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Context: Contrast-enhanced ultrasound (CEUS) is a cost-effective radiation-free diagnostic method that can be used for renal tumor postoperative visualization after ablative treatment. Objective: To assess CEUS diagnostic accuracy comparing with CT and MRI as a follow-up method in short-term and long-term postoperative periods after renal tumor ablation. Materials and methods: A systematic review and meta-analysis were performed in Scopus and Medline databases using the query "(kidney OR rena* OR RCC) AND (ablation OR RFA OR MWA OR cryo*) AND CEUS". The endpoint of the study was the evaluation of the overall accuracy of CEUS. Results: Twelve trials were included in the review. With CT or MRI as a reference, for a short-term group (< 6 weeks after ablation) pooled sensitivity was 90.2%, I2 = 0%; pooled specificity was 99.3%, I2 = 0%; pooled NPV was 98.6%, I2 = 0%; pooled PPV was 94.6%, I2 = 0%; the AUC on the SROC curve was 0.971. For the long-term group (> 6 weeks after ablation), pooled sensitivity was 95.3%, I2 = 0%; pooled specificity was 97.6%, I2 = 0%; PPV was 74.2%, I2 = 4%; NPV was 99.4%, I2 = 5%; AUC = 0.93. Conclusion: CEUS has high sensitivity and specificity in ruling out the presence of local recurrence after renal tumor ablation with a higher risk of false-positive results within follow-up > 6 weeks compared with that for CT or MRI. Further studies with a unified protocol and morphological control of local renal tumor recurrence after ablation are needed. [ABSTRACT FROM AUTHOR] more...

Introduction: The aim of this study is to compare outcomes of SRP (salvage radical prostatectomy) with SCAP (salvage cryoablation of the prostate) in local radio-recurrent PCa (prostate cancer) patients. Materials and methods: A retrospective analysis of a multicentric European Society of Uro-technology (ESUT) database was performed. Data on patients with local recurrent PCa after radiotherapy who underwent salvage treatment were collected. Patients and their respective disease characteristics, perioperative complications as well as oncological outcomes were then described. The treatment success rate was defined as PSA nadir < 0,4 ng/ml. Any complications were graded according to the modified Clavien system. A descriptive and comparative analysis was performed using SPSS software. Results: 25 patients underwent SRP and 71 patients received SCAP. The mean follow-up was 24 months. The median PSA level before initial treatment was 8.3 (range 7-127) ng/ml. The success rates of SRP and SCAP were largely comparable (88% (22 patients) vs. 67.7% (48 patients), respectively, p = 0.216). The mean serum PSA levels at 12 months after salvage treatment were 1.2 ± 0.2 ng/mL vs. 0.25 ± 0.5 ng/mL, p > 0.05). During the follow-up period, only 3 (12%) patients in the SRP group had PSA recurrence compared with 21 patients (29.6%) in the SCAP group. The 5-year BRFS was similar (51,6% and 48,2%, p = 0,08) for SRP and SCAP respectively. The 5-year overall survival rate was 91.7%, and 89,7% (p = 0.669) and the 5-year cancer-specific survival was 91.7%, and 97,1% (p = 0.077), after SRP and SCAP respectively. No difference was found regarding the complications. Conclusions: Both SRP and SCAP should be considered as valid treatment options for patients with local recurrence of PCa after radiotherapy. SCAP has a potentially lower risk of morbidity and acceptable intermediate-term oncological efficacy, but a longer follow up and a higher number of patients is ideally needed to draw any long-term conclusions regarding the oncological data. [ABSTRACT FROM AUTHOR] more...

Introduction: Kidney perfusion on CT is an encouraging surrogate for renal scintigraphy in assessing renal function. However, data on dynamic volumetric CT in patients with kidney obstruction is lacking. Thus, the aim of this study is to determine the feasibility of CT-based renal perfusion using a dynamic volume to assess renal hemodynamics at different degrees and durations of obstruction. Materials and methods: We included patients with unilateral kidney obstruction in our single-center, prospective study. The patients were divided into three groups. Patients without dilatation of the pelvicalyceal system (PCS) and normal parenchyma thickness were included into Group 1; patients with PCS dilatation and parenchyma thickness 1.8–2.4 cm—into Group 2; and patients with ureteropyelocalicoectasia and parenchyma thickness less than 1.8 cm—into Group 3. Results: Total of 56 patients were enrolled. In Group 1 mean values of cortical and medullar arterial blood flow, blood volume, and extraction fraction were within the normal range. Changes in contralateral kidney were not determined. Patients from Group 2 showed significant differences in blood flow parameters in the cortical and medulla of the obstructed kidney. No changes in perfusion values in the contralateral kidney was observed. In patients from Group 3 there was a marked decrease in perfusion on the side of obstruction compared to Group 2, indicating that the degree of expansion of the PCS directly correlates with the change in blood flow. However, in the contralateral kidney, these indicators exceeded the normal values of perfusion. Conclusion: CT perfusion allows to objectively assess changes in blood flow in the setting of renal obstruction. The degree of obstruction directly affects the measured rate of blood flow. [ABSTRACT FROM AUTHOR] more...

We aim to evaluate the incidence of incontinence following laser endoscopic enucleation of the prostate (EEP) comparing en-bloc (Group 1) versus 2-lobe/3-lobe techniques (Group 2). We performed a retrospective review of patients undergoing EEP for benign prostatic enlargement in 12 centers between January 2020 and January 2022. Data were presented as median and interquartile range (IQR). Univariable and multivariable logistic regression analysis was performed to evaluate factors associated with stress urinary incontinence (SUI) and mixed urinary incontinence (MUI). There were 1711 patients in Group 1 and 3357 patients in Group 2. Patients in Group 2 were significantly younger (68 [62-73] years vs 69 [63-74] years, P = 0.002). Median (interquartile range) prostate volume (PV) was similar between the groups (70 [52-92] ml in Group 1 vs 70 [54-90] ml in Group 2, P = 0.774). There was no difference in preoperative International Prostate Symptom Score, quality of life, or maximum flow rate. Enucleation, morcellation, and total surgical time were significantly shorter in Group 1. Within 1 month, overall incontinence rate was 6.3% in Group 1 versus 5.3% in Group 2 (P = 0.12), and urge incontinence was significantly higher in Group 1 (55.1% vs 37.3% in Group 2, P < 0.001). After 3 months, the overall rate of incontinence was 1.7% in Group 1 versus 2.3% in Group 2 (P = 0.06), and SUI was significantly higher in Group 2 (55.6% vs 24.1% in Group 1, P = 0.002). At multivariable analysis, PV and IPSS were factors significantly associated with higher odds of transient SUI/MUI. PV, surgical time, and no early apical release technique were factors associated with higher odds of persistent SUI/MUI. [ABSTRACT FROM AUTHOR] more...

