Urologic dosimetry studies with the Nd:YAG and CO2 lasers: bladder and kidney

Dose recommendations for the use of the Nd:YAG and CO2 lasers have been accepted with little laboratory analysis. We have examined both endoscopic and open applications in the bladder and open applications on the kidney with the lasers over a variety of power and pulse duration settings. In addition, we have studied the effect of varying the temperature of the tissue and irrigation solution on the depth of penetration. We found that with the Nd:YAG laser, the maximum depth of penetration in our animal model was only 2.62 mm in the bladder. This occurred during an endoscopic treatment with settings of 50 W at 4 seconds with irrigation solution of 25 degrees C. The depth of penetration using current recommendations of 40 W for 2 seconds was less than 1 mm at all temperatures. Room temperature irrigation solution may be the ideal compromise, but higher-power long-pulse durations or repeated treatments to the same area may be necessary to achieve penetrations of 3-5 mm. In open applications on bladder and kidney, the maximum depth of penetration in our animal model was 2.75 mm, which was found during a treatment with settings of 60 W at 4 seconds with the kidney parenchyma at 25 degrees C. Using the CO2 laser on open applications of bladder strips, we obtained a maximum depth of penetration of 1.75 mm at 30 W of power for 1/2 second at 85 degrees C tissue temperature. Unfortunately, penetration by the CO2 laser is accompanied by vaporization of tissue, leaving a large crater. Minimal injury exists beyond this area. In the kidney, we obtained a maximum depth of penetration of 1.75 mm at 30 W of power at 25 degrees C and 20 W of power at 2 degrees C each for 1/2 second.