Endoscopic ureteral incision using the holmium:YAG laser

BACKGROUND: We reviewed the results of endoscopic ureteral incision for benign ureteral stricture, ureteropelvic junction obstruction and ureteroenteroanastomotic stricture using the holmium laser. METHODS: We carried out endoscopic ureteral incision using the holmium laser through an 8-Fr semirigid or 6.9-Fr flexible ureteroscope on 17 ureters in 15 patients. Balloon dilatation was not necessary before insertion of the ureteroscope. The stricture was incised with the holmium laser using a 200-365 microm fiber through the working channel of the ureteroscope. After completion of the incision, a 12-Fr double-J catheter was left for 6 weeks. Thereafter patients were followed by renal scan and/or ultrasound and excretory urography at 3-6 month intervals. RESULTS: The mean operative time was 65 min (18-135 min). The stricture resolved completely in 86.7% of cases at an average follow up of 20.5 months (11-32 months). CONCLUSIONS: The holmium laser endoscopic ureteral incision was associated with a good outcome in our series. We recommend this procedure to be employed initially because it is less invasive and has a favorable outcome.     

Holmium laser incision technique for ureteral stricture using a small-caliber ureteroscope.

BACKGROUND AND OBJECTIVES: The holmium laser has a short absorption depth in tissue and possesses excellent properties both in ablation and hemostasis. We have performed endoscopic incision for ureteral stricture using the holmium laser through a small-caliber ureteroscope. METHODS: This method was used on five patients and seven ureters. The etiology of the stricture was stone scar in two patients, ureteroenteroanastomosis of Indiana urinary pouch in two, and primary in one. We used an 8F semi-rigid or 6.9F flexible ureteroscope. No prior procedures, such as balloon dilation, were necessary in any of the cases. The stricture was incised with the holmium laser using a 365-microm fiber through the working channel of the ureteroscope. The holmium laser operated at a wavelength of 2100 nm, with an output of 1.0 J/pulse at a rate of 10 Hz. After completion of the incision, a 12F Double-J catheter was left in for six weeks. RESULTS: The mean operative time was 89 minutes. The stricture resolved completely in all cases at an average follow-up of 8.6 months. CONCLUSIONS: The holmium laser incision for ureteral stricture using a small-caliber ureteroscope is an easy-to-perform, safe and effective procedure.     

输尿管镜钬激光内切开术治疗输尿管狭窄疗效分析

目的:探讨输尿管镜下钬激光内切开术治疗输尿管狭窄的临床疗效.方法:采用经输尿管镜钬激光内切开术治疗输尿管狭窄患者31例,术中留置F8双J管,术后2～3个月拔取双J管.结果:术后共随访28例,时间3～28个月.23例治愈,治愈率为82.1%(23/28).结论:输尿管镜钬激光内切开术治疗输尿管狭窄是一种疗效确切、安全微创的手术方法.     

经尿道绿激光瘢痕汽化与尿道狭窄内切开及电切术治疗尿道狭窄的疗效比较

目的比较经尿道绿激光瘢痕汽化与尿道狭窄内切开及电切术治疗尿道狭窄的疗效。方法分析33例经尿道绿激光瘢痕汽化（A组）和41例尿道狭窄内切开及电切术（B组）治疗尿道狭窄的临床资料。比较两组手术时间、住院时间、手术有效率、并发症的发生率、术后最大尿流率、术后尿道扩张次数的差异。结果两组间的手术时间、手术有效率和术后最大尿流率差异无统计学意义（P〉0．05）,但A组住院时间、手术并发症的发生率、术后尿道扩张的次数显著少于B组fP〈0．05）。结论经尿道绿激光瘢痕汽化优于尿道狭窄内切开及电切术治疗尿道狭窄。     