Introduction: The aims of the study: (1) to compare the Super Pulse Thulium Fiber Laser (SP TFL) and the holmium: yttrium–aluminium-garnet (Ho:YAG) lasers in retrograde intrarenal surgery (RIRS); (2) to compare the efficacy of SP TFL laser fibers of different diameters (150 μm and 200 μm). Methods: A prospective randomized single-blinded trial was conducted. Patients with stones from 10 to 20 mm were randomly assigned RIRS in three groups: (1) SP TFL (NTO IRE-Polus, Russia) with fiber diameter of 150 μm; (2) SP TFL with 200-μm fiber; and (3) Ho:YAG (Lumenis, USA) with 200-μm fiber. Results: Ninety-six patients with kidney stones were randomized to undergo RIRS with SP TFL using a 150-μm fiber (34 patients) and a 200-μm fiber (32 patients) and RIRS with Ho:YAG (30 patients). The median laser on time (LOT) in the 200-μm SP TFL group was 9.2 (6.2–14.6) min, in 150-μm SP TFL—11.4 (7.7–14.9) min (p = 0.390), in Ho:YAG—14.1 (10.8–18.1) min (p = 0.021). The total energy consumed in 200-μm SP TFL was 8.4 (5.8–15.2) kJ; 150-μm SP TFL − 10.8 (7.3–13.5) kJ (p = 0.626) and in Ho:YAG—15.2 (11.1–25.3) kJ (p = 0.005). Conclusions: Irrespective of the density, RIRS with SP TFL laser has proven to be both a safe and effective procedure. Whilst the introduction of smaller fibers may have the potential to reduce the duration of surgery, SP TFL results in a reduction in the LOT and total energy for stone ablation in RIRS compared with Ho:YAG. [ABSTRACT FROM AUTHOR] more...

Objective: To compare long-term reoperation rate and functional outcomes between EEP (endoscopic enucleation of the prostate) and TURP (transurethral resection of the prostate). Evidence acquisition: A systematic literature review of Medline, Scopus, and Web of Science was conducted with primary outcome assessed being reoperation rate and secondary outcomes after a long term (> 3 years) being functional outcomes or related values (prostate volume, PSA level, etc.). Evidence synthesis: Five studies were found with long-term follow-up 4–7 years. EEP reoperation rate ranged from 0 to 1.27%, while from 1.7 to 17.6% for TURP. Meta-analysis showed significantly lower OR for EEP, 0.27 (95% CI 0.24–0.31), with notable homogeneity of the results, I2 = 0%. Long-term Qmax and IPSS were significantly better for EEP. Qmax pooled mean difference was 1.79 (95% CI 1.72–1.86) ml/s with a high concordance among the studies, I2 = 0%. IPSS mean difference −1.24 (95% CI − 1.28 to − 1.2) points, I2 = 57% but QoL did not differ, with mean difference being 0.01 (95% CI − 0.02 to 0.04), I2 = 0%. IIEF-5 score was also significantly better for EEP, mean difference 1.08 (95% CI 1.03–1.13), but heterogeneity was high, I2 = 70%. PSA level and prostate volume were only reported in one study and favored EEP slightly yet statistically significant. Conclusion: EEP had a significantly lower reoperation rate and better functional outcomes (Qmax and IPSS) at long term compared with TURP. It may also be beneficial in terms of IIEF-5, PVR, and PSA level. [ABSTRACT FROM AUTHOR] more...

This study aims to evaluate the abdominal aortic atherosclerotic plaque index (API)'s predictive role in patients with pre-operatively or post-operatively developed chronic kidney disease (CKD) treated with robot-assisted partial nephrectomy (RAPN) for renal cell carcinoma (RCC). One hundred and eighty-three patients (134 with no pre- and post-operative CKD (no CKD) and 49 with persistent or post-operative CKD development (post-op CKD)) who underwent RAPN between January 2019 and January 2022 were deemed eligible for the analysis. The API was calculated using dedicated software by assessing the ratio between the CT scan atherosclerotic plaque volume and the abdominal aortic volume. The ROC regression model demonstrated the influence of API on CKD development, with an increasing effect according to its value (coefficient 0.13; 95% CI 0.04–0.23; p = 0.006). The Model 1 multivariable analysis of the predictors of post-op CKD found that the following are independently associated with post-op CKD: Charlson Comorbidity Index (OR 1.31; p = 0.01), last follow-up (FU) Δ%eGFR (OR 0.95; p < 0.01), and API ≥ 10 (OR 25.4; p = 0.01). Model 2 showed API ≥ 10 as the only factor associated with CKD development (OR 25.2; p = 0.04). The median follow-up was 22 months. Our results demonstrate API to be a strong predictor of post-operative CKD, allowing the surgeon to tailor the best treatment for each patient, especially in those who might be at higher risk of CKD. [ABSTRACT FROM AUTHOR] more...

Purpose: To compare Holmium laser with MOSES technology (MoLEP) and Thulium fiber laser enucleation of the prostate (ThuFLEP) in terms of surgical and functional outcomes. Methods: We performed a retrospective analysis of all patients who underwent either procedure in five centers (January 2020–January 2022). Exclusion criteria: previous urethral/prostatic surgery, radiotherapy, concomitant surgery. Propensity score matching (PSM) analysis was performed to adjust for the bias inherent to the different characteristics at baseline. Differences between procedures were estimated using Firth Penalized Likelihood regression for International prostate symptom score (IPSS), quality of life (QL), maximum flow rate (Qmax). Results: PSM retrieved 118 patients in each group. Baseline characteristics were similar except for PSA and number of men on indwelling catheter (higher in MoLEP group). Median surgical time was significantly longer in the MoLEP group despite the enucleation and morcellation times being similar. Median catheter dwelling time and postoperative length of stay were similar. Most of the early complications were Clavien ≤ 2 grade. There were only two Clavien grade 3 complications (one for each group), one grade 4 in MoLEP group. Rate and type of early and persistent incontinence (> 3 months) were similar. At 12-month, proportion of patients reaching a decrease (Δ) of IPSS ≥ 18 from baseline was significantly larger in MoLEP group, with no significant difference in ΔQmax > 12 ml/sec and ΔQL ≥ -3. Conclusion: MoLEP and ThuFLEP were safe and efficacious procedures with similar short-term operative and functional outcomes. At 1-year, MoLEP patients had a sustained reduction of IPPS score. [ABSTRACT FROM AUTHOR] more...

The prevalence of renal cell carcinoma (RCC) is increasing due to advanced imaging techniques. Surgical resection is the standard treatment, involving complex radical and partial nephrectomy procedures that demand extensive training and planning. Furthermore, artificial intelligence (AI) can potentially aid the training process in the field of kidney cancer. This review explores how artificial intelligence (AI) can create a framework for kidney cancer surgery to address training difficulties. Following PRISMA 2020 criteria, an exhaustive search of PubMed and SCOPUS databases was conducted without any filters or restrictions. Inclusion criteria encompassed original English articles focusing on AI's role in kidney cancer surgical training. On the other hand, all non-original articles and articles published in any language other than English were excluded. Two independent reviewers assessed the articles, with a third party settling any disagreement. Study specifics, AI tools, methodologies, endpoints, and outcomes were extracted by the same authors. The Oxford Center for Evidence-Based Medicine's evidence levels were employed to assess the studies. Out of 468 identified records, 14 eligible studies were selected. Potential AI applications in kidney cancer surgical training include analyzing surgical workflow, annotating instruments, identifying tissues, and 3D reconstruction. AI is capable of appraising surgical skills, including the identification of procedural steps and instrument tracking. While AI and augmented reality (AR) enhance training, challenges persist in real-time tracking and registration. The utilization of AI-driven 3D reconstruction proves beneficial for intraoperative guidance and preoperative preparation. Artificial intelligence (AI) shows potential for advancing surgical training by providing unbiased evaluations, personalized feedback, and enhanced learning processes. Yet challenges such as consistent metric measurement, ethical concerns, and data privacy must be addressed. The integration of AI into kidney cancer surgical training offers solutions to training difficulties and a boost to surgical education. However, to fully harness its potential, additional studies are imperative. [ABSTRACT FROM AUTHOR] more...

