Laser energy has revolutionised the treatment of pathology
within the upper urinary tract. Lasers were first introduced into urology with
early Nd: YAG and CO₂ systems, which were mainly used for coagulation and
treatment of superficial urothelial lesions. Over subsequent decades, technological
advances led to pulsed holmium: YAG and, more recently, thulium fibre lasers,
enabling safe intracorporeal lithotripsy and precise soft‑tissue
ablation throughout the urinary tract. They underpin flexible ureteroscopy and
percutaneous nephrolithotomy for stone disease, enable organ‑preserving
management of upper tract urothelial carcinoma and treat benign strictures.
However, each platform has unique physical properties that influence its
clinical utility. This chapter reviews laser physics, evolution of technology,
and compares Ho: YAG with TFL, emphasising their mechanisms of lithotripsy,
modes of operation, instrumentation and safety considerations. Clinical
applications in stone fragmentation, tumour ablation and stricture incision are
discussed, supported by contemporary evidence. We present a practical algorithm
for laser selection and settings in upper tract endourology and highlight
future directions, including pulse modulation, dual‑wavelength
systems and integration with digital ureteroscopy. Understanding the
capabilities and limitations of lasers is essential for urologists to optimise
outcomes while minimising complications.
Author(s) Details
Suryaram Aravind
Department of Urology, Sri Ramachandra Institute of Higher Education and
Research, Chennai, India.
Punith Jain
Department of Urology, Sri Ramachandra Institute of Higher Education and
Research, Chennai, India.
Hariharasudhan Sekar
Department of Urology, Sri Ramachandra Institute of Higher Education and
Research, Chennai, India.
Velmurugan
Palaniyandi
Department of Urology, Sri Ramachandra Institute of Higher Education and
Research, Chennai, India.
Vivek Meyyappan
Department of Urology, Sri Ramachandra Institute of Higher Education and
Research, Chennai, India.
Sriram Krishnamoorthy
Department of Urology, Sri Ramachandra Institute of Higher Education and
Research, Chennai, India.
Please see the book here :- https://doi.org/10.9734/bpi/mono/978-93-47485-93-0/CH1
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