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Background and Objective: Thulium fiber laser (TFL) emerged as a competitor of holmium:yttrium-aluminum-garnet (Ho:YAG) laser for anatomic enucleation of the prostate (AEEP) in men with lower urinary tract symptoms (LUTS) related to benign prostatic obstruction (BPO). The aim was to compare the surgical outcomes of Ho:YAG and TFL for AEEP., Methods: A literature search was conducted to identify reports published from inception until January 2024. The Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were followed to identify eligible studies. The coprimary outcomes were the postoperative International Prostate Symptom Score (IPSS), IPSS-Quality of Life (IPSS-QoL), and peak urinary flow (Qmax)., Key Findings and Limitations: Five studies met our inclusion criteria, and data from 1287 and 1555 patients who underwent AEEP with Ho:YAG (holmium laser enucleation of the prostate [HoLEP]) and TFL (thulium fiber laser enucleation of the prostate [ThuFLEP]), respectively, were reviewed. ThuFLEP was associated with a better IPSS at 3 mo even if the difference was not clinically significant (mean difference [MD] 0.59, 95% confidence interval [CI]: 0.29-0.88; p < 0.001). No difference was found for IPSS at 6-12 mo (p = 0.9), and IPSS-QoL at 3 mo (p = 0.9) and 6-12 mo (p = 0.2). HoLEP was associated with a better Qmax at 3 mo (MD 1.41 ml/s, 95% CI: 0.51-2.30; p = 0.002) and ThuFLEP at 6-12 mo (MD -2.61 ml/s, 95% CI: -4.68 to 0.59; p = 0.01), but the differences were not clinically significant. No difference was found in the major (p = 0.3) and overall (p = 0.3) complication rates. HoLEP was associated with shorter enucleation (MD -11.86, 95% CI: -22.36 to 1.36; p = 0.03) but not total operative time (p = 0.5)., Conclusions and Clinical Implications: The present review provides the most updated evidence on the impact of Ho:YAG and TFL in AEEP, demonstrating that these two energy sources are effective in relieving bothersome LUTS in men with BPO., Patient Summary: Thulium fiber laser is a new energy source that can be used safely for performing endoscopic enucleation of the prostate in men with bothersome symptoms associated with benign prostatic enlargement., (Copyright © 2024 European Association of Urology. Published by Elsevier B.V. All rights reserved.)

Context: Nowadays, urolithiasis has become a highly prevalent disease. Recent studies indicate that retrograde intrarenal surgery (RIRS) is becoming more popular among surgical treatments due to the preference of patients and providers. This minimally invasive procedure results in high stone-free rates and relatively low morbidity; however, complications resulting from infection can still occur, including acute urinary tract infection, systemic inflammatory response syndrome, and sepsis., Objective: To identify the independent risk factors for sepsis following RIRS, as well as general risk factors that may contribute to this life-threatening complication in the pre- and intraoperative periods., Evidence Acquisition: A literature review was conducted in April 2020 using the Medline, Scopus, and Cochrane databases. We searched the references of included papers., Evidence Synthesis: We screened 2306 manuscripts and selected 13 for inclusion. The sepsis rate ranged from 0.5% to 11.1%, and the septic shock rate ranged from 0.3% to 4.6%. All selected studies mentioned risks for sepsis and/or infective complications (including sepsis), but only four of them addressed independent risks for urosepsis. These independent risk factors were stone size, high irrigation pressure, prolonged stent dwelling time (>30 d), sepsis as an indication for stent insertion, female gender, positive intraoperative bladder urine culture, longer surgical time, and diabetes mellitus., Conclusions: RIRS is associated with a low sepsis rate, according to the latest evidence. However, given that this is a serious life-threatening complication, knowing its potential risk factors is extremely important., Patient Summary: In this report, we looked at the outcome of sepsis after planned retrograde intrarenal surgery for stone disease in patients with and without comorbidities. This information may be useful for colleagues in their daily practice., (© 2022 The Author(s).)

The factors that can reduce intrarenal pressure during flexible ureteroscopy and percutaneous nephrolithotomy have been identified as low irrigation pressure, use of a ureteral access sheath or operating sheath appropriate fothe diameter of the endoscope, and occupation of the working channel in the case of flexible ureteroscopy., (Copyright © 2021 European Association of Urology. Published by Elsevier B.V. All rights reserved.)

Context: Morphoconstitutional analysis of urinary stones is perhaps the most important examination in the evaluation of a patient with urolithiasis., Objective: A comprehensive stone classification system was developed in the early 1990s by Michel Daudon, which included the main types of stones and their possible physiopathogenic origin., Evidence Acquisition: A narrative review of the articles published about this classification was conducted, without time limit., Evidence Synthesis: Two analytical steps are needed for the classification process: the microscopic examination, which gives the stone morphology, and the physical analysis, which provides the stone constitution. Upon completion of a full analysis, knowledge of the principal crystal species of the stone is acquired. In addition, this analysis highlights the possible causes of the lithogenic process, taking in account less frequent, but severe, pathologies., Conclusions: The aim of this report is to summarize the principal etiological causes for urinary stone formation thanks to the morphoconstitutional analysis and to present its contribution in the field of urinary stones., Patient Summary: We looked at all types of stones and found that their origin varies according to the underlying pathology of the patient., (Copyright © 2020 European Association of Urology. All rights reserved.)

Despite the worldwide spread of Ho:YAG lasers in urology departments, the physical principles behind their functioning may still seem obscure to many urologists. Moreover, a new laser source, the thulium fiber laser (TFL), was recently approved for stone lithotripsy. Here we describe the concepts of peak power and pulse modulation for laser lithotripsy, analyzing both Ho:YAG lasers and TFLs. Different pulse modalities are available for Ho:YAG lasers-long and short pulses and Moses technology-each with a different pulse shape and peak power. Lower peak power and a more rectangular pulse shape provide higher ablation efficiency and lower stone retropulsion. These characteristics are perfectly embodied by TFL, which shows the most effective ablation efficiency in laboratory studies. A long pulse is the most effective modality for Ho:YAG lasers. Moses technology, despite its promising rationale, is not superior to long-pulse mode. Clinical studies are needed in order to confirm these laboratory data. PATIENT SUMMARY: Laser lithotripsy is one of the main options for the treatment of urinary stones. The peak power and pulse modulation influence the choice of the optimal laser mode for the treatment of urinary stones. Thulium fiber lasers have shown the most favorable dusting profile in terms of both peak power and pulse modality in laboratory studies, but clinical evidence is still lacking., (Copyright © 2021 European Association of Urology. Published by Elsevier B.V. All rights reserved.)

There is currently insufficient in vivo evidence that high-power Ho:YAG lasers improve retrograde intrarenal surgery or the ablation efficacy. While prospective trials are awaited, a low-cost, silent, low-power Ho:YAG laser that requires only a standard electrical outlet is more than sufficient for retrograde intrarenal surgery., (Copyright © 2020 European Association of Urology. Published by Elsevier B.V. All rights reserved.)

The advantage of a retrograde over an antegrade approach in ileal conduit diversion is the lower morbidity. Furthermore, in cases in which there are bone deformities and no ureteral reflux from the reservoir into the upper tract, percutaneous access can be challenging. Thus, a retrograde approach should be considered as the first-line option for the treatment of renal stones in patients with an ileal conduit, but the urologist should keep in mind that an antegrade or combined approach may be possible in the case of failure., (Copyright © 2017 European Association of Urology. Published by Elsevier B.V. All rights reserved.)