Evolving Role of Lasers in Endourology: Past, Present and Future of Lasers
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Published:2023-05-31
Issue:6
Volume:10
Page:635
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ISSN:2304-6732
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Container-title:Photonics
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language:en
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Short-container-title:Photonics
Author:
Cerrato Clara1ORCID, Jahrreiss Victoria123, Nedbal Carlotta14, Pietropaolo Amelia1ORCID, Somani Bhaskar13ORCID
Affiliation:
1. University Hospital Southampton NHS Trust, Southampton SO16 6YD, UK 2. Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, 1090 Vienna, Austria 3. EAU Section of Urolithiasis (EULIS), 6803 AA Arnhem, The Netherlands 4. Urology Unit, School of Urology, Faculty of Medicine, Marche Polytechnic Unviersity, 60121 Ancona, Italy
Abstract
The use of lasers in endourology has grown exponentially, leading to technological advancement and to miniaturization of the procedures. We aim to provide an overview of the lasers used in endourology and the associated future perspectives. Using MEDLINE, a non-systematic review was performed including articles between 2006 and 2023. English language original articles, reviews and editorials were selected based on their clinical relevance. Guidelines recommend ureteroscopy in case of stones <2 cm and a percutaneous approach for renal stones ≥2 cm. High-power holmium (Ho:YAG) lasers and the new thulium fibre laser (TFL) may change the future, offering shorter procedures for complex stones, with good outcomes. Increased intrarenal temperature associated with these new technologies may be overcome with adaptive strategies and optimal settings. For upper-tract urothelial carcinoma (UTUC), the combination of laser techniques and these new lasers may reduce the risk of stenosis and allow for a more accurate tumour ablation, potentially reducing the recurrence rates. Laser enucleation procedures are gaining a major role in benign prostate enlargement (BPE), especially in patients with larger prostates or under anticoagulant therapy. However, the superiority of one laser over the other has not been established yet, and the choice of technique is mainly deferred to the surgeon’s expertise. In conclusion, lasers will further expand their horizon in endourology, allowing for instrument adaptation to challenging anatomy. Prospective, randomized clinical trials are however needed to confirm available results and to provide the optimal settings for each pathology.
Subject
Radiology, Nuclear Medicine and imaging,Instrumentation,Atomic and Molecular Physics, and Optics
Reference106 articles.
1. The role of lasers in modern urology;Krajewski;Cent. Eur. J. Urol.,2015 2. Pietropaolo, A., Hughes, T., Mani, M., and Somani, B. (2021). Outcomes of ureteroscopy and laser stone fragmentation (URSL) for kidney stone disease (KSD): Comparative cohort study using moses technology 60 w laser system versus regular holmium 20 w laser. J. Clin. Med., 10. 3. Skolarikos, A., Neisius, A., Petřík, A., Somani, B., Thomas, K., and Gambaro, G. (2023, April 09). EAU Guidelines on Urolithiasis. Available online: https://uroweb.org/guidelines/urolithiasis. 4. Retrograde intra renal surgery versus percutaneous nephrolithotomy for renal stones >2 cm. A systematic review and meta-analysis;Barone;Minerva Urol. Nephrol.,2020 5. Urologic Applications of the Holmium Laser: Preliminary Experience;Erhard;J. Endourol.,1995
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