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Purpose: Holmium laser enucleation of the prostate (HoLEP) and bipolar transurethral enucleation of the prostate (B-TUEP) are safe and effective treatment options for benign prostatic hyperplasia (BPH). Spinal anesthesia (SA) is widely used for endoscopic enucleation of the prostate (EEP) in place of general anesthesia (GA). We aimed to assess the impact of GA vs. SA on blood loss, postoperative course and functional outcomes after HoLEP and B-TUEP. Methods: After propensity score matching, we analyzed data from 148 patients treated with EEP in our centre for symptomatic BPH. We recorded patient's characteristics, procedural data, type of anesthesia (SA vs. GA). Postoperatively we evaluated hemoglobin drop, catheterization time (CT), and length of hospital stay (LOS). Functional outcomes were evaluated with the International Prostate Symptoms Score (IPSS) at baseline and 3 months after surgery. Descriptive statistics and linear regression models tested the association between anesthesia type and EEP outcomes. Results: After matching groups were comparable in terms of pre- and intra-operative variables. Of all, 111 (75%) patients were treated under SA. Haemoglobin drop was lower in GA compared to SA group (1 vs. 1.4 g/dL, p < 0.01). CT was shorter in the GA group (1 vs. 2 days, p = 0.01). Postoperative IPSS score was lower in GA group (4 vs. 8, p = 0.04). Multivariable linear regression models revealed that prostate volume (p = 0.01) and SA vs. GA (p = 0.01) were associated with higher haemoglobin drop, after accounting for age and use of anticoagulants/antiplatelets. Similarly, SA vs. GA (p = 0.02) and postoperative complications occurrence (p < 0.001) were associated with a longer LOS, after accounting for age, prostate volume and use of anticoagulants/antiplatelets. Conclusion: EEP can be safely performed under both GA and SA. GA offers better outcomes in terms of perioperative bleeding and 3-month functional outcomes. [ABSTRACT FROM AUTHOR]

Background: To compare the operative effect and clinical efficacy of the Moses laser mode and the Raykeen holmium laser energy platform powder mode under flexible ureteroscopic lithotripsy in patients with impacted upper ureteral stones. Methods: From March 2022 to September 2022, 72 patients were divided into a Moses laser group and a Raykeen laser group according to surgical method, with 36 patients in each group. CT and ureteroscopy confirmed that all patients had isolated impacted upper ureteral stones. The stone volume (mm3), stone density (Hu) and severity of hydronephrosis were measured by CT. Postoperative complications were evaluated using the Clavien–Dindo score. Results: There were no complications of ureteral stenosis related to the laser treatment. The operative time and lithotripsy time were lower in the Moses laser group than in the Raykeen laser group (P < 0.05). The stone-free survival rate did not differ significantly between the two groups (P = 0.722). Stone volume was found to be positively correlated with laser energy and lithotripsy time in both groups (P < 0.01). There was no significant correlation between laser energy and lithotripsy time or ureteral stone density (Hu) in the Moses laser group (P > 0.05) or the Raykeen laser group (P > 0.05). Conclusions: The contact mode of Moses technology and the powder mode of Raykeen laser lithotripsy can be used for the ablation of a single impacted upper ureteral stone. The ablation speed was related to the stone volume and the severity of polyp hyperplasia, not the stone density. We recommend the use of the powdered mode as a therapeutic measure for the treatment of impacted upper ureteral stones in flexible ureteroscopic lithotripsy. [ABSTRACT FROM AUTHOR]

Fungal bezoars are extremely rare in the urinary bladder, and there is limited literature regarding the modality of management. We report a case, where the piecemeal removal of a vesical fungal bezoar was performed using Ho:YAG LASER. A 60-year-old man presented with lower urinary tract symptoms and on evaluation was diagnosed with vesical calculus. On cystoscopy, a white-colored, smooth contoured ball was identified in the bladder. The effective endourological modalities for the removal of fungal bezoar require mention in the literature. This case report demonstrates the possibility and efficiency of Ho:YAG LASER in the endourological retrieval of fungal bezoar in the bladder. The rarity of the diagnosis results in difficulty in prompt management.

Abstract Background To compare the operative effect and clinical efficacy of the Moses laser mode and the Raykeen holmium laser energy platform powder mode under flexible ureteroscopic lithotripsy in patients with impacted upper ureteral stones. Methods From March 2022 to September 2022, 72 patients were divided into a Moses laser group and a Raykeen laser group according to surgical method, with 36 patients in each group. CT and ureteroscopy confirmed that all patients had isolated impacted upper ureteral stones. The stone volume (mm3), stone density (Hu) and severity of hydronephrosis were measured by CT. Postoperative complications were evaluated using the Clavien–Dindo score. Results There were no complications of ureteral stenosis related to the laser treatment. The operative time and lithotripsy time were lower in the Moses laser group than in the Raykeen laser group (P 0.05) or the Raykeen laser group (P > 0.05). Conclusions The contact mode of Moses technology and the powder mode of Raykeen laser lithotripsy can be used for the ablation of a single impacted upper ureteral stone. The ablation speed was related to the stone volume and the severity of polyp hyperplasia, not the stone density. We recommend the use of the powdered mode as a therapeutic measure for the treatment of impacted upper ureteral stones in flexible ureteroscopic lithotripsy.

Mitchell Barns, Daniel Magee, Thomas England Department of Urology, Sir Charles Gardiner Hospital, Perth, Western Australia, AustraliaCorrespondence: Mitchell Barns, Sir Charles Gardiner Hospital, Department of Urology, Perth, Western Australia, 6009, Australia, Tel +61 409 439 006, Email Mitchell.barns@health.wa.gov.auBackground: Since its introduction over two decades ago, the surgical laser has served in the lithotripsy of urinary calculi, resection of bladder tumours, bladder neck incisions, and prostate enucleation. Concerns regarding the safe use of holmium lasers have resulted in potentially excessive and overly precautious theatre regulations. We aimed to evaluate the preconceived impressions and practice patterns at a single site surrounding laser use in endourology.Methods: We designed a three-part online questionnaire that could be accessed using a smart device or computer. This survey was distributed to all theatre staff involved in laser surgery at our single site, including surgical, nursing, and anaesthetic staff of varying seniority. It asked questions regarding holmium laser safety, provided an up-to-date summary of published literature surrounding the safe use of lasers, and finally gave participants further option to alter the answers to several previously encountered questions.Results: A total of 54 theatre staff completed the survey, including 17 theatre nurses (31.5%), 10 urology consultants (18.5%), 8 urology registrars (14.8%), 7 anaesthetic registrars (13%), 4 anaesthetic consultants (7.4%). About 51.9% of participants believed that current laser safety protocols were adequate, with 38.9% finding them excessive. After reading recently published information on laser safety, 22.2% thought current laser safety measures were adequate (57% decrease) and 77.8% found them to be excessive (100% increase). About 74.1% of participants found that laser safety goggles impair their vision and that 79.6% would choose not to wear them if they were optional.Conclusion: Strict laser safety guidelines reflect an overestimated risk associated with using holmium laser in operating theatres. Laser safety regulations should be re-evaluated to align with current research and potential hazards inherent to the device. In doing so, a more effective distribution of staff could enable greater access to laser surgery, thereby reducing patient morbidity and hospital wait times.Keywords: endourology, laser surgery, holmium laser