New imaging technologies play a pivotal role in the current management of patients with prostate cancer. Robotic assisted radical prostatectomy (RARP) is a standard of care for localized disease and through the already imaging-based console subject of research towards combinations of imaging technologies and RARP as well as their impact on surgical outcomes. Therefore, we aimed to provide a comprehensive analysis of the currently available literature for new imaging technologies for RARP. On 24 January 2023, we performed a systematic review of the current literature on Pubmed, Scopus and Web of Science according to the PRISMA guidelines and Oxford levels of evidence. A total of 46 studies were identified of which 19 studies focus on imaging of the primary tumor, 12 studies on the intraoperative tumor detection of lymph nodes and 15 studies on the training of surgeons. While the feasibility of combined approaches using new imaging technologies including MRI, PSMA-PET CT or intraoperatively applied radioactive and fluorescent dyes has been demonstrated, the prospective confirmation of improvements in surgical outcomes is currently ongoing. [ABSTRACT FROM AUTHOR] more...

Purpose: The aim of this research was to compare the clinically significant prostate cancer (csPCa) detection rate (International Society of Urological Pathology [ISUP] ≥2) for the four biopsy methods: transrectal ultrasound-guided biopsy (TRUS-GB), cognitive transrectal biopsy (COG-TB), fusion transperineal biopsy (FUS-TB), and transperineal template mapping biopsy (TPMB). Materials and Methods: The inclusion criteria were as follows: prostate-specific antigen (PSA) >2 ng/mL, and/or positive digital rectal examination (DRE), and/or suspicious lesion on transrectal ultrasound (TRUS) and Prostate Imaging Reporting and Data System (Pi-RADS) v2.1 ≥ 3 score. In total, 102 patients were enrolled in the study. Biopsies were performed by two urologists. In a single procedure, the first urologist performed a FUS-TB and TPMB followed by second urologist who performed TRUS-GB and COG-TB. All specimens were obtained within a single procedure. Results: The csPCa detection rate and overall cancer detection rate (CDR) per patient were comparable among the respective biopsy methods (p > 0.05). Compared with other biopsy methods, a lower clinically insignificant prostate cancer (cisPCa) was detected using COG-TB (p = 0.004). The positive cores percentage ratio (p < 0.001) as well as positive cores containing csPCa percentage ratio (p < 0.001) significantly increased for the targeted biopsy methods. The median maximum cancer core length (MCCL; p = 0.52) as well the median for the MCCL of csPCa (p = 0.47) did not differ significantly among the respective biopsy methods. Concordance of the Gleason scores between biopsy and postprostatectomy pathology did not differ significantly among biopsy methods (p = 0.87). For TRUS-GB, FUS-TB, and TPMB, the common predictive factors for csPCa were positive DRE, suspicious lesion on ultrasound and Pi-RADS 5. As for COG-TB, the only predictor was Pi-RADS 5. Conclusion: The targeted methods did not show an increase in detection of csPCa and overall CDR over systematic ones in patients with Pi-RADS ≥3. A lower cisPCa was detected using COG-TB in comparison with the other methods. The sampling efficiency increased for the targeted biopsy methods, which used only a proportion of positive cores and cores containing csPCa. There was no statistical difference in histology concordance among the biopsies. One common predictive factor of increased csPCa detection for all biopsy methods was Pi-RADS 5. [ABSTRACT FROM AUTHOR] more...

The COVID-19 pandemic has impacted urology residents and their training. However, several new technologies or knowledge platforms as social media (SoMe) and web-based learning solutions have filled this gap. Therefore, we aimed to analyze resident's learning curves of new learning modalities, identify the evidence that is provided in the literature, and evaluate the possible impact of such solutions in the future. We conducted a non-systematic literature search using Medline, PubMed, and Embase. In addition, online resources of national and international urology resident societies were queried. The identified paper described SoMe, webinars, podcasts, pre-recorded surgical videos, educational platforms, and mobile apps in the field of urology that are used to gain access to information, teach and provide feedback to residents, and were used under the conditions of the pandemic. The application of those technologies harbors the risk of mis- and disinformation, but have the potential to provide access to education and validated knowledge, training, and feedback and thereby might democratize training of residents in urology globally. [ABSTRACT FROM AUTHOR] more...

Introduction In contemporary times, the online learning process has become indispensable for healthcare education. In this direction, the European School of Urology (ESU) has taken the challenge to implement new technologies to bring down knowledge barriers. Web-based seminars (webinars) are one of the tools that help us move towards such inclusivity, and in front-facing COVID-19 pandemic, when face-to-face meetings were forbidden. Material and methods Data from ESU webinars was collected from 2016 to 2022. We described the trends through years of: a) number of webinars per year; b) number of oncological versus non-oncological webinars per year; c) number of registrations per year; d) attendance rate; e) YouTube visualisations. We also analysed audience demographics and COVID-19 impact. Results We found a 60% increase in webinars launched per year with a trend towards more non-oncological webinars. A 94% rise in the number of registrations and an 85% increase in the attendance ratio from 2016 to 2022 was observed. The mean YouTube visualisations per webinar decreased over 200%. Among registrations, we had a 3:1 male: female ratio, 53% were older than 40, and a 51% were of European precedence. COVID-19 positively impacted webinars with a remarkable increase on the amount of webinars launched, number of registrations and attendance ratio. Conclusions Webinars are a powerful tool to spread healthcare knowledge, bridging the gap in medical educational access. COVID-19 was a determinant that reinforced its implantation, but our data show that this new learning tool had a positive uptake, and has come to stay. [ABSTRACT FROM AUTHOR] more...

Simple Summary: Kidney-sparing surgery (KSS) and particularly endoscopic, has gained attractivity for the treatment of localized upper tract urothelial carcinoma (UTUC). Endoscopy results in satisfactory oncological disease control while lowering morbidity and minimizing complications in appropriately selected patients. However, up to now, there is still no solid data as to which laser energy source is superior to the others. The goal of this review is to outline the results of endoscopic UTUC treatment using different lasers and to analyze how these laser-tissue interactions may affect the surgery. Herein, we report that data remains insufficient to support the superiority of one laser type over another in the endoscopic management of UTUC. The ever-growing number of indications for minimally invasive treatment and the increasing number of centers using laser surgery will, hopefully, lead to novel randomized controlled trials comparing the performance characteristics of the lasers as well as the effects on UTUC in patients. Upper tract urothelial carcinoma (UTUC) is a relatively rare disease with an aggressive phenotype compared to urothelial carcinoma in the bladder. In recent years, kidney-sparing surgery (KSS) and, in particular, endoscopic surgery have become the procedure of choice among urologists where the treatment of localized UTUC is concerned. Endoscopy tends to result in satisfactory oncological disease control while lowering morbidity and minimizing complications amongst the appropriately selected cohort of patients. While endoscopic surgery for UTUC might appear to be standardized, it, in fact, differs considerably depending on the source of energy used for resection/ablation. There has been little reliable data up to now on which laser energy source is the most superior. The goal of this review is, therefore, to outline the results of endoscopic UTUC treatment using different lasers and to analyze how these laser-tissue interactions may affect the surgery. We start by pointing out that the data remains insufficient when trying to determine which laser is the most effective in the endoscopic management of UTUC. The ever-growing number of indications for minimally invasive treatment and the increasing number of centers using laser surgery will, hopefully, lead to novel randomized controlled trials that compare the performance characteristics of the lasers as well as the effects of UTUC on patients. [ABSTRACT FROM AUTHOR] more...

