Laser Urethrotomy

Laser energy is used as an alternative to »cold« internal urethrotomy according to Sachse in the treatment of ure-thral strictures. In theory, the advantage of using lasers rests on the assumption that high-focus energy reduces tissue damage and removes fibrous tissue. Both neody-mium-YAG (Nd/YAG), as well as argon, holmium, and CTP lasers are used to treat urethral strictures [19, 23, 35]. The Nd/YAG laser has a wavelength of 1,060 nm, which is poorly absorbed by tissue, resulting in a great depth of penetration [116]. Thus a clean cut with a depth of 5 mm and good hemostasis are achieved [114]. The calium-titanyl-phosphate (CTP) laser produces energy with a wavelength of 532 nm, leading to a carbonization and vaporization of the tissue. Hemostasis is achieved as well as the removal of scar tissue [19, 118].

Treatment using laser energy can be done with local, spinal, or general anesthesia. The energy is transported across a cystoscopic shaft with a special laser adapter via a 600-micron laser fiber. Various power levels from 25 to 45 W have been used. The laser energy should be guided along the total circumference of the stricture, whereby using direct contact seems to be advantageous [114]. Postoperatively, a bladder catheter should hinder urinary retention on the basis of the tissue edema [99].

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