PURPOSE: We report our experience to assess the effectiveness and safety of Holmium:YAG laser lithotripsy for managing ureteral calculi. MATERIALS AND METHODS: Ureteroscopic Holmium:YAG laser lithotripsy was performed in 116 cases from November 1999 to October 2003. Calculi were located at the upper ureter in 9%, mid ureter in 19% and lower ureter in 72%. The mean stone size was 1.2cm. A 8Fr semirigid ureterorenoscope, 7.5Fr flexible ureterorenoscope and holmium:YAG laser (Trimedyne, Irvine, USA) with 365mul laser fiber were used. RESULTS: Stones were completely cleared in 113 cases among 116 cases. Stone-free rates according to stone position were 97.6% in the lower ureter, 100% in the mid ureter and 90.9% in the upper ureter. Stone-free rates according to stone size were 100%, 100% and 85.7% in the cases of which diameter is below 10mm, between 10mm and 15mm and above 15mm respectively. Fragmentation was incomplete in 3 cases, so ESWL was performed in 2 cases and repeated procedure in on case. Ureteral perforation was developed in 1 case. CONCLUSIONS: The Holmium:YAG laser lithotripsy was highly effective and safe in managing ureteral calculi irrespective of their location.
Calculi ; Holmium ; Lithotripsy ; Lithotripsy, Laser ; Ureter* ; Ureteral Calculi*

Holmium laser enucleation of the prostate (HoLEP) is a minimally invasive procedure and a size-independent treatment for benign prostatic hyperplasia with excellent long-term surgical outcome. HoLEP has become an alternative to conventional transurethral resection of the prostate or open prostatectomy owing to its efficacy and safety. Although HoLEP is known to have a steep learning curve, very few articles have addressed the technical aspects of HoLEP. Herein, we described detailed techniques and tips for HoLEP as performed at Seoul National University Hospital in a step-by-step manner with extensive review of the literature.
Holmium ; Lasers, Solid-State ; Learning Curve ; Prostate ; Prostatectomy ; Prostatic Hyperplasia

No abstract available.
Holmium* ; Lasers, Solid-State* ; Lithotripsy* ; Ureter* ; Ureteral Calculi*

PURPOSE: We developed an inverse technique for tissue morcellation by modifying the conventional upward technique and then examined its safety and efficiency. MATERIALS AND METHODS: From July 2008 to December 2010, a total of 389 consecutive patients treated with holmium laser enucleation of the prostate (HoLEP) were enrolled in this study. For tissue morcellation, we used an upward technique for an initial series of 84 patients and an inverse technique for a consecutive series of 305 patients. We compared efficiency and safety between the inverse technique and the upward technique. RESULTS: There were no significant differences in mean age or prostate volume between the two groups. The mean morcellation efficiency was higher in the inverse technique group. The incidence of severe bladder injury was significantly higher in the upward technique group. Regarding the site of bladder injury, 7 and 4 cases of bladder injury occurred in the bladder dome and posterior wall, respectively, in the upward technique group. In the inverse technique group, however, the site of bladder injury was limited to the trigone. We divided our clinical series of patients into the upward technique group and three inverse technique groups on the basis of the timing. The mean morcellation efficiency was significantly higher in all three inverse technique groups than in the upward technique group. However, there was no significant difference in mean morcellation efficiency between the three inverse technique groups. CONCLUSIONS: In conclusion, the inverse technique might be a more effective, safer, and more excellent method of morcellation than the conventional upward technique.
Holmium ; Humans ; Incidence ; Lasers, Solid-State ; Prostate ; Urinary Bladder

PURPOSE: We developed an inverse technique for tissue morcellation by modifying the conventional upward technique and then examined its safety and efficiency. MATERIALS AND METHODS: From July 2008 to December 2010, a total of 389 consecutive patients treated with holmium laser enucleation of the prostate (HoLEP) were enrolled in this study. For tissue morcellation, we used an upward technique for an initial series of 84 patients and an inverse technique for a consecutive series of 305 patients. We compared efficiency and safety between the inverse technique and the upward technique. RESULTS: There were no significant differences in mean age or prostate volume between the two groups. The mean morcellation efficiency was higher in the inverse technique group. The incidence of severe bladder injury was significantly higher in the upward technique group. Regarding the site of bladder injury, 7 and 4 cases of bladder injury occurred in the bladder dome and posterior wall, respectively, in the upward technique group. In the inverse technique group, however, the site of bladder injury was limited to the trigone. We divided our clinical series of patients into the upward technique group and three inverse technique groups on the basis of the timing. The mean morcellation efficiency was significantly higher in all three inverse technique groups than in the upward technique group. However, there was no significant difference in mean morcellation efficiency between the three inverse technique groups. CONCLUSIONS: In conclusion, the inverse technique might be a more effective, safer, and more excellent method of morcellation than the conventional upward technique.
Holmium ; Humans ; Incidence ; Lasers, Solid-State ; Prostate ; Urinary Bladder

Several methods of mitomycin administration or subconjunctival injection of ascorbic acid was combined with holmium laser scleorstomy for the evaluation of their effects in the sclerostomy. Thirty rabbits(60 eyes) were divided into 6 groups. Group 1 received topical application of 0.04% mitomycin for 2 weeks ostoperatively. Group 2 received subconjunctival injection of 0.04% mitomycin 3 hours before sclerostomy combined with postoperative topical use of mitomycin. Group 3 received subconjunctival injection of 0.04% mitomycin just before operation. Suconjunctival injection of 0.004% mitomycin was underwent 3 hours before surgery in group 4 and just before scierostomy in group 5. After subconjuctival injection of 25mg ascorbic acid, sclerotomy was performed on group 6. We evaluated duration of success and complication, mean duration of success was 7.4 days, in group 1, 35 days in group 2, 11.9 days in group 3, 7.2 day in group 4, 10.1 days in group 5, and 10.7 days in group 6. All methods were less effective than Subconjunctival mitomycin injection 3 hours before surgery. Corneal erosion, corneal, opacity, hyphema, and early hypotony were found in mitomycin use. Ascorbic acid injection did not develop complications. In these results, the subconjunctival injection of 0.04% mitomycin C 3 hours before the holmium laser sclerostomy was regarded as the most effective to holmium laser sclerostomy without complications. Subconjunctival injection of ascorbic acid was helpful for sclerostomy but less effective than mitomycin use.
Ascorbic Acid* ; Holmium* ; Hyphema ; Lasers, Solid-State* ; Mitomycin* ; Rabbits* ; Sclerostomy*

