The Trends of Urolithiasis Therapeutic Interventions over the Last 20 Years: A Bibliographic Study

Introduction: The clinical and economic burden of kidney stones is a challenge for the healthcare system. There is a limited bibliometric project exploring the literature trends on ‘urolithiasis’ and its related management.Methods: A review was conducted to discover the related abstracts regarding each specific issue, investigated year by year from May 2000 to May 2020. To make an effective comparison, the statistics resulting from every single study were allocated to two 10-year periods: period 1 (2000 to 2010) and period 2 (2010 to 2020). We included all English language articles, all non-English articles with English abstracts, and studies in which interventions were used for stone removal, including laser technology.Results: These articles are about ureteroscopy (URS) (n=10360, 33.45%), percutaneous nephrolithotomy (PCN) (n =10790, 34.84%) and extracorporeal shockwave lithotripsy (ESWL) (n=9846, 31.76%). When evaluating the two time periods, there were 9912 studies available in period one, which increased by ×2.12 times (112.71% rise) to 21 084 studies in period two (P=0.001). The increase was 133%, 103.51%, and 70.4% for URS, PCN, and SWL respectively. A total of 855 studies on Laser application via URS were published on PubMed over a 20-year period. There was an increasing trend toward using laser applications via URS over the study period. Also, there were 230 articles published in period one, which increased by nearly 2.71 times to 625 papers in period two (P< 0.001). There was an increasing trend toward using laser application via PCN; 126 papers were published in period one, which increased by nearly 3.05 times (rise of 205.5%) to 385 papers in period two (P = 0.002).Conclusion: The minimal invasive interventions for stone removal, including URS and PCN, increased dramatically in the last decade, and the use of lasers in stone treatment increased significantly in the last decade. DOI:10.34172/jlms.2021.1

A Comparative Study of 660 nm Low-Level Laser and Light Emitted Diode in Proliferative Effects of Fibroblast Cells

Background: In recent years the use of low-power lasers has been widely used in medicine. With the introduction of affordable LED light, clinical application of LED light has become more and more popular. However, some researchers believe that because of the lack of coherence of the LED light, it can be different   in biological effects in comparison to laser. In this study, we compared the biological effects of low level laser to those of LED light. Methods: Human skin fibroblast cell line Hu02 was irradiated with low level laser and LED light with a wavelength of 660 nm, power output of 35 mW and in continuous mode and the control group was not irradiated.  The biological effects were compared through the analyzing of cell proliferation, production of reactive oxygen species within the cell and the rate of cell division.Results: Our findings showed that production of reactive oxygen species within the cell was linearly increased both in the LED and laser light irradiated cells. However, laser light is more increment in comparison the LED light. The MTT results showed that laser light at low energy density (less than 5 joules per square centimeter) was increased the rate of cell proliferation after 24 hours. Although, the rate of cell division was increased in energy density of 1 J/cm2 compared to the control group, but this increasing was not statistically significant.Discussion: The findings indicated that the coherence properties of laser light provided more energy for the cells, and in a constant energy density, laser light created more oxidative stresses in compared with LED light.

Pneumatic Lithotripsy Versus Laser Lithotripsy for Ureteral Stones

Introduction: Several different modalities are available for ureteral stone fragmentation. From them pneumatic and holmium: yttrium-aluminum-garnet (Ho: YAG) lithotripsy have supportive outcomes. In this study we studied 250 subjects who had ureteroscopic pneumatic lithotripsy (PL) or laser lithotripsy (LL).Methods: Two-hundred fifty patients with ureteral stones underwent ureteroscopic lithotripsy (115 subjects in the PL group, 135 subjects in the LL group) from August 2010 to April 2016. The purpose of this investigation was to evaluate stone-free rate (SFR), mean operation time (MOT), mean hospital stay (MHS), stone migration and complications.Results: Two groups were similar in age, gender, mean size of stones, side of stone, and complications. There was a statistical difference in terms of SFR, stone migration and MHS in favor of the LL group (P ≤ 0.05, P ≤ 0.05 respectively), and MOT in favor of the PL group (P ≤ 0.05).Conclusion: Both the PL and LL techniques were effective and safe for ureteral stones, however a slightly higher SFR was found in the LL group