Simple Summary: Robotic devices are being actively introduced into the urology field. We aimed to assess the diagnostic performance and safety of robot-assisted targeted (RA-TB) and systematic prostate biopsies (RA-SB). RA-TB and RA-SB are both technically feasible and have comparable csPCa and overall detection rates [OR = 1.02 (95% CI 0.83; 1.26), p = 0.05, I2 = 62% and OR = 0.95 (95% CI 0.78; 1.17), p = 0.17, I2 = 40%, respectively]. A robot-assisted biopsy can potentially be performed under local anesthesia or sedation. Furthermore, a robot-assisted biopsy is a safe and feasible option with a low risk of complications. Introduction: Robot-assisted devices have been recently developed for use in prostate biopsy. However, it is possible advantages over standard biopsy remain unclear. We aimed to assess the diagnostic performance and safety of robot-assisted targeted (RA-TB) and systematic prostate biopsies (RA-SB). Methods: A systematic literature search was performed in MEDLINE and Scopus databases. The detailed search strategy is available at Prospero (CRD42021269290). The primary outcome was the clinically significant prostate cancer (PCa) detection rate. The secondary outcomes included the overall detection rate of PCa, cancer detection rate per core, and complications. Results: The clinically significant cancer detection rate, overall cancer detection rate, and "per patient" did not significantly differ between RA-TB and RA-SB [OR = 1.02 (95% CI 0.83; 1.26), p = 0.05, I2 = 62% and OR = 0.95 (95% CI 0.78; 1.17), p = 0.17, I2 = 40%, respectively]. There were no differences in the clinically insignificant cancer detection rate "per patient" between RA-TB and RA-SB [OR = 0.81 (95% CI 0.54; 1.21), p = 0.31, I2 = 0%]. RA-TB had a significantly higher cancer detection rate "per core" [OR = 3.01 (95% CI 2.77; 3.27), p < 0.0001, I2 = 96%]. Conclusion: RA-TB and RA-SB are both technically feasible and have comparable clinical significance and overall PCa detection rates. [ABSTRACT FROM AUTHOR] more...

Background: The COVID‐19 pandemic has led the international community to conduct extensive research into potential negative effects of the disease on multiple organs and systems in the human body. One of the most discussed areas is potential of the virus to compromise the testicular function. However, the lack of prospective studies on this topic makes it impossible to draw reliable conclusions on whether the disease affects the male reproductive system and, if so, to what extent. Objectives: The current trial is aimed at investigating the effect of SARS‐CoV‐2 on the testicular function, hormone levels and determining the extent of impact on spermatogenesis and damage to testicular tissue. Materials and methods: This prospective study included healthy controls and cases of patients suffering from viral pneumonia based on chest computed tomography (CT) and a positive SARS‐CoV‐2 throat swab exhibited moderate symptoms (World Health Organization (WHO) classification). Epidemiological, clinical, laboratory and ultrasound data were collected. A semen analysis was performed in cases during their hospital stay and 3 months after the discharge home. We also assessed the testicles obtained during autopsies of patients who died of COVID‐19 (n = 20). Results: A total of 88 participants were included (44 controls and 44 cases). Blood testosterone levels were significantly decreased in 27.3% of the cases (12/44). The mean level (7.3±2.7 nmol/L) was lower than that in the healthy controls (13.5±5.2 nmol/L, p < 0.001). An increase in luteinizing hormone (LH) and follicle‐stimulating hormone (FSH) was also detected compared to the healthy controls (p = 0.04 and p = 0.002). The semen analysis revealed decreased motility in COVID‐19 patients (p = 0.001), and a higher number of immobile sperm (during COVID‐19: 58.8% and at 3 months 47.4%, p = 0.005). All parameters returned to normal at 3 months after discharge. Direct mixed agglutination reaction (MAR) test at 3 months showed an increase of Ig A (p = 0.03). In the majority of autopsies (18/20), structural disorders of the testicular tissue, with signs of damage to germ cells were observed. Discussion and conclusion: COVID‐19 and its management strategies significantly affect male hormone levels and sperm quality at the onset of the disease. Postmortem examination of testicular tissue confirmed inflammation and viral infiltration of the testicles. However, in patients with moderate to severe disease, the studied parameters of the testicular function returned to normal values within 3 months. [ABSTRACT FROM AUTHOR] more...

Objective: The objective of our study was to estimate the long-term efficacy and safety of thulium fiber laser enucleation of the prostate (ThuFLEP). Materials and Methods: We analyzed patients who underwent ThuFLEP due to lower urinary tract symptoms (LUTS) related to benign prostatic obstruction (BPO). Both the pre- and perioperative data as well as the follow-up data for 3 years were evaluated: prostate volume, postvoid residual (PVR), maximum flow rate (Qmax), International Prostate Symptom Score (IPSS), quality of life (QoL), prostate-specific antigen level, and the complication rate. Intraoperative data relating to the weight of resected tissue, the duration of surgery, catheterization, and data on hospital stays were also collected. A subgroup analysis was performed to assess whether older patients (>65 years) or those with larger glands (>80 cc) are prone to increased complication risks. Results: A total of 1328 patients were included in the analysis. The mean age was 66.9 ± 7.5 years. Mean prostate volume was 86.9 ± 41.9 (20–330) cc. All the functional parameters (IPSS, QoL, PVR, Qmax) significantly improved after surgery (p < 0.05) and showed durable improvement up to 3 years of follow-up. The frequency of late complications was as follows: stress urinary incontinence—1.2%; urethral stricture—1.1%; and bladder neck contracture—0.9%. Subgroup analyses revealed increased urinary tract infection frequency in older patients (3.5% vs 0.8%, p = 0.003) as well as higher rate of stress urinary incontinence (0.4% vs 1.8%, p = 0.002) and higher rate of clot retention (11.3% vs 4.4%, p < 0.001) in those with larger glands. Conclusions: Irrespective of the patient's age and prostate volume, ThuFLEP represents an effective and durable technique of endoscopic enucleation characterized by a low incidence of complications after 3 years of follow-up. In the hands of an experienced surgeon, ThuFLEP can rightly be a promising alternative to holmium laser enucleation of the prostate for treatment of LUTS associated with BPO. [ABSTRACT FROM AUTHOR] more...

