laser,stone fragmentation,turp

1. Laser
therapy in
urology
Dr.omar al-asadi
F.I.B.M.S C.A.B.M.S EAU member

2. History
• Although the concept of stimulated
emission of radiation was hypothesized
by Einstein in 1917, the first beam of
laser light was not generated until 1960
• this theory put to use by Maimen to
produce the first visible light laser.

3. • The term laser is an acronym
for light amplification
by stimulated emission
of radiation.

4. • Laser energy is produced when an atom is
stimulated by an external energy source,
which creates a population of electrons in
an excited state. These excited or higher
energy electrons can release their excess
energy in the form of photons or light
energy. ( laser is produced by changing
electrical energy to light energy)

5. • Einstein used 2 principles of physics as the
basis for his discovery: (1) Light travels in
packets of energy known as photons, and
(2) most atoms or molecules exist naturally
in a ground or low-energy state
• By adding electricity, heat, or light energy to
atoms in their ground state, their energy
level can be raised. The energy is then
released spontaneously in the form of
photons or electromagnetic (EM) waves to
return to the ground state.

6. Laser light differs from natural
light in that it is
1. coherent (all photons are in one phase so it
is very intense and bright ).
2. collimated (photons travel parallel to each
other otherwise there is no divergence of
light waves).
3. monochromatic (all photons have the same
wavelength ), these unique features of laser
light allow considerable energy to be
transmitted in a highly concentrated
manner.

7. How laser produce its effect on the
body?
By 3 major ways
1. Photo thermal can either develop tissue
coagulation with denaturation of
protein and cell death, to do this the
temperature should be between 60-100
c e.g. Nd:YAG laser or tissue
evaporization here the temperature is
usually more than 100c.

8. 2. Photo acoustic ( for stones)
Energy absorbed by stone lead to plasma
bubble and when these bubble collapse
lead to shock waves which lead to stone
fragmentation( intracorporeal shock wave
lithotripsy ).
3. Photo chemical certain substances which is
called photo sensitizing against (example
porfimer) is given to the patient and it will
be taken up by malignant cells and when
exposed to laser energy lead to oxidative
changes damage protein and nucleic acid.

9. Uses of laser in urology
1-Stone Disease :
Laser Lithotripsy
1. coumarin pulsed-dye laser
When it is applied to the stone surface, the
pulsed laser causes release of electrons and
formation of a “plasma” bubble ; the
expansion followed by the subsequent
collapse of the plasma bubble generates a
shockwave that is responsible for the stone
fragmentation effect of most pulsed lasers,
Cystine stone may not be fragmented.

10. 2. Holmium laser lithotripsy
holmium laser occurs primarily through a
photothermal mechanism that causes stone
vaporization.
The ability of the holmium laser to
fragment all stones regardless of
composition. The holmium laser is one of
the safest, most effective, and most
versatile intracorporeal lithotripters.

11. 2-BPH
Energy soruce of laser is Nd:YAG , Holmium ,
KTP
Several different techniques have been
described
1. Transurethral laser-induced
prostatectomy (TULIP)
Is done with TRUS guidance,
the TULIP device is aprobe placed in the
urethra, and TRUS is used to direct the
device

12. 2. VLAP ( visual laser ablative
technique)
Under cystoscopic control, side-firing
noncontact coagulation prostatectomy ;
Laser fibers located in the prostatic urethra,
the principle tissue effect done by
coagulation .
3. Visual contact ablative techniques
the fiber is placed in direct contact with the
prostatic tissue produce vaporization.

13. 4. Interstitial laser therapy ILP
Performed by transurethral placement of
laser fibers directly into the prostate under
cystoscopic control resulting in submucosal
coagulative necrosis; Coagulative techniques
do not create an immediate visual defect in
the prostatic urethra, but rather tissue is
sloughed over several weeks following the
procedure.

14. Holmium laser prostatectomy.
3 technique of holmium laser
prostatectomy
1. Vaporization suitable for small prostate
2. Resection similar to TURP
3. Enucleation loops of the prostate are
dissected off the capsule of the prostate
and then pushed back in to the bladder
transurethral morcellator introduced in
to the bladder to slice the loops in to
pieces that can be removed.

15. GreenLight Laser Therapy |
Enlarged Prostate Treatment
GreenLight Laser Therapy cause
coagulation and vaporizaton and is a
treatment for BPH that combines the
effectiveness of the traditional surgical
procedure known as “Trans Urethral
Resection of the Prostate” (TURP) with
fewer side effects.

16. Advantages and disadvantages of
laser surgery include:
(1) minimal blood loss,
(2) rare instances of
TUR syndrome,
(3) ability to treat
patients receiving
anticoagulation
therapy, and
(4) ability to be done
as an outpatient
procedure.
• Disadvantages
(1) lack of availability of
tissue for pathologic
examination,
(2) longer postoperative
catheterization time,
(3) more irritative
voiding complaints,
and
(4) high cost of laser
fibers and generators.

17. 3-INTERSTITIAL LASER
COAGULATION OF RENAL MASSES:
• By inserting bare-tip laser fibers
directly into tissue, laser energy can be
utilized for focal tissue ablation by
thermal processes.

18. 4-Laser Therapy of urothelial
Tumors:
Laser coagulation for minimally invasive
tumors . The neodymium:yttrium-aluminum-
garnet (Nd:YAG) laser has the best properties
for use in bladder cancer, uretral and tumor
of renal pelvis through uretroscope ( URS )or
percutanious nephrostomy (PCN).

19. 5-Laser Therapy for hypospadius
and vasovasostomy
Use of laser-tissue welding , joining
tissue by photo thermal properties ,
excellent strength and anti leak
compared with sutured wounds ;the
laser used CO2 ,Nd:YAG , KTP .

20. 6-Laser Therapy of penile tumors:
Laser therapy has been extensively evaluated
as a form of conservative treatment of
superficial penile carcinoma.
It is attractive in that it has the potential
advantage of eliminating the primary tumor
with preservation of surrounding tissues and
penile function.

21. 7-Lasers therapy for genital
lesions:
• Laser surgery and cryosurgery play a
relatively small role in the management
of genital lesions, although the CO2
laser has been used effectively to
manage genital condyloma accuminata.

22. 8-Lasers therapy for urethral and
uretric stricture:
The ideal laser for use in the treatment of
urethral and uretric stricture disease is one
that totally vaporizes tissue, exhibits negligible
peripheral tissue destruction.

23. THANK
YOU