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Objective To investigate the application of transurethral holmium laser enucleation of the middle lobe of the prostate in middle-aged patients with middle lobe hyperplasia. Methods A total of 20 cases of prostatic hyperplasia with middle lobe hyperplasia and sexual needs admitted to the department of urology, affiliated hospital of Qingdao university from January 2022 to June 2022 were enrolled in the study. Intravesical prostatic protrusion（IPP) of prostatic protrusion into the bladder was more than 1.5 cm before surgery. Urinary symptoms, residual urine volume, international prostate symptom score（IPSS), urinary flow rate, urinary incontinence, International Index of Erectile Function-5（IIEF-5) and ejaculation were analyzed after tranthral holmium laser enucleation of the middle lobe of the prostate. Results The symptoms of dysuria were significantly improved in all patients, and no incontinence patient was observed. There was one case of reverse ejaculation 1year after surgery, and the incidence of reverse ejaculation was 5%. Conclusion Simple transurethral holmium laser enucleation of the middle lobe of the prostate for the patients with middle lobe hyperplasia significantly improves perioperative indexes, and has prominent therapeutic effect, which can reduce the incidences of reverse ejaculation, urinary incontinence and bladder neck contracture. [ABSTRACT FROM AUTHOR]

Objective To analyze the effect of preservation of partial urethral mucosa on urinary continence and sexual function in holmium laser enucleation of the prostate（HoLEP）. Methods From June 2018 to December 2021, the data of 73 patients with benign prostatic hyperplasia in our hospital were retrospectively analyzed. Among them, 39 patients were treated with the modified HoLEP, and the others were treated with classic HoLEP. The two groups of patients were compared in terms of post-void residual volume（PVR）, prostate specific antigen（PSA）, peak urinary flow rate（Qmax）, international prostate symptom score（IPSS）, and quality of life （QOL）. The changes in urinary incontinence and sexual function（incidence of retrograde ejaculation and international index of erectile function score）were observed in the two groups after operation. Results There was no significant difference in the amount of postoperative hemoglobin decline, the average operation time, indwelling catheterization time and weight of resected glands（P > 0.05）. After 12 months, there was no significant difference in PSA, Qmax, IPSS, QOL and IIEF-5 between the two groups（P > 0.05）. The incidence of transient urinary incontinence and retrograde ejaculation in the modified group was significantly better than that in the classic group （P < 0.05）. Conclusion The modified HoLEP with urethral mucosa preservation does not increase the risk of operation. With the same efficacy, it can effectively reduce the incidence of urinary incontinence and retrograde ejaculation, and improve the quality of life of patients after surgery. [ABSTRACT FROM AUTHOR]

Objective To observe clinical effect of transurethral columnar balloon dilatation of the prostate combined with Holmuim laser for the treatment of bladder neck contracture. Methods A total of 46 patients with BNC who were treated by transurethral columnar balloon dilatation of the prostate in our hospital from Jan. 2020 to Jul. Patients were divided into two groups according to the methods of surgery. The admission, operation and discharge of all patients were completed in 24 hours. Clinic parameters such as IPSS,Qmax, QOL and PVR were recorded. Results All the patients underwent operations successfully. The symptoms of all patients were significantly relieved compared with those before surgery. Urinary parameters (IPSS, Qmax, and PVR) in TUCBDP combined with holmium laser at 6 months after surgery were significantly better than those in the holmium laser group alone(P<0.05). There were 2 case of stress urinary incontinence in both groups within half a year after operation. In the holmium laser group, there were 4 patients with BNC recurrence in 6 months of follow-up after surgery. Conclusion Transurethral columnar balloon dilatation of the prostate combined with Holmium can effectively treat BNC, with simple performance and satisfactory clinical effects. It is a minimally invasive treatment that is worthy of the popularization of day-surgery. [ABSTRACT FROM AUTHOR]

