Lasers in Urology – what has Survived of our Research Starting 1970

Abstract

In 1970 I started to investigate the Laser-Technology for urologic surgery together with H. Müßiggang. First of all it was to check the interacting of the different lasers with biological tissue. Decisive are the two factors: absorption and scattering of light into the tissue. The strong light absorption of the CO2-laser leads to an excellent incision effect with low edema reaction. The light of the Argon Ion-laser is mainly absorbed in the tissue by hemoglobine and pigment colourings and therefore suitable for the destruction of highly vascularized tumors or malformations. For achieving greater volume effects, necessary to tumors, bilharzial bladder-lesions and interstitial cystitis, the Nd:YAG-laser was used by us since 1976. Presupposed was the developing of a quartz glass fiber transmissions systemby Nath, a physisist fromthe Neuherberg laser labor ( 1973 ) and the developing of a special cystoscope insert, designed bymy working-group ( Staehler, Frank et al.) and constructed by the Storz Compagny/Tuttlingen/Germany. The next steps were the laser induced shock wave lithotripsy from 1978 to 1986 ( Munich/Lübeck ) and the photodynamic procedures for early tumor diagnosis and therapy. Now is to ask-what survived? The laser-lithotripsy, especially in ureter, and after a long fight, the photodynamic diagnosis for bladder tumors and Cis, are on routine. Also in tumors of external genitalia e. c. condylomata acuminate, hemangiomas, penile cancer, the ND:YAG-and Diode-lasers are well established. Established are also the vaporization and enucleation of prostate tumors by laser. In contrast to these indications, the Nd:YAG-laser-application in bladdertumors seems to be forgotten. I think this method is head and shoulders above the common TUR-resection, because it generates a total homogenous necrosis with closing the blood-and lymphatic vessels simultaneously, itmeans, no bleeding, no tumor-cell-spreading. You can perform the operation under excellent viewing, so that its possible to destroy the satellite-tumors and the tumor vessels, also Histological examinations after Nd:YAG-laser-applications never have been problematic ( Keiditsch ). I observed 5 patients, who refused the radical cystectomy and were therefore treated byND:YAG-laser, between 10 and 40 years. They all remain tumor free. Our photodynamic therapy of localized prostate cancer, published 1993, is still in the early stages. Forgotten seems to be our interstitial laser coagulation ( ILC ) of small prostate adenomas and bladder-neck-stenoses, although by this procedure the so called retrograde ejaculation can be avoided in the most cases. Summing up: after 50 years of lasers in urology there is always still a big field for research and novel clinical applications.