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Fulguración ambulatoria con láser Holmium: Un procedimiento seguro para el tratamiento de la recidiva del carcinoma vesical no músculo infiltrante
摘要： Background and Objective: Nonmuscle invasive bladder cancer has a high recurrence rate and a low progression rate. The aim of this study was to assess the effectiveness, safety and feasibility of Holmium laser fulguration in an outpatient regimen for selected tumours. Material and Method: A prospective, longitudinal cohort study was conducted between January 2009 and December 2016. Seventy-nine Holmium laser fulguration procedures with subsequent instillation of mitomycin C were performed in an outpatient regimen on 59 patients with a history of low-risk bladder cancer and recurrence of small papillary tumours. We performed a descriptive data analysis and analysed the relapse-free time using Kaplan-Meier curves. Results: All procedures were completed in one day, and only one patient required subsequent hospitalisation due to haematuria. Some 87.2% of the patients presented pain with a visual analogue score ≤3. Recurrence occurred after 49.4% of the procedures (27.3% at 12 months). The median follow-up time was 17 months (range, 2-65). The onset of recurrence was significantly earlier after the second fulguration than after the first (median, 10 months vs. 56 months). Conclusions: Holmium laser fulguration and subsequent mitomycin C instillation in an outpatient regimen is a safe and feasible alternative to transurethral resection of bladder tumours in selected patients. Transurethral resection of the bladder tumour is recommended for patients with recurrence after fulguration, given the possibly higher risk of progression in these patients.
关键词： Nonmuscle invasive bladder cancer,Outpatient fulguration,Holmium laser
更新于2025-09-23 15:22:29
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Perioperative Safety and Efficacy of Holmium Laser Enucleation of the Prostate in Patients Receiving Antithrombotic Therapy: A Prospective Cohort Study
摘要： We investigated the efficacy of and risk from holmium laser enucleation of the prostate (HoLEP) due to discontinuation of antithrombotics in patients with benign prostatic hyperplasia (BPH). Patients in the prospective SNUH-BPH Database Registry who underwent HoLEP between December 2010 and December 2017 were enrolled. Preoperative evaluation included symptom score questionnaires, laboratory tests, urine tests, prostate-specific antigens, urodynamic study, and transrectal ultrasonography. Postoperative evaluation was performed at 2 weeks, 3 months, and 6 months. Information regarding the types of antithrombotics and their use, underlying disease, and antithrombotic management during surgery was collected. The study included 55 patients. The mean age and preoperative prostate volume were 68.7 ± 6.4 years and 70.3 ± 32.2 mL, respectively. The mean preoperative hemoglobin level was 13.5 ± 2.6 g/dL in the patients receiving antithrombotics. Of the patients, 71% were taking aspirin. Seventy-five (66.5%) and 70 patients (28.2%) discontinued the antithrombotic therapy 5–7 days and <1 week preoperatively, respectively. Three patients (1.21%) were switched to low-molecular-weight heparin therapy, and 10 (4.03%) continued antithrombotic therapy. No significant differences were found in the incidence rates of postoperative transfusion (p = 0.894) or complications from antithrombotic use, thrombosis (p = 0.946), haemorrhage requiring bladder irrigation (p = 0.959), transurethral coagulation (p = 0.894), cardiovascular events (p = 0.845), and cerebrovascular events (p = 0.848). Efficacy and complications related to the short-term antithrombotic withdrawal before and after HoLEP also showed no significant differences. HoLEP may be a beneficial surgical technique for patients with BPH who are receiving antithrombotics.