Objective To evaluate the occurrence of stress urinary incontinence after functional urethra sparing HoLEP (Fus-HoLEP) and its clinical value. Methods Clinical data of 776 patients who underwent HoLEP from June 2017 to December 2019 were retrospectively analyzed. The patients were divided into two groups. The patients in group A received "partial urethral mucosa preservation" technique, and the patients group B received "functional urethral preservation" technique. The intraoperative and postoperative parameters were recorded. The status of urinary incontinence and symptoms after micturition were evaluated according to the international recommended standards for urinary incontinence. Results The average ages of the two groups were 75±7.23 (62~91) years old and 76±7.12 (60~88)years old, the prostate volumes were 110±45.5 (48 ~ 160ml) and 108±47.8 (50 ~ 172ml), the enucleation times were 35±10.3min and 36±12.4min, the enucleation speeds were 3.2±0.24g/min and 3.4±0.28g/min. All patients were extubated within 24 hours, and the incidence of stress urinary incontinence immediately after extubation was 30.5% in group A and 13.2% in group B, which was significantly lower than that in group A. Two weeks after operation, the incidence of stress urinary incontinence was 1.6% in group B, which was significantly lower than 18.4% in group A. One month after operation, the incidence of urinary incontinence was 5.4% in group A and 0.7% in group B, which was significantly lower than that in group A. There were no significant differences in IPSS, QOL, Qmax and PVR between the two groups. In group A, urinary retention occurred in 7 patients after extubation, including 4 cases of blood clogging. In group B, urinary retention occurred in 4 patients after extubation, including 2 cases of blood clogging, and all catheters removal 3 days later after repeated catheterization and bladder irrigation. All patients had no severe bleeding and blood transfusion. Conclusion Holmium laser enucleation of prostate with functional urethra preservation can significantly reduce the incidence of urinary incontinence after operation, which is worthy of promotion. [ABSTRACT FROM AUTHOR]

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Objective · To estimate the efficacy and safety of flexible ureteroscopy combined with holmium laser lithotripsy in the treatment of upper urinary tract calculi in infants aged 3 years old and below. Methods · January 2016 to March 2019, the cases of infants aged 3 years old and below who were treated with flexible ureteroscopy combined with holmium laser lithotripsy for upper urinary tract calculi in Department of Urology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine were collected. The double J (DJ) stents were placed in the cases for 0.5-3 months, followedflexible ureteroscopy combined with holmium laser lithotripsy after urinary tract infection was controlled. OLYMPUS flexible ureteroscope and 200 μm holmium laser fiber were used in the operation. Holmium laser power was 20-30 Hz/0.5-1.0 J according to the size and hardness of the stones, and then DJ stent was retained after retraction of the ureteroscope to finish the operation. Results · A total of 32 infants aged 3 and below with upper urinary tract stones were included in the study, including 21 males and 11 females, and the median age was 26 months (7-36 months). All 32 cases were successfully treated with flexible ureteroscopy combined with holmium laser lithotripsy. Among them calculi in 22 cases were removed after one operation, and the calculi-free rate after one operation was 68.8%. The median duration of operation was 53 min (15-110 min); the median hospitalization after operation was 3 d (2-12 d); the median days of DJ stent removal after operation was 60 d (18-100 d). Urinary tract infection occurred in 4 cases, and high fever with urinary tract infection occurred in 2 cases. Anti-infection and other symptomatic treatments were given respectively to improve the symptoms. Conclusion · Flexible ureteroscopy combined with holmium laser lithotripsy is effective and safe in the treatment of upper urinary tract calculi in infants, which can be widely used in clinic. [ABSTRACT FROM AUTHOR]

