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Background To evaluate the efficacy and safety of Holmium YAG laser circumcision in adolescents. Methods Eighty-one patients underwent circumcision for medical reasons, and patients’ requests were collected retrospectively during February 2017 to February 2019. They were divided into two groups: Holmium YAG laser (group 1, n = 41) and conventional group (group 2, n = 40). The guillotine method with a Holmium YAG laser was applied for circumcisions, and all the procedures were performed by a single urologist who was well-experienced with circumcision practices. Results The average age of group 1 was 15.53 ± 7.35 years old, and the average age was 16.34 ± 9.22 years old in group 2. There was no significant difference in age and indications. The average operative time was significantly shorter in group 1 than in group 2 (24.40 ± 3.94 vs. 27.25 ± 4.35 min, p p p Conclusions The use of Holmium YAG laser in circumcision is a novel, less complicated, easy, and less painful alternative procedure for circumcision in young males.

A 12‐year‐old boy received steroid for his minimal change nephrotic syndrome for 10 years, and bilateral renal and ureteral stones and hydronephrosis were observed. Single‐use flexible ureteroscopy is usable for pediatric lithotripsy with Ho: YAG laser.

Introduction: Genital condylomatosis is a highly contagious disease caused by the human papilloma virus (HPV). The aim of this prospective multicentre study was to evaluate the safety and efficacy of the Holmium:YAG (yttrium-aluminium-garnet) laser in the treatment of genital and intra-urethral warts; the secondary aim was to assess the patients’ postoperative satisfaction and cosmetic results. Methods: From December 2016 to March 2019, patients with genital warts were prospectively enrolled in three hospitals. The inclusion criteria were male gender, age over 18 years-old and treatment-naïve. External and urethral genitalia warts were treated by the Holmium YAG laser. The follow-up analysis consisted of physical examination, flexible urethro-cystoscopy in case of meatal lesions, and administration of Dermatology Quality of Life Index (DLQI) and Patient Global Impression of Improvement (PGI-I) questionnaires at 1, 3, 6 and 12 months after surgery and subsequently yearly. Results: Sixty patients were enrolled. The single treatment was effective in 57/60 patients (95%). At a mean follow-up of 26 months, recurrences occurred in 8 patients (13.3%). No peri- or post-operative complication occurred. An improvement in pre-operative condition was highlighted with PGI-I and DLQI questionnaires. Conclusion: Our prospective multicentre study showed that holmium laser surgery seems to be a safe and effective treatment for external genital and urethral warts. Good dermatological outcomes aid to further improve patient satisfaction.

Intraoperative iatrogenic burns that occur under general anesthesia may become deep and wide, because patients do not notice or complain about them. We here present a patient who suffered burns to both the buttocks and thighs from a holmium YAG laser used during surgery for cervical cancer. An investigating committee was set up to determine the cause of this incident, and concluded that it was highly likely that the patient’s flammable gastrointestinal gases during the use of the holmium YAG laser caused the fire.This case report describes the etiology of this unusual incident, together with a literature review, and recommendations on how to avoid such injuries. In addition, we report the successful treatment of this patient by a strategic surgical method. Keywords: Iatrogenic burns, Gastrointestinal gas explosion, Holmium YAG laser

