The evolution of lasers in urology

Abstract

The world's first laser was developed by Theodore Maiman in 1960. Over the course of the past five decades, this technology has evolved into a highly specialized entity, also finding a niche market in the field of urology. Lasers obtained from various lasing mediums producing amplified light of different wavelengths have been tested for urological applications. Today, these lasers are most commonly used in the surgical management of benign prostatic hyperplasia and as intracorporeal lithotripters. Other uses include ablation of various urologic tumors and incising strictures of the upper-and lower urinary tract. A continuous process of evolution of this technology is taking place, resulting in surgical lasers becoming ever safer, more effective, and more affordable.

A comparison of efficacies of holmium YAG laser, and pneumatic lithotripsy in the endoscopic treatment of ureteral stones

“…In 1985, firstly Green and Lytton [20] used EHL in intracorporeal rigid ureteroscopy which had been hitherto employed during open renal stone surgery. The invention of laser in the world is credited to Theodore Mainman [21] in (1960), who used a ruby laser. In 1968 Mulvaney [22] succeeded in fragmenting a urinary system stone using ruby laser, however because of extreme warming of ruby laser during procedure, ruby laser could not be introduced into clinical use.…”

“…Currently in the urology practice Nd: YAG laser, Holmium: YAG (Ho: YAG) laser, Thulium: YAG (Tul: YAG) laser, carbon dioxide (CO 2 ) laser, potassium titanyl phosphate (KTP) laser, lithium triborate (LBO) laser, and diode laser have been used. [21] Among them, currently Ho:YAG laser lithotriptor is the most prevalently used ureteroscopic lithotriptor in the world. [23] Ho: YAG laser was essentially developed for prostatic surgeries, and it is used in the names of some endoscopic prostate surgeries including HoLAP (Holmium laser ablation of the prostate), and HoLRP (Holmium laser resection of the prostate).…”

“…The most conspicuous advantage of Ho: YAG laser lithotriptors include its capability of disintegrating all stones irrespective of their compositions into smaller fragments when compared with other lithotriptors, and lower risk of stone migration into renal collecting system because of weaker shock waves. [21] European Association of Urology (EAU) recommends Ho:YAG laser lithotripsy as a gold standard procedure for ureteroscopic intracorporeal lithotripsy. [1] US lithotripsy was firstly used for the management of renal stones in 1953 by Mulvaney.…”

Moses technology in a stone simulator

“…1,2 However, retropulsion of stone fragments are frequently seen during laser lithotripsy especially when using high energies for ureteral stones. 3,4,5,6 This necessitates the use of expensive and fragile flexible ureterosopes to look for the migrated renal stones.…”

Laser nun auch in der organerhaltenden Nierenchirurgie?

“…B. bei der Steinbehandlung und Prostataresektion durchgesetzt [24,25]. Je nach den entsprechenden Anforderungen an den Laser, die sich nach Einsatzgewebe, -ort oder Zweck der Laseranwendung richten, kann der Urologe zwischen verschiedene Lasertypen wie den Holmium-YAG-Laser, Thulium-YAG-Laser, CO 2 -Laser, den KTP-("potassium titanyl phosphat") oder Diodenlaser wählen [26].…”