Objective To investigate the efficacy of Shuotong Jing combined with holmium laser in the treatment of renal pelvis. Methods Sixty- six patients with pyelonesis treated with Shuotong Jing combined with holmium laser and 76 patients with ureteral calculi treated with ureteroscope and holmium laser were selected from the urinary ward of the Second Affiliated Hospital of KunmingMedical University from January to September 2018. In the Shuotong group，there were 34 males and 30 females， aged 23- 64 years old， with an average of （41.09±7.11） years old，with a diameter of 0.8- 2.0 cm，an average of 1.2 cm. And there were 40 males in the ureteroscopy group， 36 female，aged 25 to 68 years，mean （43.38 ± 7.81） years old， stone diameter of 0.7 ~ 2.0cm， an average of 1.1cm. All patients underwent general anesthesia， and then placed under the guidance of super- sliding black guide wire，then enter the Shuotong Jing and ureteroscope to find the renal calculus，and crush the stone. We observed the operation time， hospital stay， intraoperative bleeding， stone clearance rate （January）， postoperative complications， success rate of sheathing and other related conditions. Results The operation time of the Shuotong group was 60.84±10.27min， the average intraoperative blood loss was 27.98ml， the stone clearance rate was （16.87%） （62/64）， and the postoperative complications were 4.68% （3/64） . The ureter was soft. The average operation time of the microscope group was 75.05±8.61min， the average intraoperative blood loss was 54.71ml， the stone clearance rate （January） was 78.94% （62/64）， and the postoperative complications were 21.05% （3/64. There were significant differences in operation time， intraoperative bleeding， stone clearance rate， and postoperative complications between the two groups （P < 0.05）， but there was no significant difference in hospitalization time and catheterization success rate（P > 0.05） . Conclusion Shuotong Jing lithotripsy has the advantages of feasibility， relative safety， high stone removal rate and lowinfection rate in the treatment of renal pelvis. [ABSTRACT FROM AUTHOR]

Objective To perform a perspective randomized controlled study to assess the efficacy of percutaneous nephrostomy combined with ureteroscopic holmium laser lithotripsy in the treatment of ureteral calculi complicated with moderate or severe hydronephrosis below the fourth lumbar vertebrae (L4). Methods From Jun., 2014 to Oct., 2017, 112 cases of ureteral calculi complicated with moderate or severe hydronephrosis below L4 were admitted in the Department of Urology, Pudong Hospital, Fudan University. Sixty-four males and 48 females aged from 17 to 90 years old and degree of hydronephrosis from 25 to 60 mm confirmed by B ultrasound tomogrph and CT before the operation. The patients were randomized divided into two groups:percutaneous nephrostomy combined with ureteroscopic holmium laser lithotripsy group (nephrostomy combined group, n=56) and ureteroscopic holmium laser lithotripsy group (ureteroscopic group, n=56). The perioperative data of two groups were collected and compared. Perioperative data included procalcitonin, C-reactive protein, blood leukocyte count, blood red cell count, body temperature, urinary sepsis and residual stone. Results The postoperative data of the two groups was compared: procalcitonin was (0.34±0.76) ng/mL in nephrostomy combined group and (2.82±8.58) ng/mL in ureteroscopic group (P=0.006); blood leukocyte count was (7.59±2.12)×109/L in nephrostomy combined group and (9.18±4.2)×109/L in ureteroscopic group (P=0.040). There were no significant differences between the two groups in C-reactive protein ［(24.55±42.53) mg/L vs.(15.19±23.55) mg/L, P=0.528］, blood red cell count ［(3.98±0.53)×1012/L vs. (4.13±0.52)×1012/L, P=0.126］, body temperature ［(37.3±0.5)℃ vs. (37.5±0.7)℃, P=0.119］ and severe urinary sepsis (1 case vs. 4 cases, P=0.384) and residual stone (4 cases vs. 8 cases, P=0.247). Conclusions For patients with ureteral calculi associated with moderate or severe hydronephrosis below fourth lumbar vertebrae, percutaneous nephrostomy combined with ureteroscopic holmium laser lithotripsy can effectively reduce the incidence of systemic bacterial infection compared with ureteroscopic holmium laser lithotripsy. [ABSTRACT FROM AUTHOR]