Purpose: To compare the short-term postoperative functional outcomes and severity of irritative symptoms following holmium and thulium fiber laser enucleation (HoLEP and ThuFLEP). Methods: This prospective randomized single-blinded study was performed in accordance with CONSORT. The inclusion criteria were IPSS > 20 or Qmax < 10 ml/s. Patients were randomized between HoLEP and ThuFLEP. Demographics, objective data (PSA, prostate volume, etc.), data on urinary and sexual function (IPSS, IIEF, QoL, QUID, Qmax, ICIQ-MLUTS) were collected. Detailed perioperative information and postoperative data on functional outcomes at 1, 2, 3, 4, 6, 8, 10, 12 weeks and 6 months were collected. Results: Data on 163 participants were included (77—HoLEP, 86—ThuFLEP). No differences were found in surgery duration; number of postoperative complications (Clavien–Dindo I-III), catheterization time and hospital stay. Functional outcomes up to 6 months didn't differ between the groups (IPPS, IIEF, QoL, QUID, ICIQ-MLUTS, Qmax, p > 0.05). Total ICIQ‐MLUTS, bother and voiding scores at 1 and 3 months significantly increased compared with the baseline in both groups (p < 0.05). No difference between the groups were observed. In HoLEP the SUI series rate was 1.3% and 1.3% after 3 and 6 months following the procedure; in ThuFLEP: it was 3.5% and 2.3% respectively (p = 0.35 and p = 0.54). Conclusion: The preliminary results of the study showed no apparent differences in functional outcomes (IPSS, Qmax), rate of SUI or irritative symptoms. Both ThuFLEP and HoLEP are efficient ways of treating benign prostatic obstruction. Both surgeries are comparable in terms of duration and postoperative complication rates. [ABSTRACT FROM AUTHOR] more...

Simple Summary: Prostate cancer (PCa) is notoriously difficult to diagnose owing to the lack of reliable biomarkers and the invasiveness of obtaining a tissue biopsy from the prostate. As an alternative, we developed a liquid biopsy technique, based on isolating tumor cells from semen samples via a microfluidic device. To optimize the device, we first attempted to recover PCa cells from semen samples spiked with PCa cell lines, achieving an average efficiency of >87% cell recovery at the chosen flow rate. We then transitioned to a clinical setting using semen samples from PCa patients. The yield of isolated clinical PCa cells varied between 67 and 307 cells per mL of semen (in 15 cancer patients). These cells were stained and compared to the standard prognostic parameters such as Gleason score and PSA serum level. This study presents a potential liquid biopsy technique to augment the existing diagnosis and prognosis of PCa. Prostate cancer (PCa) diagnosis is primarily based on prostate-specific antigen (PSA) testing and prostate tissue biopsies. However, PSA testing has relatively low specificity, while tissue biopsies are highly invasive and have relatively low sensitivity at early stages of PCa. As an alternative, we developed a technique of liquid biopsy, based on isolation of circulating tumor cells (CTCs) from seminal fluid (SF). The recovery of PCa cells from SF was demonstrated using PCa cell lines, achieving an efficiency and throughput as high as 89% (±3.8%) and 1.7 mL min−1, respectively, while 99% (±0.7%) of sperm cells were disposed of. The introduced approach was further tested in a clinical setting by collecting and processing SF samples of PCa patients. The yield of isolated CTCs measured as high as 613 cells per SF sample in comparison with that of 6 cells from SF of healthy donors, holding significant promise for PCa diagnosis. The correlation analysis of the isolated CTC numbers with the standard prognostic parameters such as Gleason score and PSA serum level showed correlation coefficient values at 0.40 and 0.73, respectively. Taken together, our results show promise in the developed liquid biopsy technique to augment the existing diagnosis and prognosis of PCa. [ABSTRACT FROM AUTHOR] more...

Background: The aim of this systematic review is to assess the robot-assisted radical cystectomy (RARC) learning curve (LC), which is important to consider in both risk–benefit assessment and training. Materials and Methods: We performed a systematic literature search using two databases (Medline and Scopus) with the search query "learning AND cystectomy" and included all articles containing data on the assessment of the RARC LC. Our primary outcome was the surgeons' experience (a number of performed procedures) required to achieve the LC plateau. The secondary outcomes related to the methods for assessing the relevant LC. Results: Between 9 and 50 procedures were required to reduce the operation time significantly. The data on estimated blood loss during RARC are somewhat controversial. To optimize the lymph node (LN) yield, it was necessary to treat between 20 and 50 patients. The LC for positive surgical margin was described only in one study, it was completed after 24–30 cases. Between 10 and 15 cases were necessary to reduce length of stay (LOS). Complications became less frequent after 10 to 75 patients but there was no clear plateau in the figures. Conclusions: Based on the relevant assessment criteria, the RARC LC length varies from 10 to 50 cases. The most common criteria for evaluating the learning experience include operation time and the LN yield. Blood loss, length of stay, and complications rate show variable outcomes and may be harder to use systematically as a means of LC assessment. [ABSTRACT FROM AUTHOR] more...

Introduction: The objective of this study was to present our clinical experience of using the thulium fiber laser in retrograde intrarenal surgery (RIRS). Methods: A prospective clinical study performed after the IRB approval (Sechenov University, Russia). Patients with stones <30 mm were treated with SuperPulsed thulium fiber laser (SP TFL) (NTO IRE-Polus, Russia) through a 200-μm-diameter fiber. Stone size, density, the duration of the operation, and laser on time (LOT) were measured. Based on the surgeon's feedback, retropulsion and intraoperative visibility were also assessed (Likert scale). Stone-free rates (SFRs) were assessed with a low-dose CT scan 90 days after the operation. Results: Between January 2018 and December 2019, 153 patients (mean age 54 ± 2.8 years) underwent RIRS with SP TFL (mean stone density 1,020 ± 382 HU). Median stone volume was 279.6 (139.4–615.8) mm3. Median LOT was 2.8 (IQR 1.6–6.6) min with median total energy for stone ablation 4.0 (IQR 2.1–7.17) kJ, median ablation speed was 1.7 (1.0–2.8) mm3/s, median ablation efficacy was 13.3 (7.3–20.9) J/mm3, and energy consumption was 170.3 (59.7–743.3) J/s. Overall, the SFR (at 3 months) was 89%. The overall complication rate was 8.4%. Retropulsion was present in 23 (15.1%) patients. Visibility was estimated as optimal in most patients, with poor visibility reported in only 13 (8.5%) patients. Conclusion: The SP TFL is a safe and efficient tool in lithotripsy, irrespective of the stone type and density. Retropulsion is minimal and visibility is maintained with SP TFL. Nonetheless, further clinical studies are needed to ensure optimal comparison with conventional holmium:YAG lithotripsy. [ABSTRACT FROM AUTHOR] more...

The goal of this study was to assess the ablation, coagulation, and carbonization characteristics of the holmium:YAG (Ho:YAG) laser and thulium fiber lasers (TFL). The Ho:YAG laser (100 W av.power), the quasi-continuous (QCW) TFL (120 W av.power), and the SuperPulsed (SP) TFL (50 W av.power) were compared on a non-frozen porcine kidney. To control the cutting speed (2 or 5 mm/s), an XY translation stage was used. The Ho:YAG was tested using E = 1.5 J and Pav = 40 W or Pav = 70 W settings. The TFL was tested using E = 1.5 J and Pav = 30 W or Pav = 60 W settings. After ex vivo incision, histological analysis was performed in order to estimate thermal damage. At 40 W, the Ho:YAG displayed a shallower cutting at 2 and 5 mm/s (1.1 ± 0.2 mm and 0.5 ± 0.2 mm, respectively) with virtually zero coagulation. While at 70 W, the minimal coagulation depth measured 0.1 ± 0.1 mm. The incisions demonstrated zero carbonization. Both the QCW and SP TFL did show effective cutting at all speeds (2.1 ± 0.2 mm and 1.3 ± 0.2 mm, respectively, at 30 W) with prominent coagulation (0.6 ± 0.1 mm and 0.4 ± 0.1 mm, respectively, at 70 W) and carbonization. Our study introduced the TFL as a novel efficient alternative for soft tissue surgery to the Ho:YAG laser. The SP TFL offers a Ho:YAG-like incision, while QCW TFL allows for fast, deep, and precise cutting with increased carbonization. [ABSTRACT FROM AUTHOR] more...