Objective: Holmium laser percutaneous nephrolithotripsy was simulated by porcine kidney calculus model in vitro to investigate thermal damage of renal tissue by different energy parameters of the holmium laser. Methods: We placed human kidney calculus specimen in fresh vitro porcine kidney, then insert thermocouple temperature probes into the submucosa of the renal pelvis and reheated in a 37 °C water bath. A percutaneous nephrological sheath was used to penetrate the renal parenchyma with a moderate irrigation rate of 30 ml/min at 18 ℃. The Holmium laser was used to fragment the stones under a nephroscope, and the temperature was recorded. Results: The four independent models were lithotripsy with 30 W and 60 W laser for 5 and 10 min, respectively; the mean temperature of 30 W vs. 60 W within 5 min was 36.06 °C vs. 39.21 °C (t = 5.36, P < 0.01) and the highest temperature was 43.60 °C vs. 46.60 °C; the mean temperature of 30 W vs. 60 W within 10 min was 37.91 °C vs. 40.13 ℃ (t = 5.28, P < 0.01), maximum temperature 46.80 ℃ vs. 49.20 ℃. Pathologically, each kidney was observed to have different degrees of thermal damage lesions, and the higher power and longer time the more severe the injury, but the injury was mainly limited to the uroepithelial and subepithelial tissues, with rare damage to renal tubules. Conclusion: The higher laser excitation power and longer duration raised the intrarenal temperature significantly and caused a certain degree of thermal damage to the kidney tissue, but overall it was found to be safe and reliable. Urologists can avoid further side effects through surgical expertise. [ABSTRACT FROM AUTHOR]

The evolution of laser medical devices for benign prostatic hyperplasia (BPH) treatment aims to enhance vaporization, coagulation, or tissue removal. In this study, we aim to evaluate the effectiveness and safety of the innovative application of insulated-gate bipolar transistor (IGBT) xenon lamp-pulsed drive technology holmium laser in endoscopic prostate enucleation operations using canine models. Six canines were used as an experimental unit, the breed of the canine unit used was beagle. Each canine served as its own control to minimize the number of experimental units. Endoscopic enucleation, performed by a single surgeon, involved enucleating the left hemi-prostate, leaving the right hem-prostate untouched to serve as the control. Throughout the study period, all canines maintained good health. No adverse events were observed in all six canines. Postoperatively, there were no indications of redness, swelling, or other adverse effects at the surgical sites. No abnormalities were observed in the appearance and morphology of major organs. The prostate and bladder, removed for further pathological evaluation, exhibited no abnormalities in size, color, or texture. No abnormalities or inflammation were observed, and the tissues were free of adhesions, indicating successful healing. In conclusion, our comparison of preoperative and postoperative parameters in canines suggests that the IGBT pulsed laser, at a power setting of 100 W, demonstrates characteristics of safety, efficacy, minimal tissue damage, and no major postoperative complications. This study establishes a theoretical foundation for future applications in human settings, encouraging further exploration of the IGBT holmium laser's potential in clinical practice. [ABSTRACT FROM AUTHOR]

En bloc resection of bladder tumor (ERBT) involves removing bladder tumors and their base. Laser resection has been used to reduce complications including bleeding and obturator nerve reflex (ONR). We developed a novel approach (rotatable bi-channel en bloc resection of bladder tumor (RBC-ERBT)) and assessed its efficacy in a pilot in-vivo study to enhance laser ERBT's applicability in challenging bladder regions. In the laser RBC-ERBT procedure, lesions were excised by inserting a holmium laser through the rotating external working channel, while forceps were inserted through the internal working channel provided traction on the tissue. Fifteen laser RBC-ERBT procedures were performed in five different bladder areas of three live pigs. The technical success rate (TSR), procedure time, lesion size, occurrence of complications (bleeding, perforation, ONR), and detrusor muscle (DM) presence rate and DM thickness were evaluated. All 15 procedures were performed with a 100% TSR. The resections were successful in all bladder regions (posterior, left, right and anterior walls and dome). Median procedure time was 20 min. The resected specimen size was 10 mm × 7 mm to 17 mm × 13 mm. Mild bleeding occurred in two procedures (13.3%) but was effectively managed. No incidents of ONR or perforation were observed. Histological examination confirmed presence of DM in all specimens with a median DM thickness of 1.26 mm. Our pilot in-vivo study suggested the feasibility and effectiveness of laser RBC-ERBT for bladder tumors in various locations. This technique offers effective traction, improved visualization, and enhanced laser accessibility. Further studies are required to validate its effectiveness in humans. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate perioperative parameters, clinical outcomes, and the learning curve of holmium laser enucleation of the prostate (HoLEP) of a single surgeon in 500 consecutive cases. Methods: Demographic parameters, outcomes, and adverse events were evaluated. The learning curve for HoLEP in en-bloc technique of the first 500 consecutive patients was analyzed in clusters of 100 (clusters 1–5) using the Wilcoxen rank test, Chi² test and Kruskal Wallis test. Results: Enucleation weight was similar in the clusters 1,2,3, and 5 (62 g, 63 g, 61 g, 61 g), in cluster 4 it was slightly higher at 73 g. There was a significant reduction in operating time from 67 min (cluster 1) to 57 min (cluster 2), 46 min (cluster 3), 53 min (cluster 4), and 43 min (cluster 5), p < 0.001. Enucleation efficiency (g/min) showed a steady increase (1.72, 2.24, 2.79, 2.92 vs. 2.99, p < 0.001). Laser energy efficiency also improved (2.17 vs. 2.12 vs. 1.71 vs. 1.65 vs. 1.55; p < 0.001). There was no measurable learning curve regarding the length of hospital stay (mean 2.5 days), catheterization time (1.9 days), hemoglobin drop (approx. 1 g/dl) or complications (p > 0.1). Conclusions: HoLEP using the en-bloc technique is a safe and highly effective method. Over time, a slight but steady learning curve and improvement in operation time, enucleation efficiency and laser energy efficiency were shown even for an experienced surgeon - after 500 cases, still no plateau was reached. There was no measurable learning curve regarding blood loss, complications, length of hospital stay, and catheterization time. [ABSTRACT FROM AUTHOR]

Through an ex vivo experimental study, we aimed to compare the effects of the Ho: YAG laser Virtual Basket (VB™) modulation and a Thulium fiber laser (TFL) on kidney tissue in different environments and using laser configurations. The 100 W Ho: YAG (Cyber Ho, Quanta System, Italy) and 60 W TFL (Fiber Dust, Quanta System, Italy) laser devices were used. The following laser settings were selected: power in the range of 10–60 W, frequency of 20–40 Hz, and energy of 0.5–1–1.5 J. A medium pulse duration of 600 µsec was used for VB™, while short (spdTFL; 50 µsec) and long (lpdTFL; 15,000 µsec) were used for TFL. The tissue's incision depth (ID), vaporization area (VA), coagulation area (CA), total laser area (TLA = VA + CA), surface section (SS), and lateral effect (LE) were measured. In total, 108 experiments were conducted. No statistically significant difference in mean VA, TLA, ID, LE, or SS was observed between VB™, spdTFL, and lpdTFL in the low-power output group in saline (p > 0.05). However, the mean CA was statistically significantly higher for VB™ (p = 0.005). In saline and high-power output group, the mean VA, CA, TLA, LE, and ID were higher when using lpdTFL than other pulse durations (p = 0.001, p = 0.001, p = 0.001, p = 0.006, and p = 0.001, respectively). Similar to lpdTFL, VB™ may provide controlled dissection and incision as well as haemostasis. At different laser settings, the individual effects of laser properties (such as pulse length, energy and frequency) on tissue may be more significant. [ABSTRACT FROM AUTHOR]