Objective To compare the clinical efficacy between transurethral plasmakinetic enucleation of prostate （PKEP） and holmium laser enucleation of the prostate （HoLEP） in the treatment of benign prostatic hyperplasia （BPH） . Methods 90 patients who were diagnosed BPH were randomly and equally divided into PKEP group and HoLEP group. The perioperative and postoperative indexes after 6 months were recorded and analyzed. Results There were no significance differences in preoperative factors between the two groups （P > 0.05） . The operative time in HoLEP group was longer than that in PKEP group， but the incidence of hemorrhage，the mean bladder irrigating time， catheter indwelling time and hospital stay time in HoLEP were significant shorter or less than those in PKEP （ < 0.01） . After 6 months，PVR，IPSS，Qmax and QOL were both significantly improved （ < 0.01）， but the differences between the two groups were not significant （P > 0.05） . The complications in HoLEP were less than those in PKEP （ < 0.05） . Conclusion HoLEP and PKEP have the same short-term curative effect in the treatment of BPH， but the former is more security with fewer complications. HoLEP is worthy of widely application. [ABSTRACT FROM AUTHOR]

Objective: To investigate the efficacy and safety of holmium laser and transurethral resection of prostate for treatment of elderly hypertensive patients with prostatic hyperplasia. Methods: The clinical data of 48 cases were retrospectively analyzed from January in2011 to January in 2013 in our department, then they were randomly divided into two groups, 24 cases in each group, were respectively treated with transurethral resection of the prostate (TURP group) and thulium laser (thulium laser group). The operation time, amount of bleeding during the operation, the time of hospitalization, the weight of the prostate, IPSS and QOL score and blood pressure change were observed and compared between two groups. Results: The operation time, amount of bleeding in surgery and the hospitalization time in holmium laser group was significantly lower than that of TURP group (P<0.05); and the postoperative prostate weight, IPSS score and QOL score and blood pressure in holmium laser group were lower than that of TURP group (P<0.05). Conclusions: Transurethral holmium laser in the treatment of elderly hypertensive patients with benign prostatic hyperplasia is safe and effective, and can be popularized in clinic. [ABSTRACT FROM AUTHOR]

Objective: To observe the clinical efficacy and safety of the HoLEP treatment of BPH. Methods: 102 BPH patients with HoLEP clinical data were collected in our hospital. Age of the BPH patients, size of their removal gland, surgical blood loss, as well as the Qmax, the Pdet/ Qmax, IPSS and QOLS before and after operation were analyzed. Then another 100 BPH patients treated with TURP clinical data in our hospital were selected and complications of the patients were compared between the two groups. Results : The age of 102 BPH patients was (71.58± 9.74) years. The removal glands of patients was (84.32± 36.39)g. The loss of surgical blood was (146± 24.68) mL. Before the operation, the Qmax was(8.37± 5.28) mL/s, Pdet/ Qmax (72.93± 26.49) cm H2O, IPSS (28.8± 5.98), and QOLS (5.8± 0.46). After the operation, the Qmax of patients was (24.77± 5.89) mL/s, Pdet/ Qmax of patients (42.35± 10.37) cm H2O, IPSS (9.4± 1.28), and QOLS (2.8± 0.28), which means that Qmax increased significantly (P<0.05), while Pdet/ Qmax, IPSS score and QOLS were significantly lower (P<0.05). Complications occurred significantly less with BPH patients of HoLEP treatment than that with TURP (P<0.05). HoLEP is a safe and effective minimally invasive surgery in the treatment of BPH. [ABSTRACT FROM AUTHOR]