Objective: To critically appraise the methodological rigour of the clinical practice guidelines (CPGs) vis-à-vis BPH surgery as used by specialist research associations in the US, Europe and UK, and to compare whether the guidelines cover all or only some of the available treatments. Methods: The current guidelines issued by the EUA, AUA and NICE associations have been analyzed by 4 appraisers using the AGREE-II instrument. We also compared the recommendations given in the guidelines for surgical and minimally invasive treatment to find out which of these CPGs include most of the available treatment options. Results: According to the AGREE II tool, the median scores of domains were: domain 1 scope and purpose 66.7%, domain 2 stakeholder involvement 50.0%, domain 3 rigor of development 65.1%, domain 4 clarity of presentation 80.6%, domain 5 applicability 33.3%, domain 6 editorial independence 72.9%. The overall assessment according to AGREE II is 83.3%. The NICE guideline scored highest on 5 out of 6 domains and the highest overall assessment score (91.6%). The EAU guideline scored lowest on 4 out of 6 domains and has the lowest overall assessment score (79.1%). Conclusions: The analyzed CPGs comprehensively highlight the minimally invasive and surgical treatment options for BPH. According to the AGREE II tool, the domains for clarity of presentation and editorial independence received the highest scores. The stakeholder involvement and applicability domains were ranked as the lowest. Improving the CPG in these domains may help to improve the clinical utility and applicability of CPGs. [ABSTRACT FROM AUTHOR] more...

Purpose: To investigate the thermal effects, stone retropulsion and ablation rate of SuperPulse Thulium-fiber laser (SP TFL) with two different surgical fibers of 200 and 150 μm in diameter. Methods: SP TFL (NTO IRE-Polus, Fryazino, Russia) performance with 200 and 150 μm fibers (NTO IRE-Polus, Fryazino, Russia) was evaluated. Before each test, the laser fiber was cleaved, and the power measurement was taken to verify the actual laser output power. To compare the laser fibers in well-controlled environments, a number of setups were used to assess retropulsion, ablation efficacy, fiber burnback, energy transmission, and safety. Results: Power measurements performed before each test revealed a 4.7% power drop for a 200 μm fiber SP TFL (14.3 ± 0.5 W) and 7.3% power drop for a 150 μm fiber SP TFL (13.9 ± 0.5 W) versus the nominally indicated power (15.0 W). Retropulsion with the TFL was minimal and comparable between fibers. We found no clinically relevant temperature differences between SP TFL with either 200 or 150 μm fibers. The ablation efficacy tended to be comparable under most parameters. Yet, we did observe a decreased diameter of residual fragments after the ablation with a 150 μm fiber. Conclusion: The smaller fiber (150 μm) is not inferior to 200 μm fiber in terms of fiber burnback, retropulsion, safety, and ablation rate. Moreover, it has the potential to decrease the diameter of fragments during lithotripsy, which may facilitate dusting during RIRS. [ABSTRACT FROM AUTHOR] more...

We aimed to assess the efficacy and safety of minimally invasive percutaneous nephrolithotomy (PCNL) with SuperPulsed Thulium-fiber laser (SP TFL) using different frequency settings. 125 patients with solitary kidney calculi of up to 55 mm in the maximum diameter underwent mini-PCNL with the SP TFL. Stone-free rate, laser-on time, ablation efficacy, energy consumption, ablation speed and complications were all analyzed. Negative low-dose computed tomography scan or asymptomatic patients with stone fragments < 2 mm were the criteria for assessing the stone-free status. In 36 patients (28.8%) low frequency regimens were used (LF: 3–19 Hz—0.5–6 J), in 75 patients (60%) high frequency regimens were chosen (HF: 20–49 Hz—0.2–2 J) and in 14 (11.2%) patients higher frequency (HRF: 50–200 Hz—0.1–0.5 J) regimens were preferred. The mean age was 52 ± 1.8 years. Median stone diameter and median stone volume were larger at low frequency regimens compared to high frequency regimens. Ablation efficacy (J/mm3) was lower at low rather than at high frequency regimens. Ablation speed (mm3/sec) was higher at low compared to high frequency regimens. Surgeons reported minimal and absent retropulsion at higher frequency regimens. The best visibility was observed at high frequency regimens. The overall stone free rate (SFR) at 3 months was 85%. The majority of the postoperative complications were classified between Clavien grades I–II. SP TFL is an effective and safe tool for performing mini-PCNL regardless of the laser settings. [ABSTRACT FROM AUTHOR] more...

Context: The value of Histoscanning™ (HS) in prostate cancer (PCa) imaging is much debated, although it has been used in clinical practice for more than 10 years now. Objective: To summarize the data on HS from various PCa diagnostic perspectives to determine its potential. Materials and methods: We performed a systematic search using 2 databases (Medline and Scopus) on the query "Histoscan*". The primary endpoint was HS accuracy. The secondary endpoints were: correlation of lesion volume by HS and histology, ability of HS to predict extracapsular extension or seminal vesicle invasion. Results: HS improved cancer detection rate "per core", OR = 16.37 (95% CI 13.2; 20.3), p < 0.0001, I2 = 98% and "per patient", OR = 1.83 (95% CI 1.51; 2.21), p < 0.0001, I2 = 95%. The pooled accuracy was markedly low: sensitivity − 0.2 (95% CI 0.19–0.21), specificity − 0.12 (0.11–0.13), AUC 0.12. 8 of 10 studiers showed no additional value for HS. The pooled accuracy with histology after RP was relatively better, yet still very low: sensitivity − 0.56 (95% CI 0.5–0.63), specificity − 0.23 (0.18–0.28), AUC 0.4. 9 of 12 studies did not show any benefit of HS. Conclusion: This meta-analysis does not see the incremental value in comparing prostate Histoscanning with conventional TRUS in prostate cancer screening and targeted biopsy. HS proved to be slightly more accurate in predicting extracapsular extension on RP, but the available data does not allow us to draw any conclusions on its effectiveness in practice. Patient summary: Histoscanning is a modification of ultrasound for prostate cancer visualization. The available data suggest its low accuracy in screening and detecting of prostate cancer. [ABSTRACT FROM AUTHOR] more...

Introduction: It has been shown that endoscopic enucleation of the prostate (EEP) allows for similar efficacy and safety, no matter what energy and type of instruments we use, but the length of learning may differ greatly. The aim of this systematic review is to verify if there is any significant difference between EEP methods in learning. Evidence acquisition: We performed a systematic literature search in three databases and included only the articles containing their own data on the EEP learning curve assessment during the last 10 years. The primary endpoint was to determine the necessary experience needed to achieve a plateau. The secondary endpoints were to review methods used to evaluate a learning curve. Evidence synthesis: The final sample included 17 articles, containing a total of 4615 EEPs performed by 76 surgeons, the most common method was HoLEP (9/17). The majority of articles studying HoLEP report a learning curve of experience level achievement in roughly 30–40 (min 20; max 60) cases. The studies of GreenLight laser showed high heterogeneity in the results with minimum of 20 cases and maximum of 150–200 cases. TUEB required roughly 40–50 cases to reach the plateau. Conclusion: Although EEP is considered challenging, it shows a steep learning curve with a plateau after 30–50 cases. Proper criteria are critical for accurate assessment of the learning curve. The Trifecta and Pentafecta criteria are currently the most appropriate method to evaluate EEP learning. [ABSTRACT FROM AUTHOR] more...

