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Mares C, Geavlete P, Ene C, Iordache V, Geavlete B. Semirigid vs Flexible Ureteroscopy in the Management of Ureteral Stones - Review. MAEDICA 2023; 18:490-497. [PMID: 38023749 PMCID: PMC10674128 DOI: 10.26574/maedica.2023.18.3.490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
Ureteral stones are a major clinical problem in urology that require effective and safe therapeutic options. Semirigid and flexible ureteroscopy ar two well-established procedures for treating these stones. The present review provides an outline of the advantages and disadvantages of these approaches. Semirigid ureteroscopy, which uses a rigid straight instrument, provides excellent stone visualisation and successful fragmentation. It is especially useful for proximal and bigger stones, frequently resulting in high stone-free rates and reduced procedure times. Nonetheless, its stiffness can make it difficult to navigate the delicate ureteral anatomy and increase the risk of mucosal injury. On the other hand, flexible ureteroscopy employs a more adjustable flexible scope, allowing access to complicated ureteral configurations while reducing the risk of ureteral trauma. It excels at treating distal and difficult stones but has a lower efficacy with larger stones and often requires longer procedure times. The choice between semirigid and flexible ureteroscopy is determined by patient-specific factors such as stone characteristics or anatomical considerations and the surgeon's skill. A customised approach that uses the capabilities of both treatments as needed can improve stone management outcomes while reducing potential problems. The continued advancement of technology and methodological modifications is predicted to improve the field of ureteroscopic stone management.
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Affiliation(s)
- C Mares
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
- "Saint John" Emergency Clinical Hospital, Department of Urology, Bucharest, Romania
| | - P Geavlete
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
- "Saint John" Emergency Clinical Hospital, Department of Urology, Bucharest, Romania
- Sanador Hospital, Bucharest, Romania
| | - C Ene
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
- "Saint John" Emergency Clinical Hospital, Department of Urology, Bucharest, Romania
| | - V Iordache
- "Saint John" Emergency Clinical Hospital, Department of Urology, Bucharest, Romania
| | - B Geavlete
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
- "Saint John" Emergency Clinical Hospital, Department of Urology, Bucharest, Romania
- Sanador Hospital, Bucharest, Romania
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2
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Peteinaris A, Tsaturyan A, Pantazis L, Farsari E, Martinez BB, Pagonis K, Adamou C, Vagionis A, Natsos A, Liatsikos E, Kallidonis P. Factors affecting the irrigation fluid temperature during laser lithotripsy: in vitro experimental study. Urology 2022; 170:53-59. [PMID: 36115430 DOI: 10.1016/j.urology.2022.07.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 07/21/2022] [Accepted: 07/31/2022] [Indexed: 10/14/2022]
Abstract
OBJECTIVE To investigate the effect of the diameter of laser fiber, pelvis volume, presence and type of the stone on irrigation fluid temperature rise. MATERIAL AND METHODS A 20ml syringe, 12/14 ureteral access sheath(UAS), a dual-lumen catheter and a thermocouple were used. The 12/14Fr UAS(Cook Ireland Ltd., Limerick, Ireland) and the Thermocouple(SE001, Pico Technologies, Cambridgeshire, UK) were inserted in the syringe. The syringe was closed allowing outflow from the UAS with rate at 10ml/min. The Quanta Ho 150W(Quanta System, Samarate, Italy) laser was used and fired with 10W(2Jx5Hz), 20W(2 × 10 Hz), 40W(2 × 20 Hz), 60W(2 × 30 Hz). These power settings were tested in different conditions: fibers(200µm, 365µm and 550µm), volumes(5ml, 10ml and 20ml) and artificial stones(soft, hard). The laser was activated for 30 seconds and reactivation was performed when the temperature reached below 26 0C. RESULTS For all trials 60W of energy resulted in higher temperature rise. No differences were observed when different fibers were used. The highest temperatures (up to 80 0C) for 60W were reported in 5ml syringe and the lowest (<45 0C) with 20ml. The maximal temperature of >59°C was recorded for the power of 60W(1Jx60Hz). The temperature exceeded 43 0C when power settings >40W were applied. CONCLUSION Increasing the overall power, increases the irrigation fluid temperature significantly. The smaller the volume of the pelvis, the greater the temperature elevation. The fiber size did not affect the temperature increase pattern. The presence of artificial stones was associated with the absorption of energy emitted by the laser.
