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Objective: To compare regular and Moses modes of holmium laser lithotripsy during ureteroscopy in terms of fragmentation/pulverization and procedural times in addition to perioperative complications. Patients and Methods: After obtaining ethics approval, a prospective double-blinded randomized trial was conducted for patients undergoing holmium laser lithotripsy during retrograde ureteroscopy. Patients were randomly assigned to either regular or Moses modes. Patients and surgeons were blinded to the laser mode. Lumenis 120W generator with 200 Moses D/F/L fibers were used. Demographic data, stone parameters, perioperative complications, and success rates were compared. The degree of stone retropulsion was graded on a Likert scale from 0—no retropulsion to 3—maximum retropulsion. Results: A total of 72 patients were included in the study (36 per arm). Both groups were comparable in terms of age and preoperative stone size (1.4 cm vs 1.7 cm, p > 0.05). When compared with the regular mode, Moses mode was associated with significantly lower fragmentation/pulverization time (21.1 minutes vs 14.2 minutes; p = 0.03) and procedural time (50.9 minutes vs 41.1 minutes, p = 0.03). However, there were no significant differences in terms of lasing time (7.4 minutes vs 6.1 minutes, p > 0.05) and total energy applied to the stones (11.1 kJ vs 10.8 kJ, p > 0.05). Moses mode was associated with significantly less retropulsion (mean grade was 1.0 vs 0.5, p = 0.01). There were no significant differences between both modes in terms of intraoperative complications (11.1% vs 8.3%, p > 0.05), with one patient requiring endoureterotomy for stricture in the Moses group. Success rate at the end of 3 months was comparable between both groups (83.3% vs 88.4%, p > 0.05). Conclusion: Moses technology was associated with significantly lower fragmentation/pulverization and procedural times. The reduced fragmentation/pulverization time seen using Moses technology could be explained by the significantly lower retropulsion of stones during laser lithotripsy. [ABSTRACT FROM AUTHOR]

Introduction and Objectives: Photoselective vaporization of the prostate (PVP) is a frequently performed procedure by postgraduate trainees (PGTs). However, there is no PVP-specific objective assessment tool to evaluate the acquisition of PVP skills. The aim of the present study was to develop and validate an objective structured assessment of technical skills tool for the PVP procedure (PVP-OSATS). Methods: This study was conducted in two phases. Phase I included the development of PVP-OSATS and assessment of its reliability and construct validity. Panel discussion among experts led to the development of the PVP-OSATS tool with 12 parameters, each scored from 1 (worst) to 5 (best) with a maximum score of 60. Laser prostatectomy experts and PGTs from postgraduate years (PGY) 4 and 5 were recruited. Inter-rater reliability, using Cohen's and Fleiss's kappa, was calculated for all parameters. To assess for construct validity, PGTs were compared with experts. Phase II included assessment of the concurrent validity of this novel tool. This was performed by recruiting Quebec urology PGTs between PGY-3 and -5 to test their PVP skills during the semiannual objective structured clinical examination using the validated GreenLight simulator. Results: During phase I,116 intraoperative PVP-OSATS assessments were collected; 102 for PGTs and 14 for experts. Cohen's and Fleiss's kappa was adequate (k ≥ 0.6) for all 12 parameters, confirming adequate inter-rater reliability. There was significant difference between PGTs and experts in all PVP-OSATS parameters (p ≤ 0.01) except in respect to anatomical landmarks and instrument damage. During phase II, there was significant positive correlation between PVP-OSATS scores inside the operating room and global scores obtained by the GreenLight™ simulator (r = 0.814; p<0.001). Conclusion: This study reports inter-rater reliability, construct, and concurrent validity of PVP-OSATS as a novel PVP-specific objective assessment tool. [ABSTRACT FROM AUTHOR]