Thulium laser treatment for bladder cancer

Recent innovations in thulium laser techniques have allowed application in the treatment of bladder cancer.Laser en bloc resection of bladder cancer is a transurethral procedure that may offer an alternative to the conventional transurethral resection procedure.We conducted a review of basic thulium laser physics and laser en bloc resection procedures and summarized the current clinical literature with a focus on complications and outcomes.Literature evidence suggests that thulium laser techniques including smooth incision,tissue vaporization,and en bloc resection represent feasible,safe,and effective procedures in the treatment of bladder cancer.Moreover,these techniques allow improved specimen orientation and accurate determination of invasion depth,facilitating correct diagnosis,restaging,and reevaluation of the need for a second resection.Nonetheless,large-scale multicentre studies with longer follow-up are warranted for a robust assessment.The present review is meant as a quick reference for urologists.

Feasibility of en bloc thulium laser enucleation of the prostate in a large case series. Are results enhanced by experience?

Objective:To provide the first large single-operator case series of patients who undergo“en bloc”thulium laser enucleation of the prostate(ThuLEP)and to demonstrate an improvement in enucleation efficacy with experience.Methods:We prospectively evaluated a cohort of patients with symptomatic benign prostatic hyperplasia(BPH)who underwent“en bloc”ThuLEP between May 2015 and November 2017.Association between dependent variables(delivered energy and operating time)and independent variables(adenoma volume and experience)were estimated with regression analysis.The experience was calculated as the time interval between the date of the first operation of the series and the date of the operation being considered.Results:A total of 100 patients were registered for the study.Median operative time was 56.5 min(interquartile range[IQR]:40-85 min).Median enucleation time was 17.4 min(IQR:15-21.5 min).Median enucleation index(enucleation time per adenoma gram)was 0.3 min/g(0.2-0.3 min/g).The overall operative time is not influenced by experience,but we registered a significant trend towards a reduction in the total amount of energy delivered energy normalized per adenoma gram(p=0.0148).Conclusion:We believe that further attention is needed for these new“en bloc”prostatic enucleation techniques,which can facilitate some surgical steps,leading to a widespread use of laser technology for BPH surgical treatment.

Flexible ureteroscopic treatment of kidney stones: How do the new laser systems change our concepts?

Objective: Flexible ureteroscopy (fURS) has become a widely accepted and effective technique for treating kidney stones. With the development of new laser systems, the fURS approach has evolved significantly. This literature review aims to examine the current state of knowledge on fURS treatment of kidney stones, with a particular focus on the impact of the latest laser technologies on clinical outcomes and patient safety.Methods: We conducted a search of the PubMed/PMC, Web of Science Core Collection, Scopus, Embase (Ovid), and Cochrane Databases for all randomized controlled trial articles on laser lithotripsy in September 2023 without time restriction.Results: We found a total of 22 relevant pieces of literature. Holmium laser has been used for intracavitary laser lithotripsy for nearly 30 years and has become the golden standard for the treatment of urinary stones. However, the existing holmium laser cannot completely powder the stone, and the retropulsion of the stone after the laser emission and the thermal damage to the tissue have caused many problems for clinicians. The introduction of thulium fiber laser and Moses technology brings highly efficient dusting lithotripsy effect through laser innovation, limiting pulse energy and broadening pulse frequency.Conclusion: While the holmium:yttrium-aluminum-garnet laser remains the primary choice for endoscopic laser lithotripsy, recent technological advancements hint at a potential new gold standard. Parameter range, retropulsion effect, laser fiber adaptability, and overall system performance demand comprehensive attention. The ablation efficacy of high-pulse-frequency devices relies on precise targeting, which may pose practical challenges.

Thulium fiber laser lithotripsy:Is it living up to the hype?