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Affiliation(s)
| | | | | | - Ergina Farsari
- Plasma Technology Laboratory, Department of Chemical Engineering, University of Patras, Patras, Greece
| | | | | | | | | | | | - Evangelos Liatsikos
- Department of Urology, University of Patras, Patras, Greece; Department of Urology, Medical University of Vienna, Vienna, Austria; Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
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3
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Allameh F, Javadi A, Dadkhahfar S, Naeeji Z, Moridi A, Tadayon N, Alahyari S. A Systematic Review of Elective Laser Therapy during Pregnancy. J Lasers Med Sci 2021; 12:e50. [PMID: 34733773 DOI: 10.34172/jlms.2021.50] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 06/26/2021] [Indexed: 12/15/2022]
Abstract
Introduction: Currently, lasers are used to treat many diseases and their complications. However, the use of lasers in pregnant patients is still controversial. Methods: In this review, the application of lasers in the fields of urology, surgery, obstetrics, dermatology, and musculoskeletal disorders is evaluated. The following keywords were used to search through PubMed, Google Scholar, and Scopus: pregnancy, laser, urolithiasis, endovenous laser ablation (EVLA) or treatment, leg edema, varicose vein, venous insufficiencies, hair removal, pigmentation, telangiectasia, vascular lesions, Q switch laser, diode laser, holmium, holmium-YAG laser, erbium laser and Pulsed dye laser, low-level laser therapy, high-intensity laser therapy, pain, musculoskeletal disorders, twin to twin transfusion syndrome (TTTS), amnioreduction, and safety. Results: Totally, 147 articles were found, and their abstracts were evaluated; out of 53 articles extracted, 14 articles were about dermatology, 24 articles were about urology, 12 articles were about obstetrics and gynecology, 10 articles were about musculoskeletal disorders and three articles were related to surgery. Conclusion: Laser therapy can be used as a safe treatment for urolithiasis, skin diseases, TTTS and varicose veins of the lower extremities. However, the use of laser therapy for musculoskeletal disorders during pregnancy is not recommended due to lack of evidence, and also we cannot recommend endovenous ablation.
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Affiliation(s)
- Farzad Allameh
- Laser Application in Medical Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Atefeh Javadi
- Physical Medicine and Rehabilitation Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sahar Dadkhahfar
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Naeeji
- Clinical Research Development Center, Mahdiyeh Educational Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Atefeh Moridi
- Department of Gynecology and Obstetrics, Mahdiye Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Niki Tadayon
- Department of General and Vascular Surgery, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sam Alahyari
- Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Teymourian H, Ghiasy S, Tayebi-Azar A, Razzaghi M, Sadri G, Ansari Djafari A, Hojjati SA, Poury M, Shahabi V, Javanmard B. The Effect of Propofol on the Success Rate of Transurethral Lithotripsy by Holmium Laser: A Randomized Clinical Trial. J Lasers Med Sci 2020; 11:305-309. [PMID: 32802292 DOI: 10.34172/jlms.2020.51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Introduction: Urinary stone disease is the third most common affliction of the urinary tract that has been associated with an increasing incidence. Over decades, great advances have been made in the minimally invasive treatment of urinary stones. Recently, transurethral lithotripsy (TUL) by holmium laser was introduced as a possible therapeutic option. This study evaluated the effect of propofol on the success rate of TUL by holmium laser. Methods: A double-blind randomized controlled trial was conducted on 180 patients to investigate the effect of propofol on the success and complication rate of TUL by holmium laser. The enrolled patients were divided into two groups: the first group received sodium thiopental (n=89) while the second group received propofol (n=91). The two groups were compared in terms of the fluctuations of systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), operation time, future stone-free rate (SFR), stone migration, post-operative fever, and ureteral complications such as perforation and mucosal damage. Other developed complications were also recorded. After data gathering, statistical analysis was performed with SPSS version 21. Results: the patients' data such as age, sex, stone diameter, stone laterality, duration of stone impaction, primary SBP, DBP and HR were not significantly different between the two groups (P>0.05). TUL and anesthesia duration, first-minute and fifth-minute SBP and DBP, and also changes of HR were significantly lower in the propofol group compared with the sodium thiopental group (P <0.001). Moreover, SFR of TUL was more evident in the propofol group. Ureteral mucosal damage was significantly less in the propofol group. Conclusion: Propofol was associated with a higher reduction in SBP and DBP, decreased duration of TUL, fewer fluctuations in HR, and an increased success rate of stone removal by TUL with holmium laser.
