There has been renewed interest in the use of
lasers for minimally invasive treatment of
urologic diseases in recent years. The introduction of more compact, higher power, less expensive and more user-friendly
solid-state lasers, such as the
holmium:
yttrium-aluminum-garnet (YAG), frequency-doubled
neodymium:YAG and
diode lasers has made the technology more attractive for clinical use. The availability of small, flexible, biocompatible, inexpensive and disposable
silica optical fiber delivery systems for use in flexible
endoscopes has also promoted the development of new
laser procedures. The
holmium:YAG laser is currently the workhorse
laser in urology since it can be used for multiple soft- and hard-tissue applications, including
laser lithotripsy, benign prostate
hyperplasia,
bladder tumors and
strictures. More recently, higher power
potassium-titanyl-phosphate lasers have been introduced and show promise for the treatment of
benign prostatic hyperplasia. On the horizon, newer and more effective photosensitizing drugs are being tested for potential use in
photodynamic therapy of bladder and
prostate cancer. Additionally, new experimental
lasers such as the
erbium:YAG,
Thulium and
Thulium fiber
lasers, may provide more precise incision of soft tissues, more efficient
laser lithotripsy and more rapid prostate ablation. This review provides an update on the most important new clinical and experimental therapeutic applications of
lasers in urology over the past 5 years.