The laser has attracted the attention of the doctors as well as the patients for a long time. A lot of lasers are being used in different medical fields today. A lot of lasers have also been adopted by urology. Urology uses many different lasers including KTP laser, Diode laser, Thulium laser & Holmium laser. Ophthalmology and dermatology used the oldest known therapeutic lasers. A medical laser is a non-invasive and effective light source for tissue treatment that provides rapid cure without scarring or discoloration.
The evolution of lasers in urology
Over the last five decades, laser technology has evolved into a highly specialized entity, finding a niche market in the urology field as well. Lasers obtained from various lasing devices have also been tested for urological applications, generating intensified light of different wavelengths.
Currently, these lasers are most widely used as intracorporeal lithotripters in the surgical treatment of benign prostatic hyperplasia. Such applications include the ablation of various urological tumors and the incising of upper and lower urinary tract strictures. The technology is undergoing a relentless process of evolution, resulting in surgical lasers getting safer, more effective, and more affordable.
What is a urology laser and what role does it have in modern-day urology?
The term laser is derived from the first letters of the words of the phrase "Light Amplification by Stimulated Radiation Emission". It is a monochromatic light-emitting device. The light source may also include crystal, gas, dye, or semiconductor.
Urology laser surgical equipment is used for incision and soft tissue resection and ablation of tumors. Laser therapy is a medical treatment that uses a direct beam of light to cut, burn or destroy tissues. Therapeutic lasers can be used in many medical treatment areas. Ophthalmology and dermatology used the oldest known therapeutic lasers. A medical laser is a non-invasive and effective light source for tissue treatment that provides rapid cure without scarring or discoloration.
Laser therapies have become an extremely popular treatment method for patients with benign prostatic hyperplasia, urolithiasis, bladder tumors, and strictures of the urinary tract or external genitalia lesions over the last two decades. Nowadays, due to the advancement of equipment, a better understanding of the needs of urologists on the part of producers, and a growing experience of laser treatment operators, this is a favorable option for conventional urology surgical procedures. Easy accessibility to the appropriate equipment, a relatively short learning curve, and promising therapeutic effects have led to a higher interest in these methods.
Prevalence of kidney stone diseases and subsequently increasing demand for urology laser technology
In the present era, the prevalence of kidney stone disease has increased due to the effects on urinary stone development of increased obesity, diabetes and improvements throughout dietary habits. While minimally invasive therapies remain the pillar of treatment in this new stone-affected generation, the use of ureteroscopy (URS) has increased significantly, so that URS is now the most common surgical therapy for upper urinary tract stones.
One explanation for the change toward URS in practice was the widespread availability of the holmium laser, which allows for lithotripsy in all stone locations, irrespective of stone composition. With the proliferation of more efficient higher watt holmium systems and developments in laser technology, possibilities for laser settings and techniques for breaking down stones have increased for surgeons. The surgical method for treating upper urinary tract stones with URS generally consists of either fragmentation and successful basket retrieval or fragmentation leading to small fragments left in place for spontaneous passage, which is also known as the dusting technique.
Advanced urology laser techniques are an essential tool for treating urolithiasis patients. The progress of the ureteroscopes of the new generation and the increasing power of the lasers make the lithotripsy of larger concretions shorter. More than 90 percent of lithotripsy procedures are mostly successful. The effectiveness and protection of laser lithotripsy have been demonstrated in numerous studies on symptomatic ureteral stones at all sites, care of pregnant women, overweight/obese patients and children of all ages.
Laser methods have also found a place in the treatment of urinary bladder tumor patients. Nowadays, laser resection procedures for bladder tumors are returning with the introduction of new devices. Some reports suggest that the laser approach is preferable to TURBT because it appears that cancer recurrence after laser treatment is not more common than after TURBT and complication rates tend to be lower with current laser procedures compared to TURBT. Laser vaporization is suitable as an outpatient procedure because general anesthesia is not required.
Laser BPH treatment has evolved from clotting to enucleation. Compared with transurethral resection and open prostatectomy, blood loss is significantly reduced. Visual laser ablation of the prostate triggers coagulative necrosis with secondary ablation and interstitial laser coagulation. Long postoperative catheterization, unpredictable results and high rates of reoperation have limited the use of these technologies. With the marketing of new high-powered 80-W KTP and 100-W Ho lasers, ablative/vaporizing techniques have once again become prevalent. Vaporization removes tissue obstruction immediately. Short-term results are promising, but there is a lack of large series, long-term outcomes, and randomized trials. Holmium laser enucleation (HoLEP) permits the removal of whole prostate lobes, mimicking the index finger operation of open prostatectomy.
Where does the industry lack?
When using lasers, protection is very critical. To prevent severe injuries, all intra-operative personnel have to wear proper protection. Although lasers with holmium: YAG (Ho: YAG) do not penetrate as deeply, if they are aimed at the unprotected area, they can cause defects. Suitable draping should be used for all lasers to protect outside areas, with wet towels, draped over cutaneous lesions. Preferably, reflective surfaces have to be kept away from the treatment field; nevertheless, the treatment field should be draped with wet drapes if this is not feasible. In fact, if oxygen is in use anywhere in the operational area, it is very risky to use a laser as this can result in a laser fire and serious burns.
The urology laser market has witnessed a rapid prominence in the treatment of various diseases. Further, the growing need for non-invasive treatments is a significant factor that drives the growth of the market. Laser procedures have several benefits over conventional surgeries. First is more accuracy and precision. Secondly, laser procedures are much less invasive, laser energy heat-seals blood vessels, with less bleeding, swelling, pain, or scarring. Second, laser procedures are a great alternative for high comorbidity patients who may not be suited to open operations.
In comparison, laser treatment and hospitalization time may be shorter, and more procedures may be conducted in outpatient environments. Laser techniques are flexible urological devices. Their use in prostate disease patients is particularly significant. Promising therapeutic effects of laser treatments tend to show their use in treating patients with other illnesses.