关键词： Benign Prostatic Hyperplasia,Perioperative Safety,Antithrombotic Therapy,Holmium Laser Enucleation of the Prostate,Efficacy
更新于2025-09-23 15:21:01
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Holmium laser enucleation of the prostate for very large benign prostatic hyperplasia (a?￥a??200??cc)
摘要： Purpose Patients presenting with prostate gland sizes greater than 200?cc pose a unique surgical challenge to both patients and surgeons. The objective of this study is to critically assess the efficacy and risks associated with performing holmium laser enucleation of the prostate (HoLEP) on glands ≥ 200?cc. Materials and methods Using a prospective maintained database, all consecutive benign prostatic hyperplasia (BPH) patients with gland size ≥ 200?cc who underwent HoLEP were included. We reported patient preoperative, intraoperative, postoperative outcomes and complications. Subgroup analysis of outcomes was stratified by gland sizes 200–299?cc and ≥ 300?cc. Univariate analysis using Kruskal–Wallis and Fisher exact test was performed to compare the two groups. Results There were 88 patients with a mean preoperative gland size of 255.9?cc (200–770?cc). Mean operative (171 vs 182?min) and enucleation time (77 vs 83?min) were not different between the two subgroups (200–299?cc vs ≥ 300?cc). Enucleation efficiency was greater for glands ≥ 300?cc (2.6?cc/min vs 2.0?cc/min, p = 0.04). Morcellation time was longer in the ≥ 300?cc group (74.5?min vs 46.8?min, p = 0.021). Mean length of stay was 1.8 ± 1.2?days and catheter duration was 2.6 ± 2.7?days. 1 (1.1%) patient required retreatment of BPH at last follow-up. The main limitation of this study is the retrospective data analysis. Conclusions Holmium laser enucleation for prostate glands volume > 200?cc is feasible with minimal morbidity. These data further reinforce the size independence success of this procedure for BPH.
关键词： Transurethral resection of prostate,Laser,Benign prostate hyperplasia,Holmium,Prostate,Holmium laser enucleation of the prostate,Lower urinary tract symptoms
更新于2025-09-23 15:19:57
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Combination of holmium and thulium laser ablation in upper tract urothelial carcinoma
摘要： Thanks to the latest technological and technical advances in endourology, the management of upper tract urothelial cancer (UTUC) has changed over the last years, with expanding indications for a conservative approach. The endourological management has been described by means of flexible ureteroscopes and of holmium:YAG fibre lasers. A systematic review showed that oncologic outcomes at 5 and 10 years of follow-up were similar by comparing cohorts of low-risk UTUC patients undertaking either nephroureterectomy or endourological ablation. Accordingly, since 2018 the European Association of Urology Guidelines on UTUC have recommended the elective conservative management of UTUC in selected patients with low-risk lesions, i.e., those 2 cm in size, solitary, low-grade, non-muscle-infiltrative and without upper urinary tract dilatation at CT scan. More recently, the use of thulium laser (TL) has been described in the context of UTUC: as far as it concerns the technical features, TL consists of a diode-pumped laser that provides a continuous wave and a lower tissue penetration, which allow for a more precise vaporization, excellent coagulation, and a lower risk of injury to normal tissue, making it the ideal laser to deal with soft tissue disease. In 2011, Defidio et al., in a series of 59 cases of UTUC, demonstrated that the thulium laser ablation was non-inferior to holmium:YAG laser ablation in terms of oncological outcomes. More recently, Musi et al. reported the outcomes of the largest published cohort of UTUC patients (n = 42) undertaking thulium laser vaporization: the authors showed oncological outcomes comparable to those available in literature, with a recurrence-free survival of 81% at a median of 44 months of follow-up, and a very low rate of complications.
