Robert K. Luntz, M.D.
Over the past 20 years, the medical community and the patients we care for have been the beneficiary of many medical advances. There is a trend in medicine towards minimizing the invasiveness of the procedures that we perform and the urological community has been extremely proactive in leading this charge.
One technology that has been particularly versatile is laser technology. Although this technology has existed for over 50 years, in the last 20 years there have been innovative applications of this technology for medical applications.
By manipulating wavelengths of light, we can generate laser energy and use that energy to our advantage. By changing how we manipulate these light wavelengths, we can change the property of the lasers we use. Some lasers are helpful in coagulating blood vessels and prevent bleeding whereas other lasers are better capable of removing tissue and breaking up kidney stones that develop within the urinary tract.
In the current practice of Urology, lasers are used for two principal purposes:
– To break apart urinary stones.
– To treat symptoms of urinary obstruction from an enlarged prostate gland.
Kidney stones have plagued man since prehistoric times. In addition to causing pain, the obstruction that they may cause can create life-threatening situations ranging from infection to kidney failure. In the past, therapy for obstructing stones required a major surgical procedure that resulted in prolonged hospitalization and absence from work. With the development of fiber-optic technology, small laser fibers can be advanced into the urinary system and stones can be systematically fragmented and removed. The Holmium laser technology allows this process to occur in a controlled and systematic manner and minimizes trauma to surrounding normal structures. In the majority of cases, patients return to their normal routine within days of being treated. A video of this procedure can be found on line atwww.kidneystoners.org/treatments/ureteroscopy.
Treatment of prostate enlargement can also be addressed in a minimally invasive manner due to advances in laser technology. In the recent past, the older technologies utilized necessitated overnight hospitalization and had risks including significant blood loss as well as life threatening electrolyte imbalances. The need for prolonged catheterization contributed to post operative discomfort and infection as well.
The two basic types of laser technology used to treat BPH include:
Interstitial Laser Technology such as the Indigo Laser-Optic Treatment System utilizes a fiber-optic probe that is introduced through a scope directly into the prostate. The heat energy that is generated by the laser causes coagulation of the obstructing prostate tissue. The process is repeated in different areas within the prostate until the obstructing tissue is opened in its entirety. In properly selected patients, symptoms normally improve markedly over a 6 to 12 week period.
Green-Light Laser Therapy utilizes non-contact laser energy to vaporize and remove the obstructing prostate tissue. The Green-Light is performed in an outpatient setting under sedation monitored by an anesthesiologist. Using a scope to visualize the area, the area is assessed and the laser energy is applied directly to the prostate to remove unwanted tissue. At the end of the procedure, the results are immediately apparent. A urinary catheter is required overnight but the benefit to the patient is apparent upon catheter removal the following day. To explore this technology further on line at www.greenlighthps.com.
In the future, the potential applications of laser technology in the healthcare field are likely to be limited only by the imaginations of the developers. I certainly look forward to seeing what the future has in store for us!