Objective:The holmium:yttrium-aluminium-garnet laser(Ho:YAG)has been the gold standard for laser lithotripsy over the last three decades.After demonstrating good in vitro efficacy,the thulium fiber laser(TFL)has been recently released in the market and the initial clinical results are encouraging.This article aims to review the main technology differences between the Ho:YAG laser and the TFL,discuss the initial clinical results with the TFL as well as the optimal settings for TFL lithotripsy.Methods:We reviewed the literature focusing on the technological aspects of the Ho:YAG laser and TFL as well as the results of in vitro and in vivo studies comparing both technologies.Results:In vitro studies show a technical superiority of TFL compared to the Ho:YAG laser and encouraging results have been demonstrated in clinical practice.However,as TFL is a new technology,limited studies are currently available,and the optimal settings for lithotripsy are not yet established.Conclusion:TFL has the potential to be an alternative to the Ho:YAG laser,but more reports are still needed to determine the optimal laser for lithotripsy of urinary tract stones when considering all parameters including effectiveness,safety,and costs.

Two-micrometer thulium laser resection of the prostate-tangerine technique in benign prostatic hyperplasia patients with previously negative transrectal prostate biopsy

The 2-1μm thulium laser resection of the prostate-tangerine technique （TmLRP-TT） has been introduced as a minimally invasive treatment for benign prostatic hyperplasia （BPH）. This study was undertaken to assess the clinical efficacy and safety of TmLRP-TT for the treatment of BPH patients with previously negative transrectal prostate biopsy. A prospective analysis of 51 patients with previously negative transrectal prostate biopsy who underwent surgical treatment using TmLRP-TT was performed from December 2011 to December 2013. Preoperative status, surgical details, and perioperative complications were recorded. The follow-up outcome was evaluated with subjective and objective tests at I and 6 months. TmLRP-TT was successfully completed in all patients. Mean prostate volume, operative duration, and catheterization time were 93.3 ± 37.9 ml, 69.5 ± 39.5 min, and 6.5 ± 1.3 days, respectively. The mean International Prostate Symptom Score, quality of life score, maximum urinary flow rate, and post-void residual urine volume changed notably at 6-month follow-up （22.5 ± 6.9 vs 6.1 ± 3.2, 4.8 ± 1.3 vs 1.1 ± 0.9, 7.3 ± 4.5 vs 18.9 ± 7.1 ml s^-1, and 148.7 ± 168.7 vs 28.4 ± 17.9 ml）. Two （3.9%） patients required blood transfusion perioperatively, while 3 （5.9%） patients experienced transient hematuria postoperatively, and 2 （3.9%） patients received 3 days recatheterization due to clot retention. TmLRP-TT is a safe and effective minimally invasive technique for patients with previously negative transrectal prostate biopsy during the 6-month follow-up. This promising technology may be a feasible surgical method for previously negative transrectal prostate biopsy in the future.

A theoretical and experimental investigation of an in-band pumped gain-switched thulium-doped fiber laser

In this paper, the theoretical rate equation model of an in-band pumped gain-switched thulium-doped fiber （TDF） laser is investigated. The analytical formulations of pump energy threshold, peak power extraction efficiency, and pulse extraction efficiency are derived through analyzing the interaction process between the pump pulse and the laser pulse. They are useful for understanding, designing, and optimizing the in-band pumped TDF lasers in a 1.9 μm-2.1 μm wavelength region. The experiment with an all-fiber gain-switched TDF laser pumped by a 1.558-μm pulse amplifier is conducted, and our experimental results show good agreement with theoretical analysis.

Two-micron （thulium） laser resection of the prostate- tangerine technique： a new method for BPH treatment

Two-micron （thulium） laser resection of the prostate-tangerine technique （TmLRP-TT） is a transurethral procedure that uses a thulium laser fiber to dissect whole prostatic lobes off the surgical capsule, similar to peeling a tangerine. We recently reported the primary results. Here we introduce this procedure in detail. A 70-W, 2-um （thulium） laser was used in continuous-wave mode. We joined the incision by making a transverse cut from the level of the verumontanum to the bladder neck, making the resection sufficiently deep to reach the surgical capsule, and resected the prostate into small pieces, just like peeling a tangerine. As we resected the prostate, the pieces were vaporized, sufficiently small to be evacuated through the reseetoscope sheath, and the use of the mechanical tissue morcellator was not required. The excellent hemostasis of the thulium laser ensured the safety of TmLRP-TT. No patient required blood transfusion. Saline irrigation was used intraoperatively, and no case of transurethral resection syndrome was observed. The bladder outlet obstruction had clearly resolved after catheter removal in all cases. We designed the tangerine technique and proved it to be the most suitable procedure for the use of thulium laser in the treatment of benign prostatic hyperplasia （BPH）. This procedure, which takes less operative time than standard techniques, is safe and combines efficient cutting and rapid organic vaporization, thereby showing the great superiority of the thulium fiber laser in the treatment of BPH. It has been proven to be as safe and efficient as transurethral resection of the prostate （TURP） during the 1-year follow-up.

