The current status of laser applications in Urology

The overall development of laser use in urology is recessing. The reasons are the refinement of methods of radical surgery and the continuing development of alternative technologies involving electric current. To date, only a few laser therapies fully utilize the unique optical properties of lasers and justify the high cost with unsurpassed therapeutical efficiency. The multitude of laser applications of the 80' s have not held their promise. Alone the Nd:YAG laser continues to strive as a therapeutic instrument for coagulation of superficial multifocal bladder cancer and adjuvant therapy of superficial invasive bladder cancer after TUR. The benifit of this treatment form in minimal invasive therapy of upper urinary tract lesions is limited to a tiny population with renal insufficiency. Multi-purpose use of the Nd:YAG laser as a cutting or lithotripsy instrument has failed. Investigational demand has led to the development of the Alexandriteand infrared solid state lasers solely for these purposes. These expensive technical developments are challenged by equally effective products like the regulated electrohydraulic lithotripter at a fraction of cost. Taking the cost factor into account, are lasers still opportune in medicine? The answer is definitely yes. Cost reduction in medical practice without quality loss is only possible with effective methods of minimally invasive surgery. Continuing investigation of cutting, welding, coagulating and ablating instruments is justified. Competition of lasers to other technologies can only be benificial to the cause. But where are the highlights of laser applications? The unsurpassed utilization of optical properties of lasers lie in the concept of photodynamic therapies and in optical feedback mechanisms for laser applications. The combination of lasers with three dimensional visualisation of the treatment area by ultrasound (TULIPprocedure for benign prostatic hyperplasia) is a novel approach in laser application.The further development of these treatment modalities will reveal the true benefit of laser technology in urological applications.