关键词： UTUC,thulium laser,endourology,holmium laser,upper tract urothelial carcinoma
更新于2025-09-23 15:19:57
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“VaporTunnel” ureteroscopic holmium laser lithotripsy: Intraoperative and early postoperative outcomes
摘要： “VaporTunnel” ureteroscopic holmium laser lithotripsy: Intraoperative and early postoperative outcomes. A prospective trial was conducted for patients undergoing holmium laser lithotripsy for ureteral stones. Patients were randomly assigned to have holmium laser lithotripsy with or without Vapor Tunnel technology. All procedures were performed by four experienced urologists. Quanta Cyber Ho 100 W generator with 365 μ fiber was used for all cases. Demographic data, stone parameters, perioperative complications and success rates were compared. The degree of stone retropulsion was graded on a Likert scale from zero-no retropulsion to 3-maximum retropulsion. Results: A total of 80 patients were included in the study (40 per each group). Both groups were comparable in terms of age, and pre-operative stone size (1.2 vs. 1.1 cm, p > 0.05). When compared with the Regular mode, Vapor Tunnel Technology was associated with significantly lower fragmentation time (20.4 vs. 16.1 min, p < 0.05) and total procedural time (49 vs. 35.7 min, p < 0.05). However, there were no significant differences in terms of total energy applied to the stones (9.9 vs. 10.7 KJ, p > 0.05). Vapor Tunnel technology was associated with significantly less retropulsion. There was no significant difference between both modes in terms of intraoperative complications. The success rate at the end of 1 month was comparable between both groups (92.3 vs. 88.3%, p > 0.05). Discussion: Vapor Tunnel technology is associated with significantly lower fragmentation and procedural times. The reduced fragmentation time is a result of the significantly lower retropulsion of the stones during laser lithotripsy; thus improving stone fragmentation efficiency.
关键词： holmium laser lithotripsy,intraoperative,VaporTunnel,ureteroscopic,postoperative outcomes
更新于2025-09-23 15:19:57
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Primary Bladder Neck Obstruction in a Young Woman: A Novel Technique of Bladder Neck Incision Using Holmium Laser
摘要： Background: Management of primary bladder neck obstruction (PBNO) in women is dif?cult. Surgical treatment in the form of bladder neck incision (BNI) is indicated in many cases. There is no de?ned consensus on the best surgical technique of BNI in women. We present a novel technique of BNI in such cases using pediatric cystoscope and holmium laser, which is a promising alternative to the existing management techniques. Case Presentation: A 28-year-old lady complained of obstructive lower urinary tract symptoms. Serum biochemistry revealed azotemia. Further investigation utilizing a micturating cystourethrogram showed a closed bladder neck, and urodynamic studies revealed a high bladder outlet obstruction index suggestive of PBNO. BNI was effectively performed using pediatric cystoscope and holmium laser at 3, 9, and 12 o’clock positions. Postoperatively the patient had improving renal function and clinical improvement. Conclusion: Use of pediatric cystoscope with holmium laser for BNI in females is a novel technique that offers the advantage of higher maneuverability in the female urethra, precise incision with protection of external sphincter from thermal damage, and avoidance of the complication of vesicovaginal ?stula caused by posterior incisions.
关键词： pediatric cystoscope,bladder neck incision,holmium laser,female primary bladder neck obstruction
更新于2025-09-23 15:19:57
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Double-Blind Prospective Randomized Clinical Trial Comparing Regular and Moses Mode of Holmium Laser Lithotripsy
摘要： Objective: To compare Regular and Moses modes of holmium laser lithotripsy during ureteroscopy in terms of fragmentation/pulverization and procedural times in addition to perioperative complications. Patients and methods: After obtaining ethics approval, a prospective double‐blinded randomized trial was conducted for patients undergoing holmium laser lithotripsy during retrograde ureteroscopy. Patients were randomly assigned to either Regular or Moses modes. Patients and surgeons were blinded to the laser mode. Lumenis 120W generator with 200 Moses D/F/L fibers were used. Demographic data, stone parameters, peri‐ operative complications and success rates were compared. The degree of stone retropulsion was graded on a Likert scale from zero‐no retropulsion to 3‐maximum retropulsion. Results: A total of 72 patients were included in the study (36 per each arm). Both groups were comparable in terms of age, and pre‐operative stone size (1.4 vs. 1.7 cm, p>0.05). When compared with the Regular mode, Moses mode was associated with significantly lower fragmentation/pulverization time (21.1 vs. 14.2 min; p=0.03) and procedural time (50.9 vs. 41.1 min, p=0.03). However, there were no significant differences in terms of lasing time (7.4 vs. 6.1 min, p>0.05) and total energy applied to the stones (11.1 vs. 10.8 KJ, p>0.05). Moses mode was associated with significantly less retropulsion (mean grade was 1.0 vs. 0.5, p=0.01). There were no significant differences between both modes in terms of intra‐operative complications (11.1% vs. 8.3%, p>0.05), with one patient requiring endo‐ureterotomy for stricture in the Moses group. Success rate at the end of 3 months was comparable between both groups (83.3% vs. 88.4%, p> 0.05). Conclusion: Moses technology was associated with significantly lower fragmentation/pulverization and procedural times. The reduced fragmentation/pulverization time seen using Moses technology could be explained by the significantly lower retropulsion of stones during laser lithotripsy.