Generation and evolution of multiple operation states in passively mode-locked thulium-doped fiber laser by using a graphene-covered-microfiber

Using graphene-covered-microfiber （GCM） as a saturable absorber, the generation and evolution of multiple operation states are proposed and demonstrated in passively mode-locked thulium-doped fiber laser. The microfiber was fabricated using the flame brushing method to an interaction length of - 1.2 cm with a waist diameter of -10 μm. Graphene layers were grown on copper foils by chemical vapor deposition and transferred onto the polydimethylsiloxane （PDMS） to form a PDMS/graphene film, which allowed light-graphene interaction via evanescent field. With the increase of the pump power from 1.25 W to 2.15 W, five different lasing regimes, including continuous-wave, conventional soliton mode-locking, multi- soliton mode-locking, a period of transition, and noise-like mode-locking, were achieved in a fiber ring cavity. To the best of our knowledge, it is the first report of the generation and evolution of multiple operation states by covering graphene on the microfiber in the 2-μ.m region. The results demonstrate that GCM can be a promising method for fabricating all fiber SA, and the switchable operation states can provide more portability in complex application domain.

Analysis of gain distribution in cladding-pumped thulium-doped fiber laser and optical feedback inhibition problem in fiber-bulk laser system

The steady-state gain distribution in cladding pumped thulium-doped fiber laser（TDFL） is analytically and numerically solved based on the rate equations including loss coefficients and cross relaxation effect. With the gain curve, a problem, which is named optical feedback inhibition（OFI） and always occurs in tandem TDFL-Ho：YAG laser system, is analyzed quantitatively. The actual characteristics of output spectra and power basically prove the conclusion of theoretical analysis. Then a simple mirror-deflected L-shaped cavity is employed to restrain the external feedback and simplify the structure of fiber-bulk Ho：YAG laser. Finally, 25 W of 2097-nm laser power and 51.2% of optical-to-optical conversion efficiency are obtained, and the beam quality factor is less than 1.43 obtained by knife-edge method.

2μm大能量掺铥脉冲光纤激光器研究进展

2μm波段掺铥脉冲光纤激光器目前可实现最高毫焦量级的能量输出,对医疗、材料、通信等领域有重要意义。本文主要介绍近年来大能量掺铥光纤激光器系统研究的主要进展,讨论大能量掺铥光纤激光器的技术类型和影响因素。在此基础上,对大能量掺铥光纤激光器的研究前景进行展望。

铥激光治疗非肌层浸润性膀胱癌的临床研究

目的探讨经尿道膀胱肿瘤铥激光整块切除术与TURBT在治疗NMIBC的差异。方法收集2020年6月1日-2022年7月31日在本院行经尿道膀胱肿瘤铥激光切除术与TURBT的89例NMIBC患者的临床资料,将患者随机分成2组,铥激光组46例(行铥激光术),电切组43例(行电切术),比较分析2组患者的住院时间、术后尿管留置时间、手术出血量、手术耗时,膀胱刺激症、闭孔神经反射等并发症发生率,术后1年复发率。结果铥激光组并发症发生率6.52%低于电切组27.91%,差异有统计学意义(P<0.05)。铥激光组与电切组间,手术耗时无统计学意义(P>0.05)。铥激光组患者术中出血量、尿管留置时间、住院时间,均优于电切组,差异具有统计学意义(P<0.05)。铥激光组与电切组间术后1年复发率差异无统计学意义(P>0.05)。结论经尿道铥激光膀胱肿瘤完整切除术用于对NMIBC患者的治疗优于经尿道膀胱肿瘤电切术。

227-W output all-fiberized Tm-doped fiber laser at 1908 nm

In this paper, we report that a diode-pumped thulium-doped double clad silica fiber laser can provide powers of up to 227 W at 1908 nm, corresponding to a slope efficiency of 54.3%, and an optical-to-optical efficiency of 51.2%. The output power, to the best of our knowledge, is the highest output at 1908 nm. The beam quality M2 factor is about 1.56. Also discussed in this paper is the dependence of the laser performance on fiber length.