Objective: Urethral stricture management has posed enduring challenges in urology, demanding innovative and effective treatment modalities. This study addresses the persistent issues associated with urethral strictures, focusing on the comparative evaluation of two contemporary treatment modalities: Ho: YAG Laser Internal Urethrotomy (HIU) and Cold Knife Optical Internal Urethrotomy (CIU). Methods: A comprehensive search of PubMed, Embase, Web of Science, Cochrane Library, and ResearchGate was conducted to identify relevant studies up to November 2023. Inclusion criteria encompassed comparative studies evaluating HIU and CIU in patients with urethral stricture. Data extraction, quality assessment, and subgroup analyses were performed using standardized methods. Outcome measures included preoperative and postoperative mean the maximum urine flow rate (Qmax), mean surgical time, recurrence rates, and perioperative complications. Results: Nine articles met the inclusion criteria, and their data were analyzed using RevMan 5.4.1. Forest plots were generated for preoperative and postoperative mean Qmax, mean surgical time, recurrence rates, and perioperative complications. While postoperative mean Qmax (MD - 0.06; 95% CI: - 0.28-0.16; P = 0.60, I2 = 75%) and mean surgical time (MD 2.16; 95% CI: - 1.66-5.99; P = 0.27, I2 = 98%) showed no significant differences between HIU and CIU, a trend towards lower recurrence rates (RR 0.71; 95% CI: 0.48-1.06; P = 0.09, I2 = 46%) was observed with HIU but without statistical significance. Perioperative complications, particularly bleeding (RR 0.21; 95% CI: 0.08-0.53; P = 0.001, I2 = 0%), favored HIU over CIU. The subanalysis indicates that for the treatment of complex urethral strictures, the two surgical methods differ in terms of mean Qmax at 6 months postoperatively (MD - 2.51; 95% CI: - 4.10-- 0.91; P = 0.002, I2 = 59%) and 12 months postoperatively (MD 2.62; 95% CI: 0.93-4.30; P = 0.002, I2 = 0%). The HIU group shows a significant decrease in recurrence rate at 12 months postoperatively (RR 0.44; 95% CI: 0.21-0.92; P = 0.03, I2 = 0%). For short-segment urethral strictures with a length = 1.5 cm, CIU had a shorter operative time compared to the HIU (MD 4.49; 95% CI: 3.87-5.10; P < 0.00001, I2 = 44%). Conclusion: Overall, both interventions demonstrated similar efficacy in improving postoperative mean Qmax, mean surgical time, and recurrence rates. However, subanalysis indicates that in the short-term, CIU is more effective than HIU in improving Qmax after complex urethral stricture surgery. In long-term Qmax follow-up after surgery, HIU is significantly higher than CIU, and HIU has a low recurrence rate. In addition, for short-segment urethral stricture (= 1.5 cm), CIU requires less time. In terms of complications, HIU has a lower risk of bleeding. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to assess the clinical outcome and safety of holmium laser enucleation of the prostate (HoLEP) following transrectal ultrasound-guided prostate biopsy (TR biopsy) in the treatment of benign prostate hyperplasia. Materials and Methods: We retrospectively analyzed data from 556 patients who underwent HoLEP between 2014 and 2021. The patients were categorized into six groups: Group 1-A (n=45) underwent HoLEP within four months post TR biopsy. Group 1-B (n=94) underwent HoLEP more than four months post TR biopsy. Group 1-C (n=120) underwent HoLEP after a single TR biopsy. Group 1-D (n=19) underwent HoLEP after two or more TR biopsies. Group 1-total (n=139, group 1-A+group 1-B or group 1-C+group 1-D) underwent HoLEP post TR biopsy. Group 2 (control group, n=417) underwent HoLEP without prior TR biopsy. We examined perioperative parameters, safety, and functional outcomes. Results: The age, body mass index, International Prostate Symptom Score (IPSS), uroflowmetry, and comorbid diseases between group 1-total and group 2 were comparable. However, group 1-total exhibited significantly elevated prostate-specific antigen levels and larger prostate volumes (p

Introduction: Urolithiasis is a serious health issue that is constantly getting worse around the world. In relation to laser lithotripsy, new techniques and technological advancements have emerged, giving urologists a wide range of choices for treating stone disease. The objective of the present review is to provide an overview of the most current developments and show how effective they are for reducing complications and boosting surgical effectiveness. Material and method: In October 2023, we performed a comprehensive search of the literature, including relevant articles using the PubMed international database to identify related publications concerning ureteroscopic laser stone lithotripsy in renal lithiasis. Both review and original articles were selected. Searches were limited to studies written in English which involved human and adult subjects. Results: All eligible studies concerning ureteroscopic laser lithotripsy were published in 2022 and 2023. They were conducted in Asia (5/10), the North America (3/10) and Europe (2/10), and totalized 1570 patients with an age range between 18 and 85 years. Regarding the primary efficacy outcome, all studies focused on stone free rates (SFRs), complications and average operative time. Conclusion: The rising frequency and incidence of stone disease has led to ongoing breakthroughs in endourology through technological advancements and ongoing developments. Unlike the relatively well-known Holmium laser, which has several uses in the field of stone lithotripsy, Thulium fiber laser (TFL) is a brand-new technological arrangement. [ABSTRACT FROM AUTHOR]

The purpose of this study was to evaluate the efficacy and safety of flexible ureteroscopy with holmium laser lithotripsy in the management of calyceal diverticular calculi. In this study, we retrospectively analyzed the clinical data of 27 patients with calyceal diverticular calculi admitted to the Department of Urology of the Zigong First People's Hospital from May 2018 to May 2021. Intraoperatively, the diverticular neck was found in all 27 patients, but flexible ureterorenoscopy lithotripsy was not performed in 2 cases because of the slender diverticular neck, and the success rate of the operation was 92.6%. Of the 25 patients with successful lithotripsy, the mean operative time was 76.9 ± 35.5 (43–200) min. There were no serious intraoperative complications such as ureteral perforation, mucosal avulsion, or hemorrhage. Postoperative minor complications (Clavien classification I-II) occurred in 4 (16%) patients. The mean hospital stay was 4.4 ± 1.7 (3–12) days. The stone-free rate was 80% at the 1-month postoperative follow-up. After the second-stage treatment, the stone-free rate was 88%. In 22 cases with complete stone clearance, no stone recurrence was observed at 5.3 ± 2.6 (3–12) months follow-up. This retrospective study demonstrated that flexible ureterorenoscopy with holmium laser is a safe and effective choice for the treatment of calyceal diverticular calculi, because it utilizes the natural lumen of the human body and has the advantages of less trauma, fewer complications, and a higher stone-free rate. [ABSTRACT FROM AUTHOR]

Purpose: Few studies have evaluated the usefulness of anteroposterior dissection holmium laser enucleation of the prostate (HoLEP). Thus, this study investigated the incidence of stress urinary incontinence (SUI) after HoLEP and the usefulness of anteroposterior dissection HoLEP in preventing postoperative SUI. Materials and Methods: In total, 288 patients who underwent HoLEP performed by a single experienced surgeon between May 2014 and September 2021 were enrolled. Furthermore, 134 patients underwent retrograde dissection using the modified Gilling method (surgery 1) and 154 patients underwent anteroposterior dissection HoLEP (surgery 2). The risk factors for SUI, as well as the rates of SUI improvement for the two surgical procedures, were evaluated. Results: Postoperative SUI was observed in 58 (20.1%) of 288 patients, of whom, 48 (82.8%) recovered continence within 6 months. SUI incidence 1 month after HoLEP was 29.9% (40/134 patients) for surgery 1 and 11.7% (18/154 patients) for surgery 2; a statistically significant difference was observed between the two groups (odds ratio [OR], 0.311; 95% confidence interval [CI], 0.168-0.575; p < 0.001). In addition, surgery 2 was significantly associated with early recovery from SUI compared with surgery 1 (stratified hazard ratio, 0.782; 95% CI, 0.615-0.995; p < 0.001). The multivariable analysis demonstrated that only surgical procedure (OR, 0.350; 95%CI, 0.168-0.732; p = 0.005) was an independent predictor of SUI. Conclusion: We reaffirmed that anteroposterior dissection HoLEP is a useful procedure for reducing the risk of postoperative SUI and early recovery of urinary continence. [ABSTRACT FROM AUTHOR]

