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We present avidity sequencing, a sequencing chemistry that separately optimizes the processes of stepping along a DNA template and that of identifying each nucleotide within the template. Nucleotide identification uses multivalent nucleotide ligands on dye-labeled cores to form polymerase–polymer–nucleotide complexes bound to clonal copies of DNA targets. These polymer–nucleotide substrates, termed avidites, decrease the required concentration of reporting nucleotides from micromolar to nanomolar and yield negligible dissociation rates. Avidity sequencing achieves high accuracy, with 96.2% and 85.4% of base calls having an average of one error per 1,000 and 10,000 base pairs, respectively. We show that the average error rate of avidity sequencing remained stable following a long homopolymer.

We present a novel sequencing chemistry implemented as part of the AVITI system. Relying on the proximal DNA binding sites created through DNA amplification on a solid support, avidity sequencing uses multivalent nucleotide ligands on dye-labeled cores to simultaneously form polymerase-polymer nucleotide complexes bound to clonal copies of DNA targets. These polymer-nucleotide substrates, termed avidites, decrease the required concentration of reporting nucleotides by 100x and yield a negligible dissociation rate. We demonstrate the use of avidites within a novel sequencing technology that surpasses Q40 accuracy and enables a diversity of applications that include single cell RNA-seq and whole human genome sequencing.

Due to demographic changes in today's society, the number of patients with lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) is increasing. Similarly, the proportion of patients with cardiovascular risk factors undergoing antiplatelet (AP) or anticoagulation (AC) therapy is growing as well. This review discusses the current literature on various techniques used for anatomic endoscopic enucleation of the prostate (AEEP) in patients on AC/AP therapy. The large number of energy sources used for AEEP makes it difficult to compare them. Overall, fewer bleeding-associated complications arise in patients under AP compared to AC or bridging therapy with low molecular weight heparin. However, perioperatively both AP and AC therapy lead to a higher risk of bleeding complications compared to patients not taking anticoagulants. The literature shows that AEEP is possible and efficacious in patients under AC/AP therapy, with only slight differences compared to patients not taking AC/AP drugs, on a short and long-term basis. Nevertheless, the sparse data, the retrospective nature of many studies and the inclusion of prostate sizes between 50 and 110 ml only, make it difficult to come to strong conclusions.

We performed a prospective randomized comparison among Retrograde IntraRenal Surgery (RIRS) and MiniPerc (MP) for stones between 10 and 20 mm to evaluate outcomes with the same laser device: Fiber Dust.Patients with a single renal stone between 10 and 20 mm were randomized to RIRS (Group A) versus MP (Group B). Exclusion criteria were age 18 or 75, presence of acute infection, coagulation impairments, cardiovascular or pulmonary comorbidities. In both groups, the Fiber Dust laser was used. A CT scan after 3 months was performed. A negative CT scan or asymptomatic patients with stone fragments 3 mm and a negative urinary culture were the criteria to assess the stone-free status. A statistical analysis was carried out to assess success, complication and retreatment rates and need for auxiliary treatments.Between January 2021 and January 2022, 186 patients were enrolled (90 in Group A and 96 in Group B). Mean stone size was 15.8 mm and 14.9 mm in Group A and B, respectively (p = 0.23). The overall stone-free rate (SFR) was 73.3% for Group A and 84.4% for Group B. A higher SFR was reached for upper calyceal stones in Group A (90.4%) lower calyceal stones in Group B (91.6%). Retreatment rate (p = 0.31) and auxiliary procedure rate (p = 0.18) were comparable. Complication rate was 5.5% and 5.2% for Groups A and B, respectively.RIRS and MP are both effective to obtain a postoperative SFR with Fiber Dust. According to the stone position one treatment is superior to the other one.