TmLEP、PKEP和TURP术治疗前列腺增生的围术期指标及尿动力学指标比较

目的比较经尿道2μm铥激光前列腺剜除术(Tm LEP)、经尿道前列腺等离子剜除术(PKEP)及经尿道前列腺电切术(TURP)3种术式治疗前列腺增生的围术期指标及尿动力学指标。方法 选取华中科技大学同济医学院附属同济医院2020年1月~2022年2月158例前列腺增生患者,依据治疗方式的不同分为Tm LEP组(55例)、PKEP组(53例)和TURP组(50例)。比较3组患者手术前后国际前列腺症状评分(IPSS)和生活质量问卷评分(IPSS-Qo L),比较3组患者围术期指标,比较3组患者手术前后尿动力学指标[膀胱最大容量(MCC)、最大逼尿肌压(MDP)、膀胱顺应性(BC)、最大尿流率(Qmax)、残余尿量(RUV)],比较3组患者手术治疗后并发症总发生率。结果 Tm LEP组、PKEP组和TURP组术后IPSS、IPSS-Qo L评分与同组术前比较,差异有统计学意义(P <0.05);Tm LEP组、PKEP组术后IPSS、IPSS-Qo L评分显著低于TURP组术后,差异有统计学意义(P <0.05);Tm LEP组和PKEP组术后IPSS、IPSS-Qo L评分比较,差异无统计学意义(P> 0.05)。Tm LEP组、PKEP组手术时间、术中出血量、术后膀胱冲洗时间、拔尿管时间、住院时间显著少于TURP组,差异有统计学意义(P <0.05);Tm LEP组、PKEP组前列腺切除量明显高于TURP组,差异有统计学意义(P <0.05);Tm LEP组与PKEP组各项指标比较,差异无统计学意义(P>0.05)。Tm LEP组、PKEP组和TURP组术后MDP、RUV水平均低于同组术前,MCC、BC、Qmax水平均高于同组术前,差异有统计学意义(P <0.05);Tm LEP组、PKEP组术后MDP、RUV水平显著低于TURP组术后,MCC、BC、Qmax水平显著高于TURP组,差异有统计学意义(P <0.05);Tm LEP组与PKEP组术后各项指标比较,差异无统计学意义(P> 0.05)。Tm LEP组、PKEP组并发症总发生率明显低于TURP组,差异有统计学意义(P <0.05);Tm LEP组与PKEP组并发症总发生率比较,差异无统计学意义(P>0.05)。结论 Tm LEP术和PKEP术在治疗前列腺增生中疗效较好,TURP术并发症发生风险较高。

精囊镜下铥激光治疗射精管梗阻的临床结局分析

目的:评估射精管梗阻所致的少精子症或无精子症患者行精囊镜下铥激光烧灼术治疗后的临床结局。方法:回顾性分析2018年4月至2020年1月42例南京医科大学第一附属医院泌尿外科男科门诊因射精管梗阻导致的少弱精子症或无精子症患者的临床资料,术前均经相关检查诊断明确,术中利用精囊镜寻找射精管开口,铥激光技术解除射精管梗阻,术后定期随访,监测患者精液常规变化,对手术前后参数采用t检验。结果:42例患者术前完善相关检查,均行经尿道精囊镜探查,并辅以铥激光治疗射精管梗阻,平均手术时间为52.7 min,与患者术前两周精液常规相比,患者术后3个月,6个月及9个月精液体积,精子浓度,精子总活力显著改善(P<0.05),所有患者精液常规中均发现精子,其中40例患者于术后3个月内于精液常规中发现精子,2例患者于术后6~9月于精液常规中发现精子,其中7例患者出现术后并发症,包括附睾炎,会阴部或睾丸疼痛及术后血尿,经相应对症治疗后症状消失,所有病例术后均未出现逆行射精,直肠损伤,尿道狭窄或尿失禁等严重并发症。结论:作为治疗射精管梗阻的强有力武器,精囊镜探查辅以铥激光技术可行,术后并发症较少,患者术后精子质量恢复较好,是治疗射精管梗阻性少弱精子症安全且有效的手段。