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Affiliation(s)
- Houman Teymourian
- Department of Anesthesiology and Critical Care, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saleh Ghiasy
- Department of Urology, Shohada-e-Tajrish Hospital, Shahid Beheshti University Of Medical Sciences, Tehran, Iran.,Laser Application in Medical Sciences Research Center, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Tayebi-Azar
- Nephrology and Kidney transplant Research Center, Urmia University of Medical Sciences, Urmia, Iran
| | - Mohammadreza Razzaghi
- Department of Urology, Shohada-e-Tajrish Hospital, Shahid Beheshti University Of Medical Sciences, Tehran, Iran
| | - Ghazal Sadri
- Resident of Radiology, Department of Radiology, Iran University of Medical Sciences, Tehran, Iran
| | - Anahita Ansari Djafari
- Department of Urology, Shohada-e-Tajrish Hospital, Shahid Beheshti University Of Medical Sciences, Tehran, Iran
| | - Seyyed Ali Hojjati
- Department of Urology, Shohada-e-Tajrish Hospital, Shahid Beheshti University Of Medical Sciences, Tehran, Iran
| | - Mohammad Poury
- Clinical Research Development Center, Shohadaye Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Vahid Shahabi
- Department of Urology, Shohada-e-Tajrish Hospital, Shahid Beheshti University Of Medical Sciences, Tehran, Iran
| | - Babak Javanmard
- Department of Urology, Shohada-e-Tajrish Hospital, Shahid Beheshti University Of Medical Sciences, Tehran, Iran
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5
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Abedi A, Razzaghi MR, Rahavian A, Hazrati E, Aliakbari F, Vahedisoraki V, Allameh F. Is Holmium Laser Enucleation of the Prostate a Good Surgical Alternative in Benign Prostatic Hyperplasia Management? A Review Article. J Lasers Med Sci 2020; 11:197-203. [PMID: 32273963 DOI: 10.34172/jlms.2020.33] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Several therapeutic approaches such as holmium laser enucleation of the prostate (HoLEP) have been introduced to relieve bladder outlet obstruction caused by benign prostatic hyperplasia (BPH). Compared with other techniques including the transurethral resection of the prostate (TURP) and simple open prostatectomy, HoLEP results in a shorter hospital stay and catheterization time and fewer blood loss and transfusions. HoLEP is a size-independent treatment option for BPH with average gland size from 36 g to 170 g. HoLEP is a safe procedure in patients receiving an anticoagulant and has no significant influence on the hemoglobin level. Also, HoLEP is an easy and safe technique in patients with a prior history of prostate surgery and a need for retreatment because of adenoma regrowth. The postoperative erectile dysfunction rate of patients treated with HoLEP is similar to TURP or open prostatectomy and about 77% of these patients experience loss of ejaculation. Patients with transitional zone volume less than 30 mL may suffer from persistent stress urinary incontinence following HoLEP so other surgical techniques like bipolar TURP are a good choice for these patients. In young patients, considering HoLEP with high prostate-specific antigen density and a negative standard template prostate biopsy, multiparametric MRI needs to be considered to exclude prostate cancer.
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Affiliation(s)
- Amirreza Abedi
- Urology Department, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Razzaghi
- Laser Application in Medical Science Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amirhossein Rahavian
- Urology Department, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ebrahim Hazrati
- School of Medicine, 501 Hospital (Imam Reza), AJA University of Medical Sciences, Tehran, Iran
| | - Fereshte Aliakbari
- Men's Health and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Vahid Vahedisoraki
- Department of Urology, Hasheminejad Kidney Center, Iran University of Medical Sciences, Tehran, Iran
| | - Farzad Allameh
- Laser Application in Medical Science Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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6
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Rabani SM, Rabani S, Rashidi N. Laser Versus Pneumatic Lithotripsy With Semi-Rigid Ureteroscope; A Comparative Randomized Study. J Lasers Med Sci 2019; 10:185-188. [PMID: 31749943 DOI: 10.15171/jlms.2019.29] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Introduction: Ureteral stones are among the most common disorders in the urologic field. Miniaturization of endoscopic devices in urology and extracorporeal shock wave lithotripsy (ESWL) has revolutionized the management of ureteral stones. The aim of this study was to compare the efficacy and results of laser versus pneumatic lithotripsy (PL) with semi-rigid ureteroscope in a randomized prospective clinical trial in removing stones. Methods: 117 adult patients underwent transurethral lithotripsy (TUL) in a single academic center and by a single surgeon. The patients were randomized in 2 groups: In group 1, 58 patients with ureteral stones underwent ureteroscopy and stone fragmentation was done by Ho: YAG laser lithotripsy (LL) and in group 2, 59 patients underwent PL (Swiss LithoClast) by using the same ureteroscope. Results: Mean age was 41.77 years and 41.1years in group one and 2 respectively (P=0.79), there was no significant difference in male to female ratio and mean stone in both groups. The success rate for stone clearance was 79.31% and 77.96% in group 1 and 2 respectively (P=0.52). No difference between complications was seen in both groups, but the duration of operations was different (significantly lower in group 2). Conclusion: In both techniques, acceptable results were achieved. We have found a significant statistical difference in duration of operation between our results (P=0.001) and similar studies, while this was shorter in the pneumatic group in our study, it was longer in other similar ones. This might be a result of more experience in working with PL in our center.