Objective To explore the clinical value of modular flexible ureteroscope combined with holmium laser lithotripsy in the treatment of renal calculi. Methods From November 2013 to June 2015，72 patients with renal calculi were treated by modular flexible ureteroscope (Polydiagnost，German) combined with holmium laser lithotripsy. The diameter of stones was 10-45 mm，16 mm on average. Twenty cases were indwelling double J tube for 3-4 weeks before operation. 200 μm holmium laser fiber was used and laser power was set to 1.5J/10-20Hz (5 to 30 W). KUB examination was performed 1 month after operation. Results Seventy-two cases were treated. F12 ureter sheath was successfully inserted into ureter in 56 cases， and failed in 16 cases. In 6 cases，modular flexible ureteroscope was put into renal pelvis and calices with the help of guidewire，and stones were successfully treated. MPCNL was selected to treat calculi in 6 cases，and modular flexible ureteroscope lithotripsy was successfully applid after double J tubes were placed for 4 weeks in 4 cases. Lower renal calyceal calculi were not found in 6 cases cases， ESWL was selected to treat these cases after double J tube indwelling. The stone found rate was 90.9% (60/66). KUB was examined 1 month after operation. Residul stones were found in 5 cases. Total free rate was 91.7% (55/60) through single operation. Calculus lines up clean the zone leading 95% credibilities is 84.84% -98.56%. The time of lithotripsy was 20-150 min， and the average time was 50 min. During operation， perfusion fluid extravasation and peritoneal effusion were found in 1 case. No severe complications such as heavy bleeding， ureteral avulsion or perforation， urinary tract infection were found in all cases. The average hospitalization was 3 days after modular flexible ureteroscope. Conclusions Modular flexible ureteroscope is easy to operate， and the usage cost is lower. The technology， modular flexible ureteroscope combined with holmium laser lithotripsy for treatment of renal calculi， has the advantages of minimal invasion，high safety and effectiveness， less complications. So this technology is worthy of clinical popularization and application. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the safety and clinical efficiency of holmium laser enucleation of the prostate (HoLEP) in the treatment of small-volume BPH (SBPH) complicated by severe lower urinary tract symptoms (LUTS)., Methods: We retrospectively analyzed the clinical data on 82 cases of SBPH with severe LUTS treated by HoLEP from January 2017 to December 2018. The patients were aged (65.5 ± 7.6) years, with a mean prostate volume of <40 ml, a total IPSS of 24.8 ± 4.6, a QOL score of 5.2 ± 0.8, the maximum urinary flow rate (Qmax) of (7.6 ± 3.7) ml/s, and a mean PSA level of (1.8 ± 1.4) μg/L., Results: All the operations were successfully completed, the mean operation time averaging (30.2 ± 5.0) min, enucleation time (26.7 ± 5.6) min and comminution time (3.5 ± 1.1) min, and the enucleated tissue weighing (20.3 ± 4.9) g. After surgery, the bladders were irrigated for (3.5 ± 1.9) h, with (3.0 ± 1.7) L of rinse solution, and catheterization lasted (24.8 ± 9.7) h. Histopathology revealed moderate or severe lymphocytic infiltration in 69 cases (84.1%). At 6 months after operation, significant improvement was observed in the IPSS, QOL, Qmax and PSA level compared with the baseline (P < 0.05). To date, no urethral stricture-related reoperation was ever necessitated., Conclusions: HoLEP is safe and effective for the treatment of SBPH complicated by severe LUTS and can be employed after adequate preoperative evaluation of the patient.《.

