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Transurethral en bloc resection of non-muscle invasive bladder cancer with holmium:YAG laser in pediatric patients: cases series and review of literatures
摘要： Introduction Urothelial bladder carcinoma frequently occurs in adults over 60?years of age; yet it affects only 0.1–0.4% of patients before the first 2?decades of life. We present two cases of transitional cell carcinoma in two young patients treated with holmium:YAG laser to demonstrate the effectiveness of this technique in pediatrics. Cases and methods Case study 1 During a routine abdomen ultrasound, a 14-year-old female showed a endoluminal formation about 10 × 6 × 10?mm of size, in the left paramedian site. There was an absence of meaningful vascular signs during color-Doppler. Physical examination and laboratory exams were all normal. Case study 2 A 12-year-old female presented with acute macroscopic haematuria. No other symptoms were associated. Bladder ultrasound revealed an irregular 15?mm intravesical endophytic lesion in the posterior-superior area. In both cases, treatment commenced with an en bloc enucleation. For the resections, a 272?μm holmium:YAG fiber laser was used through the 12 Ch cystoscopy working channel with an energy of 0.8–1?J/pulse and a frequency of 8–10?Hz. Results There was no haematuria after the procedure and the transurethral catheter remained for 12?h. The histological diagnosis was papillary urothelial neoplasm of low malignant potential. Cystoscopy was performed 3 and 9?months after the surgery and an ultrasound every 6?months, which all came back normal. The follow-up continued for each patient with a cystoscopy once a year, according to EAU guidelines. Conclusion Based on the findings, holmium:YAG laser is a good alternative to treat superficial transitional cell carcinoma in pediatric patients.
关键词： Transurethral en bloc resection,Transitional cell carcinoma,PUNLMP,Holmium:YAG laser,Pediatric bladder cancer
更新于2025-09-23 15:21:01
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Optimal settings for the Holmium: YAG laser in pediatric endourology: tips and tricks
摘要： To the best of our knowledge, no pediatric paper has been published regarding specifically how to set the Holmium:YAG laser for multiple urologic applications. Objective: To provide insight into the laser parameters for pediatric applications Study design: We describe the principle and the settings of the laser Results: The Holmium:YAG laser can produce four different biological effects: (1) fragmentation of stones in small fragments that can be retrieved with grasping instruments, thereby increasing the immediate stone-free outcome. For fragmentation lithotripsy, the laser has to be set with a high energy, low frequency and short pulse duration; (2) dusting which produces fine dust that can spontaneously evacuate, avoiding the use of basket retrieval. The dusting setting requires low energy, high frequency and long pulse duration; (3) incision of posterior urethral valves or ureterocele when all settings are maximized: high energy, high frequency and long pulse duration; (4) coagulation of urothelial tumors using high frequency, long pulse duration and slightly lower energy than required for incision. Discussion: Both dusting by painting and fragmentation with retrieval for ureteroscopic laser lithotripsy are effective. Although dusting tends to be associated with shorter operative times and a lower risk of ureteral trauma, this approach has a potential risk of recurrent stone formation from dust failing to pass. In contrast, fragmentation with extraction may provide for a more immediate postoperative stone-free result. Altering the pulse energy, frequency, width and modulation can help to optimize lithotripsy efficiency. Lower pulse energy settings result in smaller fragments, less retropulsion and reduce fiber tip degradation. A shallow depth of penetration in water and tissue allows precise energy application and provides a margin of safety. Conclusion: An understanding of Ho-YAG laser settings will permit the pediatric surgeon to make a better use of the device for different urological applications.
