Department of Urology and Urooncology, Medical School of Hanover [MHH], Hanover, Germany.
Eur Urol. 2012 Apr;61(4):783-95. doi: 10.1016/j.eururo.2012.01.010. Epub 2012 Jan 17.
The European Association of Urology (EAU) Guidelines Office has set up a guideline working panel to analyse the scientific evidence published in the world literature on lasers in urologic practice.
Review the physical background and physiologic and technical aspects of the use of lasers in urology, as well as current clinical results from these new and evolving technologies, together with recommendations for the application of lasers in urology. The primary objective of this structured presentation of the current evidence base in this area is to assist clinicians in making informed choices regarding the use of lasers in their practice.
Structured literature searches using an expert consultant were designed for each section of this document. Searches were carried out in the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, and Medline and Embase on the Dialog/DataStar platform. The controlled terminology of the respective databases was used, and both Medical Subject Headings and EMTREE were analysed for relevant entry terms. One Cochrane review was identified.
Depending on the date of publication, the evidence for different laser treatments is heterogeneous. The available evidence allows treatments to be classified as safe alternatives for the treatment of bladder outlet obstruction in different clinical scenarios, such as refractory urinary retention, anticoagulation, and antiplatelet medication. Laser treatment for bladder cancer should only be used in a clinical trial setting or for patients who are not suitable for conventional treatment due to comorbidities or other complications. For the treatment of urinary stones and retrograde endoureterotomy, lasers provide a standard tool to augment the endourologic procedure.
In benign prostatic obstruction (BPO), laser vaporisation, resection, or enucleation are alternative treatment options. The standard treatment for BPO remains transurethral resection of the prostate for small to moderate size prostates and open prostatectomy for large prostates. Laser energy is an optimal treatment method for disintegrating urinary stones. The use of lasers to treat bladder tumours and in laparoscopy remains investigational.
欧洲泌尿外科学会（EAU）指南办公室成立了一个指南工作组，以分析世界文献中关于激光在泌尿科实践中的科学证据。
回顾激光在泌尿科应用中的物理背景、生理和技术方面，以及这些新技术的当前临床结果，以及在泌尿科应用激光的建议。本文件以结构化的方式介绍该领域当前证据基础，旨在帮助临床医生在实践中做出明智的激光应用决策。
为本文档的每个部分设计了使用专家顾问的结构化文献检索。在 Cochrane 系统评价数据库、Cochrane 对照试验中心注册库以及 Medline 和 Embase 数据库上使用 Dialog/DataStar 平台进行了搜索。使用了各自数据库的受控术语，并分析了 Medical Subject Headings 和 EMTREE 以获得相关的主题词。确定了一项 Cochrane 综述。
根据发表日期的不同，不同激光治疗的证据存在异质性。现有的证据允许将治疗方法分类为治疗不同临床情况下膀胱出口梗阻的安全替代方法，如难治性尿潴留、抗凝和抗血小板药物。激光治疗膀胱癌只能在临床试验环境中或因合并症或其他并发症不适合常规治疗的患者中使用。对于治疗尿路结石和逆行输尿管内切开术，激光提供了增强腔内泌尿外科手术的标准工具。
在良性前列腺增生（BPO）中，激光汽化、切除或剜除是替代治疗选择。BPO 的标准治疗仍然是经尿道前列腺切除术治疗小至中等大小的前列腺和开放性前列腺切除术治疗大前列腺。激光能量是分解尿路结石的最佳治疗方法。激光在膀胱癌治疗和腹腔镜中的应用仍处于研究阶段。
