Ho:YAG-laser: treatment of vesicourethral strictures after radical prostatectomy

Abstract

Objective: To review the indication, feasibility and treatment outcome of Ho:YAG laser application for definitive endoscopic treatment of anastomotic stricture formation after radical prostatectomy.

Evidence synthesis: Currently, no universally accepted regime for managing post-prostatectomy anastomotic strictures exists. Cold knife incision is the most commonly utilized invasive technique for the treatment of bladder neck contractures. The Ho:YAG laser with its shallow tissue absorption of <0.5 mm offers favorable cutting properties including low blood loss and less induction of scar tissue formation and could be a valid alternative to endoscopic knife incision.

Evidence acquisition: PubMed and Medline were searched for reports on Ho:YAG laser therapy in strictures from 1980 to 2009 with particular focus on the operating techniques using the Ho:YAG laser system.

Conclusion: Ho:YAG laser endourethrotomy tends to be a safe and at least minimally invasive therapeutic modality for the treatment of bladder neck contractures after radical prostatectomy. No cohort study that evaluates the use of laser for this modality is available in literature. Due to the lack of comparable randomized multicentre trials, the indications for a laser-related endoscopic treatment option has to be defined based on the operators expertise and the patient's individual situation.