关键词： children,dusting,fragmentation,section,laser Holmium-YAG
更新于2025-09-23 15:19:57
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Hounsfield units-a significant predictor of lasering time and energy in the management of upper urinary tract stones using Holmium: Yttriuma??Aluminum Garnet lasers
摘要： Purpose To study the impact of stone density as assessed by Hounsfield units (HU) on total laser energy (TLE) used and total laser time (TLT) spent in complete fragmentation of upper urinary tract stones. In addition, we also studied the impact of stone composition on the laser energy and time required for fragmentation. Methods Thirty consecutive patients fulfilling inclusion and exclusion criteria were included in the study. Patients with renal or proximal ureteral stones with a size of 5–20?mm were included. Stone fragmentation was performed using Ho:YAG 100?W laser and TLT and TLE were correlated with the HU and stone composition. Results The mean stone diameter was 10.83 ± 3.5?mm and the mean HU was 893 ± 315. The mean TLE and TLT were 8.86 ± 3.12?kJ and 18.46 ± 6.9?min, respectively. We observed a strong positive correlation between HU and TLE (r = 0.84, p value < 0.001) and between HU and TLT (r = 0.58, p value = 0.001). However, the stone composition did not influence the lasering energy (p value = 0.36) and lasering time (p value = 0.30). Stone diameter also had significant positive correlation with TLE (r = 0.41; p = 0.02) and TLT (r = 0.54; p? 0.002). When controlling for stone size the correlation of HU with TLE (r = 0.83; p < 0.001) and TLT (r = 0.52; p = 0.004) remained significant. Conclusions HU and stone diameter are significant predictors of TLE and TLT when using Ho:YAG laser for stone fragmentation. However, stone composition and stone location failed to show any significant effect on either of these parameters.
关键词： Urolithiasis,Energy,fURS,RIRS,Laser,Holmium YAG
更新于2025-09-23 15:19:57
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Advanced Application of Holmium: YAG Laser Combined ALA-PDT for the Treatment of Refractory Condylomata Acuminata in Anal Canal
摘要： Background: Anal canal condylomata acuminata is a disease caused by the human papilloma virus. Conventional cauterizing laser treatment cannot achieve a satisfactory result owing to a high recurrence rate, and the application of 5-aminolaevulinic acid-photodynamic therapy (ALA-PDT) also has limitations in the anal canal. Holmium yttrium aluminum garnet (Ho: YAG) laser with fiber is found to be effective at removing canal lesions, and may create suitable conditions for ALA-PDT. We aim to investigate the feasibility of Ho: YAG laser combined with ALA-PDT and to explore a more optimal therapy in refractory anal canal condylomata. Methods: Data of 37 patients with anal canal condylomata (number of warts≥ 10 lesions) from May 2017 to March 2019 were reviewed. In total 17 cases were treated with Ho: YAG laser plus ALA-PDT, and 20 patients treated with CO2 laser plus ALA-PDT were selected as control. Wart clearance and recurrence rates were evaluated as well as laser complications. Results: Most warts (88.23 %) were removed after a session of Ho: YAG laser pretreatment. The average number of laser sessions required to clear all warts was 1.94 in the Ho: YAG laser plus ALA-PDT group. Meanwhile, no wound infections or defecation disfunctions were found. Ho: YAG laser with ALA-PDT could significantly reduce wart recurrence rates (17.6 %) in comparison with CO2 laser with ALA-PDT (55 %). Conclusions: Ho: YAG laser combined with ALA-PDT raised the cure rate of refractory anal canal condylomata and has important guidance implications for clinical application.
关键词： Anal canal,ALA-PDT,Condylomata acuminata,Holmium: YAG laser
更新于2025-09-19 17:13:59
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Percutaneous transhepatic laser lithotripsy for intrahepatic cholelithiasis: A technical report
摘要： Advances in interventional radiology have seen the adaptation of urological endoscopic laser techniques to treat biliary tract calculi. Percutaneous transhepatic biliary laser lithotripsy provides an effective alternative procedure for the management of intrahepatic or conventionally refractory choledocholithiasis which would otherwise require invasive and high-risk surgical intervention. Several small studies have validated the procedure for management in this subset of patients, with most achieving 100% calculi clearance with minimal complications. Most patients are suitable for percutaneous transhepatic biliary laser lithotripsy. Preprocedural imaging is useful for evaluating stone burden and planning percutaneous access. Holmium lasers are commonly used and act by vaporising water particles on and in the calculi, fragmenting the stone via thermal expansion. A series of catheters, wires, sheaths and dilators are used to allow introduction of the choledochoscope and laser so that calculi can be targeted. Percutaneous transhepatic biliary laser lithotripsy is often used in conjunction with balloon dredging and biliary stricture dilatation. Only experienced interventionalists should perform this procedure, and users should be aware of associated hazards. Repeat percutaneous transhepatic cholangiography is routinely performed to con?rm eradication of stones. Treatment of biliary calculi and obstruction is important in preventing diseases such as cholangitis and cirrhosis. For patients unsuitable for conventional treatment, percutaneous transhepatic laser lithotripsy is a safe and effective alternative when performed by experienced interventional radiologists. Preprocedural planning is imperative to procedure success.
