efficacy and safety of laser lithotripsy in pregnancy

Introduction: The aim of our study was to assess the efficacy and safety of laser lithotripsy in pregnant patients

Methods: In this retrospective study, we reviewed the 15 pregnant women who have been treated for ureteral stones with semi-rigid ureteroscope and holmium laser at our center between Januarys 2007and April 2015

Results: The mean age of patients and mean gestational age was 29.3 years old 27.3 weeks respectively. Mean size of stones was 7.84 mm. Twelve patients had renal colic, and hematuria was found in 3 cases. Irritative urinary symptoms such as frequency and urgency detected in 6 ones and 2 patients had fever. The stone of all patients were fragmented by using holmium laser lithotripter. In 5 patients stone residual fragments were removed by grasper while other 10 patients were left to pass fragments spontaneously. No intraoperative and postoperative urological or obstetric complication was seen

Conclusion: Laser lithotripsy is safe and efficacious in pregnant patients who have ureteral stone that does not respond to conservative management

Holmium-YAG laser ureteroscopic lithotripsy in a patient with ectopic malrotated kidney

The incidence of stone disease among patients with congenital renal anomalies including malrotated kidney is more than in normal population due to poor urine drainage and stasis [1]. Various minimally invasive options have been used for the management. Ureteroscopy and Holmium:YAG laser lithotripsy have been reported with favorable outcomes [2]. We report a 30-year-old male who presented to our hospital having a right side malrotated kidney with a large stone in it. He underwent two session of ureteroscopy and Holmium:YAG laser lithotripsy

Diode laser treatment of human prostates

Laser-assisted vaporization of prostate tissue by means of the potassiumtitanyl-phosphate [KTP] laser is in clinical use. Alternative laser sources are available but are lacking clinical experience. The 980 nm wavelength diode laser provides good hemostasis, in addition to a more rapid ablation rate. The aim of this study is approving the capability, feasibility, and good post-operative outcome of vaporization of prostate by means of a diode laser in a long-term follow up. The light [980 nm, 100 W] of a diode laser was transmitted to prostate tissue. The study included 70 men suffering from bladder outlet obstruction due to benign prostatic hyperplasia [BPH]. The prostatic lobes were vaporized within the prostatic capsule. Post-operative outcome and voiding were evaluated during a follow-up period of 24 months. During surgery, no significant blood loss or any fluid absorption occurred. Catheters were removed in the 20.1 +/- 4.6 hours. All patients except two were satisfied with their voiding outcome. After removing the catheter, the mean peak urine flow rate significantly increased from 6.8 +/- 2.5 ml/s pre-operatively to 15.6 +/- 3.1 ml/s postoperatively. No evidence of urgency, dysuria, hematuria, or incontinence was observed. Four patients required re-catheterization, and two of them needed consecutive TURP. After a 1- month, as well as after a 6-month, a 12-mouth, and a 1-year follow-up, all patients were still satisfied with the outcome. This long term experience showed that 100 W-980 nm-diode-laser vaporization prostatectomy was feasible and appeared to be safe and effective for quickly relieving bladder outlet obstruction due to BPH

Effect of KTP laser on surgically resected adenomas of prostate

Transurethral resection of prostate [TURP] is the most common urological operation performed. Regarding the complications of this surgery, studies are looking for alternative endoscopic techniques in order to reduce risk of complications. Use of high energy lasers is the most promising method for managing patients with benign prostate hyperplasia [BPH]. In this study, we evaluated the effect of homemade KTP laser on resected prostate adenoma after open prostatectomy. A total of forty resected prostate adenoma by open prostatectomy, assigned in to the study groups. One part of specimens without any intervention was sent to the pathology department and the rests divided to four KTP dose response groups [10 patients in each group]. The prostate specimens were ablated by KTP laser in one, two, three, and four sessions according to their number of subgroups. Prostate tissue was irradiated by 5-watt KTP laser for 15 seconds in each stage. All prostate specimens ablated with laser were sent to pathology for evaluation of tissue ablation capacity and tissue penetration depth. Mean age of the participants was 73.25 +/- 6.8 years with mean serum level PSA of 3.65 +/- 2.1 ng/dl. 1 to 2 mm of the tissue was ablated at each session of laser administration. In pathologic examination, 0 to 2 mm of tissue destruction with disappearance of nuclei of the cells, basophilia of the stroma, and damaged tissue [cutter like effect] were witnessed. Findings were compatible with burn effect. KTP laser prostatectomy is a safe and effective procedure with low risk of complications in which bladder outlet obstruction symptoms will relieve. According to our study, extra penetration of prostate tissue during laser irradiation is rare. This finding could be suggestive this theory that KTP laser has little risk of capsule perforation

Desmopressin as an alternative solution for urinary leakage after ureterocaliceal surgeries

Presistent urine leakage is common following iatrogenic urinary collecting system injuries. Management of a urine leak usually includes manipulations such as catheter drainage, ureteral stenting, and percutaneous nephrostomy placement. The aim of this study was investigation the potential beneficial effect of desmopressin in reduction of urinary leakage duration. Fifteen patients with incisional urinary leakage were enrolled in this study. They had undergone pyeloplasty [n = 9], pyelolithotomy [n = 4], and ureterocaliceal anastomosis [n = 1]. All of them had ureteral stenting or nephrostomy catheters, and urinary leakage had lasted for at least 15 days. Seven patients received desmopressin spray, 1 puff, twice a day, from the 16th days of urinary leakage, and 8 patients [control group] did not receive any medical treatment. The duration of urinary leakage was compared between the two groups. The patients were 5 women and 10 men with the median age of 37 years [range, 26 to 58 years]. None of the patients had urinary obstruction. There were no significant differences in age and sex distribution between the two groups. The mean urinary leakage duration was 28.7 +/- 7.2 days in the patients of desmopressin group and 47.7 +/- 8.8 days in those of the control group [P= .04]. Our study showed that desmopressin can reduce the duration of incisional urinary leakage. We conclude that patients with prolonged urinary leakage after pyelocaliceal surgery who does not respond to surgical urinary drainage may benefit from desmopressin

Laser prostatectomy versus transurethral resection of prostate in the treatment of benign prostatic hyperplasia

To assess the effectiveness of laser-prostatectomy compared with transurethral resection of prostate [TURP]. This randomized clinical trial with one year follow-up, was conducted on 87 patients with benign prostatic hyperplasia [BPH] at Shohada-e-Tajrish Hospital, Tehran, Iran, from 1999 to 2003. Fifty-two patients underwent TURP and 35 patients were treated by non-contact laser prostatectomy using ND: YAG laser at 40-60 watt power and 13000-29000 jules energy settings. Comparing variables of urinary maximum flow and residue, changes of urine volume and severity of symptoms during consequent periods of 3, 6 and 12 months after the operation in 3 groups revealed that differences in maximum urinary flow changes were significant only in the sixth month [p<0.05]. Also, changes in the severity of symptoms before and after the operation showed more decrease in the TURP group during all 3 periods of follow-up [p=0.01]. In the laser prostatectomy group duration of operation [p=0.01], amount of fluid used during the operation [p<0.001] and duration of bed rest [p<0.001] were less than those of the TURP group. Laser prostatectomy can decrease duration of operation, duration of bed rest and pathogenesis following the operation in patients. Although changes in the severity of symptoms are more pronounced in TURP patients, changes in urodynamic indexes are similar in both groups