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Abstract Introduction Water Jet Ablation Therapy (WJAT) and Holmium Laser Enucleation of the Prostate (HoLEP) represent two common surgical treatments for Benign Prostatic Hyperplasia (BPH). Despite their increasing use, there is no study between these two methods. We aim to evaluate their efficacy and safety through a network meta‐analysis (NMA), providing critical insights for clinical decision‐making in the management of moderate to severe lower urinary tract symptoms (LUTS) due to BPH. Methods Pubmed, EMBASE and Cochrane Library were searched. Randomized controlled trials and prospective single‐arm studies comparing WJAT and HoLEP with TURP, reporting symptom scores, flow rates and adverse events. Data extraction and quality assessments were independently performed. Bayesian modelling in RStudio was used for statistical analysis, evaluating continuous outcomes through mean difference and categorical variables via risk ratios. Risk‐of‐Bias (RoB) and GRADE assessments were performed. Findings Twenty‐three studies were included (WJAT‐11, HoLEP‐12). Most studies were at some or high risk of bias. At 12 months, the IPSS, Qol, PVR and Qmax improvements were 4.14 points (95% CI: ‐0.34 to 8.64, not‐significant [NS], GRADE‐rating: Low), 0.32‐points (95% CI:‐10.70 to 3.27, NS, GRADE‐rating: Low), 2.45 ml/s (95% CI: ‐1.85 to 7.05, NS, GRADE‐rating: Low), 63.10 ml (95% CI: 39.80 to 87.30, statistically‐significant [SS], GRADE‐rating: Moderate), respectively, all in favour of HoLEP. Haemoglobin‐loss was lower with HoLEP, 1.16 g/dl (95% CI: ‐2.56 to 0.54 mg/dl, NS, GRADE‐rating: Moderate) than WJAT. The risk of incontinence was higher with HoLEP; 4.48 (95% CI: 0.22 to 168.50, NS, GRADE‐rating: Very Low) than WJAT in single–arm analysis. The risk of blood transfusion was higher with WJAT (RR = 0.14; 95% CI: 0.00 to 4.21, NS, GRADE‐rating: Low) than HoLEP. Risk of Total Serious Adverse Events (Clavien‐Dindo grade>3) was higher with HoLEP (RR = 1.12, higher with HoLEP, 95% CI: 0.20 to 12.71, NS, GRADE‐rating: Low) than WJAT. Retreatment was lower with HoLEP (RR = 0.46, 95% CI: 0.02 to 10.54 GRADE‐rating: Low) than WJAT. Interpretation Our study suggests that both HoLEP and WJAT are effective treatments for BPH, both with similar IPSS and QoL improvements. HoLEP excels in functional outcomes, particularly in improving Qmax and PVR. Conversely, WJAT, with its shorter operation time and hospital stays, presents a compelling alternative, particularly for outpatient settings.

Abstract Objectives We aim to compare efficacy and safety of water vapour therapy (Rezūm), transurethral needle ablation (TUNA) and transurethral microwave therapy (TUMT) for treating men with moderate to severe benign prostatic hyperplasia (BPH) symptoms. Materials PubMed/MEDLINE, EMBASE and Cochrane Library were searched from inception to 30 July 2023, followed by reference searching and dual‐independent study selection. We analysed only randomized clinical trials. RoB‐2, NIH‐quality assessment tool and GRADE guidelines were used for quality‐of‐evidence (QoE) assessment. Relevant prospective studies without a critical risk‐of‐bias were included. Results At 12 months, Rezūm showed similar efficacy to TUNA and TUMT for improvement in International Prostate Symptoms Score – Rezūm versus TUMT: 1.33 points (95% CI: −1.66 to 4.35) favouring TUMT (QoE: Moderate) and Rezūm versus TUNA: 0.07 points (95% CI: −3.64 to 3.88) favouring TUNA (QoE: Low). Rezum had similar outcomes to TUNA and TUMT for Maximum Peak‐Flow Rate (Qmax): Rezūm versus TUMT: 1.05 mL/s (95% CI: −4.88 to 2.82) favouring Rezūm (QoE: Low) and Rezūm versus TUNA: 0.37 mL/s (95% CI: −4.61 to 4.21) favouring TUNA (QoE: Low). Furthermore, post‐void residual volume (PVR) comparisons demonstrated that Rezūm was similar, or inferior to other techniques at 12 months – Rezūm versus TUMT: 11.20 mL (95% CI: −32.40 to 10.30) favouring TUMT (QoE: Low) and Rezūm versus TUNA: 24.10 mL (95% CI: 2.81 to 45.10) favouring TUNA (QoE: Low). Rezūm also had a similar surgical retreatment rate with TUMT and TUNA up to 3‐years – TUMT versus Rezūm RR: 1.21 (95% CI: 0.20 to 15.90) (QoE: Low) and TUNA versus Rezūm showed RR: 1.81 (95% CI: 0.2 to 24.60) (QoE: Low). In the first 12 months after treatment, Rezūm had a higher rate of serious adverse events (Clavien‐Dindo ≥ Grade 3) than TUMT and TUNA. TUMT versus Rezūm with RR = 0.53 (95% CI: 0.13 to 3.14) (QoE: Low) and TUNA versus Rezūm with RR = 0.38 (95% CI: 0.04 to 3.49) (QoE: Low). Conclusions Moderate to weak evidence suggests that Rezūm is not superior to TUNA and TUMT in all domains studied.