To compare endoscopic enucleation of the prostate using a thulium: yttrium-aluminum-garnet (Tm:YAG) laser and a super-pulsed thulium fiber laser set in continuous-wave (CW) mode, and to evaluate whether theoretical advantages of thulium fiber lasers, related to their shorter wavelength, translate into relevant clinical differences.In total, 110 patients suffering from lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia were randomized to undergo either thulium:YAG laser enucleation of the prostate (ThuLEP) or CW thulium fiber laser enucleation of the prostate (CW-ThuFLEP). Intraoperative and postoperative variables and complications were compared. Micturition improvement was assessed at 3-month follow-up using the International Prostate Symptom Score (IPSS), post-void residual urine (PVR) and maximum flow rate (Qmax). Erectile function was evaluated using the International Index of Erectile Function-5 (IIEF-5).No significant differences between the ThuLEP and CW-ThuFLEP groups were found in terms of operative time (70.69 vs 72.41 min), enucleation time (50.23 vs 53.33 min), enucleated tissue weight (40.2 vs 41.9 g), enucleation efficiency (0.80 vs 0.79 g/min), catheterization time (2.45 vs 2.57 days), hospital stay (2.82 vs 2.95 days) and hemoglobin drop (1.05 vs 1.27 g/dl). At 3-month follow-up, no significant differences were found in IPSS (5.09 vs 5.81), Qmax (26.51 vs 27.13 ml/s), PVR (25.22 vs 23.81 ml) and IIEF-5 (14.01 vs 14.54).ThuLEP and CW-ThuFLEP were equivalent in relieving patients from LUTS and improving micturition. Theoretical advantages of the TFL, such as shallower penetration depth and improved vaporization capacity, did not translate into relevant perioperative outcomes or clinical differences.

To assess the effects of a new ejaculation-sparing thulium laser enucleation of the prostate (ES-ThuLEP) technique on sexual functions and micturition, in patients with lower urinary tract symptoms secondary to benign prostatic hyperplasia (BPH) and to evaluate how the surgical technique of ES-ThuLEP can lead to ejaculation preservation. A prospective study was carried out between January 2015 and January 2018 on patients with surgical indication for BPH, who wished to preserve ejaculation. The patients were treated with ES-ThuLEP and were evaluated before and 3 and 6 months after surgery. Three validated questionnaires (ICIQ-MLUTSsex, IIEF-5 and IPSS) were used to assess changes in ejaculation, erectile function and urinary symptoms. Uroflowmetry (Qmax and Qavg), post-void residual volume and voided volume were also evaluated, to assess micturition improvement. Patients with moderate to severe erectile dysfunction were excluded. Statistical analysis was performed with the Student’s t test, Chi-square test and logistic regression analysis. Two hundred and eighty three patients were enrolled. Ejaculation was spared in 203 and 219 patients at 3 and 6 months after surgery. No significant differences were observed between erectile function before and after surgery: baseline IIEF-5 = 16.2 ± 4.47 vs 16.7 ± 2.9 (p = 0.419) and 17.7 ± 3.2 (p = 0.410) at 3 and 6 months. Significant improvement in urinary symptoms was achieved: baseline IPSS = 19.4 ± 7.24 vs 5.8 ± 4.3 (p = 0.032) and 3.9 ± 4.1 (p = 0.029) at 3 and 6 months. ES-ThuLEP effectively preserved ejaculation in over two thirds of the patients without compromising micturition improvement or erectile function. ES-ThuLEP could be a valid treatment option for BPH in young and sexually active men.