Introduction: There are two main mechanisms of stone ablation with long-pulsed infrared lasers: photothermal and photomechanical. Which of them is primary in stone destruction is still a matter of discussion. Water holds importance in both mechanisms but plays a major role in the latter. We sought to identify the prevailing mechanism of stone ablation by evaluating the stone mass loss after lithotripsy in different media. Materials and Methods: We tested a holmium:yttrium–aluminum–garnet (Ho:YAG) laser (100 W; Lumenis), a thulium-fiber laser U1 (TFL U1) (120 W; NTO IRE-Polus, Russia), and a SuperPulse thulium-fiber laser U2 (TFL U2) (500 W; NTO IRE-Polus). A single set of laser parameters (15 W = 0.5 J × 30 Hz) was used. Contact lithotripsy was performed in phantoms (BegoStones) in different settings: (a) hydrated phantoms in water, (b) hydrated phantoms in air, (c) dehydrated phantoms in water, and (d) dehydrated phantoms in air. Laser ablation was performed with total energy of 0.3 kJ. Phantom mass loss was defined as the difference between the initial phantom mass and the final phantom mass of the ablated phantoms. Results: All lasers demonstrated effective ablation in hydrated phantoms ablated in water; no visual differences between the lasers were detected. The ablation of dehydrated phantoms in air was also effective with visible vapor during ablation and condensation on the cuvette wall. Dehydrated phantoms in water and in air show minimal to no ablation accompanied with formation of white crust on phantom surface. Among laser types, TFL U2 had the highest phantom mass loss in all groups except for dehydrated phantoms ablated in air. Conclusions: Our results suggest that both photothermal and thermomechanical ablation mechanisms (explosive vaporization) occur in parallel during laser lithotripsy. In Ho:YAG and TFL U2 stone ablation explosive vaporization prevails, whereas in TFL U1 ablation photothermal mechanism appears to predominate. [ABSTRACT FROM AUTHOR] more...

Purpose: To evaluate the impact of the fiber–tissue distance on histological parameters in a porcine kidney model. Methods: Four lasers were tested at 60 W using a 600-µm bare-ended fiber: a continuous wave (cw) thulium fiber laser (TFL), a super pulsed (SP) TFL, a Ho:YAG laser, and a blue diode laser (BDL). All tissue samples were mounted on a motorized XY-translation stage. The fiber–tissue distance was changed within a range from 0to 6 mm. Ten incisions were made with each laser at each distance. Afterwards, the tissue samples were sliced with a microtome for lactate dehydrogenase staining to determine zones of thermal damage. Results: In contact mode, the largest incision depth was found for the cw TFL (1.7 ± 0.1 mm) compared to the SP TFL (1.0 ± 0.1 mm), BDL (0.9 ± 0.1 mm) and HoYAG laser (1.1 ± 0.1 mm), respectively. With regard to the coagulative properties, the SP TFL and the Ho:YAG laser showed comparable coagulation depths with 0.7 ± 0.1 and 0.6 ± 0.1 mm, respectively. At 2 mm fiber–tissue distance, the Ho:YAG laser was the only laser that vaporized tissue (incision depth: 0.2 ± 0.1 mm). The BDL was the only laser that caused coagulation at a distance of 3–5 mm. Conclusion: Our results support the clinical observation that cw TFL must be defocused for best coagulation, while the coagulation depth of the SP TFL remains nearly constant within the range of 0–3 mm. Increasing the distance of the laser fiber to the tissue up to 5 mm did not cause significant differences with regard to coagulation depth using the BDL. [ABSTRACT FROM AUTHOR] more...

Introduction The aim of this article was to compare retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PCNL) efficacy and safety with SuperPulsed Thulium-fiber laser (SP TFL) for stones 20 mm and larger. Material and methods Patients with large kidney stones (20 mm and larger) were recruited to undergo PCNL or RIRS with SP TFL lithotripsy. Both groups were comparable in terms of stone size and density, operation time, laser-on time (LOT), stone-free rate, residual fragments and complication rate. Stone retropulsion and visibility were assessed based on the surgeon's feedback using Likert scales. Results A total of 14 and 56 patients were included in the RIRS and PCNL groups, respectively. The mean stone density was 833.8 ±298.3 HU in the RIRS group and 882.3 ±408.5 HU in the PCNL group (p = 0.072). The median LOT was 11.7 (10.0-15.5) min for RIRS and 10.0 (6.0-12.1) min for PCNL (p = 0.207). The median total energy for stone ablation was 13.8 (11.8-25.0) kJ for RIRS and 12.0 (7.0-20.1) kJ for PCNL (p = 0.508). The median ablation speed was 3.9 (3.9-5.7) mm³/sec for RIRS and 5.0 (4.6-11.3) mm³/sec for PCNL (p = 0.085). We found a significant correlation between retropulsion and the type of surgery performed: with higher retropulsion in the PCNL (r = 0.298 with p = 0.012). The stone-free rate at 3-months was 85.7% in RIRS and 89.3% in PCNL (p = 0.505). Conclusions SP TFL is a safe and effective modality for lithotripsy for both, RIRS and PCNL, achieving minimal retropulsion and good visibility. No discrepancies in procedure duration, complications, or LOT were identified between the different modalities. [ABSTRACT FROM AUTHOR] more...

Objectives: To estimate the efficacy and safety of SuperPulsed thulium‐fiber laser ureteral lithotripsy and to identify optimal laser settings. Methods: Patients with solitary stones were prospectively included. Lithotripsy was performed with a SuperPulsed thulium‐fiber laser (NTO IRE‐Polus, Fryazino, Russia) using a rigid ureteroscope 7.5 Ch (Richard Wolf, Knittlingen, Germany). We analyzed the efficacy of lithotripsy by measuring total energy required for stone disintegration, "laser‐on" time, ablation speed, ablation efficacy, and energy consumption. Stone retropulsion and visibility were assessed using a three‐point Likert scale. Complications were assessed using the Clavien–Dindo classification system. Results: A total of 149 patients were included. The mean stone density was 985 ± 360 Hounsfield units, the median (interquartile range) stone volume was 179 (94–357) mm3. The median (interquartile range) total energy was 1 (0.4–2) kJ, and laser‐on time 1.2 (0.5–2.7) min. The median (interquartile range) stone ablation speed was 140 (80–279) mm3/min, energy for ablation of 1 mm3 was 5.6 (3–9.9) J/mm3 and energy consumption was 0.9 (0.6–1) J/min. A correlation was found between retropulsion and the energy used (r = 0.5, P < 0.001). Multivariable analysis showed energy to be a predictor of increased retropulsion (odds ratio 65.7, 95% confidence interval 1.6–2774.1; P = 0.028). No predictors for worse visibility were identified. Conclusion: The SuperPulsed thulium‐fiber laser provides effective and safe lithotripsy during ureteroscopy regardless of stone density. Fiber diameter and laser frequency do not influence visibility or safety. Optimal laser settings are 0.5 J × 30 Hz for fragmentation and 0.15 J × 100 Hz for dusting. [ABSTRACT FROM AUTHOR] more...

