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OBJECTIVE To compare the healthcare utilisation and repeat surgical treatment rate amongst older men undergoing an electrosurgical-transurethral resection of the prostate (TURP) vs photoselective vaporisation of the prostate (PVP), as the real-world implementation and outcomes of laser-based treatment have not been well studied. PATIENTS AND METHODS We used administrative data from the province of Ontario, Canada, to identify all men aged >66 years who underwent their first electrosurgical-TURP/PVP between 2003 and 2016. Our primary exposure was type of procedure (PVP or electrosurgical-TURP). Our primary outcome was need for repeat surgical treatment. The primary analysis was an adjusted marginal Cox model approach, which accounted for clustering of patients within surgeons; adjusted hazard ratios (aHRs) or odds ratios (aORs) and 95% confidence intervals (CIs) are reported. RESULTS We identified 52 748 men: 6838 (13%) underwent PVP, and 45 910 (87%) underwent electrosurgical-TURP. The median age was similar, and PVP became more common with time. Compared to the PVP group, more patients in the electrosurgical-TURP group had prior gross haematuria or urinary retention, and fewer had used anticoagulants, α-blockers, or 5α-reductase inhibitors. The need for repeat surgical treatment was significantly higher amongst men who had PVP (aHR 1.57, 95% CI 1.38-1.78; absolute risk difference +2.3%). PVP was also associated with a slightly higher risk of return to the emergency room within 30 days (aOR 1.11, 95% CI 1.01-1.22) and a significantly lower risk of blood transfusion (aOR 0.24, CI 0.16-0.37); the majority of PVP cases were done with a

Objective To evaluate the outcome in patients undergoing photoselective vaporization of the prostate for benign prostatic obstruction as part of the Clinical Research Office of the Endourological Society Global GreenLight Laser Study. Methods Data were collected on 713 patients with lower urinary tract symptoms suggestive of benign prostatic obstruction undergoing photoselective vaporization of the prostate at 25 centers worldwide, between April 2010 and April 2012. Three types of GreenLight laser powers were used: 80 W, 120 W or 180 W. Intraoperative and postoperative complications were recorded. Outcome parameters measured at baseline, 6–12 weeks, 6 months and 12 months were: uroflow measurements, International Prostate Symptom Score; prostate-specific antigen and International Index of Erectile Function. Results Operating time was shortest with the 180-W laser at 53.8 min. Intraoperatively, bleeding occurred in 3.1% of patients. Statistically significant changes were reported in maximum flow rate, postvoid residual urine, International Prostate Symptom Score, quality of life score and prostate-specific antigen (P

OBJECTIVES • To compare the Cyberwand (Gyrus/ACMI, Southborough, MA, USA), a dual-probe ultrasonic lithotrite, with a single-probe ultrasonic lithotrite. • The Cyberwand incorporates coaxial high-and low-frequency ultrasonic probes that work synergistically. PATIENTS AND METHODS • An institutional review board-approved, multicentre, randomized controlled trial to compare the Cyberwand to the Olympus LUS-II (Olympus America, Inc., Melville, NY, USA) single-probe lithotrite was performed. • Patients undergoing a percutaneous nephrolithotomy (PCNL) with a target stone >2 cm in diameter were eligible for the study. • The primary outcome was the time to removal of the targeted stone. RESULTS • A total of 57 PCNLs were performed after randomization: 25 Cyberwand and 32 LUS-II. • There was no difference (P> 0.05) observed between the two devices for target stone surface area (Cyberwand 526.6 cm 3 vs LUS-II 540.1 cm 3 ), time to clearance of target stone (Cyberwand 15.8 min vs LUS-II 14.2 min) and target stone clearance rate (Cyberwand 61.9 mm 2 /min vs LUS-II 75.8 mm 2 /min). • Of the patients with stone analysis, hard stones (calcium oxalate monohydrate, brushite and cystine) were noted in 14 (56.0%) of the 25 Cyberwand and 18 (62.1%) of the 29 LUS-II patients. • Fifteen of the 25 (60.0%) Cyberwand and 20 of the 32 (62.5%) LUS-II patients were stone-free after the initial PCNL. • Those patients not rendered stone-free went on to receive a secondary PCNL. • Device malfunction occurred in eight of 25(32.0%) Cyberwand and five of 32 (15.6%) LUS II patients. • Complications were similar in both treatment groups. CONCLUSION • No appreciable difference between the dual-probe Cyberwand and the standard ultrasonic Olympus LUS-II lithotrites can be identified.

OBJECTIVES To compare the thermal and histopathological effects of two commercially available bipolar systems and conventional monopolar transurethral resection of the prostate (TURP) in a canine model. Bipolar TURP is an alternative to monopolar electrosurgery for treating benign prostatic hyperplasia and has several potential clinical advantages, including the ability to use normal saline irrigation, enhanced haemostasis and less collateral thermal damage. MATERIAL AND METHODS In all, 12 adult male beagles were studied. After midline laparotomy and exposure of the bladder and prostate, two fibre-optic thermosensors were placed to record tissue temperatures; one sensor was placed into the substance of the prostate 2 cm from the urethra and the second in the prostatic-rectal groove on the capsular surface of the prostate to measure temperatures in the region of the neurovascular bundles. Through a midline cystotomy, antegrade TURP was performed using two different bipolar systems (Gyrus PlasmaKinetic and Vista, both from Gyrus-ACMI Corporation, Maple Grove, MN, USA) or a monopolar device (ForceTM 2, Valleylab, Boulder, CO, USA). TURP was performed in each lateral lobe using 24 F resection loops. The dogs were humanely killed acutely and the prostates excised for histopathological assessment. RESULTS When comparing intraprostatic temperature data, the mean (sem) temperature changes recorded for the monopolar group were significantly higher than in either the Gyrus or Vista bipolar groups, at 24.2 (3.9) °C vs 8.1 (1.5) °C and 6.8 (1.8) °C, respectively (P

Percutaneous nephrolithotomy (PCNL) plays an integral role in managing large renal stones. Establishing percutaneous renal access is the most crucial step in the procedure and requires a thorough understanding of renal, retroperitoneal and thoracic anatomy to minimize the risk of complications. Moreover, access to fluoroscopy and the proper equipment are critical to ensuring complete stone removal. In this review we describe the technique of PCNL used in a high-volume endourology centre, where the urologist is involved in all aspects of the procedure.