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 investigate the feasibility, safety and efficacy of holmium laser enucleation of the prostate (HoLEP) in the re‐treatment setting (salvage HoLEP) and compare it to the primary HoLEP procedure that is commonly used for the treatment of benign prostate hyperplasia (BPH). Materials and Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses statement, PubMed, Scopus, and Cochrane databases were systematically screened, from inception to 8 August 2022. Other potentially eligible studies were retrieved using the reference lists of the included studies. Retrospective and prospective studies, both comparative and non‐comparative, were included. Results: A total of 12 studies met the inclusion criteria and were included in the final qualitative synthesis. One study was prospective comparative (non‐randomised), seven studies were retrospective comparative, and four studies were retrospective non‐comparative or case series. In total, 831 patients were treated with salvage HoLEP in the above studies. Previous intervention before salvage HoLEP ranged among studies. The most commonly performed was transurethral resection of the prostate. Intraoperative parameters of salvage HoLEP were comparable with those reported during primary HoLEP, while all postoperative outcomes were significantly improved after salvage HoLEP and were similar with those observed after primary HoLEP. No major complications were noted after salvage HoLEP according to Clavien–Dindo classification. Conclusions: Salvage HoLEP after previous interventions for treating recurrent or residual BPH is a feasible, safe, and efficient procedure. Data presented in selected studies, along with the holmium laser's physical properties to resect more tissue and to dissect along the true anatomical plane of BPH, render HoLEP an ideal salvage treatment modality for recurrent or residual BPH symptoms. [ABSTRACT FROM AUTHOR]

The introduction of the Ho:YAG laser 3 decades ago revolutionized the endoscopic treatment of urolithiasis. Since then, a variety of innovations have continued to evolve these devices, including the development of high-power lasers capable of high-frequency lithotripsy. The clinical utility of high-frequency lithotripsy, however, has not necessarily lived up to the potential suggested by in vitro studies. A review of the relevant literature, confirming strong similarities between the outcomes associated with high and lower power laser lithotripsy, follows. [ABSTRACT FROM AUTHOR]

Purpose: Holmium laser enucleation of the prostate (HoLEP) represents the current standard procedure for size-independent surgical therapy of benign prostatic obstruction (BPO). With advent of the novel laser technology thulium fiber laser (TFL), we hypothesized that the functional outcome of TFL enucleation of the prostate (ThuFLEP) is non-inferior compared to HoLEP. Methods: From October 2021 to October 2022, 150 patients with BPO were recruited for the prospective randomized trial in accordance with CONSORT. Stratified randomization into the arms ThuFLEP (n = 74) or HoLEP (n = 76) was carried out. The primary endpoint was non-inferior international prostate symptom score (IPSS) and quality of life (QoL) at three months after treatment. Secondary endpoints were rates of complications, peak flow, residual urine and operation times. Results: Preoperative characteristics showed no significant differences. Overall IPSS and QoL improved from 21 to 8 and 4 to 1.5, respectively, after three months of follow-up. No statistically significant differences between ThuFLEP and HoLEP were observed regarding median postoperative IPSS (8.5 vs. 7, p > 0.9), QoL (1 vs. 2, p = 0.6), residual urine (48 vs. 30ml, p = 0.065) and peak flow (19 vs. 17ml/s, p > 0.9). Similarly, safety profile was comparable with no statistically significant differences regarding rate of major complications (5.3 vs. 5.4%, p = 0.5), laser hemostasis time (3 vs. 2min, p = 0.2), use of additive electric coagulation (74 vs. 87%, p = 0.06) or electric coagulation time (8 vs. 8min, p = 0.4). Conclusions: In this prospective, randomized trial ThuFLEP showed non-inferior results compared to HoLEP in terms of functional outcomes measured by IPSS and QoL as primary endpoint. Trial registration number: DRKS00032699 (18.09.2023, retrospectively registered). [ABSTRACT FROM AUTHOR]

The results of development and investigation of the characteristics of a holmium fiber laser generating at the wavelength of 2 μm in cavity configurations with distributed Bragg reflectors (DBRs) and with random distributed feedback (RDFB) provided by artificial Rayleigh reflectors are considered. The length of the active medium was 75 cm. For the linear scheme with DBRs, the output power was about 330 mW at a pump power of 3.9 W, while the linewidth did not exceed 10 pm. For the configuration with RDFB, the maximum output power was 360 mW, and the generation linewidth was about 3 pm, while up to the output power level of 90 mW, a single-frequency generation regime was observed and the temporal dynamics was pulsed. [ABSTRACT FROM AUTHOR]

Introduction: Holmium laser enucleation of the prostate (HoLEP) is routinely performed with a 24F, 26F, or a 28F scope. Proponents of the larger scopes propose that a bigger sheath size allows for superior flow and visibility leading to a more efficient operation and better hemostasis. Those utilizing the smaller scopes suggest that the smaller sheath is less traumatic, resulting in lower stricture rates and temporary incontinence. We sought to compare outcomes of ambulatory HoLEP using the 24F and 28F laser scope. Materials and Methods: From May 2022 to March 2023, we randomized patients undergoing HoLEP (<200 cm3 in size) 1:1 to either a 24F or 28F scope. The primary outcome was differences in surgical duration between groups (minutes). Secondary outcomes included surgeon scope evaluation and postoperative patient results. Results: There was no difference in patient characteristics in those randomized to 28F (n = 76) vs 24F (n = 76) (p > 0.05) scopes. Procedural duration and efficiencies were not different between groups (all p > 0.05). The 28F scope was associated with improved surgeon-graded irrigation flow and visibility (p < 0.001). Patients treated with the 28F scope were more likely to achieve effective same-day trial of void (SDTOV) (28F 94.3% vs 24F 82.1%, p = 0.048) and have a shorter length of stay (LOS) (28F 7.0 vs 24F 11.9 hours, p = 0.014), however, rates of same-day discharge (SDD) were not statistically different (28F 87.8% vs 24F 78.4%, p = 0.126). There was no difference between the cohorts in rates of 90-day emergency room presentations, re-admissions, complications, or functional ouctomes (p > 0.05). Conclusions: We identified no clear advantage of scope size with regard to intraoperative or postoperative outcomes at 3-month follow-up due to scope size. However, if SDD is part of your postoperative pathway, the 28F scope may shorten LOS and increase rates of effective SDTOV. Clinicaltrials.gov: NCT05308017. [ABSTRACT FROM AUTHOR]

The aim of the study was to compare standard high-power laser (with < 80 Hz) to extended frequency (> 100 Hz) lithotripsy during miniPCNL. 40 patients were randomized in to two groups undergoing MiniPCNL. For both groups, the Holmium Pulse laser Moses 2.0 (Lumenis) was used. For group A, standard high-power laser with < 80 Hz, with Moses distance was set using up to 3 J. For Group B, extended frequency (100–120 Hz) was used allowing up to 0.6 J. All patients underwent MiniPCNL using an 18 Fr balloon access. Demographics were comparable between groups. Mean stone diameter was 19 mm (14–23) with no differences between groups (p = 0.14). Mean operative time was 91 and 87 min for group A and B (p = 0.71), mean laser time was similar in both groups, 6.5 min and 7.5 min, respectively (p = 0.52) as well as the number of laser activations during the surgery (p = 0.43). Mean Watts used was 18 and 16 respectively being similar in both groups (p = 0.54) as well as the total KJoules (p = 0.29). Endoscopic vision was good in all surgeries. The endoscopic and radiologic stone free rate was achieved in all patients expect for two in both groups (p = 0.72). Two Clavien I complications were seen, a small bleeding for group A and a small pelvic perforation in group B. The use of high-power holmium laser with extended frequency and optimized Moses was effective and safe being comparable to standard high-power laser for MiniPCNL allowing more versatility with the setting range. [ABSTRACT FROM AUTHOR]

