Nd : YAG LASER IN ENDOSCOPIC UROLOGY

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Nd : YAG LASER IN ENDOSCOPIC UROLOGY

R. Sanseverino, A. Gelet, X. Martin, J. Dubernard

To cite this version:

R. Sanseverino, A. Gelet, X. Martin, J. Dubernard. Nd : YAG LASER IN ENDOSCOPIC UROLOGY.

Journal de Physique Colloques, 1987, 48 (C7), pp.C7-219-C7-220. �10.1051/jphyscol:1987748�. �jpa-

00227052�

JOURNAL D E PHYSIQUE

Colloque C7, suppl6ment au n012, Tome 48, dbcembre 1987

Nd:YAG LASER IN ENDOSCOPIC UROLOGY

R. SANSEVERINO, A. GELET, X. MARTIN and J.M. DUBERNARD

Service d'Urologie et de Chirurgie de la ~ransplantation, Hapita1 Edouard Herriot, Pavillon V , F-69437 Lyon Cedex 0 3 , France

S i n c e t h e f i r s t use of Nd: YAG l a s e r f o r t r e a t m t of bladder t u m o r s ( H o f s e t t e r and S t a e h l e r 1 9 7 7 ) ( 1 )

,

t h e i n d i c a t i o n s f o r u t i l i s a t i o n of l a s e r i n urology and p a r t i c u l a r l y m endo-urology have been s i g n i f i c a n t l y widened.

Among d i f f e r e n t l a s e r s a v a i l a b l e Nd: YAG i s c e r t a i n l y the most u s e f u l in ado-urology (21, mainly f o r its c h a r a c t e r i s t i c s of deep t i s s u e 2 e n e t r a t i o n and p o s s i b i l i t y t o u s e it i n a water m d i u m ; f u r t h e r m o r e t h e a d a p t a b l i l i t y of f i b e r s t o a s w e l l r i g i d a s f l e x i b l e endoscopes mkes this laser a very v e r s a t i l e device.

I n d i c a t i o n s f o r l a s e r t r e a t m e n t i n endoscopic urology have keen b a s i c a l l y r e s t r i c t e d t o s u p e r f i c i a l bladder t w r s : nevertheless its a p p l i c a t i o n has been r e c e n t l y proposed i n various other pathologies.

P r e s e n t main a p p l i c a t i o n s f o r l a s e r i n endo-urology are summarized i n t a b l e I . Q u i t e a l a r g e e x p e r i e n c e has been achieved f o r treafxent of s u p e r f i c i a l t r a n s i t i o n a l b l a d d e r tumors ( 3 )

.

L a s e r , a l l o w i n g a "no t o u c h " technique f o r tumor d e s t r u c t i o n , should reduce the very high r e c u r r e n c e r a t e observed a f t e r endoscopic resection alone (TIM); t i s s u e p e n e t r a t i o n s h o u l d a l s o p r o v i d e a "kransrnural s t e r i l i z a t i o n " . Only t u m o r s s i z e d less t h e n 2 , 5 cm are a c t u a l l y s u i t a b l e f o r a l a s e r monotherap y ; r o u t i n e p r a t i c t e should coxbine TUR f o r t m r debulkning and s t a g i n g , and l a s e r i r r a d i a t i o n to minimize the r i s k of inconpslete tumor e x c i s i o n . . D e s p i t e a l a r g e number o f p a t i e n t s t r e a t e d no d e f i n i t i v e r e s u l t s are available y e t ; hovever preliminary r e s u l t s s e e m t o confirrn an advantage f o r p a t i e n t s t r e a t e d with l a s e r ( 3 ) . Recently l a s e r has a l s o been proposed f o r treatrrent of invasive bladder cancer ( 4 ) ; p o s s i b i l i t y t o o b t a i n a t r a n s m u r a l c o a g u l a t i o n and a lymphatic s e a l i n g a p p e a r s t o be of i n t e r e s t i n p a t i e n t s non s u i t a b l e f o r q e n surgery.

The i n t r o d u c t i o n of endoscopic therqoy of w p e r urinary t r a c t s u p e r f i c i a l tumors has extended the use of l a s e r t o the kidney and 'he u r e t e r ( 5 ) .

Laser has a l s o k e n used f o r endoscopic t r e a t r e n t of ureteral.

s t r i c t u r e s o r UPJ s t e n o s i s w i t h a very good control of t i s s u e section and h e m s t a s i s .

L a s e r u t i l i z a t i o n has a l s o been pro9osed f o r lover urinary t r a c t o b s t r u c t i v e pathology (BPH

-

u r e t h c a l s t r i c t u r e s ) ; p r e l i m n a r y r e s u l t s d o n o t show a n y a d v a n t a g e i n comparison t o c o n v e n t i o n a l elec trocautery

Article published online by EDP Sciences and available at http://dx.doi.org/10.1051/jphyscol:1987748

JOURNAL DE PHYSIQUE

L a s t a p p l i c a t i o n of l a s e r e n e r g y t o urology concerns stone f r a g m e n t a t i o n ( 6 ) ; it h a s r e c e n t l y become a 2 p a r e n t t h a t it may b e p o s s i b l e t o f r a g m n t u r e t e r a l c a l u l i v i a an ureteroscope using e i t h e r a Q - Switched Nd: YAG l a s e r o r a t u r n a b l e p u l s e d - dye l a s e r energy passed down a f i b e r .

I n c o n c l u s i o n l a s e r and p a r t i c u l a r l y Nd: YAG has proven t o k an e f f e c t i v e and v e r s a t i l e d e v i c e i n endo-urology; l a r g e r experience a n d l o n g e r f o l l o w - u p a r e n e c e s s a r y t o d e m o n s t r a t e i t s r e a l e f f e c t i v e n e s s

.

1 ) HOFSETTER A. et all : "EXperimntal erzengung von m l i g n e t m r e n an der kaninchen. Harnblase f o r t s c h r Pkd., 95; 346; 1977

2 ) HOFSETTER A. ^" I n t e r n a t i o n a l syqmsium l a s e r in Urology" Eur. Urol.

12 suppl 1 , pp 1-3, 1986.

3 ) MALLOY T.R. I' Neodymium YAG l a s e r in t r a n s i t i o n a l cell cancer of t h e b l a d d e r w i t h Emphasis on o u t p a t i e n t p o t e n t i a l " Eur. Urol. 12 suppl. 1, pp 25-27, 1986.

4 ) SWITH J.A.": "Treatment of invasive bladder cancer w i t h a neodymium Y X l a s e r " J. Urol. 135: 55, 1986

5 ) HUTSCHENZEITER B., "Percutaneous l a s e r t h e r a p y of tumors of the Upper Urinary t r a c t " Eur. Urol 12 suppl. 1 , pp 28-29, 1986.

6 ) FRANK F e t c o l l " E x p e r i ~ n t a l investigation of neodymium YAG l a s e r induced shock waves f o r l i t h o t r i p s y " . Eur. Urol. 12 suppl. 1, 54-57, 1986.

TABLE I

CLINICAL LPSER APPLICATIONS IN UROLOGY

BLADDER :

UPPW URINARY TWCT:

URETHRA:

- kblignant lesions 'JCC

hemangioms - Benign lesions

i n t e r s t i d c y s t i t i s - Plalignant lesions

-

^'!XX

- m i g n lesions < Z E T I t r i c t u r e s

-

Malignant lesions TCC

<

-

Benign lesions

PROSTATE : - BPH

- Prostatic Cancer