Prescriptive Information: Holmium 60W Laser
Urology indications
The following applications are indicated for urology while using the Ho:YAG wavelength:
Open and endoscopic urological surgery (ablation, vaporization, incision, excision, and coagulation of soft tissue) including treatment of:
- Superficial and invasive bladder, urethral, and ureteral tumors
- Condylomata
- Lesions of external genitalia
- Urethral and penile hemangiomas
- Urethral strictures
- Bladder neck obstructions
Urology contraindications
The Ho:YAG wavelength should not be used in patients with the following conditions:
- Inability to receive endoscopic treatment
- Intolerance to anesthesia
Urology warnings
Read “General laser warnings” the operators manual for a list of warnings.
Urology precautions
CAUTION – Care should be exercised so as not to over distend the bladder when using the laser endoscopically. Excessive bladder distention could result in coagulative
necrosis of the superficial and inner muscular region of the bladder wall.
Read “General laser precautions” in the operators manual for a list of additional precautions.
Urology complications
Read “General laser complications” in the operators manual for a list of complications.
Urinary lithotripsy indications
The following applications are indicated for urinary lithotripsy while using the Ho:YAG wavelength:
- Endoscopic fragmentation of urinary (urethral, ureteral, bladder and renal) calculi, including cystine, calcium oxalate, monohydrate and calcium oxalate dihydrate stones
- Treatment of distal impacted fragments of steinstrasse when guide wires cannot be passed
Urinary lithotripsy contraindications
The Ho:YAG wavelength must not be used in patients with the following conditions:
- Inability to receive endoscopic treatment
- Intolerance to anesthesia
Urinary lithotripsy warnings
WARNING – Unexpected tissue damage may occur due to excessive power application. Refer to “Urinary lithotripsy clinical parameters” in the operators manual for recommended initial power settings. Use of excessive power may result in inadvertent perforation of the ureter or damage to other urologic structures.
Read “General laser warnings” in operators manual for a list of additional warnings.
Indications for Use Specific to the Ho:YAG Wavelength
Urinary lithotripsy precautions
CAUTION – The laser should be used with an optical fiber delivery system in direct view and in direct contact with the target ureteral stone. To minimize the potential for migration up the ureter, laser energy should be directed to the side of the stone, if possible, rather than the leading edge. Maintaining low energy levels and repetition rates will reduce the potential for possible stone migration.
CAUTION – Be aware of edematous folds of epithelium that may lie between the optical fiber and the stone; however, research suggests such folds are very rare.
CAUTION – Basketing may be used with larger stone fragments that are relatively hard or tend to escape in a retrograde fashion up the ureter. Use of endoscopes in
laser procedures allows excellent viewing and minimal trauma to the ureter during fragmentation. Baskets, guide wires, and other ureteroscopic accessories may be damaged by direct contact with the laser treatment beam.
CAUTION – The use of irrigation is recommended throughout the lithotripsy procedure to absorb any heat produced, to carry stone fragments out of the urinary system, and to enhance direct visualization. The rate of irrigation should be carefully adjusted to avoid flux of calculi into the kidney.
Read “General laser precautions” in operators manual for a list of additional precautions.
Indications for Use
Urinary lithotripsy complications
- As with other endoscopic urologic procedures, there may be urine leakage following the laser procedure.
- The use of flexible endoscopes carries an equivalent incidence of stricture formation; these rates may improve with further advances in ureteroscope design.
- Although rare, loss of a kidney may occur as a result of the procedure or because of the stone, itself.
Read “General laser complications” in the operators manual for a list of additional complications.