超脉冲铥光纤激光在输尿管中温度变化的体外实验

目的利用3D肾模型模拟体内输尿管环境碎石,研究超脉冲铥光纤激光(TFL)在不同功率、碎石模式及灌注速度下的热效应情况。方法构建体外热效应模型,在实验室温度、设备固定等相同条件下,测量并比较采用不同光纤直径、功率、碎石模式、灌注速度等进行TFL模拟碎石时的光纤周围温度。结果两种不同直径的光纤在相同条件下所引起的光纤周围温度变化比较,差异具有统计学意义(P<0.05)。在同等条件下,不同的碎石模式所产生的光纤周围温度不同,“高能低频”的温度要低于“低能高频”,数据分别进行组间比较,差异具有统计学意义(P<0.05)。随着灌注速度的增加,光纤周围的温度逐渐下降,数据分别进行了组内多重比较,差异具有统计学意义(P<0.05)。当碎石功率为10 W,灌注速度最小为10 mL/min,平台期温度未达到安全阈值(43℃)。当碎石功率为20 W时,灌注速度最小为10 mL/min,平台期温度超过安全阈值,而灌注速度为20 mL/min时,平台期的温度未达到安全阈值。结论在体外输尿管模型碎石研究中,激光的碎石功率、碎石模式、灌注速度、光纤直径等是TFL热效应的影响因素。无论哪种碎石模式、光纤直径,当碎石功率≤10 W,灌注速度≥10 mL/min时,光纤周围温度是安全的,当碎石功率≤20 W,灌注速度≥20 mL/min时,光纤周围温度是安全的。

“三沟两弧”铥激光前列腺剜除术治疗高龄高危大体积前列腺增生

目的:探讨“三沟两弧”法经尿道铥激光前列腺剜除术治疗大体积良性前列腺增生症(BPH)的临床疗效及安全性。方法:回顾性分析2018年1月至2021年12月在我院实施经尿道铥激光前列腺剜除术的91例高龄高危大体积良性前列腺增生的患者临床资料,观察患者术中术后的并症,手术时间、铥激光剜除组织时间、组织粉碎时间、术后血红蛋白下降量、术后膀胱冲洗时间、导尿管留置天数、术前及术后1、3、6个月患者国际前列腺症状评分(IPSS)、生活质量评分(QOL)、最大尿流率(Qmax)和排尿后残余尿量(PVR)的变化。结果:91例患者手术顺利完成。铥激光剜除组织时间28~104(45.6±9.2)min。组织粉碎时间7~26(10.8±1.6)min。术后血红蛋白下降0.1~1.4(0.6±0.2)g。术后膀胱冲洗时间10~36(18±7.2)h。导尿管留置时间36~80(66.6±10.2)h。患者术前与术后第1,3,6个月IPSS、QOL、Qmax、PVR比较,均较术前显著改善(P<0.05)。1例发生压力性尿失禁于术后2.5月自行恢复,余病例均在术后48h内恢复尿控。无输血病例。无发生严重心脑肺等系统并发症病例。结论:“三沟两弧”法经尿道铥激光前列腺剜除术组织清除彻底,术中术后出血少,术后尿控恢复好,是一种值得推广的治疗高龄高危大体积BPH的微创技术。

ThULEP与HoLEP治疗良性前列腺增生疗效比较的Meta分析

目的通过Meta分析比较铥激光前列腺剜除术(ThULEP)与钬激光前列腺切除术(HoLEP)治疗良性前列腺增生(BPH)的疗效和安全性。方法计算机检索PubMed、Embase、Cochrane Library、中国知网、万方等数据库,收集比较ThULEP和HoLEP治疗BPH的随机对照试验及对照临床试验,检索时限从2010年1月1日-2022年5月30日,由两位研究者独立进行文献的筛选、评价和数据提取,所有分歧均由第3位研究者解决,采用RevMan 5.4软件进行统计学分析。结果共纳入7项研究共1726例患者,其中ThULEP组750例,HoLEP组976例;Meta结果显示,与HoLEP组相比,ThULEP组留置导尿时间[MD=-0.10,95%CI(-0.17~-0.03),P=0.004]、住院时间[MD=-0.43,95%CI(-0.60~-0.25),P<0.00001]更短,术后12个月IPSS评分更低[MD=-1.13,95%CI(-1.95~-0.30),P=0.007]、术后12月QoL评分更低[MD=-1.00,95%CI(-1.19~-0.81),P<0.001],需要输血的患者更少[OR=0.11,95%CI(0.03~0.36),P=0.0003],发生尿失禁的概率更低[OR=0.24,95%CI(0.09~0.66),P=0.006]。结论ThULEP相较于HoLEP在治疗BPH上可能具有类似的疗效及安全性,并在某些方面更具有优势。

