The Use of Laser (Laser) in Urology
What is Laser (LASER)?: Laser or the word Laser, “Light Amplification of Stimulated
Emission of Radiation-LASER” is the Turkish abbreviation of the term. laser devices; nowadays, thanks to the technological advances, especially in the treatment of benign prostate enlargement, kidney and urinary tract stones; It can be a successful method used in
endoscopic cleaning (resection) and staging of bladder and upper urinary tract tumors, and in many other urological
diseases. Laser, cutting, blood arrest (coagulation) and
vaporization In addition to performing the (vaporization) function simultaneously
it can greatly reduce the risk of edema, induration and stenosis.
Laser types used in urological surgery so far:
- The Carbon Dioxide-CO2 Laser is no longer used
- Neodymium:Yttrium-Aluminum-Garnet (Nd:YAG),
- Holmium:Yttrium-Aluminum-Garnet (Ho:YAG), Holmium Laser
- Thulium laser
- Potassium-Titanyl-Phosphate (KTP): Greenlight
Prostate Surgery with Holmium Laser: HoLEP
What is HOLEP? : HoLEP refers to prostate surgery performed with Holmium laser.
Holmium laser is absorbed very well in tissue and kidney stones and allows effective
use. The Holmium laser device is used both for stone breaking, and for simultaneous cutting, bleeding control and vaporization, especially in the prostate and other tissues. its destructive/caustic effect
is not very deep (0.40 mm). When applied to the prostate, the depth of action does not suddenly increase,
does not exceed the capsule of the prostate. Due to this feature of the holmium laser, it can be easily scraped between the
capsule of the prostate and the enlarged prostate tissue, that is,
enucleation can be performed. Prostate surgery with HoLEP refers to this procedure. It is entered through the external urethra
with an endoscopic instrument with a camera, prostate tissue, urinary canal, the valve that controls the urine, that is, the valve (sphincter) that controls the urine, and then proceeds to the bladder
starts with checking whether there is another problem (tumor, stone, etc.) inside the bladder. Then
prostate lobes are stripped from their own capsule back towards the bladder by preserving the valve-sphincter that allows us to hold urine with the prostate Holmium laser probe, and left to the bladder in 2-3
pieces, bleeding places are again Holmium laser probe
Prostate pieces left in the bladder are broken up with a special device called a morcellator and
are vacuumed and taken out. After making sure that there are no pieces inside and bleeding
control, the procedure is terminated by placing a urinary catheter. The removed tissue is sent to pathology to be examined
. In contrast to some laser surgeries, in Holep surgery
the prostate is taken out completely and it is possible to examine it in pathology. If cancer
is found, additional treatment should be given accordingly.
How many days to stay in the hospital after HoLEP surgery, when
to take the urinary catheter?:
After the prostate surgery with HoLEP, the urinary catheter is removed 1-2 days later and the patient is discharged
is done.
Does HoLEP Surgery Affect Masculinity?
In benign prostate enlargement surgeries performed with laser, thulium laser energy reaches less
tissue depth, so that the nerves that provide hardening are affected.
According to Holep, the depth of effect of laser energy is relatively less (0.40 mm), in this respect
can be considered advantageous. As a result, HoLEP Surgery does not harm masculinity, that is, sexual
functions. However, as in prostate surgeries, since the area that prevents semen from escaping in Holep
is removed, at the time of orgasm, semen flows backwards into the bladder
and is then thrown out with urine (retrograde ejaculation). This situation is
harmless to the patient.
Patients may have the following problems after surgery:
- Temporary Bleeding may occur, and in patients whose blood-thinning medication has been discontinued, it may be delayed for a while.
it may take a few weeks. - Mild urinary incontinence in the first weeks, urinary retention gymnastics (kegel exercise) may be recommended in these patients.
- Post-operative urinary tract infection, antibiotic treatment can be applied, plenty of water is recommended.
Inability to urinate, that is, temporary urinary obstruction, may require a urinary catheter for 1-2 days. as possible
but not seen in practice.
Results with Holep:Comparing the healing results with HoLEP with other types of prostate surgeries ;
The improvement in voiding rate and prostate symptoms is the same. In addition, the length of hospital stay
and the length of stay at the probe are, on average, one day shorter in HOLEP. However, TUR-P, which is still the classic
prostate surgery, continues to be the most ideal surgical treatment.