BACKGROUND The "VirtualBasket" technology is the result of pulse modulation during holmium laser emission: the laser emits part of the energy to create an initial bubble, and a second pulse is emitted when the vapor bubble is at its maximum expansion, so that it can pass through the previously created vapor channel. The aim of this study is to outline the outcomes of the "VirtualBasket" technology in ureteral and renal stones. METHODS 160 Patients were randomly assigned to holmium laser lithotripsy with or without the "VirtualBasket" technology in ureteric or renal cases (40 per 4 groups). All procedures were performed by four experienced urologists. The Quanta System Cyber Ho 100W laser generator with 365 μm fibers was used for all of the ureteral cases, whereas, 272 μm fibers were used for all of the cases in the renal pelvis. Demographic data, stone parameters, perioperative complications and success rates were compared. A statistical analysis was carried out to assess patients data and outcomes. All of the reported p-values were obtained with the two-sided exact method at the conventional 5% significance level. The degree of stone retropulsion was graded on a Likert scale from zero (no retropulsion) to 3 (maximum retropulsion). RESULTS All groups were comparable in terms of age, and pre-operative stone size (ureter stone size: 1.2 vs. 1.1 cm; renal pelvis stone size: 1.55 vs. 1.62 cm). Compared to the regular mode, the "VirtualBasket" technology was associated with significantly lower fragmentation time (mean time for ureteral stones: 20.4 vs. 16.1 minutes, p

INTRODUCTION AND OBJECTIVE:To compare clinical intra and early postoperative outcomes between conventional Holmium laser enucleation of the prostate (HoLEP) and Holmium laser enucleation of the pro...

INTRODUCTION AND OBJECTIVE:We performed a prospective randomized comparison between Retrograde Intrarenal Surgery (RIRS) and MiniPerc (MP) for renal stones between 1 and 2 cm, to evaluate the effic...

INTRODUCTION AND OBJECTIVE:The most challenging part of a percutaneous nephrolithotomy (PCNL) is the perfect puncture of the planned calyx. HoloLens based augmented reality system has been descibed...

Urolithiasis is a rare complication after kidney transplant. Over the years, treatment of kidney stones has evolved radically, but a standard approach for transplanted kidneys has not yet been defined. Here, we present a 69-year-old male patient who received successful treatment of nephrolithiasis of the transplanted kidney. The patient, who had received a kidney from a deceased donor, was admitted to our department following a posttransplant Doppler ultrasonography showing severe hydronephrosis of the transplanted kidney associated with acute renal function decay. Computed tomography scan confirmed the hydronephrosis of the transplanted kidney, showing a large, impacted, ureteropelvic 3-cm-diameter stone and other concretions around the ureteral stent. The patient was then treated with retrograde intrarenal surgery during an open ureterotomy. His postoperative course was uneventful, and he showed good functional reprise and a rapid decrease of serum creatinine levels. Intraoperative retrograde intrarenal surgery could be a valid option for treatment of kidney stones of the transplanted kidney during open surgery of the ureter or during ureterovesical anastomosis.

Objective: To provide the first large single-operator case series of patients who undergo “en bloc” thulium laser enucleation of the prostate (ThuLEP) and to demonstrate an improvement in enucleation efficacy with experience. Methods: We prospectively evaluated a cohort of patients with symptomatic benign prostatic hyperplasia (BPH) who underwent “en bloc” ThuLEP between May 2015 and November 2017. Association between dependent variables (delivered energy and operating time) and independent variables (adenoma volume and experience) were estimated with regression analysis. The experience was calculated as the time interval between the date of the first operation of the series and the date of the operation being considered. Results: A total of 100 patients were registered for the study. Median operative time was 56.5 min (interquartile range [IQR]: 40–85 min). Median enucleation time was 17.4 min (IQR: 15–21.5 min). Median enucleation index (enucleation time per adenoma gram) was 0.3 min/g (0.2–0.3 min/g). The overall operative time is not influenced by experience, but we registered a significant trend towards a reduction in the total amount of energy delivered energy normalized per adenoma gram (p = 0.0148). Conclusion: We believe that further attention is needed for these new “en bloc” prostatic enucleation techniques, which can facilitate some surgical steps, leading to a widespread use of laser technology for BPH surgical treatment. Keywords: Benign prostatic hyperplasia, Endoscopic enucleation of the prostate, Laser surgery, Thulium laser enucleation of the prostate