This study sought to analyze the ablation rates of Holmium:YAG (Ho:YAG) and thulium fiber laser (TFL) under different settings combinations. Lasering was carried out by a computed spiral pattern through a stepper motor bearing a laser fiber. BegoStones were placed inside a water container and lasered therein and the ablation rate was calculated. Different combinations were tested for ~12 Watts (W) for Ho:YAG and TFL lasers. Further 25 W combination for TFL were conducted testing higher frequencies. One-hundred-one experiments were conducted. Under ~12 W, the highest ablation rate for Ho:YAG was obtained with 40 Hz/0.3 J, and Virtual Basket™ (VB) emission mode [114.35 (88.30 – 126.40) mg/min] whereas for TFL, using 40 Hz/0.3 J, and long pulse [143.40 (137.40 – 146) mg/min]. A matched-comparison for 12 Hz/1 J settings showed that TFL outperformed Ho:YAG using medium pulse [63.30 (55.30 – 81.30) vs 132.00 (115.70 – 228.60) mg/min, p=0.016] and long pulse [62.90 (51.60 – 78.90) vs 134.70 (110.60 – 149.30) mg/min, p=0.016]. In the 40 Hz/0.3 J settings, TFL outperformed Ho:YAG (p=0.034). Nonetheless, Ho:YAG with VB’s ablation rate increased [114.35 (88.30 – 126.40)], being comparable to that of TFL with medium pulse [127.5 (88.90 – 141.70)] (p=0.400). In TFL 25 W experiments, the ablation rate of 500 Hz / 0.05 J, was higher than those of 1000 Hz / 0.025 J (p=0.049). TFL ablation rate is higher than that of Ho:YAG. Moreover, the Virtual Basket™ emission mode, increased Ho:YAG ablation rates, resulting reaching similar to that of TFL in certain modalities. [ABSTRACT FROM AUTHOR]

Purpose: To summarize all existing evidence regarding the feasibility, safety, and efficacy of same-day trial of void and catheter removal after Holmium Laser Enucleation of the Prostate (HoLEP). Although there have been many reports of the safety and efficacy of same-day discharge from the hospital for selected patients undergoing HoLEP, in most of these reports, patients return to the hospital, usually on postoperative day one, to undergo a trial of void and catheter removal. Methods: PubMed®, Scopus®, and Cochrane® primary databases were systematically screened, from inception to 17 January 2023. The search strategy used the PICO (Patient, Intervention, Comparison, Outcomes) Framework. We followed the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Results: Six studies met all the predefined criteria and were included in the final qualitative synthesis. Four studies were retrospective and two were prospective. Four studies were non-comparative, while two were comparative ones. The same-day catheter removal success rate ranged from 85.5 to 90% among studies, while only one grade-IIIb Clavien-Dindo complication was reported, which was unrelated to surgery. Conclusion: Same-day catheter removal is a feasible, safe, and efficient approach for selected patients undergoing HoLEP. Certain factors, such as intraoperative furosemide administration, were found to improve same-day catheter-free rates, while preoperative PVR and urinary retention were independent predictive factors of same-day trial of void failure. [ABSTRACT FROM AUTHOR]

Purpose: We evaluated the efficacy and safety of mid-term follow-up in low-power (LP) Holmium laser enucleation of the prostate (HoLEP) compared with high-power (HP) surgery for benign prostatic hyperplasia (BPH). Materials and Methods: This prospective, single-blind, randomized controlled study was conducted between September 2020 and April 2021. Ninety male patients >50 years who underwent HoLEP for BPH were randomly assigned to HP (80 W/2 J/40 Hz) and LP (24 W/2 J/12 Hz) groups. The primary endpoint was the total International Prostate Symptom Score (IPSS) six months after surgery. The secondary endpoints were perioperative results and postoperative outcomes at two weeks, three and six months after the surgery, including Clavien–Dindo complication classification. Results: At six months after HoLEP, 41 and 42 patients were followed up in the HP and LP groups, respectively. There was no difference in the preoperative characteristics between the two groups. The prostate volumes were 67.1±23.7 mL for the HP group and 64.3±25.7 mL for the LP group (p=0.592), respectively. Although the total operative time was significantly longer by 13.1 minutes in the LP group (47.8±20.3 min vs. 60.9±23.3 min, p=0.006), the total delivered energy was significantly lower, which was only about 68% of the HP group (58.2±23.9 kJ vs. 39.9±13.2 kJ, p

Purpose: To determine the factors affecting morcellation efficiency in holmium laser enucleation of the prostate (HoLEP) surgery. Materials and Methods: Patients who underwent HoLEP surgery by a single surgeon between 2018 and 2022 were included in the study. Our primary outcome of interest in this study was morcellation efficiency. The effect of preoperative and perioperative variables on morcellation efficiency was evaluated with linear regression analysis. Results: A total of 410 patients were included in the study. The mean morcellation efficiency was 6.95±1.70 g/min. Univariable and multivariable linear regression analysis was performed to identify factors affecting morcellation efficiency. Presence of the “beach ball” effect (small, round prostatic tissue fragments that are fibrotic and difficult to morcellate), the learning curve, resectoscope sheath type, prostate-specific antigen (PSA) density, morcellated tissue weight, and the presence of prostate calcification were found to be independent predictive factors (β=-1.107, 95% CI: -1.59 to -0.55, p

Background: Bilateral kidney stones are commonly treated in staged procedures. Objective: To evaluate outcomes after same-sitting bilateral retrograde intrarenal surgery (SSB-RIRS) for renal stones. Design, setting, and participants: Data from adults who underwent bilateral RIRS in 21 centers were retrospectively reviewed (from January 2015 to June 2022). The inclusion criteria were unilateral/bilateral symptomatic bilateral stone(s) of any size/location in both kidneys and bilateral stones on follow-up with symptom/stone progression. Stone-free rate (SFR) was defined as absence of any fragment >3 mm at 3 mo. Outcome measurements and statistical analysis: Continuous variables are presented as medians and 25–75th percentiles. A multivariable logistic regression analysis was performed to evaluate independent predictors of sepsis and bilateral SFR. Results and limitations: A total of 1250 patients were included. The median age was 48.0 (36–61) yr. Of the patients, 58.2% were prestented. The median stone diameter was 10 mm on both sides. Multiple stones were present in 45.3% and 47.9% of the left and right kidneys, respectively. Surgery was stopped in 6.8% of cases. The median surgical time was 75.0 (55–90) min. Complications were transient fever (10.7%), fever/infection needing prolonged stay (5.5%), sepsis (2%), and blood transfusion (1.3%). Bilateral and unilateral SFRs were 73.0% and 17.4%, respectively. Female (odds ratio [OR] 2.97, 95% confidence interval [CI] 1.18–7.49, p = 0.02), no antibiotic prophylaxis (OR 5.99, 95% CI 2.28–15.73, p

Background Central airway stenosis (CAS) in infants is characterized by dysphonia, dyspnea, cyanosis, repeated apnea, and infection. This case series study aimed to evaluate the safety and efficacy of holmium laser, cryoablation and budesonide inhalation in treating infants with severe CAS. Methods This retrospective study reviewed medical records data of 28 infants with severe CAS who underwent holmium laser treatment with cryoablation and/or balloon dilatation and budesonide inhalation therapy at Shanghai Children’s Medical Center between June 2014 and May 2020. Outcomes were defined as treatment success when the stenotic area was

