Improved laser procedures for kidney stones and prostate enlargement: An insight into urological practice

Dr T. Manohar, Chairman, Silicon City Urology Group, Urologist – Endourologist, Laser & laparoscopic surgeon, Robotic surgeon, and Renal Transplant Surgeon, Director, Apollo institute of Renal Sciences (AIRS) gives an insight into advanced urological practice

Prostate problems in men are quite common after the age of 50, as the prostate gland begins to enlarge due to hormonal reasons. The prostate gland in the male body is essential for fertility. It is a small gland resembling the shape and size of a walnut in men that helps in making some of the fluid in semen, which carries sperm from one’s testicles when one ejaculates. It tends to get larger as one gets older.

If the prostate gets too large, it can cause several health issues because it surrounds part of the urethra. The enlarged prostate can squeeze that tube, which causes problems when one urinates. Common symptoms of benign prostatic hyperplasia (BPH) include a frequent urge to urinate, the need to get up several times during the night to urinate, blood in the urine or sperm, pain or burning urination, painful ejaculation, frequent pain or stiffness in the lower back, hips, pelvic or rectal area, or upper thighs, and dribbling of urine.

To treat this problem, active surveillance, medications, surgery, or other treatments are recommended depending upon the symptoms and medical condition of the patient. Sometimes radio waves, microwaves, or lasers are used to treat urinary problems caused by BPH. These methods use different kinds of heat to reduce extra prostate tissue.

Improvement in technology for better treatment

There are various lasers available in the market which are widely used in medical practice, especially in the field of urology for problems like BPH and kidney stones, which have increased in the last 5 years. Currently, the lasers used in urology practice are low watt holmium, high power holmium, thulium, thallium fibre lasers (TFL), diode, and KTP (potassium titanyl phosphate). Each has a specific role to play in the management of BPH, kidney stones, and certain cancers of the bladder and kidney.

All lasers work on the principle of a certain wavelength with tissue penetration capability just enough to target and cut the tissue with minimal or no bleeding. These lasers have the capability to vaporise the tumour in question or fragment the stones when targeted. For this, one requires a target lesion and a medium for the laser to pass through while targeting. In urology practice, the target organs are the kidney stones, prostate, and certain tumors, and endoscopes are the medium for passing the laser fibers.

Pulse modulated, high-power holmium laser (120 watts) with ‘Moses’ effect is useful for urological issues

There are various types of lasers available, each having their own specific effects and advantages for the treatment. They are available in two forms i.e., low-power, and high-power (30-watt, 100-watt, and 120-watt) lasers. Recently, there has been a rise in usage of TFL, holmium, and holmium with high-power 120-watt, ‘Moses’ technology like modulated lasers to treat BPH (prostate enlargement) effectively. The ‘Moses’ effect with pulse modulated laser is the new innovative high-power laser that has revolutionised the way the prostate and kidney stones are treated.

The advantages of a pulse modulated high-power holmium laser with ‘Moses’ effect are:

• It can treat prostate of any size
• It is a painless procedure in which minimum blood is lost
• It can be a day-care procedure in some cases, which means the least hospital stay for the patient
• It is a minimally invasive technique which leaves no scar
• It is a procedure that is safer for people with comorbidities like heart problems, those on anticoagulants, or patients with symptoms of long COVID

The pulse modulated laser (Moses) is efficient in treating any size of kidney stones. It can fine dust the stone in the kidney, making it easier to pass. Unlike other lasers, it needs no puncture and is scarless and one day procedure.

This ‘Moses’ technology is a paradigm shift in transforming the treatment methodologies and has proven to be efficacious and safe to treat the prostate condition. Though there are various other laser treatments available to treat prostate enlargement, ‘Moses’ laser treatment works efficiently due to its high power and the patient can be discharged on the same day, catheter free which in turn is less expensive for the patient.