Objective Italy is facing the COVID‐19 outbreak with an abrupt reorganization of its national health‐system, in order to augment care provision to symptomatic patients. The sudden shift of personnel and resources towards COVID‐19 care has led to the reduction of surgery, with possible severe drawbacks. The aim of the study is to describe the trend in surgical volume in urology, in Italy. Materials and Methods Thirty‐three urological units with physicians affiliated to the AGILE consortium were involved in a survey. Urologists were asked to report the amount of surgical elective procedures week‐by‐week, from the beginning of the emergency to the following month. Results The 33 hospitals involved in the study account, globally, for 22,945 beds and are distributed in 13/20 Italian regions. Before the outbreak, the involved urology units performed an overall amount of 1,213 procedures per week, half of which were oncological. One month later, the amount of surgery declined by 78%. Lombardy, the first region with positive‐cases, experienced a 94% reduction. The decrease in oncological and non‐oncological surgical activity was 35,9% and 89%, respectively. The trend of the decline showed a delay of roughly 2 weeks for the other regions. Conclusion Italy, the country with the highest fatality rate from COVID‐19, is experiencing a sudden decline in surgical activity. It is inversely related to the increase in COVID‐19 care, with potential harm particularly in the oncological field. The Italian experience can be helpful for future surgical pre‐planning in other countries not so hardly hit by the disease yet.

Endoscopic enucleation of the prostate (EEP) techniques for the treatment of benign prostatic hyperplasia (BPH) have become increasingly popular among urologists over the past 23 years. Despite the energy source employed, the aim of all these procedures is to endoscopically remove the prostatic lobes by enucleating them from the prostate surgical capsule. The reasons for which EEP has gained popularity among urologists are the reduction in complications and hospital stay compared to endoscopic gold standard Transurethral Resection of the Prostate (TURP), but especially the possibility to treat large prostates, allowing to abandon open simple prostatectomy (OP) and to avoid the burden related to open surgery. Holmium laser enucleation of the prostate (HoLEP) sets the basic principles of all EEP techniques in 1998 and has become the treatment of reference for BPH. Since then, various lasers have been developed and applied to prostatic enucleation. The thulium laser has a slightly shorter wavelength compared to the holmium laser and a continuous wave output, which increase vaporization and reduce penetration depth. These features make it ideal for prostatic enucleation. A vapoenucleating technique called Thulium Laser Vapoenucleation of the Prostate was presented in 2009, followed by a blunt enucleating technique called Thulium Laser Enucleation of the Prostate in 2010. These techniques have become alternatives to HoLEP and TURP; however, the amount of literature and randomized controlled trials available are inferior compared to HoLEP. The aim of th describe, and discuss current evidence on thulium enucleating techniques.

Background To compare clinical intra and early postoperative outcomes between conventional Holmium laser enucleation of the prostate (HoLEP) and Holmium laser enucleation of the prostate using the Virtual Basket tool (VB-HoLEP) to treat benign prostatic hyperplasia (BPH). Methods This prospective randomized study enrolled consecutive patients with BPH, who were assigned to undergo either HoLEP (n = 100), or VB-HoLEP (n = 100). All patients were evaluated preoperatively and postoperatively, with particular attention to catheterization time, operative time, blood loss, irrigation volume and hospital stay. We also evaluated the patients at 3 and 6 months after surgery and assessed maximum flow rate (Qmax), postvoid residual urine volume (PVR), the International Prostate Symptom Score (IPSS) and the Quality of Life score (QOLS). Results No significant differences in preoperative parameters between patients in each study arm were found. Compared to HoLEP, VB-HoLEP resulted in less hemoglobin decrease (2.54 vs. 1.12 g/dl, P = 0.03) and reduced operative time (57.33 ± 29.71 vs. 42.99 ± 18.51 min, P = 0.04). HoLEP and VB-HoLEP detrmined similar catheterization time (2.2 vs. 1.9 days, P = 0.45), irrigation volume (33.3 vs. 31.7 l, P = 0.69), and hospital stay (2.8 vs. 2.7 days, P = 0.21). During the 6-month follow-up no significant differences in IPSS, Qmax, PVR, and QOLS were demonstrated. Conclusions HoLEP and VB-HoLEP are both efficient and safe procedures for relieving lower urinary tract symptoms. VB-HoLEP was statistically superior to HoLEP in blood loss and operative time. However, procedures did not differ significantly in catheterization time, hospital stay, and irrigation volume. No significant differences were demonstrated in QOLS, IPSS, Qmax and PVR throughout the 6-month follow-up. Trial Registration: Current Controlled Trials ISRCTN72879639; date of registration: June 25th, 2015. Retrospectively registred.