低功率融合波铥激光前列腺剜切术对良性前列腺增生患者性功能的影响

目的:探讨应用新型低功率融合波铥激光行经尿道前列腺剜切术对良性前列腺增生(BPH)患者性功能的影响。方法:选取2022年1月至2023年6月江苏大学附属金坛医院泌尿外科收治的BPH患者89例,随机分为低功率融合波铥激光行经尿道前列腺剜切(LP-ThuVEP)组45例和经尿道前列腺等离子切除(TUPKRP)组44例,记录围手术期指标,对比分析两组患者术前和术后3、6个月IPSS、Qmax、Qavg、PVR、QoL,通过国际勃起功能指数评分问卷表5(IIEF-5)和男性性健康调查问卷-射精功能障碍评分(MSHQ-EjD)评价手术对男性性功能的影响。结果:与TUPKRP组比较,LP-ThuVEP组在手术时间上差异无统计学意义(P>0.05),在膀胱冲洗时间、留置尿管时间、手术日血红蛋白下降幅度、术后排便诱发肉眼血尿消失时间方面,有显著差异(P<0.05或P<0.01)。两组围手术期并发症相当。排尿状况指标中,LP-ThuVEP组术后3个月IPSS、QoL评分和PVR较TUPKRP组有统计学差异(P<0.05);在男性性功能方面,IIEF-5评分在术后3个月及术后6个月两组间比较均有统计学差异(P<0.05);除了术后3个月组间射精相关满意度评分无统计学差异(P>0.05)之外,其他的组间及组内的术后3个月和术后6个月射精功能及满意度评分均有显著差异(P<0.01)。结论:较之TUPKRP,LP-ThuVEP同样可以高效解除BPH导致的尿路梗阻,且具有损伤更小、患者勃起功能和射精功能恢复更快等优势。

高功率连续掺铥光纤激光器研究进展及展望

2μm高功率掺铥光纤激光器(thulium doped fiber lasers, TDFL)在激光测距、激光雷达及医疗检测等领域有重要应用。本文主要梳理了高功率连续TDFL的国内外最新研究进展,介绍了连续TDFL的发展现状,总结了高功率TDFL功率提升的主要限制因素,并从热效应、非线性效应及模式不稳定性3个方面进行了分析。最后,提出采用新型泵浦结构、优化增益光纤的结构设计、研制高品质光纤耦合器和高亮度泵浦源等方法可进一步提高2μm高功率TDFL掺铥光纤激光器的综合输出性能。

2-μm MOPA结构全光纤激光器输出特性研究

为改善高功率掺铥光纤激光器(TDFL)的输出性能,提高系统的光-光转化效率,研制了一种全光纤主振荡功率放大结构(MOPA)的高功率TDFL,可在连续(CW)和准连续(QCW)两种模式下工作。首先,搭建了激光振荡器,对种子源激光器的输出特性进行研究。接着,搭建掺铥光纤放大器,并将其与激光振荡器连接,研究MOPA结构光纤激光器的输出特性。最后,在QCW调制模式下,分析MOPA结构光纤激光器的脉冲特性。结果表明:激光振荡器实现了中心波长为1 940 nm连续稳定的激光输出,最高平均输出功率为18.56 W,斜率效率为54.84%,且光谱无拉曼成分。利用该低功率连续激光作为种子源经过自制的掺铥光纤放大器后,平均输出功率可达66.9 W,斜率效率为48.48%。当系统在QCW模式下工作时,可以实现对频率和占空比的调节,且当频率为75 Hz,占空比为10%时,经计算其峰值功率为80.3 W。该研究方案对研制2μm波段更高功率的MOPA激光器具有参考意义。