Retrograde-assisted Percutaneous Cystolitholapaxy versus Transurethral Cystolithotripsy with Holmium-YAG Laser, A Retrospective Study

Introduction: The retrograde approach is a modification that makes the percutaneous cystolitholapaxy (PCCL) a more trendy method, especially in operating rooms with limited facilities. The transurethral approach for bladder calculi lithotripsy by a laser has become popular among urologists. In this study, we investigate the feasibility and safety of retrograde assisted access for PCCL in comparison with transurethral cystolithotripsy by the holmium-YAG laser (Ho:YAG).Methods: According to the type of intervention, the patients were stratified to two matched groups. In the retrograde-assisted percutaneous cystolitholapaxy (RPCCL) group, a Benique was conducted through the urethra into the bladder; palpating the suprapubic region, an about 1.5 cm incision was done over the tip, then an Amplatz sheath was placed over it, treading into the bladder; further cystolitholapaxy was done by a routine order. In transurethral Ho: YAG laser lithotripsy (TULL) via 200 μm fiber vaporize the stone.Results: A total of 124 male patients with the mean age of 50.33 ± 9.64 years and the average stone burden of 3.35 ± 1.07 cm were included in the study. The most common cause of vesical calculi was spinal cord injury. Statistically significant differences were found in terms of the mean operation time in favor of the RPCCL group (P ≤ 0.05) and the mean hospital stay in favor of the TULL group (P ≤ 0.05). The stone-free rate (SFR) was 100% in both methods after a one month follow-up. None of the interventions changed to open surgery. There were not any major complications in both methods.Conclusion: RPCCL is a safe and effective method in bladder stone treatment and is applicable inmedical centers without Ho: YAG equipment

Laser Therapy for Peyronie’s Disease: A Randomized Control Double-Blind Pilot Study

Introduction: The management of Peyronie’s disease (PD) has remained a therapeutic dilemma for physicians and there is no gold standard treatment. In this paper, we decided to investigate the beneficial effect of the intralesional administration of verapamil compared with the intralesional administration of verapamil plus a low-intensity laser (LIL).Methods: Research was activated from May 2016 to May 2018 and a total of 38 men aged 18 years and older completed the investigation. The subjects were randomly divided into 2 groups. Group 1 was composed of 22 patients that were treated only by verapamil (5 mg) plus a sham laser weekly for 6 weeks, and group 2 consisted of 22 patients that received a laser, using the BTL – 6000 HIGH-INTENSITY LASER 12 W machine and the same protocol of intralesional verapamil injection. The visual analogue scale (VAS) was used to evaluate pain during an erection, penile ultrasonography was used to measure plaque size, the penile curvature angle degree was measured using the photographs taken during an erection, and the International Index of Erectile Function questionnaire was used to assess erectile function. The follow-up treatment lasted for nine months, with visits performed in the 3rd and 9th months.Results: All study parameters decreased significantly after treatment in both arms, but the reduction in pain and penile curvature improvements in combination therapy revealed more significant changes in 3 months (p = .035, p=.032). Nevertheless, these improvements were not seen in the follow-up session after 9 months.Conclusion: A laser appears to be safe treatment modality in carefully-selected patients with PD. It has moderate efficacy in the short term

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

Evaluation of skin response after erbium:yttrium–aluminum–garnet laser irradiation: a network analysis approach