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Affiliation(s)
| | | | - Najmeh Rashidi
- Health Center, Yasuj University of Medical Sciences, Yasuj, Iran
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7
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Allameh F, Razzaghi M, Fallah-Karkan M, Hosseini B, Tayyebi Azar A, Ranjbar A, Rahavian AH, Ghiasy S. Comparison of Stone Retrieval Basket, Stone Cone and Holmium Laser: Which One Is Better in Retropulsion and Stone-Free Status for Patients with Upper Ureteral Calculi? J Lasers Med Sci 2019; 10:179-184. [PMID: 31749942 DOI: 10.15171/jlms.2019.28] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Introduction: Transurethral lithotripsy (TUL) is an appropriate treatment for ureteral stones and is usually used for stones in the middle and lower part of the ureter. Different devices such as the Holmium laser, the stone basket, and the stone cone exist to prevent any fragments from retropulsion during TUL. The present study aims to compare the advantages and disadvantages of the Holmium laser, the stone basket, and the stone cone. Methods: A retrospective study was conducted from September 2016 to January 2018 comparing various TUL methods in 88 subjects with proximal ureteral calculi. The study participants were divided into 4 matched groups. The first one included 20 patients undergoing TUL with no device (group 1), the second group included 22 patients undergoing TUL while using the stone retrieval basket, the third group included 18 patients undergoing TUL while utilizing the stone cone and the fourth group included 28 patients undergoing TUL while using the Hol-YAG laser. Results: A residual stone ≥3 mm was recorded in 15.9% of the patients. The stone free rate was seen in 100%, 90.9, 83.3%, and 55% of the Holmium laser group, the retrieval basket group, the stone cone group and the no device group respectively (P=0.001). The lowest rate of surgery complications including ureteral perforation, post-operative fever, and mucosal damage between the 4 groups (P=0.003) and the highest time of surgery (P=0.001) belonged to the laser group. If we want to ignore the laser group, the success rate for lithotripsy was better in both groups with a stone retrieval device compared to the no device group, but no advantage existed between the stone basket and the stone cone. Conclusion: We can safely conclude that lasers significantly help to prevent stone migration during TUL. If we want to ignore the laser group, the success rate for lithotripsy was significantly better in both groups with a stone retrieval device compared to the no device group, but no advantage existed between the stone basket and the stone cone.