Objectives: Benign prostatic hyperplasia is one of the most common urological diseases. Among these patients, the presence of detrusor underactivity or acontractility represents a challenging condition since no medical treatment is available. Our objective is to evaluate early term outcomes following transurethral anatomical enucleation of the prostate with Tm:YAG support. Methods: In a retrospective analysis of 115 patients who underwent this procedure between January 2019 and March 2022 due to lower urinary tract symptoms, 8 patients with urodynamic evidence of detrusor underactivity secondary to a non-neurogenic aetiology were identified. Detrusor underactivity was defined as a bladder contractility index of Results: Median age, prostate volume and bladder contractility index were 73.2 years, 78.5 cm3 and 63.9, respectively. Median International Prostate Symptom Score/quality of life, Qmax and post-void residual volume were 15/3.5 points, 4.4 mL/s and 189 mL, respectively. Postoperatively, immediate catheter-removal success rate was 87.5% (7/8), at 2 months all patients were catheter-free and remained so at 1-year follow-up. Significant improvements for quality of life, Qmax and post-void residual volume were detected. Median postoperative International Prostate Symptom Score/Quality of life, Qmax and post-void residual volume were 7/2, 21.6 mL/s and 0 mL, respectively. Conclusions: This surgical approach offers high catheter-free rates, significantly improves functional voiding parameters and increases patient satisfaction in patients with benign prostatic hyperplasia and concomitant detrusor underactivity. Therefore, it can be regarded as an effective approach for such patients.

Abstract Indirect Drive Inertial Confinement Fusion Experiments on the National Ignition Facility (NIF) have achieved a burning plasma state with neutron yields exceeding 170 kJ, roughly 3 times the prior record and a necessary stage for igniting plasmas. The results are achieved despite multiple sources of degradations that lead to high variability in performance. Results shown here, for the first time, include an empirical correction factor for mode-2 asymmetry in the burning plasma regime in addition to previously determined corrections for radiative mix and mode-1. Analysis shows that including these three corrections alone accounts for the measured fusion performance variability in the two highest performing experimental campaigns on the NIF to within error. Here we quantify the performance sensitivity to mode-2 symmetry in the burning plasma regime and apply the results, in the form of an empirical correction to a 1D performance model. Furthermore, we find the sensitivity to mode-2 determined through a series of integrated 2D radiation hydrodynamic simulations to be consistent with the experimentally determined sensitivity only when including alpha-heating.

Abstract Background Although holmium laser enucleation (HoLEP) is considered a size‐independent procedure for treatment of an enlarged prostate, prostate artery embolization (PAE) is emerging as an alternative modality to treat moderate and large benign prostatic hyperplasia. This study aims to compare the early post‐operative and short‐term efficacy of PAE and HoLEP. Methods PubMed, Cochrane Library and EMBASE databases were searched. Network meta‐analysis was performed following PRISMA‐N‐guidelines. Post‐operative parameters analysed include international prostate symptom score (IPSS), quality of life (QOL), post‐void residual urine (PVR), maximal uroflow rate (Qmax) and serious adverse events (SAE). Random effects model calculated weighted mean differences (WMD). If 95%CI crossed the line of no effect (WMD = 0), evidence indicated no statistically significant difference between treatments compared. Results Qualitative and quantitative syntheses included 20 and 18 studies with 1991 and 1606 patients, respectively. At 3 months, there was no statistically significant difference between PAE and HoLEP in IPSS score improvement [WMD: −2.21: 95%CI: (−10.20, 5.78), favouring PAE], QoL score improvement [WMD: −0.22:95%CI: (−1.75, 1.32), favouring PAE] and PVR improvement [WMD: 26.97: 95%CI: (−59.53, 113.48), favouring HoLEP]. However, PAE was found inferior to HoLEP for Qmax improvement [WMD: 8.47, 95%CI: (2.89, 14.05), favouring HoLEP]. At 1‐year follow‐up, there was no statistically significant was found between PAE and HoLEP for IPSS score improvement [WMD:6.03, 95%CI: (−1.30, 13.35)], QoL score improvement [WMD: 0.03, 95%CI: (−1.19, 1.25)], PVR improvement [WMD:4.11, 95%CI: (−32.31, 40.53)] and Qmax improvement [WMD:2.60, 95%CI: (−2.20, 7.41)] with all differences favouring HoLEP. PAE was superior to HoLEP for SAE [PAE vs. HoLEP‐OR: 0.68, 95%CI: (0.25, 1.37)]. Conclusion HoLEP was superior to PAE at 3 months for Qmax improvement. There was no significant difference in IPSS, QoL, PVR and Qmax improvement at 1 year between PAE and HoLEP. PAE was also associated with lesser SAE compared to HoLEP. Studies on the long‐term outcome of PAE are needed to establish the durability of early outcomes after PAE.