钬激光联合电切治疗后尿道狭窄与开放手术的疗效比较

目的:评价钬激光联合电切与传统开放手术治疗后尿道狭窄及闭锁的疗效及安全性。方法:收治后尿道狭窄及闭锁患者40例,非选择性对其中18例采用钬激光联合电切尿道狭窄内切开术,22例患者行传统开放手术切除瘢痕加尿道吻合术。40例随访12～20个月,平均15个月,比较两组术中及术后的相关临床指标,包括手术时间、术中出血量、留置尿管时间、术后尿道扩张次数、住院时间、治愈率及尿失禁、尿外渗及继发出血等并发症发生情况。结果:钬激光联合治疗组治愈率83.3%,开放组治愈率86.3%,2组术后最大尿流率均明显改善,组间差异无统计学意义(P>0.05);钬激光联合治疗组平均手术时间,术中出血量,住院时间,留置尿管时间,并发症发生率,尿失禁及阴茎勃起功能障碍等均少于开放手术组(P<0.05)。术后尿道扩张次数组间无显著差异(P>0.05)。结论:钬激光联合电切是治疗单纯性后尿道狭窄的首选方法。开放手术在复杂性尿道狭窄的治疗上有明显优势,而且是解决尿道狭窄的最终方法。     

Hybrid germanium/silica optical fibers for endoscopic delivery of erbium:YAG laser radiation

BACKGROUND AND OBJECTIVES: Endoscopic applications of the erbium (Er):YAG laser have been limited due to the lack of an optical fiber delivery system that is robust, flexible, and biocompatible. This study reports the testing of a hybrid germanium/silica fiber capable of delivering Er:YAG laser radiation through a flexible endoscope. STUDY DESIGN/MATERIALS AND METHODS: Hybrid optical fibers were assembled from 1-cm length, 550-microm core, silica fiber tips attached to either 350- or 425-microm germanium oxide "trunk" fibers. Er:YAG laser radiation (lambda = 2.94 microm) with laser pulse lengths of 70 and 220 microseconds, pulse repetition rates of 3-10 Hz, and laser output energies of up to 300 mJ was delivered through the fibers for testing. RESULTS: Maximum fiber output energies measured 180+/-30 and 82+/-20 mJ (n = 10) under straight and tight bending configurations, respectively, before fiber interface damage occurred. By comparison, the damage threshold for the germanium fibers without silica tips during contact soft tissue ablation was only 9 mJ (n = 3). Studies using the hybrid fibers for lithotripsy also resulted in fiber damage thresholds (55-114 mJ) above the stone ablation threshold (15-23 mJ). CONCLUSIONS: Hybrid germanium/silica fibers represent a robust, flexible, and biocompatible method of delivering Er:YAG laser radiation during contact soft tissue ablation. However, significant improvement in the hybrid fibers will be necessary before they can be used for efficient Er:YAG laser lithotripsy.     

腔镜下钬激光内切开加定期尿道扩张治疗男性尿道狭窄及闭锁

目的探讨腔镜下钬激光内切开治疗男性尿道狭窄及闭锁的效果及安全性。方法我院2007年4月～2009年11月收治男性尿道狭窄或闭锁病人17例,狭窄段长0.5～3.0cm,平均1.4cm,采用腔镜下钬激光狭窄段内切开治疗。术后留置尿管2～4周。拔除尿管后根据随访排尿状况定期作尿道扩张。结果 17例病例均取得手术成功,手术时间30～90min,平均40min,术后排尿显著改善,最大尿流率(Qmax)由术前平均6.5(2.8～11.5)ml/s提高到术后20.4(16.6～25.3)ml/s,无尿失禁、阳痿、尿瘘并发症。术后随访3～18个月,均排尿良好,无再狭窄发生,B超检查剩余尿<20ml。结论腔镜下钬激光内切开加定期尿道扩张治疗男性尿道狭窄及闭锁安全有效,近期治疗效果良好,手术创伤小,并发症少,值得推广应用。     

输尿管镜下钬激光内切开与内切开联合气囊扩张治疗输尿管狭窄的疗效比较

【摘要】 目的 比较输尿管镜下钬激光内切开与内切开联合期囊扩张治疗输尿管狭窄的临床疗效。方法〓回顾性分析我院从2008年1月到2015年12月入院治疗的66例输尿管狭窄患者的临床资料。以2011年12月之前接受输尿管镜下钬激光狭窄内切开手术治疗的患者为对照组,共30例;2012年1月以后接受输尿管镜下钬激光狭窄内切开联合球囊扩张手术治疗的患者为研究组,共36例。评价两组的临床疗效与并发症等情况。结果〓研究组患者的临床疗效显著优于对照组患者(有效率:73.3% vs 91.7%),差异具有统计学意义(P<0.05);两组患者术中及术后均未见输血尿管穿孔及脱套等严重并发症。结论〓输尿管镜下钬激光内切开联合球囊扩张治疗输尿管狭窄,具有临床疗效显著、损伤小、恢复快等优点,值得临床推广应用。     