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Affiliation(s)
- Farzad Allameh
- Center of Excellence for Training Laser Applications in Medicine, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Ministry of Health, Tehran, Iran
| | - Mohammadreza Razzaghi
- Laser Application in Medical Sciences Research Center, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Morteza Fallah-Karkan
- Laser Application in Medical Sciences Research Center, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Behnam Hosseini
- Akhtar Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Tayyebi Azar
- Nephrology and Kidney Transplant Research Center, Urmia University of Medical Sciences, Urmia, Iran
| | - Arash Ranjbar
- Laser Application in Medical Sciences Research Center, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amir Hossein Rahavian
- Laser Application in Medical Sciences Research Center, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saleh Ghiasy
- Laser Application in Medical Sciences Research Center, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Urology, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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8
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Fallah Karkan M, Razzaghi MR, Karami H, Ghiasy S, Tayyebiazar A, Javanmard B. Experience of 138 Transurethral Urethrotomy With Holmium:YAG Laser. J Lasers Med Sci 2019; 10:104-107. [PMID: 31360378 PMCID: PMC6499575 DOI: 10.15171/jlms.2019.17] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Introduction: Many valid option modalities are available for the management of urethral stricture disease (USD), such as internal urethrotomy which has the success rates of 33%-60%. The aim of this study was to assess the outcome of holmium: YAG (Ho: YAG) laser urethrotomy (HLU). Methods: One hundred thirty-eight patients with urethral stricture with the mean age of 48±3.03 years old treated by HLU from March 2011 to August 2017. The main purpose of this investigation was to evaluate mean operation time, stricture recurrence rate and post-operation Qmax and complications of transurethral HLU. Results: The most common cause of USD was trauma in 82 (59.4%) patients. Mean laser operation time, mean hospital stay and mean postoperative duration of catheterization were 23.08 ± 9.1 minutes, 19.02 ± 10.7 hours and 10.3 ± 1.05 days respectively. The mean Qmax was 8.3 ± 2.07 mL/s before surgery and 16 ±3.1 mL/s afterward. At the end of 12 months follow-up, a total of 37 (26.8%) patients developed recurrence of the stricture. Patients with posterior, longer urethral strictures and previous history of interventions have more recurrence rate of the stricture. Conclusion: HLU is minimally invasive and seems to be an effective and safe management option for primary, short, urethral strictures. The hospital stay is remarkably short and complications are negligible.
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Affiliation(s)
- Morteza Fallah Karkan
- Urology Department, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Razzaghi
- Urology Department, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Laser Application in Medical Science Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hossein Karami
- Urology Department, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saleh Ghiasy
- Urology Department, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Tayyebiazar
- Infertility and Reproductive Health Research Center Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Urology Department, Urmia University of Medical Sciences, Urmia, Iran
| | - Babak Javanmard
- Urology Department, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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9
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Holmium: YAG Laser Incision of Bladder Neck Contracture Following Radical Retropubic Prostatectomy. Nephrourol Mon 2019. [DOI: 10.5812/numonthly.88677] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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10
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Ghiasy S, Fallah-Karkan M, Razzaghi MR, Ranjbar A, Rahavian A, Javanmard B. Is Holmium Laser an Appropriate Modality to Treat Genital Warts? J Lasers Med Sci 2018; 10:70-74. [PMID: 31360372 DOI: 10.15171/jlms.2019.11] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Introduction: Genital warts in young adults aged 18-28 years are very common. Several approaches are routinely used in the treatment of warts, viz., medical treatment (podophyllin and trichloroacetic acid), conventional surgery (excision or electrocautery), cryotherapy, and laser treatment. Because of high recurrence rates after treatment, complications and long duration of treatment, newer modalities have been developed. One of these newer methods is laser, which has been used in several urologic diseases. However, there are only a few studies about use of Holmium laser for treatment of genital warts. This retrospective study compared the success rate of Holmium laser with other available treatments for genital warts. Methods: Between October 2011 and May 2016, 142 patients with genital warts attended the urology clinics at Shohada-e-Tajrish hospital in Tehran, Iran. Out of these, a total of 101 patients were included in this study consisting of 42, 39, 11 and 9 patients treated with cryotherapy, laser, conventional surgery and podophyllin respectively. Results: The most successfully cleared lesions were seen in the holmium laser treatment group (P=0.001). The lowest recurrence rate was observed in the holmium laser treatment group (P=0.001). 17 patients had one of these following problems: dysuria, initial hematuria or a change in the force and caliber of their urinary stream that after physical examination showed them to have a meatal wart. These patients then underwent cystoscopy up to urinary sphincter. All of them in addition to the meatus wart had a penile shaft lesion(s). Thirteen patients had meatal lesions, 9 of whom received holmium laser therapy and 4 patients were treated with electrocautery. Based on routine follow up after treatment, none of the patients treated with holmium laser had urinary stricture, but one case treated with electrocautery returned with a penile urethral stricture. Conclusion: This study showed that treatment with Holmium laser has the highest clearance rate (92.2%) and lowest recurrence rate (14.3%) compared to other available treatments in this study. It may be concluded that holmium laser is a safe and effective treatment for genital warts with a low rate of recurrence.