A 27-year-old male presented with recurrent urinary tract infections, calculus formation and hair follicles in urine following urethroplasty. The patient was treated with urethroscopic holmium laser in 2012, which was performed by Beiko for the first time in the literature to remove stones and epilate hair follicles. At 3-month, 3-year and 6-year follow-ups, the patient was symptom and infection-free. Urethrocystoscopy was performed in the 6-year follow-up, and no stone formation was observed. There were only a few hair follicles that were too short to require re-surgery. Urethral hair follicles and stone formation are uncommon long term complications following urethroplasty. Endoscopic holmium laser hair epilation is a rarely performed treatment option for hair follicles and urethral stone. Holmium:YAG laser epilation may be an alternative, minimally invasive treatment option with successful long term outcomes., 27 yaşında erkek hasta, tekrarlayan idrar yolu enfeksiyonu, idrarda taş oluşumu ve idrarla kıl gelmesi şikayetleri ile başvurdu. Hasta 2012 yılında, Beiko tarafından literatürde ilk kez uygulanan üretradan taş çıkarmak ve kıl köklerinin epilasyonu için yapılan üretroskopik olarak holmium lazer ile tedavi edildi. Kısa süreli 3.ay ve uzun süreli 3 ve 6 yıllık takiplerde hastada enfeksiyon gelişmedi. Üretrosistoskopi 6.yıl takibinde yapıldı. Üretrosistoskopide cerrahi gerektirecek taş ve kıl kökü oluşumu görülmedi. Semptom vermeyen ve cerrahi gerektirmeyecek kadar kısa olan birkaç kıl kökü görüldü. Üretral kıl folikülleri ve taş oluşumu, üretroplastiyi takiben nadir görülen uzun dönem komplikasyonlardır. Endoskopik holmium lazer epilasyonu kıl kökleri ve üretra taşı için nadiren uygulanan bir tedavi seçeneğidir. Holmium:YAG lazer epilasyonu minimal invaziv yaklaşım ve iyi uzun dönem sonuçlar ile alternatif bir tedavi seçeneği olabilir.

Bouveret's syndrome is a rare presentation of duodenal obstruction or gastric outlet obstruction caused by a large gallstone migrating through a cholecystoduodenal or choledochoduodenal fistula. Most patients are elderly and often have underlying comorbidities, complicating surgery. Endoscopic therapy should be used as first-line treatment for these patients who are not good surgical candidates. We report a case of a 98-year-old Chinese female who presented with vomiting for three days. Esophagogastroduodenoscopy and computed tomography confirmed the diagnosis of Bouveret's syndrome. The patient successfully underwent endoscopic lithotripsy with the Holmium: Yttrium–Aluminum–Garnet (Ho: YAG) laser. Ho: YAG laser lithotripsy has been used to treat Bouveret's syndrome in four case reports. It can be recommended in patients with Bouveret's syndrome who are poor candidates for surgery. SIMILAR CASES PUBLISHED: 4

Objective: Prospective evaluation of the efficacy and safety of the extracorporeal shock wave lithotripsy (SWL) and ureteroscopy with Holmium: YAG laser lithotripsy (URSL) as a primary treatment for impacted stone in the proximal ureter. Patients and Methods: A total of 82 patients with a single impacted stone in the proximal ureter were included in the study. Patients were allocated into two groups according to patient preference for either procedure. The first group included 37 patients who were treated by SWL and the second group included 45 patients treated by URSL. The preoperative data and treatment outcomes of both procedures were compared and analyzed. Results: There was no difference as regards to patient and stone characters between the two groups. There was significantly higher mean session number and re-treatment rate in the SWL group in comparison to URSL group (1.5 ± 0.8 vs. 1.02 ± 0.15 session, and 43.2% vs. 2.2%, respectively). At one month, the stone-free rate of the URSL group was statistically significantly higher than that of the SWL group (80% vs. 67.6%, respectively). The stone-free rate at three months was still higher in the URSL group, but without statistically significant difference (80.2% vs. 78.4%, respectively). There was no statistically significant difference in the rate of complications between the SWL and URSL (24.3% vs. 15.6%, respectively). Conclusion: Both procedures can be used effectively and safely as a primary treatment for impacted stone in the proximal ureter; however, the URSL has a significantly higher initial stone-free rate and lower re-treatment rate.

Osteoma is one of the most common tumors of the cranial vault and the facial skeleton. For osteoma in the facial region, endoscopic resection is widely used to prevent surgical scarring. Tumors in a total of 14 patients were resected using an endoscopic holmium-doped yttrium aluminium garnet (Ho:YAG) laser with a long flexible fiber. Aside from having the advantage of not leaving a scar due to the use of endoscopy, this procedure allowed resection at any position, was minimally invasive, and caused less postoperative pain. This method yielded excellent cosmetic results, so the endoscopic Ho:YAG laser is expected to emerge as a good treatment option for osteoma.