输尿管镜钬激光治疗输尿管纤维上皮息肉14例报告

目的：探讨输尿管镜钬激光治疗输尿管纤维上皮息肉的有效性和安全性。方法：应用输尿管镜钬激光技术治疗输尿管纤维上皮息肉患者14例，其中上段息肉10例，中、下段息肉各2例，并发输尿管结石9例。结果：术后随访3个月，12例疗效满意，肾积水明显改善．保护了肾功能；1例发生输尿管狭窄．1例残留结石。结论：输尿管镜钬激光技术是治疗输尿管纤维上皮息肉安全、有效的方法，但远期疗效尚需进一步研究。     

钬激光碎石治疗输尿管结石238例

目的探讨钬激光碎石治疗输尿管结石的有效性和安全性。方法应用半硬性输尿管肾镜和钬激光碎石治疗238例输尿管结石，其中输尿管上段结石60例，中段93例，下段85例。结果单次碎石成功率97．1％(231／238)，其中上段结石单次碎石成功率91．7％(55／60)，中、下段为98．9％(176／178)。5例双侧输尿管结石合并急性肾功能衰竭、无尿恢复迅速。术中无输尿管穿孔及严重损伤等并发症发生。231例术后住院1～2d，平均1．3d。术后随访0．5～12个月，平均4．1月，结石排净率98．7%(228／231)，无输尿管狭窄发生。结论钬激光碎石术治疗输尿管结石疗效好、创伤轻微、安全，是输尿管结石特别是中、下段结石首选的治疗方法。     

小儿输尿管镜钬激光内切开术治疗男性尿道狭窄

目的探讨小儿输尿管镜钬激光内切开术治疗男性尿道狭窄的安全性及临床疗效。 方法回顾性分析2014年8月至2017年4月我院42例行经尿道小儿输尿管镜钬激光内切开术治疗的男性尿道狭窄患者病历资料,患者年龄23～72岁,平均43岁,其中膜部尿道狭窄18例,前列腺部尿道狭窄5例,前尿道狭窄19例;狭窄段长度：0.3～2.5 cm,平均（1.4±0.3）cm,其中2例狭窄段长度2.0～2.5 cm;38例术前行自由尿流率检查,最大尿流率（Qmax）2.5～7.8 ml/s,平均（4.5±1.2）ml/s;术后留置尿管4～6周,拔除尿管后常规行尿道扩张3～4次,每次间隔1周,定期复查尿流率。 结果42例患者均顺利完成手术,手术时间30～70 min,平均（48±9）min,出血量少,无尿外渗、穿孔、感染等并发症,拔除尿管后排尿通畅。随访6～12个月,39例患者排尿通畅,最大尿流率明显改善,为12.6～22.5 ml/s,平均（16.3±3.7）ml/s,3例术后3个月尿线变细、尿流率下降行尿道扩张3～4次后排尿正常。 结论经尿道小儿输尿管镜钬激光内切开术治疗男性尿道狭窄安全、创伤小、并发症少,近期疗效满意。     

Effective outpatient treatment of Kaposi's sarcoma of the urethral meatus using the neodymium:YAG laser

An unusual presentation of acquired immunodeficiency syndrome (AIDS)--a case of Kaposi's sarcoma involving the glans penis and fossa navicularis--was treated palliatively with neodymium:YAG (Nd:YAG) laser photoablation. A single outpatient treatment removed the two lesions and restored the patient's ability to void normally. The Nd:YAG laser proved extremely useful, providing effective outpatient therapy with minimal morbidity and excellent local results.     

