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Background and Objectives: In the surgical treatment of benign prostatic hyperplasia (BPH), laser enucleation of the prostate is recommended as an alternative to transurethral resection (TURP) and open prostatectomy (OP). The thulium fiber laser, with its superficial penetration depth, can offer a rapid learning process by causing less heat injury and capsule damage. This study compares the first 60 cases of an endourologist performing thulium fiber enucleation of the prostate (ThuFLEP) without a mentor to the results of OP and TURP performed by experienced surgeons. It also identifies the case number at which the operation time for ThuFLEP starts to plateau. Materials and Methods: Between 1 November 2021 and 1 November 2023, the initial 60 ThuFLEP cases of an endourologist with no prior enucleation experience were compared with TURP and OP operations performed by experienced surgeons. Since the first 60 ThuFLEP cases involved 80–120 cc prostates, TURP and OP operations within this size range performed during the same period were included in the study. The groups were assessed for age, preoperative and postoperative prostate volume, PSA levels, the IPSS, the IPSS Quality of Life (QoL), and maximum urinary flow (Qmax). The 60 consecutive ThuFLEP cases were divided into three groups of 20 (Groups 1, 2, and 3) and compared for operation time, IPSS, and Qmax. Results: The operation time for TURP was shorter than for ThuFLEP and OP (p < 0.001). There was no significant difference between ThuFLEP and OP in postoperative Qmax and IPSS, while TURP had lower values than the other two methods. For ThuFLEP, the operation time was longer in the first 20 cases but plateaued in groups 2 and 3 (p < 0.001). Postoperative Qmax and IPSS values showed no significant differences among the three ThuFLEP groups (p > 0.05). Conclusions: For large prostates, ThuFLEP provides better postoperative results than TURP and offers shorter catheterization and hospital stay times than OP. Its short learning curve makes it a preferable method for treating BPH compared to other laser techniques. [ABSTRACT FROM AUTHOR]

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This document discusses the use of different imaging modalities in diagnosing urolithiasis, or kidney and ureteral stone disease. The authors compare non-contrast CT scans (NCCT) and plain kidney ureter and bladder X-rays (KUB) in diagnosing urolithiasis patients, noting that NCCT provides more precise information, particularly in high-risk cases. They also mention the advantages and limitations of using Ultrasonography (USG) and KUB together, highlighting its real-time imaging capabilities and absence of ionizing radiation. The document further discusses the decreasing preference for KUB in diagnosing urolithiasis due to its limited sensitivity, and the potential use of artificial intelligence (AI) to improve diagnostic accuracy. The authors conclude by stating that the integration of KUB and USG can be effective in diagnosing ureteral stones in certain patient populations, and that technological advancements and the use of AI are expected to revolutionize the field of urolithiasis diagnosis. [Extracted from the article]

This letter discusses the importance of considering anatomical factors in the management of urolithiasis (kidney stones) in children. Anatomical abnormalities and variations, such as medullary sponge kidneys, caliceal diverticula, horseshoe kidney, or pelvic-ureteral junction obstruction, can contribute to stone formation by increasing crystal retention. The length and angle of the lower pole infundibulum, specifically the infundibulopelvic angle (IPA), play a significant role in the stability of kidney stones, particularly in the lower pole. Studies have shown that wider IPA and shorter infundibulum length are associated with better stone clearance. Understanding the pelvicalyceal anatomy is crucial in assessing the risk of kidney stone formation, especially in patients with lower pole kidney stones. [Extracted from the article]