Aim: To evaluate the effectiveness and safety of holmium:YAG (Ho:YAG) laser endopyelotomy in distinctive ureteropelvic junction obstructions (UPJO) with distinctive aetiologies. Material and methods: Thirty-one patients diagnosed with UPJO of distinctive causes were included. Aetiology consisted of 7 congenital UPJO, 10 post-pyeloplasty UPJO, 7 post-lithotomy obstructions, 4 ureteropelvic junction obstructions post-extracorporeal shockwave lithotripsy stenoses and 3 post-ureteroscopic lithotriptic UPJO. Retrograde ureteroscopic Ho:YAG laser endopyelotomy was performed in all patients. Operation related parameters were studied. Results: Average procedure duration was 46 min. Mean discharge was 1.81 days. There was no notable complication such as perforation or haemorrhage. All patients were followed for at least 12 months. The single success rate was 80.6%, leaving 6 patients undergoing secondary endopyelotomy, among whom 4 were successful while 2 required an open approach. The overall success rate was 93.5%. Failed pyeloplasty UPJO is more disposed to restenosis (p = 0.0075). Inversely implanted ureteral stent yielded a higher success rate (p = 0.0158). Conclusions: Ho:YAG laser endopyelotomy is a safe, minimally invasive approach effective in both primary and secondary UPJO treatments. Implantation of inversed ureteral stents can be more beneficial.

The aim of this in vivo study was report the long-term results of arthroscopic laser surgery for treatment of TMJ internal drangements (Wilkes class II-III). This report included 45 patients (42 women and 03 men) with an average age of 36.7 years old (14 to 66 years). There were 69 joints involved. The criteria for inclusion were patients who had complained of TMJ pain and dysfunction and had remained refractory to nonsurgical treatment for at least 3 months without resolution of the problem. All patients filled out a questionnaire preoperatively and postoperativelly for assessment of their signs and symptoms. The range of interincisal opening was measured preoperatively and at 1, 7, 30, and 60 days after the surgery. The postoperative questionnaire, radiographic evaluation, and the last measure of range of motion were performed with one year or more after the surgical procedures. The preoperatively and postoperativelly scores were compared and tested for statistically significant differences by the paired t-test (P>0.05). Forty-five patients (69 joints) have been followed postoperativelly for an average of 28.6 months. Maximal interincisal opening improved from a mean of 25.95mm to 35.91mm (+9.96mm) in seven days after the surgery; to 39.86mm (+3.95mm) after thirty day and; to 40.92mm (+1.06mm) after 60 days. The last measurement of maximal interincisal opening made after one year or more showed a mean of 42.15mm. All postoperative VAS pain scores showed a statistical significant improvement (p

Upper urinary tract transitional (UUTT) cell carcinoma is a relatively uncommon urologic tumor. The traditional treatment approach for them is radical nephroureterectomy. However, in recent years, less-invasive treatments, including different nephron-sparing procedures, have become increasingly popular. We report a case of laser ablation of UUTT cell carcinoma using new Olympus digital flexible ureteroscope (URF-V).

Burch colposuspension remains one of the successful operations performed for stress incontinence. Accidental suturing of the bladder wall during the procedure or subsequent erosion may lead to lower urinary tract symptoms. Diagnosis and management of these sutures indicate precise evaluation for which a 70 degree cystoscope is used. In selected cases, Holmium-YAG laser may enable us to manage long-standing, encrustated neglected sutures. Here we would like to report successful removal of intravesical sutures using the Holmium-YAG laser.Burch kolposüspansiyonu stres inkontinans tedavisinde kullanılan en başarılı tedavilerden biri olmaya devam etmektedir. İşlem esnasında sütürün yanlışlıkla mesane duvarından geçmesi yada daha sonra gelişen erozyon nedeniyle sütürün mesane içinde kalması alt üriner sistem semptomlarına yol açmaktadır. Bu sütürlerin belirlenmesi ve ortadan kaldırılmasında ayrıntılı inceleme ve bunun için daha çok 70 derecelik sistoskopun kullanılması gerekmektedir. Seçilmiş vakalarda, uzun süre içeride kalmış ve katılaşmış sütürün çıkarılmasında Holmium-YAG lazer özellikle yardımcı olabilir. Bu vakada, intravesikal sütürlerin Holmium-YAG lazer ile başarılı şekilde çıkarılması anlatılmaktadır.