These data are presented when patients choose, and the surgical method should be decided by the joint decision of the patient and the surgeon.Prostate Surgery with Thulium Laser: ThuLEP
What is ThuFLEP?: ThuLEP refers to the use of Thulium laser in prostate surgery like Holep
. Although their names are different, the purpose of both
operations performed with Holmium and Thulium laser is to completely strip the prostate from the capsule as in open surgery, and
to remove the prostate from the urinary
duct by shredding it with a device called a morcellator. Holmium laser is used in HoLEP surgery, and Thulium laser is used in ThuLEP surgery. Thulium laser device is used both for stone breaking, as with Holmium laser, and for simultaneous cutting,
bleeding control and vaporization, especially in prostate and other tissues.
Holmium lasers are pulsed lasers; Thulium lasers are continuous-analog lasers.
Unlike the holmium laser, the Thulium laser produces a blade-like effect. Although the operations performed with both laser
energy are similar, the ThuLEP laser has better cutting power
and It is possible to reach less tissue depth. ThuLEP or ThuFLEP technique has side effects and d It can have important advantages such as less
deterioration in the arrow and better bleeding control.
The most up-to-date technology, ThuLEP or ThuFLEP (Thulium Fiber Laser) technology, is benign
It is used in the treatment of prostate enlargement (BPH), endoscopic resection and
staging of bladder tumors, and
resection and staging of tumors of the upper urinary tract.In which patients is ThuLEP applied?
- Prostate surgery can be performed on any patient who is considered for surgery.
- It can be applied to any size prostate regardless of the size of the prostate.
- Also, if there is a bladder stone, it can be cleaned in the same session.
- It can be applied to patients who have to carry catheters continuously.
- It can also be applied to patients who receive blood thinners.
How to Perform Prostate Surgery with ThuLEP?
HoLEP and ThuLEP are basically the same tools and technical equipment, the only difference is the laser device used. Holmium laser is used in HoLEP surgery, and Thulium laser is used in ThuLEP surgery.
The procedure is performed under hospital conditions, under general or local anesthesia (spinal), through the external urethra in the penis
with an endoscopic instrument, prostate tissue, urinary canal, It starts with the examination of the valve (sphincter) that controls the urine, that is, the
that allows us to hold urine, and then proceeds to the bladder and
checks if there is any other problem (tumor, stone, etc.) inside the bladder. Subsequently, the prostate
lobes are stripped from its capsule back to the bladder from certain points, by protecting the valve-sphincter that allows us to hold urine with the prostate Thulium
laser probe, and left to the bladder in 2-3 pieces
, the bleeding sites are again with the Thulium laser probe burned with Prostate pieces left into the bladder
are broken up with a special device called a morcellator and vacuumed
taken out. After making sure that there are no parts inside and bleeding control, the procedure is terminated by placing a urinary
catheter. The removed tissue is sent to pathology for examination. Additional treatment
should be given according to the guidelines.How many days to stay in the hospital after ThuLEP surgery, When is the urinary catheter removed?:
After prostate surgery with ThuLEP 1- After 2 days, the urinary catheter is removed and the patient is discharged.Does ThuLEP Surgery Affect Masculinity?
In benign prostate enlargement surgeries performed with laser, thulium laser energy is less effective.
Since it reaches the tissue depth, it does not harm the nerves that provide the hardening. As a result, ThuLEP surgery does not harm masculinity, that is, sexual functions
. However, as in prostate surgeries, in Holep and Thulep, since the area that prevents semen from escaping back is removed, at the time of orgasm, semen flows backwards into the bladder
and is then excreted together with urine (retrograde ejaculation). This situation is
harmless to the patient.
Patients may have the following problems after surgery:- There may be temporary bleeding, In patients whose blood-thinning medication has been discontinued, it may be delayed for a while.
- Mild urinary incontinence in the first weeks, urinary retention gymnastics (kegel exercise)
may be recommended in these patients. - Urinary tract infection after surgery, antibiotic treatment can be applied, plenty of water is recommended.
- Inability to urinate, ie temporary urinary obstruction, may require a urinary catheter for 1-2 days.
- Theoretically it is possible for the prostate to re-grow and obstruct the urinary tract in the long term
but it is rarely seen in practice.
When can patients return to their normal daily life?: Patients can return to work
within 1-2 weeks. After 4 weeks, it is recommended to abstain from sex. In the first sexual contact
bleeding in the urine-semen can be seen.Prostate Surgery with GreenLight Laser: GreenLight
What is the GreenLight laser method?: GreenLight laser method; Greenlight laser energy of enlarged parts of the prostate, used in the surgical treatment of benign prostate enlargement
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