Introduction: Application of laser in medicine and cosmetic purposes has raised grossly in recent years. There are contradictory finding about its side effects. In this research critical differentially expressed proteins after irradiation erbium:yttrium–aluminum–garnet (Er:YAG) laser on skin are investigated.Methods: Proteome data including 31 proteins were obtained from a proteomics investigation of laser irradiation, Er:YAG on female mouse skin that are published by Pan et al. The query proteins and 100 related ones were included in the protein-protein interaction (PPI) network. The central nodes were determined and all of nodes were included in action maps. Expression, activation, inhibition, binding, and reaction were considered in action plan.Results: Numbers of 16 proteins were recognized by STRING database and were included in the network. Except PHRF1, the other 15 query proteins were included in the main connected component of the constructed network. Ten central nodes of the network and ten numbers of top query proteins based on degree value were identified as central proteins of the network. All nodes of the network analyzed via action maps and the important acted nodes were determined as RPSA, GAPDH, TPT1, DCTN2, HSPB1, and PDIA3.Conclusion: Two balanced processes including cancer promotion and cancer prevention were after irradiation were identified

A trend of Medical Negligence in Laser Therapy in the Capital City: A Nine-Year Survey

Background: the purpose of the present study is to investigate the common causes of injuries, claims, and decisions related to laser therapy medical malpractice during a nine-year survey. Study design: This study is a retrospective descriptive study. Methods: The legal documents in the coroner’s Office of Forensic Medicine were investigated in a national database from 2012 to 2020 in Tehran, Iran. The frequency and nature of the cases, including the year of litigation, the location and certificate of the provider, the injury sustained, the cause of legal action and judgment were collected. Results: Three hundred and eighty-three cases related to injury from laser therapy were registered in the coroner’s Office of Forensic Medicine during the study period. The incidence of litigation related to laser surgery showed an increasing trend, with a peak occurrence in 2020. Laser hair removal was the most common (51.2%) litigated procedure. General practice operators (48%) recorded the highest rate of laser-related medical complaints. lack of skill was the most common reason for failure. Among 383 cases with public decisions, 62.4% of them were fault liability in paid judgment. Conclusions: Medical claims related to laser application are increasing. However, as it is clear, the growth of laser technology and the increasing demand for lasers in medical science require more surveillance to avoid probable injuries and improve patient safety, especially surveillance of the physicians who work outside the scope of their specialty.&nbsp

Evaluation of Efficacy of Low-Level Laser Therapy

Introduction: Given the inconsistencies in the literature regarding laser performance in non-surgical treatments, this study investigated the available literature to determine the advantages and disadvantages of low-power lasers in treating non-surgical complications and diseases.Methods: Authentic information from articles was extracted and evaluated to assess low-power laser performance for non-surgical treatments. A systematic search of studies on low-level laser therapy (LLLT) for non-surgical treatments was conducted mainly in PubMed and google scholar articles.Results: Four categories of diseases, including brain-related diseases, skin-related diseases, cancers, and bone-related disorders, which were treated by LLLT were identified and introduced. The various types of LLLT regarding the studied diseases were discussed.Conclusion: Positive aspects of LLLT versus a few disadvantages of its application imply more investigation to find better and efficient new methods

Evaluation of Laser Effects on the Human Body After Laser Therapy

Lasers have wide applications in the treatment and diagnosis of diseases and various medical fields. Laser therapy like the other methods has advantages and disadvantages. Some risks such as bleeding, pain, and infection are created after laser therapy. Explanation and evaluation of laser effects on cell function, tissue, and the body are the aims of this study. We reviewed papers available from 1986 to 2019 about the effects of lasers on cells and tissue. An online search of PubMed, Science Direct and Google scholar using such keywords as “laser”, “cell”, “tissue”, “body” and “side effects” was performed. The laser photons are absorbed by chromophores, resulting in the target heating and localized damage. Laser irradiation alters cellular metabolism and cellular functions. These alterations may be accompanied by undesired side effects which can be monitored via metabolites level change in the body. Based on this finding, laser therapy may be associated with several side effects and complications; therefore, before treatment, the determination of laser types and their properties is necessary to avoid creating side effects. The advantages and disadvantages of the treatment type should be considered in order to choose the best treatment with the least side effects. The patients’ awareness of possible side effects before treatment and also an effective follow-up and management of patients after action are two important points in laser therapy. Training curriculum definition should be determined for laser applicant qualifications in different medical fields