Our prospective study compare 40 holmium yag laser meniscectomies with 40 mechanical meniscectomies. Mean duration of laser meniscectomy was 12 minutes againts 10 minutes with the mechanical instruments. In only one case, laser meniscectomy was impossible due to air abuble phenomenon and two superficial cartilaginous thermal changes were observed. In the laser group the effusion was less frequent and less important. Pain difference was not statistically significant. Return to range of motion was very fast in the laser group. Helmium Yag laser is safe and effective and results are a little bit better than mechanical instruments. Unfortunately, the cost remains very high and limits its use. However, meniscectomy is not the only advantage of laser system. it is effective for synovectomy, lateral release, cartilaginous shaving, and even bone abrasion., Biz 40 holmium yağ lazer menisektomisiyle 40 mekanik menisektomiyi karşılaştırdık. Lazer menisektominin ortalama süresi 10 dakikalık mekanik menisektomiye göre 12 dakika idi. Sadece bir vakada, baloncuk fenomeni nedeniyle lazer menisektomi imkamsız idi. 2 vakada da kartilaj'da yüzeysel termal değişiklikler oldu. Lazer grubunda effüzyon daha nadir ve daha az önemliydi. Ağrı farkı istatistiksel olarak anlamlı değildi. Lazer grubunda normal eklem hareketlerine dönüş çok hızlıydı. Holmium Yag lazer güvenli ve etkilidir ve sonuçlar mekanik enstrümanlardan biraz daha iyidir. Maalesef maaliyeti çok yüksektir ve kullanımı sınırlamaktadır. Mamafih menisektomi lazer sistemi tek avantaj değildir. Sinovektomi, lateral release, kartilaj tıraşlaması ve hafta kemik abrazyonuna da lazer etkilidir.

In this prospective randomized clinical trial, we aimed to evaluate the safety and efficacy of endourethrotomy with holmium:yttrium-aluminium-garnet (HO:YAG) laser and compare the outcomes with the conventional cold-knife urethrotomy. Fifty-one male patients with single, iatrogenic, annular strictures of the urethra were randomly divided into two groups; 21 patients who underwent direct-vision endoscopic urethrotomy with Ho:YAG laser (15 W; 1,200-1,400 mJ; 8-12 Hz) at 12 o'clock position (laser group) and 30 patients who underwent direct-vision endoscopic urethrotomy with cold-knife incision at 12 o'clock position (cold-knife group). The results obtained were analyzed and compared at 3 months, 6 months, 9 months, and 12 months postoperatively by clinical evaluation, uroflowmetry, and retrograde urethrographies. Variables were compared among groups using Fisher's exact and Mann Whitney U tests. There were no differences between two groups in terms of patient age, preoperative Qmax value, stricture location, and length. Operative time was shorter in laser group (16.4 ± 8.04 minutes) when compared with cold-knife group (23.8 ± 5.47 minutes) (p < 0.001). Recurrence-free rate at 3 months was similar between two groups (p = 0.122). However, recurrence-free rates at 6 months, 9 months, and 12 months were significantly higher in laser group when compared with cold-knife group (p values were 0.045, 0.027, and 0.04, respectively). No intra- or postoperative complications were encountered. Use of Ho:YAG laser in the management of urethral stricture disease is a safe and effective method. In addition, it provides shorter operative time and lower recurrence rate when compared with the conventional technique. © 2011, Elsevier Taiwan LLC. All rights reserved.