To compare intra and perioperative parameters between HoLEP and ThuLEP in the treatment of benign prostatic hyperplasia and to evaluate clinical and functional outcomes of the two procedures with a 12-month follow-up. A prospective randomized study was performed on 236 consecutive patients who underwent ThuLEP (n = 115), or HoLEP (n = 121) in three different centers. Intra and perioperative parameters were analyzed: operative time, enucleated tissue weight, irrigation volume, blood loss, catheterization time, hospital stay and complications. Patients were evaluated preoperatively and 3 and 12 months postoperatively with the international prostate symptom score (IPSS), the quality of life (QoL) score, post-void residual volume (PVR), PSA and maximum flow rate (Qmax). Preoperative variables in each study arm did not show any significant difference. Compared to HoLEP, ThuLEP showed similar operative time (63.69 vs 71.66 min, p = 0.245), enucleated tissue weight (48.84 vs 51.13 g, p = 0.321), catheterization time (1.9 vs 2.0 days, p = 0.450) and hospital stay (2.2 vs 2.8 days, p = 0.216), but resulted in less haemoglobin decrease (0.45 vs 2.77 g/dL, p = 0.005). HoLEP presented a significantly higher number of patients with postoperative acute urinary retention and stress incontinence. No significant differences were found in PSA, Qmax, PVR, IPSS and QoL score during follow-up. ThuLEP and HoLEP both relieved lower urinary tract symptoms equally, with high efficacy and safety. ThuLEP detemined reduced blood loss and early postoperative complications. Catheterization time, enucleated tissue, hospital stay, operative time and follow-up parameters did not show any significant difference.

Background & Aims: To develop an effective model of predicting fatalOutcome in the severe coronavirus disease 2019 (COVID-19) patients.Methods: Between February 20, 2020 and April 4, 2020, consecutive COVID-19 patients from three designated hospitals were enrolled in this study. Independent high- risk factors associated with death were analyzed using Cox proportional hazard model. A prognostic nomogram was constructed to predict the survival of severe COVID-19 patients.Results: There were 124 severe patients in the training cohort, and there were 71 and 76 severe patients in the two independent validation cohorts, respectively. Multivariate Cox analysis indicated that age ≥ 70 years (HR 1.184, 95% CI 1.061-1.321), Panting(breathing rate ≥ 30/min) (HR 3.300, 95% CI 2.509-6.286), lymphocyte count < 1.0 × 109/L (HR 2.283, 95% CI 1.779-3.267), and IL-6 >10pg/mL (HR 3.029, 95% CI 1.567-7.116) were independent high-risk factors associated with fatal outcome. We developed the nomogram for identifying survival of severe COVID-19 patients in the training cohort (AUC 0.900, [95% CI 0.841-0.960], sensitivity 95.5%, specificity 77.5%); in validation cohort 1 (AUC 0.811, [95% CI 0.763-0.961], sensitivity 77.3%, specificity 73.5); in validation cohort 2 (AUC 0.862, [95% CI 0.698-0.924], sensitivity 92.9%, specificity 64.5%). The calibration curve for probability of death indicated a good consistence between prediction by the nomogram and the actual observation. The prognosis of severe COVID-19 patients with high levels of interleukin-6 (IL-6) receiving tocilizumab was better than that of those patients without tocilizumab both in the training and validation cohorts, but without difference (p = 0.105 for training cohort, p = 0.133 for validation cohort 1, and p = 0.210 for validation cohort 2).Conclusions: This nomogram could help clinicians to identify severe patients who have high risk of death, and to develop more appropriate treatment strategies to reduce the mortality of severe patients. Tocilizumab may improve the prognosis of severe COVID-19 patients with high levels of IL-6.