This experiment is to evaluate the effects of subconjunctival mitorrycin injection on the holmium laser sclerostomy in rabbits. Three hours before laser sclerostomy, subconjunctival injection of normal saline(in control group, n=10 yes) or 0.04% mitomycinGn experiment group, n=10 eyes) was performed. After laser sclerostomy, change of intraocular pressure and appearance of filtering bleb were observed in each group. The duration of success with low intraocular pressure and presence of filtering blebs were evaluated. The duration of success was 5.1 +/- 2.5 days in control group and 29.8 +/- 12.6 days in experiment group. In the former, mean intraocular pressure was not significantly low compared with preoperative one five days after sclerostomy, but latter showed significantly low intraocular pressure 35 days after operation. These results suggest that subconjunctival injection of 0.04% mitomycin C three hours before operation was effective to the success of holmium laser sclerostomy.
Blister ; Holmium* ; Intraocular Pressure ; Lasers, Solid-State* ; Mitomycin* ; Rabbits* ; Sclerostomy*

Objective: Recently, holmium laser enucleation of the prostate (HoLEP) has been established as one method of endoscopic surgery for the treatment of benign prostate hyperplasia (BPH). The purpose of our study was to assess initial clinical experiences with HoLEP at our hospital.;Patients and Methods: A retrospective analysis was conducted of 28 patients with obstructive symptoms due to BPH who underwent HoLEP during the 13 months between February 2004 and March 2005.;Results: The mean age of the patients was 67.4 years (range 59 to 78 years). The mean enucleation tissue weight was 24.3 g (range 2 to 95 g), and the average operation time was 94.1 minutes (range 40 to 268 minutes). The mean duration of postoperative catheterization was 3.4 days (range 1 to 6 days). The mean urine flow rate improved, and each patient's satisfaction for voiding, measured on a 5-point scale, was good. There were no major complications during the operations except one case, which was completed with TUR-P because of uncontrollable bleeding. No patients required transfusions. Long-term complications included five cases of stress incontinence (19%), four of urethral stricture (14%), and three temporary retention, two of which required re-catheterization (10%).;Conclusion: HoLEP can be performed without major intraoperative complications. It is an effective treatment for obstructive symptoms due to BPH. However, there are many postoperative problems that must be resolved, including stress incontinence and urethral stricture because of our lack of experience, with HoLEP.
Enucleation ; Prostatic Hypertrophy, Benign ; Complications Specific to Antepartum or Postpartum ; Lasers ; Holmium

The effectiveness and safety of ureteroscopic holmium: YAG laser lithotripsy for managing ureteral calculi was evaluated. Ureteroscopic holmium. YAG laser lithotripsy was performed in 168 ureteral calculi (upper 27 cases, middle 33 cases and lower 108 cases). The results showed that the stone-free rate was 92.6% in the upper ureteral calculi, 93.9% in the middle ureteral calculi and 94.4% in the lower ureteral calculi, respectively. The complication rate was 4.8% (8 cases). It was suggested that ureteroscopic holmium: YAG laser lithotripsy is a highly effective and safe treatment modality for managing ureteral calculi.
Holmium ; *Lithotripsy, Laser/methods ; Ureteral Calculi/*therapy ; *Ureteroscopy

PURPOSE: To date, the parameters for evaluating enucleation efficiency have only considered enucleation time, although operators simultaneously consume both time and energy during holmium laser enucleation of the prostate. This study was undertaken to find a better way of assessing enucleation skills, considering both enucleation time and consumed energy. MATERIALS AND METHODS: One hundred (n=100) consecutive patients who underwent holmium laser enucleation of the prostate from April 2012 to April 2014 by a single surgeon were enrolled. Ten groups of 10 consecutive cases were used to analyze the parameters of enucleation efficiency. RESULTS: The mean enucleation time, consumed energy, and enucleated weight were 41.3±19.2 minutes, 66.2±36.0 kJ, and 26.6±21.8 g, respectively. Concerning learning curves, like enucleation time-efficacy (=enucleated weight/enucleation time), enucleation energy-efficacy (=enucleated weight/consumed energy) also had an increasing tendency. Enucleation ratio efficacy (=enucleated weight/transitional zone volume/enucleation time) plateaued after 30 cases. However, enucleation time-energy-efficacy (=enucleated weight/enucleation time/consumed energy) continued to increase after 30 cases and plateaued at 61 to 70 cases. Furthermore, one-way analysis of variance showed that group means for enucleation time-energy-efficacy (F=3.560, p=0.001) were significantly different, but that those of enucleation ratio efficacy (F=1.931, p=0.057) were not. CONCLUSIONS: When both time and energy were considered, enucleation skills continued to improve even after 30 cases and plateaued at 61 to 70 cases. Therefore, we propose that enucleation time-energy-efficacy should be used as a more appropriate parameter than enucleation ratio efficacy for evaluating enucleation skills.
Holmium ; Humans ; Lasers, Solid-State ; Learning Curve ; Prostate ; Prostatic Hyperplasia