关键词： technology assessment,ureteroscopy,randomized clinical trial,holmium laser,Laser lithotripsy,outcomes assessment
更新于2025-09-19 17:13:59
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Exploiting the aiming beam to increase the safety of laser lithotripsy: Experimental evaluation of light reflection and fluorescence
摘要： In Holmium laser lithotripsy, usually, the surgeon is guided by a visible beam superimposing the infrared (IR) treatment radiation. It has been shown that a green aiming beam excites stone autofluorescence. This fluorescence signal can be used for calculi detection to check the correct fiber position before triggering the IR laser, thus preventing damage to soft tissue and application devices. However, also the directly reflected green light from the fiber tip gives valuable information on fiber position and its surface condition. Materials and Methods: An external fiber‐fiber‐coupling‐box (fiber core diameter 365 μm) for pulsed holmium laser radiation (2.1 μm) was set up containing a green diode laser module (520 nm, average power on the sample <0.5 mW) and optics and detectors for measuring the reflected light of this aiming beam as well as the fluorescence excited with it. Measurements were done via a lock‐in technique with more than 20 human calculi samples and porcine calix in vitro. After the implementation of automatic data storage signals during ongoing in vitro lithotripsy procedures were recorded with the fiber positioned on tissue, stone, or in/on medical equipment (working channel of an endoscope, stone retrieval basket). Results: Stone fluorescence signals measured were a factor of 7 to >100 higher than those of tissue. Stone fluorescence was detectable in “non‐contact mode” with a linear signal decrease over a distance up to ~1 mm in front of the fiber tip (core diameter 365 μm) and with severely damaged fibers (max. decrease: 75% with pinched off fiber). Reflection signals of the fiber tip surface in air and water surrounding decreased significantly when the fiber was damaged; measured ratios of intact to damaged fiber found in the air were (5–17):1 and in water (1.6–3.7):1. Surfaces in front of the fiber aggravated the evaluation of fiber condition due to reflections but enabled to detect, for example, the working channel of a flexible endoscope in combination with the (missing) fluorescence signal. Conclusions: Autofluorescence induced by a green aiming beam can be exploited for stone detection in laser lithotripsy. A reflection measurement can give further information on fiber condition and position. Implementing this kind of safety features for an automatic block of IR laser emission in case of weak or missing fluorescence and un‐normal reflections can assist the surgeon by avoiding tissue perforation, and damage to medical devices such as endoscopes.