Introduction: COVID-19 outbreak represented an unprecedented event that led to a redefinition of health care systems worldwide The impact of the emergency required a deviation of the care toward the assistance to COVID-19 patients, with reduction of resources for elective activities, including surgery We aim to report the decrease of urological surgical activity during the first weeks from the beginning of the pandemic, aiming to highlight the prioritization we applied to select patients for surgery Materials and methods: Thirty-three urological units with physicians affiliated to the AGILE group were involved in a survey Urologists were asked to report the amount of surgical elective procedures week- by-week, from the beginning of the emergency to the following month The type of surgery (oncologic, for urolithiasis, for benign prostate obstruction, other) was assessed as well Results: The 33 hospitals involved in the study account, globally, for 22,945 beds and are distributed in 13/20 Italian regions Before the outbreak, the involved urology units performed an overall amount of 1,213 procedures per week, half of which were oncological By the 20 of March, the amount of surgery declined by 78% Lombardy, the first region with positive-cases, experienced a 94% reduction The decrease in oncological and non- oncological surgical activity was 35,9% and 89%, respectively Among non-oncological procedures, stone surgery declined by 35,9% as well, whereas BPH and minor urological procedures completely dropped Reassessing for surgical activity on 20, April, a slight trend toward surgical restoration (+11%) started to appear Conclusions: Italy, the country with the highest fatality rate from COVID-19, had experienced a sudden decline in surgical activity;by the end of April, a current trend toward restoration of surgery started to appear Criteria for prioritization were consistent with an urgent/ emergent principle, with trauma, tumours and septic conditions being the ones prioritized The Italian experience can be helpful for future surgical pre-planning in other countries or pandemic settings Smart Communications (SC1–SC28) Andrology

BACKGROUND: To compare clinical intra and early postoperative outcomes between conventional Holmium laser enucleation of the prostate (HoLEP) and Holmium laser enucleation of the prostate with Virtual Basket tool (VB-HoLEP) to treat benign prostatic hyperplasia (BPH).METHODS: This prospective randomized study enrolled consecutive patients with BPH to HoLEP (n = 100) or VB-HoLEP (n =100). We evaluated all patients preoperatively with particular attention to catheterization time, operative time, blood loss, irrigation volume and hospital stay. We evaluated also the patients at 3, 6 and 12 months after surgery with the use of maximum flow rate (Qmax), postvoid residual urine volume (PVR) and International Prostate Symptom Score (IPSS).RESULTS: We didn’t see significant difference in preoperative parameters between patients in each study arm. Compared with HoLEP, VB-HoLEP resulted in less hemoglobin decrease (2.54 vs 1.12 g/dL, P = .003) and had a more rapid operative time (57.33±29.71 vs 42.99±18.51 minutes, P = 0.04). HoLEP and VB-HoLEP had same catheterization time (2.2 vs 1.9 days, P = 0.45), irrigation volume (33.3 vs 31.7 L, P = 0.69), and hospital stay (2.8 vs 2.7 days, P = 0.21). During the follow-up of subsequent 12 months, we didn’t demonstrate a significant difference in IPSS, Qmax, PVR, and QOLS.CONCLUSION: HoLEP and VB-HoLEP both are efficient a safe procedure for relieving lower urinary tract symptoms. VB-HoLEP was statistically superior to HoLEP in blood loss and to allow a faster procedure. However, procedures did not differ significantly in catheterization time, hospital stay, operation time and irrigation volume. No differences were demonstrated in QOLF, IPSS, Qmax and PVR through the post-surgery 12 months of follow-up.TRIAL REGISTRATION: Current Controlled Trials ISRCTN72879639; date of registration: June 25th, 2015. Retrospectively registred.

INTRODUCTION AND OBJECTIVE:“VaporTunnel” technique is a result in pulse modulation during holmium laser lithotripsy in which the laser emits part of the energy to create an initial bubble, and the ...

