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Proceedings Paper

Contact laser transurethral surgery using a sapphire chisel probe firing Nd:YAG
Author(s): Inder Perkash M.D.
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Paper Abstract

This is a report on a modified technique for use of a contact laser for transurethral surgery to improve voiding in spinal core injury patients. To produce a channel for voiding, chisel sapphire tips are used to deliver adequate Nd:YAG laser energy to vaporize tissue blocking the urethral passage. We present data on 51 spinal cord injury patients (range 29 - 76 years) who had contact laser surgery in the past 22 months. Urodynamic studies showed detrusor sphincter dyssynergia in 82% of patients. On cystoscopic examination prior to surgery, 39% had associated enlargement of the prostate and/or bladder-neck stenosis. Thirty-one percent also had associated strictures in the bulbous urethra. For transurethral resection of the sphincter, a 12 o'clock incision was made by passing the contact probe repeatedly and/or buttonholing and then cutting the overlying tissue. For vaporization of the prostate and eradication of urethral strictures, the contact chisel probe was passed repeatedly over the surface and also buttonholes were drilled. The overlying tissue was incised with the laser chisel. The buttonhole technique expedited the procedure for creation of an adequate urethral channel for voiding. During surgery, there was minimal blood loss of about 25 - 50 ml per procedure except in 2 patients who lost 100 to 150 ml. All except 4 patients voided satisfactorily within 1 to 8 days (mean 2.7 days) when the catheter was removed following surgery. The initial 4 patients who did not void well are also voiding satisfactorily following repeat surgery.

Paper Details

Date Published: 12 May 1995
PDF: 3 pages
Proc. SPIE 2395, Lasers in Surgery: Advanced Characterization, Therapeutics, and Systems V, (12 May 1995); doi: 10.1117/12.209079
Show Author Affiliations
Inder Perkash M.D., Dept. of Veterans Affairs Medical Ctr. and Stanford Univ. Medical Ctr. (United States)

Published in SPIE Proceedings Vol. 2395:
Lasers in Surgery: Advanced Characterization, Therapeutics, and Systems V
R. Rox Anderson M.D.; Graham M. Watson M.D.; Rudolf W. Steiner; Douglas E. Johnson M.D.; Stanley M. Shapshay M.D.; Michail M. Pankratov; George S. Abela M.D.; Lawrence S. Bass M.D.; John V. White M.D.; Rodney A. White M.D.; Kenneth Eugene Bartels D.V.M.; Lloyd P. Tate V.D.M.; C. Thomas Vangsness M.D., Editor(s)

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