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Affiliation(s)
- Saleh Ghiasy
- Laser Application in Medical Science Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Morteza Fallah-Karkan
- Laser Application in Medical Science Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Razzaghi
- Laser Application in Medical Science Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Arash Ranjbar
- Laser Application in Medical Science Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amirhosein Rahavian
- Laser Application in Medical Science Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Babak Javanmard
- Department of Urology, Shohadae-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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11
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Abedi AR, Razzaghi MR, Allameh F, Aliakbari F, FallahKarkan M, Ranjbar A. Pneumatic Lithotripsy Versus Laser Lithotripsy for Ureteral Stones. J Lasers Med Sci 2018; 9:233-236. [PMID: 31119016 PMCID: PMC6499559 DOI: 10.15171/jlms.2018.42] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Introduction: Several different modalities are available for ureteral stone fragmentation. From them pneumatic and holmium: yttrium-aluminum-garnet (Ho: YAG) lithotripsy have supportive outcomes. In this study we studied 250 subjects who had ureteroscopic pneumatic lithotripsy (PL) or laser lithotripsy (LL). Methods: Two-hundred fifty patients with ureteral stones underwent ureteroscopic lithotripsy (115 subjects in the PL group, 135 subjects in the LL group) from August 2010 to April 2016. The purpose of this investigation was to evaluate stone-free rate (SFR), mean operation time (MOT), mean hospital stay (MHS), stone migration and complications. Results: Two groups were similar in age, gender, mean size of stones, side of stone, and complications. There was a statistical difference in terms of SFR, stone migration and MHS in favor of the LL group (P ≤ 0.05, P ≤ 0.05 respectively), and MOT in favor of the PL group (P ≤ 0.05). Conclusion: Both the PL and LL techniques were effective and safe for ureteral stones, however a slightly higher SFR was found in the LL group.
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Affiliation(s)
- Amir Reza Abedi
- Laser Application in Medical Science Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Razzaghi
- Laser Application in Medical Science Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farzad Allameh
- Laser Application in Medical Science Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fereshte Aliakbari
- Infertility & Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Morteza FallahKarkan
- Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Arash Ranjbar
- Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Javanmard B, Fallah Karkan M, Razzaghi MR, Ghiasy S, Ranjbar A, Rahavian A. Surgical Management of Vesical Stones in Children: A Comparison Between Open Cystolithotomy, Percutaneous Cystolithotomy and Transurethral Cystolithotripsy With Holmium-YAG Laser. J Lasers Med Sci 2018; 9:183-187. [PMID: 30809329 PMCID: PMC6378362 DOI: 10.15171/jlms.2018.33] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Introduction: Bladder stone is more common in developing countries and it is one of the rare diseases affecting children. In recent years, there is an increasing tendency in urologists to have minimal invasive approaches. The aim of this study was to compare the results of surgical bladder stone management in our single tertiary center. Methods: From 159 children younger than 18 years with vesical stones treated during January 2000 to January 2015 in Shohada-e-Tajrish hospital, Tehran, Iran, 146 subjects entered to the study. According to type of intervention, patients stratified to three groups. First group included 80 patients that open cystolithotomy (OCL) was done for them, second group was 39 patients who underwent percutaneous cystolithotomy (PCCL) and third group was 27 patients who treated by transurethral cystolithotripsy with holmium-YAG laser (TULL). Demographic data, hospital stay, operation time, and post operation complications were recorded and comparison were drawn between the three groups. Results: Mean age was 8.3±5.1 years (8.6±5.1, 6±4.2 years for boys and girls, respectively). Mean stone size (MSS) was 2.76±1.07 cm and no significant differences were found between the three groups but it was larger in OCL group. Mean operative time (MOT) was 29.15±7.12 minutes in separate; MOT in TULL was significantly higher than PCCL and OCL respectively (36.3±5.97, 30.54±5.27 and 26.06±6.32 minutes/P =0.000). Mean hospital stay (MHS) in OCL group was 3.55±1 days that was higher than PCCL and TULL groups significantly (P =0.000). Conclusion: Based on our study, holmium:YAG lithotripsy has a high success rate, and is a minimally invasive management, therefore it is a safe method for children bladder calculi treatment if proper equipment was available and done by expert hands.
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Affiliation(s)
- Babak Javanmard
- Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Morteza Fallah Karkan
- Laser Application in Medical Science Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Razzaghi
- Laser Application in Medical Science Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saleh Ghiasy
- Laser Application in Medical Science Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Arash Ranjbar
- Laser Application in Medical Science Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amirhossein Rahavian
- Laser Application in Medical Science Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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