关键词： cholangioscopy,laser,percutaneous biliary lithotripsy,intrahepatic cholelithiasis,holmium: YAG
更新于2025-09-19 17:13:59
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Comparaison in vitro des taux d’ablation lithiasiques du laser Thulium fibré et du laser Holmium:YAG pour la lithotritie endocorporelle?: impact de l’utilisation de fibre laser de diamètre 150 μm
摘要： Le laser Thulium fibré (TFL) appara?t comme une alternative au laser Holmium:YAG (Ho:YAG) pour la lithotritie endocorporelle, permettant d’utiliser des fibres de diamètres inférieurs à 200 μm. L’objectif était de comparer in vitro les diamètres des fragments, des fissures, et des volumes d’ablation lithiasiques selon le diamètre de fibre laser (CDF) (272 μm ou 150 μm) avec le TFL et le Ho:YAG.
关键词： ablation lithiasique,laser Thulium fibré,laser Holmium:YAG,lithotritie endocorporelle
更新于2025-09-16 10:30:52
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How much energy do we need to ablate 1 mm3 of stone during Ho:YAG laser lithotripsy? An in vitro study
摘要： Introduction Holmium:yttrium–aluminium–garnet (Ho:YAG) is currently the gold standard for lithotripsy for the treatment of all known urinary stone types. Stone composition and volume are major determinants of the lithotripsy. This in?vitro study evaluated the required energy to ablate 1?mm3 of various stone types with different laser settings using Ho:YAG. Methods 272?μm core-diameter laser fibers (Boston Scientific?) were connected to a 30?Watt MH1 Ho:YAG generator (Rocamed?). An experimental setup consisting of immerged human stones of calcium oxalate monohydrate (COM), uric acid (UA) or cystine (Cys) was used with a single pulse lasing emission (0.6/0.8/1?J), in contact mode. Stones were dried out before three-dimensional scanning to measure ablation volume per pulse (AVP) and required energy to treat 1?mm3 (RE). Results All settings considered, ablation volumes per pulse (AVP) for COM were significantly lower than those for UA and Cys (p = 0.002 and p = 0.03, respectively), whereas AVP for Cys was significantly lower than those for UA (p = 0.03). The mean REs at 0.6?J pulse energy (PE) for COM, Cys and UA were 34, 8.5 and 3.2?J, respectively The mean REs at 1?J PE for COM, Cys and UA were 14.7, 6.4 and 2?J, respectively. At 0.6?J PE, RE for COM was more than tenfold and fivefold higher than those for UA and Cys, respectively. Conclusion This in?vitro study shows for the first time a volumetric evaluation of Ho:YAG efficiency by the ablation volume per pulse on human stone samples, according to various pulse energies. The REs for COM, UA and Cys should be considered in clinical practice.
关键词： Holmium YAG,Volume,Lithotripsy,Laser
更新于2025-09-16 10:30:52
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Experience of 138 Transurethral Urethrotomy With Holmium:YAG Laser
摘要： Introduction: Many valid option modalities are available for the management of urethral stricture disease (USD), such as internal urethrotomy which has the success rates of 33%–60%. The aim of this study was to assess the outcome of holmium: YAG (Ho: YAG) laser urethrotomy (HLU). Methods: One hundred thirty-eight patients with urethral stricture with the mean age of 48±3.03 years old treated by HLU from March 2011 to August 2017. The main purpose of this investigation was to evaluate mean operation time, stricture recurrence rate and post-operation Qmax and complications of transurethral HLU. Results: The most common cause of USD was trauma in 82 (59.4%) patients. Mean laser operation time, mean hospital stay and mean postoperative duration of catheterization were 23.08 ± 9.1 minutes, 19.02 ± 10.7 hours and 10.3 ± 1.05 days respectively. The mean Qmax was 8.3 ± 2.07 mL/s before surgery and 16 ±3.1 mL/s afterward. At the end of 12 months follow-up, a total of 37 (26.8%) patients developed recurrence of the stricture. Patients with posterior, longer urethral strictures and previous history of interventions have more recurrence rate of the stricture. Conclusion: HLU is minimally invasive and seems to be an effective and safe management option for primary, short, urethral strictures. The hospital stay is remarkably short and complications are negligible.
关键词： Holmium: YAG laser,Laser urethrotomy,Urethral stricture,Internal urethrotomy
更新于2025-09-11 14:15:04