Objective: To investigate the advantages and disadvantages of point electro-cauterization (PEC) and holmium laser cauterization (HLC) in the treatment of post-ejaculation hematuria., Methods: From January 2015 to December 2018, 73 patients with post-ejaculation hematuria, aged 24－63 (36.8 ± 4.2) years, underwent PEC (n = 35) or HLC (n = 38) after failure to respond to 3 months of conservative treatment. We compared the hospital days, total hospitalization expenses, maximum urinary flow rate (Qmax), average urinary flow rate (Qavg), Hamilton Anxiety Rating Scale (HAMA) score, postoperative duration of hematuria, and recurrence rate at 3 and 6 months after surgery., Results: All the patients experienced first ejaculation but no post-ejaculation hematuria at 1 month after operation. The recurrence rates were lower in the PEC than in the HLC group at 3 months (5.71% vs 2.63%, P > 0.05) and 6 months postoperatively (8.57% vs 5.26%, P > 0.05). Compared with the baseline, the Qmax was decreased from (18.56 ± 2.53) ml/s to (13.68 ± 3.31) ml/s (P < 0.05) and the Qavg from (14.35 ± 2.26) ml/s to (9.69±1.84) ml/s in the PEC group at 1 month after surgery (P < 0.01), but neither showed any statistically significant difference in the HLC group. Mild to moderate anxiety was prevalent in the patients preoperatively, particularly in those without job or regular income and those with a long disease course or frequent onset, the severity of which was not correlated with age, education or marital status. The HAMA score was decreased from18.65 ± 4.33 before to 12.35 ± 3.63 after surgery in the PEC group (P < 0.01), and from 16.88 ± 2.11 to 6.87 ± 4.36 in the HLC group (P < 0.01). The mean hospital stay was significantly longer in the former than in the latter group (［5.2 + 1.3］ vs ［3.4 ± 0.5］ d, P < 0.01), while the total cost markedly lower (［6.35 ± 1.20］ vs ［12.72 ± 2.15］ thousand RMB ¥, P < 0.05)., Conclusions: Both PEC and HLC are safe and effective for the treatment of post-ejaculation hematuria, with no significant difference in the recurrence rate at 3 and 6 months after operation, but their long-term effect needs further follow-up studies. PEC may increase the risk of negative outcomes of the postoperative urinary flow rate, while HLC has the advantages of better relieving the patient's anxiety, sooner discharge from hospital and earlier recovery from postoperative hematuria, though with a higher total cost than the former.

Objective: To investigate the clinical effect and safety of transurethral decompression and drainage with holmium laser in the treatment of prostatic abscess., Methods: We retrospectively analyzed the clinical data on 13 cases of prostatic abscess treated in our hospital from January 2015 to May 2019. One of the patients was cured by drug therapy while the other 12 underwent transurethral decompression and drainage with holmium laser after failure in medication. We recorded such postoperative symptoms as fever, frequent urination, urgent urination, painful urination, tenteria, dysuria and abdominal distension, obtained the dynamical indices of blood and urine routine and culture after surgery, and performed MRI during the follow-up for possible recurrence and complications. Those with disappearance of the clinical symptoms, negative results of urine leukocyte and pathogen examinations, and no recurrence revealed by MRI were considered to be cured., Results: After operation, the clinical symptoms were improved significantly and the urinary catheters removed within 5－10 days in all the cases. At 3－5 days after removal of the catheters, all the patients experienced smooth urination, with no urinary retention or urethral stricture. The patients were followed up for 3－16 months, during which no recurrence was observed., Conclusions: Transurethral decompression and drainage with holmium laser can achieve a definite clinical effect in the treatment of prostatic abscess and therefore deserves to be promoted in clinical practice.

Objective: To analyze the effect and safety of treatment in patients with airway stenosis caused by tracheotomy for mechanical ventilation. Method: We treated the patients with airway stenosis caused by granulation tissue. The patients with grade Ⅰ,Ⅱ airway stenosis were treated with adjustable flange tracheostomy tube, and the holmium laser under a fibro-laryngoscope were applied for the patients with grade Ⅲ airway stenosis.Two hundred and sixteen patients were enrolled in this study. Forty-four patients had been found tracheal stenosis caused by granulomatous hyperplasia, accounting for 20.4% of all patients, including 12 cases of gradeⅠ, 18 cases of grade Ⅱ, and 14 cases of grade Ⅲ. Result: Thirty patients with grade Ⅰ and Ⅱ were replaced with adjustable flange tracheostomy cannula. Fourteen cases of grade Ⅲ airway stenosis were treated with Ho:YAG laser under a fibro laryngoscope. All cases were completed operation successfully. None of cases bleeding, perforated and asphyxia during operation. The clinical symptoms disappeared after operation, and endoscopy showed that airways of patients were smooth. No recurrence were found after operation. Conclusion: Replacement of adjustable flange tracheostomy tube and Ho:YAG laser can safely and effectively treat airway obstruction caused by tracheal granulation tissue hyperplasia after tracheotomy., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.)