Pics: Brijesh Garodi
Daijiworld Media Network - Mangalore
Media Release
Mangalore, Mar 18: The high power Auriga XL Holmium Laser system in the department of Urology and Renal Transplantation was inaugurated at A J Hospital and Research Centre, here on Saturday March 17 by Prof P Venugopal, former HOD urology, KMC, Manipal, Prof Emeritus in urology, KLES Hospital, Belgaum.
Laser technology as in several other branches of medical science has ushered in a revolution in the field of urology. The endoscopic treatment of stones and tumors within the urinary tract has been revolutionized with the use of this technology. Prostate enlargement not responding to medical treatment needs surgery and laser has a cutting edge over conventional electrical cautery for its endoscopic removal.
Urinary stones
Urinary stone disease prevalence is on the increase with change in dietary habits of the population. While conventional rigid endoscopy can be used to treat a majority of stone cases, some areas of the urinary tract need flexible scopes to approach the stones. The pneumatic lithoclast (stone fragmenter) that was being used till date cannot be used through the flexible scopes. Laser can be transmitted through optical fibres and therefore can be used through the flexible scope to break up stones in relatively inaccessible locations. The Auriga XL laser system is eminently designed to pulverize stones into extremely small fragments facilitating easy passage through the urinary tract. Even the hardest of stones can disintegrate with the use of this laser. In several cases, we can also avoid the use of a stent after the procedure, thereby avoiding a second procedure to remove it.
Prostate Surgery
Prostate enlargement is one of the commonest problems dealt with by the urologist pertaining to middle and old aged individuals. Distressing symptoms like thinning of urinary stream, interruption of voiding, and severe frequency of voiding especially at night, force these individuals to seek urological intervention. Majority of these could be effectively managed by drugs but others need some form of surgery, usually endoscopic to relieve the symptoms. Conventionally, electrocautery has been used (Transurethral resection or TURP) to endoscopically core out the prostate. The procedure needs about a week of hospitalization and should be avoided in heart patients receiving concomitant ‘blood-thinning’ or anti- coagulant drugs due to the risk of bleeding. Laser technology provides for less bleed, shorter in-house stay and therefore is more convenient to the patient. Large glands can be enucleated endoscopically (HOLEP) thereby avoiding open surgery. In the vaporization mode of laser, selected heart patients on anticoagulants could be operated upon, thereby avoiding prolonged periods of unnecessary catheterization.
Bladder tumors
Conventionally electrocautery (TURBT) has been employed for endoscopic treatment of bladder tumors. Tumors in certain location run the risk of bladder muscle spasm and perforation during their removal. Laser provides for precise resection of bladder tumors, avoids this muscle spasm and associated risk of bladder complications. Laser is ideally suited for follow-up treatment of tumors which can be done on out-patient basis. Transmissibility through flexible optical fibers makes the technology suitable to treat early tumors within the kidney and upper urinary system.
Urethral strictures
Laser in cutting mode could be used as an alternative to mechanical endoscopic incision (VIU) of narrowing within the urethra (strictures). However the advantage of laser for this condition is yet to be established.
Laser provides an effective alternate energy system to treat most common urological conditions. The cost of treatment by laser is higher than conventional methodologies but the convenience and safety associated with its use may be well worth the expense. The patient however should take the final call on which modality is to be employed, after being fully educated regarding the pros and cons of individual treatment approaches.
The new addition to the armamentarium in the department of Urology, A J Hospital and Research Centre hopes to usher a positive change in the treatment scenario for common urological problems of patients in Dakshina Kannada and surrounding areas in the years to come.