Project Description
Laser treatment
Holmium Laser treatment with the High Power Lumenis Holmium Laser machine has emerged as the new “GOLD STANDARD” in the India for treating Enlarged Prostate (BPH) as well as Stones in the Kidney, Bladder, Ureter and Urethra (Urinary Passage)
It is the latest technology used in the west over last 5 years with excellent results and now is most widely used in India. In Bangalore Sree lakshmi hospital is one of the pioneers to use this technology with very good outcome
Holmium Laser Enucleation of Prostate (HoLEP) is also known as Holmium Laser Prostatectomy. HoLEP is aimed to remove the central part of prostate gland which enlarges due to ageing and causes pressure on urethra (urine passage)
The High Power Holmium Laser separates the central part of prostate from the surrounding fibrous covering (capsule) and this procedure is nearly bloodless as the laser beam when cuts the gland also seals the blood vessels. The separated part of the prostate is then pushed into urinary bladder and is cut by a special machine (Morcellator) into smaller pieces and then sucked out of the body. The smaller pieces of the prostate are sent for biopsy to detect prostate cancer.
| Particulars | HoLEP | TURP |
| Size of Gland | Any size | Not greater than 80 grams |
| Hospitalization | 1 - 2 days | More then 4 days |
| Catheter | Less than 24 hours | 48-72 hours |
| Irrigation | Normal saline | Glycine |
| Blood Loss | Minimal loss (15 ml o 50 ml] | More than 300 ml |
| Patients on anticoagulants, aspirin and with heart valves and coronary stents | Safe | High Risk |
| Recovery | Very soon | Few weeks |
| Risk of stricture, bladder neck contracture & impotence | Insignificant | High Risk |
| Particulars |
HoLEP |
Other Lasers
(Greenlight,PVP, Thulium, etc.) |
| Biopsy to detect Prostate Cancer | Possible | Not possible |
| Published Laser RCT | 8 | 2 (Greenlight); 0 (Thulium) |
| Amount of Enlarged Prostate Removed | 82 - 91% | 32 - 51 % |
| Treatment Cost | Economical | Expensive |
Extracorporeal Shock Wave Lithotrispy (ESWL) uses highly focused electro magnetic waves projected from outside the body to crush kidney stones anywhere in the urinary system. The stone is reduced to sand-like particles that can pass in the urine. Large stones may require more than one sessions. It can be used for patients of all age groups and those who have heart and breathing problems. However, the procedure is contraindicated for pregnant women. ESWL by 4th generation “SIEMENS LITHOTRIPTER” with ultrasound attachment helps to treat even radioluscent stones, which are not visible in normal fluoroscopy Lithotripters.
Percutaneous Nephrostolithotomy (PCNL) is performed under epidural or spinal anaesthesia. Percutaneous ( through skin) removal of kidney stones (lithotomy) is accomplished through the most direct route. A telescope along with the mechanical lithotripter in inserted to break the stone into fine particles so as to achieve a stone-free status in large and complicated stones. This procedure usually requires hospitalization, and most patients resume normal activity within 2 weeks.
Ureterorenoscopic Lithotrispy with Holmium Laser is performed under epidural and spinal anaesthesia to treat stones located in the middle or lower ureter. A small, fiberoptic instrument (ureteroscope) is passed into the ureter. Large stones are fragmented using 100-Watt Coherent Holmium Laser. The laser fragments the stone into sand like particles, which are then flushed out through the natural urinary passage. The advantage of Holmium Laser is its ability to fragment stones of all compositions with precision. Thus, it is the most effective laser for the treatment of urinary stones. Patients are generally admitted on the same day of the treatment and are discharged next day, which means only 24 hours of hospitalization is required.
In this procedure, the world’s thinnest 4.5 Fr ureteroscope is passed under anesthesia per urethra into bladder and ureter up to the stone. Small stones are pulled out with various instruments and bigger stones are fragmented with high power Lumenis Powersuite 100w Holmium laser machine into smaller pieces which subsequently pass naturally
| URS with Holmium Laser | URS with Pneumatic Lithotripter |
| Minimal chance of upward migration of stone during treatment | High chance of upward migration of stone during treatment |
| Very effective for soft as well as hard stones | Less effective for hard stones |
| No mucosal injury or bleeding during treatment | Some mucosal injury or bleeding during treatment |
| Reduced need for D J stent | Higher need for D J stent |
| Used with rigid and flexible URS | Used only with rigid URS |
PCNL is a keyhole surgery for removal of kidney stones in which instruments with small diameter are used for smaller kidney punctures. Laser, pneumatic and ultrasound devices are used in the process to fragment stone and there is very less bleeding in the process. With High Power Holmium laser machine, even hard and large are fragmented quickly with less bleeding.
The PCNL treatment is highly advantageous as it has a history of resulting into complete clearance in over 95% cases and the patient can be home in as little as 48 hours.
Advantages
- Reduce hospital stay
- Complete clearance in over 90% cases in single session
- With Holmium Laser, even large and hard stone is fragmented quickly with higher precision and less bleeding
- Faster recovery
- Painless treatment
- Strong clinical evidence
Sree Lakshmi Hospital has a dedicated team of urologists, nephrologists, Lithotripsy experts, anaesthetists and imaging specialists to plan your treatment.
We are one of the pioneers in Bangalore to use holmium laser for Kidney stone and prostate with very high success rate
Located in Bangalore, CV Raman nagar, it is accessible by road and metro both Indranagar and Byappanahalli as a nearest metro station