Contains fulltext : 47725.pdf (Publisher’s version ) (Open Access) BACKGROUND AND PURPOSE: Strictures of the vesicourethral anastomosis (VUA) following radical prostatectomy tend to recur. We used the holmium:YAG laser for treatment of recurrent stricture of the VUA. We evaluated the technique and its efficacy. PATIENTS AND METHODS: In 10 patients, the Ho:YAG laser was used with a 365-mum fiber at a setting of 2 J and frequency 10 to 20 Hz, creating a deep incision of the scar tissue at the 6 o'clock position. This was followed by a vaporizing resection of the remaining scar tissue between 3 and 9 o'clock. We aimed to vaporize up to well-vascularized surrounding tissue. Retrospectively, the charts were reviewed for hospital stay, voiding complaints, recurrence of stenosis, complications, and flow rates. The mean follow-up was 18 months. RESULTS: There were no operative complications. After removal of the catheter, all patients could void without difficulty. No re-treatment was needed for recurrent stenosis. Any existing irritative voiding complaints or incontinence did not change after treatment. In all patients, the flow pattern improved: the mean maximum flow rate increased, and the mean postvoiding residual volume decreased. CONCLUSION: The Ho:YAG laser seems to be a safe and effective treatment for first or recurrent strictures of the VUA after radical prostatectomy.

The effect of tissue micro-architecture and water content on ablation rates in bone is examined. Precisely machined and prepared porcine calvarial lamellar and cortical bone were ablated with a Holmium-YAG laser (λ=2.1 Μm). Lamellar and cortical bone differ substantially in their tissue micro-architecture. Both are porous hard tissues, which differ predominantly in size and distribution of pores within the bone matrix. These hard tissues were ablated under physiological (wet) and chemically dehydrated conditions. The ablation rates over the range of energy densities examined assumes many linear characteristics. Ablation rate (as a function of fluence) is considerably higher for dehydrated cortical bone (4.7 Μm cm2J-1) compared to fresh cortical bone (1.49 Μm cm2J-1). This trend is also observed in lamellar bone (2.31 Μm cm2J-1for wet and 0.37 Μm cm2J-1for dry). Under both physiological and dehydrated conditions, cortical bone was ablated faster. Mechanisms accounting for these observations are discussed. © 1995 W.B. Saunders Company Ltd.

Background Bouveret's syndrome is an unusual presentation of duodenal obstruction caused by the passage of a large gallstone through a cholecystoduodenal fistula. Endoscopic therapy has been used as first-line treatment, especially in patients with high surgical risk. Case presentation We report a 67-year-old woman who underwent an endoscopic attempt to fragment and retrieve a duodenal stone using a Holmium: Yttrium-Aluminum-Garnet Laser (Ho:YAG) which resulted in small bowel obstruction. The patient successfully underwent enterolithotomy without cholecystectomy or closure of the fistula. Conclusion We conclude that, distal gallstone obstruction, due to migration of partially fragmented stones, can occur as a possible complication of laser lithotripsy treatment of Bouveret's syndrome and might require urgent enterolithotomy.

Objectives: This study aims to investigate the efficacy of holmium:yttrium aluminum garnet (Ho:YAG) laser as an intracorporeal lithotripter in the treatment of salivary calculi during sialendoscopy and to evaluate procedure-related complications. Patients and Methods: Between April 2014 and April 2016, a total of 31 patients (22 males, 9 females; mean age 38 years; range, 8 to 57 years) who were treated with laser sialendoscopy were included. The patients were postoperatively followed on a weekly basis for four weeks and every month, thereafter. Procedural success was defined as the absence of symptoms after a three-month follow-up. Results: Calculi were located in the parotid gland in eight of the patients and in the submandibular gland in 23 patients. The dimension of calculi varied between 2 to 12 mm. A 1.6 mm-Marchal all-in-one scope was used during sialendoscopy and the Sphinx 30, Lisa Laser was used as the laser device. In 27 of the patients, calculi were completely removed using laser sialendoscopy. In one of these cases, a second session was needed, since the patient definitely refused gland excision. In the second session, calculi were removed after breaking with laser lithotripsy. In four of these cases, calculi breaking process was unable to be completed with laser lithotripsy and open surgery was carried out. There was no canal perforation or nerve damage in any of the patients. Conclusion: Based on our study results, Ho:YAG lasertripsy is an effective and safe method in the treatment of salivary calculi. The use of Ho:YAG laser as an intracorporeal lithotripter increases the treatment success rate of salivary calculi with sialendoscopy.