Purpose: There is a lack of studies in the literature on effects of Virtual Basket™ (VB) and Bubble Blast™ (BB) laser pulse modulations of the Ho:YAG laser on tissue. We aimed to compare the effects of standard modulation (SM), VB, and BB pulse modulations of Ho:YAG laser on kidney tissue. Methods: An ex vivo experiment was conducted using veal kidneys. The Quanta System Cyber Ho 100W laser generator with a broad setting spectrum at 15–80 W, 10–40 Hz, 1.5–2 J, and medium pulse duration were tested. Incision depth (ID), vaporization area (VA), coagulation area (CA), and total laser area (TLA = VA + CA) were evaluated. Histopathological measurement outcomes were grouped as a low-power group (15, 20, and 30 W) and a high-power group (40, 60, and 80 W) according to the power outputs used. Results: A total of 108 experiments were performed. In saline and high-power output (40, 60, 80 W), mean VA, TLA, and ID, histopathological measurements were higher in BB pulse modulation than VB and SM pulse modulations (p: 0.03, p: 0.001, and p: 0.003, respectively). In contrast, mean CA and LE measurements were higher in SM than in VB and BB pulse modulations (p < 0.001 and p < 0.001, respectively). There was no statistically significant difference in mean histopathological measurements of VA, CA, TLA, and ID, among SM, VB, and BB pulse modulations in the low-power output group in saline (p > 0.05). Conclusion: VB can allow controlled dissection, as it does not create a large VA during surgical procedures. BB should be used in a controlled manner in soft tissue surgery due to its strong effect on tissues. [ABSTRACT FROM AUTHOR]

Introduction: Since Holmium laser enucleation of the prostate (HoLEP) was introduced in the 1990s as an endoscopic deobstructing modality for benign prostatic hyperplasia (BPH), several reports have concluded that HoLEP has compared favourably to transurethral resection of prostate (TURP) in relieving Bladder Outlet Obstruction (BOO). However, there has been no consensus regarding the efficacy of surgical management of men with Detrusor Underactivity (DU) and BOO. Methods: We performed a literature search of PubMed, Google Scholar, Scopus, and Web of Science databases. All studies that provided data on the effectiveness of HoLEP in men with BOO and DU were assessed. Data collected included the number of patients, median follow-up, International Prostate Symptom Score (IPSS), Qmax, post-void residual (PVR) and catheter dependency pre- and post-intervention. Results: Nine studies were identified in the literature with a follow-up range between 6 and 60 months. Only one prospective study was identified where investigators performed urodynamic studies (UDSs) before and after the intervention. In addition to a significant improvement of voiding parameters, they reported partial recovery of detrusor muscle contractility in approximately 80% of patients. Furthermore, all other studies reported an improvement in all outcome parameters and proved the efficacy of HoLEP in patients with DU and BOO. Conclusion: The current literature underpins the efficacy of HoLEP in patients with impaired bladder contractility. However, current research is limited and the majority of the published data are retrospective in nature. Therefore, more well-conducted prospective randomised studies are needed to reinforce high-level evidence for this hypothesis. Level of evidence: Not applicable. [ABSTRACT FROM AUTHOR]

The anterior urethral valve (AUV) is a rare cause of obstructive uropathy in children; they are much rarer than posterior urethral valves. A 13-year-old male presented with obstructive and irritative lower urinary tract symptoms (LUTS). On urethrocystoscopy, an AUV with a diverticulum was noted in the ventral surface of the urethra. It was ablated endoscopically using the holmium laser. Postoperatively, the patient voided successfully without any immediate complications. AUV with diverticulum may occur in adolescents. Endoscopic holmium laser ablation of the valve and the diverticulum is associated with good outcome. [ABSTRACT FROM AUTHOR]

Treatment of recurrent low-volume low-risk NMIBC include: TURBT, office fulguration and active surveillance. The clinical significance of post-office fulguration single dose mitomycin C instillation is unknown. In a single-institution retrospective cohort of 108 patients, we found that single-dose post-office fulguration MMC was associated with longer recurrence-free-survival (median RFS 20 months 95% CI 4-36) compared to the controlled group that did not receive adjuvant mitomycin C instillation (median RFS 9 months 95% CI 5-13) (P = .038). The treatment was safe and well-tolerated. Prospective evaluation is warranted. Introduction: Perioperative instillation of mitomycin-C (MMC) has shown effectiveness in reducing the recurrence of low-grade non-muscle invasive bladder cancer (NMIBC). Data is lacking about the impact of single-dose MMC following office fulguration of low-grade urothelial carcinoma. We compared the outcomes of small-volume low-grade recurrent NMIBC in patients treated with office-fulguration - with and without an immediate single-dose instillation of MMC. Patients and Methods: A retrospective analysis of medical records of patients with recurrent small-volume (=1 cm) low-grade papillary urothelial cancer who underwent fulguration in a single institution between January 2017 and April 2021 either with or without instillation of post-fulguration MMC (40mg/50 mL). The primary outcome was recurrence-free survival (RFS). Results: Of 108 patients (27% women) who underwent fulguration, 41% received intravesical MMC. The treatment and control groups had similar sex ratio, mean age, mass size, tumor multifocality and or tumor grade. Median RFS was 20 months (95% CI 4-36) in the MMC group and 9 months (95% CI 5-13) in the control group (P = .038). Multivariate Cox regression analysis showed that MMC instillation was associated with longer RFS (OR = 0.552, 95% CI 0.320-0.955, P = .034) and multifocality was associated with shorter RFS (OR = 1.866, 1.078-3.229, P = .026). A higher rate of grade 1-2 adverse events was observed in the MMC group (18.2%) vs. the control (6.8%, P = .048). No complications grade 3 or higher were observed. Conclusion: A single dose of MMC instilled after office fulguration is associated with longer RFS compared to patients who did not receive MMC after the procedure, with no associated high-grade complications. [ABSTRACT FROM AUTHOR]

Background: The management of urolithiasis has undergone significant advancements with the introduction of pulsed lasers, particularly the holmium:yttrium–aluminum-garnet (Ho:YAG) laser, which is currently considered the gold standard in endourology. However, the Ho:YAG laser has certain limitations, such as the inability to support small laser fibers (150 μm) and the requirement of a heavy water cooling system, making it challenging to transfer between operating rooms. These limitations have led to the emergence of new laser technologies, including the thulium fiber laser (TFL) and the thulium:yttrium–aluminum-garnet laser (Tm:YAG), as potential alternatives to the Ho:YAG laser. Methods: In this review, we aimed to evaluate the effectiveness and safety of TFL, Ho:YAG, and Tm:YAG lasers in real-life scenarios by comparing clinical trial data with laboratory findings. A literature review was conducted, and relevant in vitro studies and clinical trials until March 2023 were analyzed. Results: The findings indicate that TFL has demonstrated high ablation efficiency for stones of any composition, size, and location, superior the capabilities of Ho:YAG lasers. TFL has shown superior dusting and fragmentation abilities, lower retropulsion, and increased patient safety. The laser parameters, such as ablation efficiency, speed, operative time, dust quality, retropulsion, visibility, temperature safety, and stone-free rate, were compared between laboratory studies and clinical outcomes. Conclusion: Although the number of studies on TFL is limited, the available evidence suggests that TFL represents a significant advancement in laser technology for lithotripsy. However, further research is needed to fully explore the implications and limitations of TFL and Tm:YAG lasers. [ABSTRACT FROM AUTHOR]

Advances in laser technology and surgical telescopic systems have propelled retrograde intrarenal surgery (RIRS) to the forefront as a viable alternative to percutaneous nephrolithotomy (PCNL). Currently, RIRS is being increasingly utilized as a treatment option, even for kidney stones larger than 2 cm. In this narrative review, we aimed to take a snapshot of current practice in renal stone treatment and the latest technological and technical developments and to evaluate the efficacy of RIRS in larger renal stones. With low complication rates and acceptable stone-free rates, RIRS offers patients a less invasive option with favorable outcomes. There are insufficient data comparing PCNL with RIRS using a new-generation high-power laser and suctioning ureteral access sheath (UAS). Further studies with novel lasers and UAS could provide superiority in terms of RIRS. It is crucial to take into account various patient-specific considerations, such as stone location and burden, when deciding on the appropriate treatment approach. [ABSTRACT FROM AUTHOR]