关键词： Holmium laser,feedback control,urolithiasis,fluorescence,laser lithotripsy,urinary calculi
更新于2025-09-19 17:13:59
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a??Vapor Tunnela??: Advantages of a New Setting Option for Urgent Holmium Laser Lithotripsy with Cyber-Ho
摘要： Introduction: The vapor tunnel (VT) technology is a result of the pulse modulation during holmium laser emission: it consists of a single specific long pulse, using the minimum peak power in accordance with selected output settings. The first part of the pulse creates a vapor channel, whereas the remaining energy is discharged immediately after, passing straight through the previously created tunnel. This particular emission allows to reduce stone retropulsion. We herein present the outcomes of this new technology in the treatment of ureteral stones in an urgent setting. Materials and Methods: In total, 210 patients with ureteral stones, renal colic, and indication to undergo urgent stone lithotripsy, according to the inclusion criteria presented by Picozzi et al.,1 were randomly assigned to holmium laser lithotripsy with or without the VT technology (105 patients per group). The 100 W Cyber-Ho laser generator (Quanta System) was used for all cases performed with the VT; the 35 W Litho laser generator was used for all regular dusting mode (RDM) procedures. A 365 lm fiber was used in both groups. Energy and frequency settings were 1 J and 12 Hz in both groups. All procedures were performed by three experienced urologists. After the procedures, a ureteral stent was always positioned and removed 20 days later. We compared dusting time, total procedural time, and stone retropulsion, graded on a Likert scale from 0 (no retropulsion) to 3 (maximum retropulsion). We also compared postoperative ureteral lesions with the Posturetroscopic Lesion Scale (PULS),2 the success rates of the two techniques based on stone-free rate at 1 month (defined as absence or presence of maximum 1 mm stone fragments at a computed tomography -scan) and postoperative ureteral strictures. The study was approved by our institutional review board and patients signed the informed consent. Results: The RDM and VT groups were comparable in terms of age and mean preoperative stone size (1.1 vs 1.0 cm, p > 0.05). The VT technology was associated with significantly lower (p > 0.05) dusting time (15.3 vs 9.7 minutes), total procedural time (37.2 vs 25.7 minutes), total delivered energy (19.9 vs 7.7 kJ), and retropulsion (Likert score 3 vs 0). Patients in the RDM group required stone fragments’ retrieval with a Tipless Basket (Kobot Filter; RocaMed) and presented a higher rate of PULS-1 ureteral lesions than the VT group: 37 (35.2%) vs 8 (7.6%) patients p < 0.05. Whereas the VT setting allowed complete dusting of the stones. We registered six cases (5.7%) of postoperative ureteral strictures in the RDM group vs no cases in the VT group, p < 0.05. Stone-free rate at 1 month was comparable between the two groups (88.6 vs 93.4%, p < 0.05). Conclusions: The VT technology is associated with significantly lower dusting time and total procedural time, because of reduced retropulsion of the stone, which makes it more precise, quicker, and easier to perform. It also allows complete dusting, with no need for fragments’ retrieval, reducing ureteral lesions, because of scratches on the ureteral wall. These features make VT an excellent setting option in an urgent setting, when the ureteral wall is more vulnerable.
关键词： vapor tunnel,ureteral calculi,laser lithotripsy,holmium laser
更新于2025-09-19 17:13:59
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The effect of holmium laser resection versus standard transurethral resection on non-muscle-invasive bladder cancer: a systematic review and meta-analysis
摘要： To explore the advantages and limitations of holmium laser resection of the bladder tumor (HOLRBT) versus standard transurethral resection of the bladder tumor (TURBT) in the treatment of non-muscle-invasive bladder cancer (NMIBC), the eligible studies were selected from the following databases: PubMed, Cochrane Library, and Embase. Studies comparing HOLRBT and TURBT for patients with NMIBC were included. The outcomes of interest were time of operation, catheterization and hospitalization, rates of recurrence, and perioperative complications, including obturator nerve reflex, bladder perforation, bladder irritation, and urethral stricture. Results of all data were compared and analyzed by Review Manager 5.3. A total of 9 comparative studies were finally included for this analysis. Pooled data demonstrated that HOLRBT significantly reduced the time to catheterization and hospitalization, the rate of recurrence in 2 years of follow-up, obturator nerve reflex, bladder perforation, and bladder irritation, compared with those in TURBT, respectively. However, no significant difference found between HOLRBT and TURBT in the time of operation, rate of recurrence in 1-year follow-up, and urethral stricture. The results of this research reached that HOLRBT would be a better choice than TURBT for patients with NMIBC.
关键词： Non-muscle-invasive bladder cancer,Meta-analysis,Transurethral resection,Holmium laser
更新于2025-09-19 17:13:59