherapy, laser, conventional surgery and podophyllin respectively.Results: The most successfully cleared lesions were seen in the holmium laser treatment group (P = 0.001). The lowest recurrence rate was observed in the holmium laser treatment group (P = 0.001). 17 patients had one of these following problems: dysuria, initial hematuria or a change in the force and caliber of their urinary stream that after physical examination showed them to have a meatal wart. These patients then underwent cystoscopy up to urinary sphincter. All of them in addition to the meatus wart had a penile shaft lesion(s). Thirteen patients had meatal lesions, 9 of whom received holmium laser therapy and 4 patients were treated with electrocautery. Based on routine follow up after treatment, none of the patients treated with holmium laser had urinary stricture, but one case treated with electrocautery returned with a penile urethral stricture.Conclusion: This study showed that treatment with Holmium laser has the highest clearance rate (92.2%) and lowest recurrence rate (14.3%) compared to other available treatments in this study. It may be concluded that holmium laser is a safe and effective treatment for genital warts with a low rate of recurrence

Trans-Ureteral Ureterolithotripsy of Ureteral Calculi:Which is the Best; Pneumatic or Holmium Laser Technique?

INTRODUCTION: Our aim was compare of two types of lithotripter include holmium: YAG laser and pneumatic one in transurethral ureterolithotripsy (TUL) for the management of ureteral calculi ≥1 cm.METHODS: 112 patients with ureteral calculi more than 1 cm were selected in randomized order for pneumatic or holmium: YAG laser transurethral ureterolithotripsy (56 patients in each group). Ultrasonography and intravenous urography were performed for all patients before surgery. Complete clearance and success was defined as the absence of any fragments on post operation KUB and ultrasonography images.RESULTS: Success rate was 85.7% in pneumatic group and 100% in holmium: YAG laser group (p =0.003). Stone migration up in the pelvicalyceal system was observed only in 8 cases of pneumatic group. No statically differences were observed in terms of patient’s age, hospital stay, and complications between two groups.CONCLUSION: According to our experience, for ureteral stone larger than 1 Cm treatment with ureteroscopy and laser lithotripsy is a preferring approach with favorable operation time and hospital admission, and no more significant complication

Effect of KTP Laser on Surgically Resected Adenomas of Prostate

INTRODUCTION: Palmoplantar psoriasis could hardly be differentiated from chronic tylotic eczema both clinically and histologically. The most commonly used therapeutic options for palmoplantar psoriasis are long-term therapy with topical corticosteroids and local PUVA. Frequently, it is a recalcitrant disease. We investigated the efficacy and tolerability of the combination of topical calcipotriol with local UVA radiation in comparison with local PUVA therapy.METHODS:In a total of 43 patients with palmoplantar psoriasis, 33 were given 15 sessions of local UVA radiation and topical calcipotriol and the remainder received 15 sessions of local PUVA (psoralen + UVA radiation).RESULTS:The statistical analyses of the results showed that the effect and tolerability of both therapeutic modalities are comparable.CONCLUSION: Combination of topical calcipotriol and local UVA radiation is an optional corticosteroid-free therapeutic modality for palmoplantar  psoriasis. It has a comparable effectiveness and tolerability with local PUVA

Outpatient Transurethral Cystolithotripsy of Large Bladder Stones by Holmium Laser

Introduction: To assessment of the efficacy and safety of transurethral cystolithotripsy of large bladder stones by holmium laser in the outpatient setting.Methods: In a prospective study, 48 consecutive adult patients with large bladder stones, were enrolled for transurethral cystolithotripsy. Patients older than 18 years, with bladder stones larger than 2 cm were enrolled. Urethral stricture, active urinary infection, and any anesthetic contraindications for operation, were the exclusion criteria. Demographic characteristics of patients, outcomes and complications related to operation and post operation period, were recorded.Results: Patients mean age was 46 ± 7.3 years. Male to female ratio was 45/3. Mean body mass index of patients was 28.5 ± 3.5. Mean stone size was 3.7 ± 1.6 cm. Mean operation time was 43.5 ± 15.5 minutes. Nearly complete stone clearance (98.5%) was achieved in all patients. Mean hospital stay was 6.5 ± 1.3 hours. No major complications were seen. Mean visual analog pain score (VAS) was 4.2 ± 2.1 and 1.4 ± 0.6, during and 1 hour after operation, respectively. During follow up of 22.4 ± 12.5 months, recurrence of bladder stone was not seen. No case of urethral stricture was detected.Conclusion: Transurethral holmium laser lithotripsy is an effective and safe alternative in selected patients with large bladder stones. This procedure can be easily performed in the outpatient setting