We are delighted that this important topic is attracting the attention of the urological community in the global scope and would like to express thanks for the positive comment [...]

Background Little is known about olfactory changes in pediatric COVID-19. It is possible that children under-report chemosensory changes on questionnaires, similar to reports in adults. Here, we aim to describe COVID-19-related olfactory dysfunction in outpatient children. We hypothesized that children with COVID-19 will demonstrate abnormal olfaction on smell-identification testing at a higher rate than children with negative COVID-19 testing. Methods A prospective cross-sectional study was undertaken from June 2020—June 2021 at a tertiary care pediatric hospital. A consecutive sample of 205 outpatients aged 5–21 years undergoing severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) PCR testing were approached for this study. Patients with prior olfactory dysfunction were excluded. Participants were given a standard COVID-19 symptom questionnaire, a Smell Identification Test (SIT) and home-odorant-based testing within 2 weeks of COVID-19 testing. Prior to study enrollment, power calculation estimated 42 patients to determine difference in rates of SIT results between groups. Data were summarized with descriptive statistics. Results Fifty-one patients underwent smell identification testing (23 positive (45%) and 28 negative (55%) for COVID-19; mean age 12.7 years; 60% female). 92% of all patients denied subjective change in their sense of smell or taste but only 58.8% were normosmic on testing. There was no difference in screening questionnaires or SIT scores between COVID-19 positive and negative groups. Conclusions Unlike adults, there was no statistical difference in olfactory function between outpatient COVID-19 positive and negative children. Our findings suggest a discrepancy between objective and patient-reported olfactory function in pediatric patients, and poor performance of current screening protocols at detecting pediatric COVID-19.

Aims: To use a computer simulation model to predict the response time and survival impact of a sample of novel cardiac arrest response systems, such as those that use cellphone apps to dispatch citizen mobile responders and those that use drones to deliver an AED to the cardiac arrest location. Methods: We developed a model which applies a Monte Carlo approach to simulate the response time and predicted survival for cardiac arrest events within a specific region. We used the model to compare the performance of 4 different novel response systems, along with simulated EMS performance, in Bellevue, Washington. We estimated the 10 year cost for each system, which was utilized together with the system performance predictions in a cost-benefit analysis. Results: The best performing systems in the simulation were a mobile responder system capable of providing both CPR and defibrillation, similar to the PulsePoint verified responder program, as well as a drone AED delivery system with bystander application. Both systems showed an incremental improvement in survival of 10% over the simulated EMS survival. The systems that provided the best cost-benefit ratio were the mobile responder system providing only CPR (PulsePoint Respond) and drone systems with bystander application. Conclusions: Our simulation results suggest that these novel response systems have the potential to substantially improve survival at an efficient cost.

Objective:. To propose a standardized methodology for estimating the embodied carbon footprint (CF) of disposable minimally-invasive surgical devices (MISDs) and their application in new benign prostatic hyperplasia (BPH) MISDs. Summary of Background Data:. The estimation of the CO2e emissions of disposable surgical devices is central to empowering the healthcare supply chain. Methods:. The proposed methodology relied on a partial product lifecycle assessment and was restricted to a specific part of scope 3, which comprised the manufacturing of surgical device- and non–device-associated products (NDAPs), including packaging and user manual. The process-sum inventory method was used, which involves collecting data on all the component processes underpinning disposable MISDs. The seven latest disposable MISDs used worldwide for transurethral prostatic surgery were dismantled, and each piece was categorized, sorted into the appropriate raw material group, and weighed. The CF was estimated according to the following formula: activity data (weight of raw material) × emission factors of the corresponding raw material (kg CO2e/kg). Results:. The total weights of disposable packaging and user manuals ranged from 0.062 to 1.013 kg. Plastic was the most common and least emissive raw material (2.38 kg CO2e/kg) identified. The estimated embodied CF of MISDs ranged from 0.07 to 3.3 kg CO2e, of which 9% to 86% was attributed to NDAPs. Conclusions:. This study described a simple and independent calculation method for estimating the embodied CF of MISDs. Using this method, our results showed a wide discrepancy in the estimated CO2 emissions of the most recent disposable MISDs for transurethral BPH surgery. Thus, the lack of CF information should be of major concern in the development of future MISDs.