Introduction: The vapor tunnel (VT) technology is a result of the pulse modulation during holmium laser emission: it consists of a single specific long pulse, using the minimum peak power ...

INTRODUCTION AND OBJECTIVE:Thulium laser enucleation of the prostate (ThuLEP) has emerged as an alternative to open prostatectomy (OP) and is recommended in EAU Guidelines for Prostate bigger than ...

Objective To evaluate whether 2 similar en bloc thulium laser enucleation of the prostate (ThuLEP) techniques can influence surgical complications and outcomes. Material Within 2 institutional databases 164 men who underwent 2 different en bloc ThuLEP techniques were compared using propensity scores. With the first technique prostatic lobes were all enucleated en bloc, whereas, with the second the median lobe was enucleated first and the lateral lobes were enucleated en bloc thereafter. All patients were evaluated at baseline and 6 months after surgery with PSA, Qmax, and self-administrated IPSS. Operative data and 30-day postoperative complications were gathered. Results Surgical time and 24-hour blood loss were similar between 2 groups (55 vs 55 minutes, P .97288; −0.9 vs −1.3 g/dL, P .112 respectively). Median hospital stay after surgery was 3 days in both groups (P .3251). IPSS and Qmax improved equally in both groups (median 3 vs 3, P .941; 19.17 vs 20.63 mL/s, P .8232 respectively). Early complications were mild to moderate (Clavien I 12.2% vs 12.2%; Clavien II 3.6% vs 4.8 4 %; Clavien IIIb 1.2% vs 2.4%). Conclusion Our results show that en bloc ThuLEP approaches appear feasible, have similar complications and outcomes and can be considered surgeon-independent techniques. En bloc ThuLEP may be proposed even for laser-naive urologists as an alternative to the original 3-lobe technique.

Objective To report a new technique for thulium laser enucleation of the prostate, which we called “en bloc” ThuLEP. Methods A full anatomic description of the technique is provided. We assessed operative variables of a 50-patient series, treated with the new “en bloc” ThuLEP, and compared them with another series of 50 patients (who had the same preoperative parameters) operated with the classical “3-lobe” technique, to assess the feasibility of the new one. All procedures were carried out by the same surgeon. Results In our experience, “en bloc” ThuLEP permits an easier enucleation of the adenoma, reduces operating time, and reduces the amount of energy delivered per adenoma gram compared with the classical technique. Further studies are needed to validate this technical evolution of prostatic enucleation and verify the reduction of postoperative irritative symptoms. Conclusion “En bloc” ThuLEP may represent a valid alternative for prostatic adenoma enucleation, mostly in medium-sized prostates.

Objective To present a reproducible step-by-step approach to en bloc thulium laser enucleation of the prostate (ThuLEP) for benign prostatic hyperplasia surgical treatment. Laser adenoma enucleation is nowadays a recognized surgical treatment for benign prostatic enlargement. Some variants to the classical 3-lobes laser technique have been proposed, in order to overcome the main concerns regarding the original procedure. 1 , 2 , 3 , 4 After a vast experience with the 3-lobes ThuLEP, we developed our own en bloc enucleation technique. Methods The capsular plane is identified only once, at the level of the prostatic apex, at 5 o'clock; this plane is followed ascending towards the bladder neck, separating the left lobe from the prostatic capsule from 5 to 11 o'clock. The right and median lobes are then enucleated following the same plane clockwise and the 2 planes are joined anteriorly at 11 o'clock. Finally, enucleation is completed by incising the remaining mucosal flap from 10 to 2 o'clock. We have already proved the clear advantages provided by this technique compared to the “3-lobes” enucleation. 5 Results Our single-center experience with this technique includes 140 procedures performed up to June 2018. Mean prostatic adenoma volume was 66.7 mL (range 20-220 ± 32.85 standard deviation [SD]). Mean total surgical time was 60.93 minutes (25-133 ± 23.6 SD); mean enucleation time was 18.3 minutes (8.2-36.53 ± 5.62 SD), mean enucleation time normalized per adenoma gram was 0.32 min/g (0.12-0.8 ± 0.15 SD) and mean energy needed for the enucleation normalized per adenoma gram was 1852.13 J/g (689-6129 ± 862.4 SD). Only 1 case of reintervention for clot evacuation (Clavien grade IIIb) was necessary. Conclusion En bloc ThuLEP provides an anatomical approach for endoscopic enucleation of prostatic adenoma. We believe that this sequence optimizes efficiency and efficacy in a reproducible way.