Objective: To explore the efficacy, safety, and feasibility of holmium laser flexible ureteroscopic intrapelvic drainage in the treatment of parapelvic renal cysts. Methods: From September 2012 to February 2019, a total of 18 patients, aged from 28 to 62 (mean±standard deviation [SD]: 46.50±9.14) years, were diagnosed with parapelvic renal cysts and treated by holmium laser flexible ureteroscopic intrapelvic drainage. There were 10 males and eight females. All of the parapelvic renal cysts were unilateral, and two cases were complicated with pyelolithiasis. The diameters of the cysts ranged from 4.1 cm to 8.2 cm. Results: All the patients completed the operation successfully in one stage without conversion to open surgery; in two cases, it was difficult to find the cysts during the operation, and the localization was completed by B-ultrasound and percutaneous injection of methylene blue. The mean operative time was 33.89 (SD: 9.68; range: 22–54) min, and the mean hospitalization time was 2.67 (SD: 0.91; range: 2–5) days. Three months and 6 months of follow-up were performed after surgery. The cysts disappeared in 13 (72%) cases, and the diameter of the cysts in five (28%) cases decreased by more than 50%. Conclusion: Holmium laser flexible ureteroscopic intrapelvic drainage in the treatment of parapelvic renal cysts is simple, safe, and effective, and can be used as the first choice for the treatment of parapelvic renal cysts.

Introduction: Retrograde intrarenal surgery (RIRS) alongside percutaneous surgery is gaining a leading position in the nephrolithiasis treatment. According to 2022 EAU Guidelines, RIRS is one of the basic surgical modalities to treat 10-20 mm kidney concrements. Turning concrements into dust, holmium laser is the most effective and safest method for concrement disintegration.Objective: To determine surgical possibilities of holmium laser lithotripsy for single and multiple unilateral nephrolithiasis using disposable flexible ureterorenoscopes.Materials and methods: We performed 124 interventions from October 2021 to October 2022 using LithoVue flexible ureterorenoscope in patients with nephrolithiasis, of them 70 males and 54 females with the mean age being 54 (27–74) years. Patients were divided into 2 groups: group I (56 patients) with a single renal concrement, group II (68 patients) with multiple concrements (2 to 7 pieces). The concrement size ranged from 5 to 20 mm. The density of kidney concrements on computed tomography (CT) was 214 to 1,620 HU. LightTrail 230 μm and 270 μm reusable laser fibers were chosen for Auriga XL holmium laser crushing mode. Laser operating settings were as follows: frequency 8 Hz, pulse energy 1,200 mJ (LightTrail 230 µm) and frequency 12 Hz, pulse energy 1,800 mJ (LightTrail 270 µm). These are the maximum setting values for the specific laser fibers.Results: Average time of 1 concrement disintegration (V = 1 cm3) was 28.3 minutes. Concrement disintegration time was 21.4 ± 6.7 minutes (group I) and 42.3 ± 9.4 minutes (group II). Intervention time was 27.4 ± 8.3 minutes (group I) and 54.6 ± 12.4 minutes (group II). In-hospital stay was 2.5 ± 1 days (group I) and 3 ± 1 days (group II). The rate of surgical success according to CT scans was 92.6% (group I) and 88.2% (group II). Two patients in group I and 5 patients in group II required reintervention. One patient (1.8%) in group I and 3 patients (4.4%) in group II developed an acute pyelonephritis (Clavien-Dindo classification, grade II). In the remaining patients the complications did not exceed Clavien-Dindo grade I. There were no equipment-related issues in the perioperative period.Conclusions: As a safe and effective procedure with low complication rate, fast postoperative recovery, and short hospital stay, RIRS can be used as a method of choice for disintegration of kidney concrements up to 20 mm in size.

PurposeThis study aimed to evaluate the efficacy and safety of same-session flexible ureteroscopy (fURS) for the treatment of bilateral upper urinary tract stones and to examine the influence of stone load on the outcome of same-session fURS, stratifying by total diameter of stones (TDS) ≤30 mm vs. >30 mm.Patients and methodsWe retrospectively reviewed all cases of same-session fURS performed for bilateral upper urinary tract stones at four institutions between January 2017 and September 2020. All patients were divided into two groups based on TDS, ≤30 mm and >30 mm. Data on patient demographics, stone characteristics, surgical results, and complications were collected and analyzed for differences between the two groups. Stone-free rate (SFR) was defined as patients endoscopically stone-free or with radiological fragments 30 mm group. The mean bilateral stone size was 28.2 ± 12.2 mm (range: 9.1–38.4 mm), with a mean operating time of 97.1 ± 39.6 min (range: 19–220 min). The SFR was 54.5% after the first fURS, and SFR increased to 97.5% after re-fURS for residual stones. The operation time for the TDS > 30 mm group was longer than that of the TDS ≤ 30 mm group (85.1 ± 36.5 vs. 115.4 ± 37.4 min, p < 0.001). The SFR after the first fURS was significantly lower in the TDS > 30 mm group than in the TDS ≤ 30 mm group (25.0% vs. 73.9%, p < 0.001). Although there was no statistically significant difference in overall SFR between the two groups (93.7% vs. 100%, p = 0.060), the rate of re-fURS for residual stones was higher in the TDS > 30 mm group than in the TDS ≤ 30 mm group (75% vs. 26%, p < 0.001). There were no significant differences in length of hospital stay (LOS) (2.2 ± 0.7 vs. 2.3 ± 1.0, p = 0.329) or complication rate (10.9% vs. 14.6%, p = 0.582) between the two groups.ConclusionThe results suggested that same-session fURS can be effectively performed with a low complication rate. A higher SFR after the first fURS can be achieved in the case of bilateral upper urinary tract stones with TDS ≤ 30 mm, and priority should be given to same-session fURS.

The aim of this study was to introduce a new surgical procedure for the resection of sigmoid colon tumours invading the bladder by combining laparoscopy and cystoscopy, and the feasibility and safety of the method were verified. The data of 6 patients with sigmoid colon cancer invading the bladder in a tertiary hospital in Chongqing from January 2020 to October 2022 were collected, sigmoid colon tumour resection was performed by this procedure, and the data related to the surgery were recorded. All six patients successfully underwent sigmoid colon tumour resection, and all sigmoid colon and bladder resections had negative margins. The mean total operative time was 211.66 ± 27.33 min, and the mean resection time of the bladder tumour was 22.16 ± 4.63 min. The median blood loss was 100 ml, and the mean number of retrieved lymph nodes was nineteen. There were no serious intraoperative complications in any of the cases. After operation, the first flatus and defecation were 4 and 4.5 days, respectively. The mean time of drainage tube retention and the time of bladder flushing were 3 and 1.5 days, respectively. The mean time of urinary tube retention was 7.5 days. There were no intestinal obstructions, dysuria, or other complications. For patients with sigmoid colon tumours invading the bladder, this method can effectively resect sigmoid colon tumours and minimize the loss of bladder tissue at the same time, which helps to prolong the survival of these patients. The surgical method is safe, reliable, and feasible. [ABSTRACT FROM AUTHOR]

In this paper the evolution of endoscopic prostate enucleation is reviewed in chronological order based on energy technology starting first with holmium laser, then bipolar electrocautery, following by thulium laser and finally greenlight laser enucleation of the prostate. [ABSTRACT FROM AUTHOR]

