- Genito Urinary Problems In Diabetes Mellitus
- Use Of Holmium Laser In Urology
- Endourology (Vesical Septum)
- Reconstructive Urology
- Uro Oncology
- Urogynecology (Female Urology)
- Pediatric Urology
Holmium laser treatment of prostate gland : It has been over two decades that various forms of laser generators have been used to ablate the obstructing prostatic adenoma. However in last 5 years two such modalities have gained stability while others have largely failed to survive. Holmium Laser enucleation of Prostate (HOLEP) involves high power (100 watts) laser energy generated using Holmium Yag medium to be delivered through an end firing contact probe. By moving this probe all around the adenoma it can be enucleated and dropped into the urinary bladder, where it could be morcellated and sucked out piecemeal. The probe works like the finger of a surgeon performing open prostatectomy.
- Almost blood less surgery, minimal blood loss.
- Excellent vision through the telescope as there is no bleeding.
- Normal saline may be used as irrigant.
- Short catheter period; 24-36 hours.
- Quick recovery.
- Early return to work.
- Very low incidence of stricture urethra and reactionary haemorrhage.
- Advisable in patients with coagulation disorder.
- One of the best options for prostate glands more than 100 gms.
- High cost of equipment.
- Recurring cost of fibre.
- Steep learning curve.
- Holmium laser treatment of urinary stone disease
- Holmium laser has been used to fragment urinary stones during endourological procedures like Cystolithotripsy, Ureterorenoscopy, Percutaneous Nephrolithotripsy (PCNL), and Retrograde Intrarenal Surgery (RIRS using flexible ureteroscope).
The main advantages of Holmium Laser over Pneumatic lithotripter are :
- Small size of fibre allows good flow of irrigant fluid through the instrument channel, thus allowing smaller sized ureteroscope / Nephroscope (MINIPERC) to be used.
- The chances of proximal migration ( Retropulsion)of stone are reduced.
- Chances of perforation of the urothelium which may occur due to counter pressure as a result of mechanical shock waves on the stone during fragmentation by pneumoclast are eliminated.
- Holmium laser in Vesical lesions
- Holmium laser incision of bladder neck