腔内钬激光碎石术治疗输尿管上段结石的体会(附121例报告)

目的探讨腔内钬激光碎石术治疗上段输尿管结石的技巧与方法。方法回顾性分析121例应用硬性输尿管肾镜和钬激光碎石术治疗上段输尿管结石患者资料。结果单次碎石成功率为95%(115/121)。术后随访2周~6个月,除6例失败者外,结石排净率98%(113/115),I VU示肾盂积水由术前(3.5±0.8)cm降至(1.5±0.4)cm(P<0.01),无输尿管狭窄发生。结论腔内钬激光碎石术治疗上段输尿管结石,尤其是结石直径>1cm同时合并输尿管息肉及狭窄者有明显优势,熟练掌握输尿管镜的技巧和方法是保证手术成功的重要因素之一。     

Holmium:YAG laser endoureterotomy in the treatment of ureteroenteric stricture following Indiana urinary diversion

A 57-year-old man who had received radical urethrocystectomy and Indiana urinary diversion 6 months earlier was treated for ureteroenteric anastomosis stricture (left side) using a Holmium:YAG laser via antegrade approach. The availability of small (6.9 Fr) flexible ureteroscope, as well as the use of the Holmium:YAG laser has facilitated the ability to precisely incise the stricture under direct endoscopic visualization. The technique is described for laser endoureterotomy in a patient with ureteroenteric stricture following Indiana urinary diversion.     

Effects of electrocautery, CO2 laser, and contact Nd:YAG laser scalpel on the healing of intestinal incision

Leakage after intestinal resection is a serious complication with a high mortality rate. A recent study claims that cutting the intestine with the CO2 laser improves the healing of intestinal anastomoses (Ferulano et al: Eur Surg Res 16:127-130, 1984). The present study was undertaken to analyze the effects of electrocautery, CO2 laser, and contact Nd:YAG laser on the healing of intestinal incisions. Fifteen piglets were used and the cutting and reanastomosing were performed by using all cutting methods in each animal in randomized order. Resection sites were 50 cm, 100 cm, and 150 cm distal to the ligament of Treitz. On the seventh day the bursting pressures were measured for each anastomosis. They were 172 +/- 17 mmHg for normal bowel segment and 133 +/- 12, 135 +/- 40, and 139 +/- 17 mmHg for electrocautery, CO2 laser, and Nd:YAG laser, respectively. There were no mortality, no anastomotic leaks, and no statistically significant differences in the bursting pressures, in histology, or in the healing of anastomotic sites, indicating that electrocautery, CO2 laser, and contact Nd:YAG laser scalpel can safely be used in the surgery of small intestine.     

Holmium:YAG laser treatment of ureteral calculi: a 5-year experience

The purpose of this study was to provide an account of the 5-year experience we have gained using holmium:yttrium–aluminium–garnet (Ho:YAG) lasertripsy in the treatment of ureteral stones. One-hundred thirty-seven transurethral ureterolithotripsies were performed in 131 patients. A Ho:YAG laser device, fibres with diameters of 360 and 550 μm, a video camera as well as semi-rigid and flexible ureterorenoscopes were used. Results showed that the direct success rates—which meant stone-free ureters on the first post-operative day—in the upper, middle and lower ureters were 84.6, 88.7 and 94.8%, respectively. The final success rates—which meant stone-free ureters 4 weeks after the operation without a second intervention—were 84.6, 96.7 and 96.7%, respectively. The pulsatile Ho:YAG laser beam fragmented all kinds of stones easily. No ureteral stricture or reflux was identified during the follow-up period. The advantages of Ho lasertripsy outweighed its disadvantages. Based on our experience, the Ho:YAG laser is one of the most effective and safest energy sources in the treatment of ureteral calculi.     

尿道内切开术治疗男性尿道狭窄或闭锁55例

目的探讨尿道内切开治疗男性尿道狭窄或闭锁的疗效。方法回顾分析1997年1月～2003年1月我科采用尿道内切开术治疗55例男性尿道狭窄或闭锁的效果。结果手术一次成功率90．9％(50／55)，2次治疗成功5例。47例随访6～12个月，平均10个月，10例拔尿管后1周内行1次尿道扩张术，2l例术后3个月内行3～5次尿道扩张术，16例术后3个月后行尿道扩张术。结论尿道内切开治疗男性尿道狭窄或闭锁疗效确切。