Aim: The aim of this study was to compare the thermal effects of Ho:YAG and Tm-fiber lasers during lithotripsy in an in-vitro model via real-time temperature measurement. Methods: We compared a Ho:YAG laser (pav up to 100 W, Lumenis, Yokneam, Israel) and a superpulse Tm-fiber laser (SP TFL, pav up to 40 W, NTO IRE-Polus, Fryazino, Russia), both equipped with 200 µm bare-ended fibers. The following settings were used: 0.2 J, 40 Hz (nominal pav 8 W). Power meter FieldMaxII-TO (Coherent, Santa Clara, CA, USA) was used to verify output laser power (pav). Each laser was fired for 60 s in two setups: (1) thermos-insulated (quasi-adiabatic) cuvette; (2) actively irrigated setup with precise flow control (irrigation rates 0, 10, 35 mL/min). Results: Power measurements performed before the test revealed a 10% power drop in Ho:YAG (up to 7.2 ± 0.1 W) and 6.25% power drop in SP TFL (up to 7.5 ± 0.1). At the second step of our experiment, irrigation reduced the respective temperatures in the same manner for both lasers (e.g., at 35 mL/s SP TFL − 1.9 °C; for Ho:YAG laser − 2.8 °C at 60 s). Conclusion: SP TFL and Ho:YAG lasers are not different in terms of volume-averaged temperature increase when the same settings are used in both lasers. Local temperature rises may fluctuate to some degree and differ for the two lasers due to varying jet streaming caused by non-uniform heating of the aqueous medium by laser light. [ABSTRACT FROM AUTHOR] more...

Purpose: To evaluate the efficacy and safety of thulium-fiber laser (TFL) in laser lithotripsy during percutaneous nephrolithotomy (PCNL). Methods: Patients with stones < 30 mm were prospectively recruited to undergo PCNL using TFL "FiberLase" (NTO IRE-Polus, Russia). Stone size, stone density, operative time, and "laser on" time (LOT) were recorded. Study included only cases managed with fragmentation. Stone-free rate and residual fragments were determined on postoperative computer tomography. Complications were classified using the Clavien–Dindo grade. Stone retropulsion and endoscopic visibility were assessed based on surgeons' feedback using a questionnaire. Results: A total of 120 patients were included in the study with a mean age of 52 (± 1.8) years; of these 77 (56%) were males. Mean stone size was 12.5 (± 8.8) mm with a mean density of 1019 (± 375) HU. Mean operative time was 23.4 (± 17.9) min and mean LOT was 5.0 (± 5.7) min. Most used settings were of 0.8 J/25–30 W/31–38 Hz (fragmentation). The mean total energy for stone ablation was 3.6 (± 4.3) kJ. Overall stone-free rate was 85%. The overall complication rate was 17%. Surgeons reported stone retropulsion that interfered with surgery in 2 (1.7%) cases insignificant retropulsion was noted in 16 (10.8%) cases. Poor visualization was reported in three (2.5%) cases and minor difficulties with visibility in four (3.3%) cases. Conclusions: TFL is a safe and effective modality for lithotripsy during PCNL and results in minimal retropulsion. [ABSTRACT FROM AUTHOR] more...

Objective: To compare the efficacy of the standard and higher frequency regimens for superpulsed thulium fiber laser (SP TFL) retrograde intrarenal surgery (RIRS). Materials and Methods: A prospective study of patients with renal calculi of 10–30 mm was performed. For RIRS, we used the SP TFL (NTO IRE-Polus, Russia) and a 9.5F flexible ureteroscope with 270° deflection and 3.6F working channel. Retropulsion and visibility were assessed based on the surgeon's feedback using three-point Likert scales. The stone-free rate was assessed at 3 months with CT. Results: A total of 40 patients were included in the study with a mean age of 56 years, mean stone density of 880 ± 381 HU, mean stone size of 16.5 ± 6.8 mm, and median stone volume of 883 (interquartile range 606–1664) mm3. Both ablation efficacy and speed were higher in the 200-Hz mode (2.7 J/mm3vs 3.8 J/mm3 and 5.5 mm3/second vs 8.0 mm3/second, respectively); moreover, the higher frequency correlated with increased ablation speed (r = −0.21, p = 0.019). However, both increased energy and frequency did not lead to increase of laser-on time or intraoperative complication rates. Conclusions: SP TFL is able to effectively disintegrate stones during RIRS with minimal complication rates. The use of higher frequency regimens showed higher efficacy and ablation speed and was not associated with increased complication rates. [ABSTRACT FROM AUTHOR] more...

Irreversible electroporation is a treatment option used for focal therapy. In this systematic review, we summarise data on irreversible electroporation outcomes in patients with localised prostate cancer. We performed a literature search in 3 databases and included articles with own data on irreversible electroporation results in patients with localised prostate cancer. Primary outcome was procedure efficacy measured as the absence of cancer in the treatment area on the follow‐up biopsy. Secondary outcomes were the absence of prostate cancer recurrence in the treatment area on MRI, out‐of‐field recurrence, complications and functional outcomes (erectile function and micturition). In‐field recurrence rate was 0%–39% and out‐field 6.4%–24%. In all studies, PSA level decreased: twice lower than baseline after 4 weeks and by 76% after 2 years. Most of the authors noted sexual and urinary toxicity during the first half year after surgery. However, functional outcomes recovered to baseline after 6 months with mild decrease in sexual function. Complication rates after irreversible electroporation were 0%–1% of Clavien–Dindo III and 5%–20% of Clavien–Dindo I–II. Irreversible electroporation has promise oncological outcomes, rate of post‐operative complications and minimal‐to‐no effects on erectile and urinary function. However, medium and long‐term data on cancer‐specific and recurrence‐free survival are still lacking. [ABSTRACT FROM AUTHOR] more...

Objective: To analyze the long-term efficacy and safety of holmium laser enucleation of the prostate (HoLEP) for benign prostatic hyperplasia. Materials and Methods: A total of 127 patients who underwent HoLEP at our institution between 2013 and 2015 were included. Patients were observed for 5 years postoperatively. We evaluated the length of the surgery, the mass of the removed tissue, prostate-specific antigen level, the maximal flow rate (Qmax), postvoid residual (PVR), the length of catheterization and hospitalization, and the International Prostate Symptom Score (IPSS) and IPSS quality of life (QoL) at each clinic visit. Results: PVR, Qmax, IPSS, and QoL all improved significantly immediately after the operation (p < 0.001). By the end of the 5th postoperative year, all the parameters showed a statistically meaningful decline: Qmax reduced by 5.8 mL/s (22.6%) and IPSS by 1.4 points (29.1%). Around 8.6% of the patients continued therapy with α-blockers. There were no differences in efficacy by the age of the patients or the volume of the prostate. Long-term complications and need for repeat operations were not affected by the volume of the prostate or patient age. Conclusions: The improvement of PVR, Qmax, IPSS, and QoL score seen in the early postoperative period after performing HoLEP remains evident at 5 years postoperatively. Long-term complications and the need for reoperation do not depend on the age of the patient or on the initial volume of the prostate. [ABSTRACT FROM AUTHOR] more...