Objective To present a modification to the classical ThuLEP technique, called 7U-ThuLEP and to compare its clinical intra- and post-operative outcomes to those of conventional ThuLEP in the treatment of benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS).

Background: The aim of our study was to compare perioperative and functional outcomes of two different prostatic laser enucleation techniques performed in two high-volume centers: 100 W holmium laser enucleation of the prostate (HoLEP) (Lyon, France) and 110 W thulium laser enucleation of the prostate (ThuLEP) (Varese, Italy). Materials and Methods: A nonrandomized, observational, retrospective and matched-pair analysis was performed on two homogeneous groups of 117 patients that underwent prostate laser enucleation in the HoLEP or ThuLEP centers between January 2015 and April 2017, following the classical ‘three lobes’ enucleation technique. The American Society of Anesthesiologists (ASA) score and prostate volume were the main parameters considered for matching the patients between the two groups. Patients on anticoagulant therapy, with documented detrusor hypoactivity or hyperactivity or with the finding of concurrent prostate cancer were excluded from the study. Follow up was assessed at 3, 6 and 12 months after surgery. Results: Median enucleation and morcellation time was 75.5 and 11.5 min, respectively, in the HoLEP group versus 70.5 and 12 min, respectively, in the ThuLEP group ( p = 0.001 and 0.49, respectively). Enucleated adenoma weight was comparable (44 g versus 45.6 g, p = 0.60). Energy index (3884.63 versus 4137.35 J/g, p = 0.30) and enucleation index (0.57 versus 0.6 g/min, p = 0.81) were similar in the two groups. Catheterization time was comparable (1 versus 1 day; p = 0.14). The International Prostate Symptom Score and Quality of Life score significantly decreased, as well as maximal urinary flow rate. Median prostate-specific antigen (PSA) drop 1 year after surgery was 2.1 ng/ml in the HoLEP group (−52.83%) versus 1.75 ng/ml in the ThuLEP group (−47.85%) ( p = 0.013). Conclusion: Both HoLEP (100 W) and ThuLEP (110 W) relieve lower urinary tract symptoms in a comparable way with high efficacy and safety, with negligible clinical differences.

Objective To provide the first large single-operator case series of patients who undergo “en bloc” thulium laser enucleation of the prostate (ThuLEP) and to demonstrate an improvement in enucleation efficacy with experience. Methods We prospectively evaluated a cohort of patients with symptomatic benign prostatic hyperplasia (BPH) who underwent “en bloc” ThuLEP between May 2015 and November 2017. Association between dependent variables (delivered energy and operating time) and independent variables (adenoma volume and experience) were estimated with regression analysis. The experience was calculated as the time interval between the date of the first operation of the series and the date of the operation being considered. Results A total of 100 patients were registered for the study. Median operative time was 56.5 min (interquartile range [IQR]: 40–85 min). Median enucleation time was 17.4 min (IQR: 15–21.5 min). Median enucleation index (enucleation time per adenoma gram) was 0.3 min/g (0.2–0.3 min/g). The overall operative time is not influenced by experience, but we registered a significant trend towards a reduction in the total amount of energy delivered energy normalized per adenoma gram (p = 0.0148). Conclusion We believe that further attention is needed for these new “en bloc” prostatic enucleation techniques, which can facilitate some surgical steps, leading to a widespread use of laser technology for BPH surgical treatment.