Objective: Laser lithotripsy has been the standard of care for lower and mid-ureteric calculi. Thulium fiber laser (TFL) is a new introduction to this field, which has been extensively studied for retrograde intrarenal surgery. We have done a prospective randomized study of ureteroscopic lithotripsy between TFL and holmium: Yttrium-aluminum-garnet (HO: YAG) laser to know the efficacy of stone fragmentation, stone-free rate, and complications. Methodology: A prospective randomized study was done in our hospital from March 2021 to May 2022 on patients planned for ureteroscopic laser lithotripsy. Patients with distal and mid-ureteral stones from 4 mm to 15 mm were included. The laser was used to fragment the stone. All the stones were fragmented from the center to periphery. The setting used was up to 10 W (6–10 Hz, 1J) for TFL and up to 10W for HO: YAG (5–10 Hz, 0.5–1J). Once the stones were fragmented, they were retrieved until complete visual clearance. Demographic data and stone parameters such as stone size, volume, density, laterality, laser usage time, total operative time, and total energy used were recorded. Operative time, lasering time, retropulsion rate, ablation speed, and visibility score were recorded. Results: Each group had 90 randomized patients. Both the groups had similar kinds of patient and stone profiles. The mean operating time was 18.5 ± 1.5 min (95% confidence interval [CI] 16.2–25.6) in the TFL group, which was shorter than the holmium group 31.6 ± 1.2 min (95% CI 18.4–38.5), and it was statistically significant (P = 0.024,). Lasering time was also statistically significant with less lasering time with TFL group 7.4 ± 1.8 min (95% CI 5.2–10.3) versus holmium group 14.8 ± 1.5 min (95% CI 12.3–18.4) (P = 0.011). Laser efficacy and ablation speed were better in the TFL group compared to the HO: YAG group and were statistically significant. The visual score was better in HO: YAG group compared to the TFL group. Conclusion: TFL is more efficacious and faster than Holmium: Yag laser. Complications were similar between the groups. Stone-free rate was also similar between both the groups. [ABSTRACT FROM AUTHOR]

Objectives: To report the safety and efficacy of holmium laser and compare its results with cold knife visual internal urethrotomy (VIU) in the management of short segment urethral stricture. Methods: This prospective randomized study included 66 male patients aged more than 18 years, with short segment bulbar urethral strictures < 2 cm from March 2020 to March 2022. The patients were randomized into two groups each containing 33 patients. In group A (Cold knife group), Sachse cold knife was used for stricture treatment. In group B (Holmium group), internal urethrotomy was done with Ho:YAG laser. Patients were evaluated before the operation and followed up after the operation at 1, 3, 6 and 12 months by physical examination, IPSS, PVR, Qmax and retrograde urethrography. Results: There was significant improvement in the mean values of IPSS, PVR and Qmax in both groups. There was no significant difference between both groups in the mean values of IPSS, PVR and Qmax during follow-up visits. However, at the end of follow-up at one year there was statistically significant difference between both groups in the mean values of IPSS, PVR and Qmax due to higher recurrence rate in cold knife group than laser group. The overall complication rate is significantly lower in laser group (p = 0.014). Conclusion: Holmium laser VIU is an effective and safe treatment option for short segment urethral stricture with shorter operative time, less complication rate and less recurrence than cold knife VIU. [ABSTRACT FROM AUTHOR]

Purpose: To determine the factors affecting morcellation efficiency in holmium laser enucleation of the prostate (HoLEP) surgery. Materials and Methods: Patients who underwent HoLEP surgery by a single surgeon between 2018 and 2022 were included in the study. Our primary outcome of interest in this study was morcellation efficiency. The effect of preoperative and perioperative variables on morcellation efficiency was evaluated with linear regression analysis. Results: A total of 410 patients were included in the study. The mean morcellation efficiency was 6.95±1.70 g/min. Univariable and multivariable linear regression analysis was performed to identify factors affecting morcellation efficiency. Presence of the "beach ball" effect (small, round prostatic tissue fragments that are fibrotic and difficult to morcellate), the learning curve, resectoscope sheath type, prostate-specific antigen (PSA) density, morcellated tissue weight, and the presence of prostate calcification were found to be independent predictive factors (β=-1.107, 95% CI: -1.59 to -0.55, p<0.001; β=-0.514, 95% CI: -0.85 to -0.17, p=0.003; β=-0.394, 95% CI: -0.65 to -0.13, p=0.003; β=-0.302, 95% CI: -0.59 to -0.09, p=0.043; β=0.062, 95% CI: 0.05 to 0.06, p<0.001; β=-0.329, 95% CI: -0.55 to -0.10, p=0.004; respectively). Conclusions: This study reports that presence of the beach ball effect, the learning curve, small resectoscope sheath, PSA density, and presence of prostate calcification negatively affect morcellation efficiency. On the contrary, morcellated tissue weight has a linear relationship with morcellation efficiency. [ABSTRACT FROM AUTHOR]

Abstract Purpose In this study, the feasibility of a no bladder irrigation strategy after transurethral holmium laser enucleation of the prostate (HoLEP) for the treatment of benign prostatic hyperplasia (BPH) was studied. Methods From August 2021 to December 2021, the clinical data of 62 patients who received no bladder irrigation after HoLEP (Group A) were studied. The control group contained the clinical data of 150 patients in the same therapy group (from January 2021 to July 2021) who received continuous bladder irrigation after HoLEP (Group B). The baseline was consistent after using the propensity score matching (PSM) method, and the differences between groups were compared. The pre- and postoperative complications, international prostate symptom score (IPSS), quality of life (QOL), maximum urinary flow rate (Qmax), and postvoid residual urine (PVR) of the two groups were compared, accompanied by a follow-up evaluation of surgical effects. Results 47 pairs of patients were successfully matched by PSM. There was no statistically significant difference in the intraoperative conditions and the incidence of early postoperative complications between the two groups (P > 0.05). Before and one month after the surgery, significant differences were also found in the IPSS, QOL, Qmax, and PVR of both groups (P 0.05). Conclusion For appropriately selected patients according to the exclusion criteria, the no bladder irrigation strategy after HoLEP for BPH is safe and effective.

Objective: Laser lithotripsy has been the standard of care for lower and mid-ureteric calculi. Thulium fiber laser (TFL) is a new introduction to this field, which has been extensively studied for retrograde intrarenal surgery. We have done a prospective randomized study of ureteroscopic lithotripsy between TFL and holmium: Yttrium-aluminum-garnet (HO: YAG) laser to know the efficacy of stone fragmentation, stone-free rate, and complications. Methodology: A prospective randomized study was done in our hospital from March 2021 to May 2022 on patients planned for ureteroscopic laser lithotripsy. Patients with distal and mid-ureteral stones from 4 mm to 15 mm were included. The laser was used to fragment the stone. All the stones were fragmented from the center to periphery. The setting used was up to 10 W (6–10 Hz, 1J) for TFL and up to 10W for HO: YAG (5–10 Hz, 0.5–1J). Once the stones were fragmented, they were retrieved until complete visual clearance. Demographic data and stone parameters such as stone size, volume, density, laterality, laser usage time, total operative time, and total energy used were recorded. Operative time, lasering time, retropulsion rate, ablation speed, and visibility score were recorded. Results: Each group had 90 randomized patients. Both the groups had similar kinds of patient and stone profiles. The mean operating time was 18.5 ± 1.5 min (95% confidence interval [CI] 16.2–25.6) in the TFL group, which was shorter than the holmium group 31.6 ± 1.2 min (95% CI 18.4–38.5), and it was statistically significant (P = 0.024,). Lasering time was also statistically significant with less lasering time with TFL group 7.4 ± 1.8 min (95% CI 5.2–10.3) versus holmium group 14.8 ± 1.5 min (95% CI 12.3–18.4) (P = 0.011). Laser efficacy and ablation speed were better in the TFL group compared to the HO: YAG group and were statistically significant. The visual score was better in HO: YAG group compared to the TFL group. Conclusion: TFL is more efficacious and faster than Holmium: Yag laser. Complications were similar between the groups. Stone-free rate was also similar between both the groups.

Objective: Many studies have demonstrated the heat effect from the holmium laser lithotripsy can cause persistent thermal injury to the ureter. The purpose of this study was to elucidate the use of a modified ureteral catheter with appropriate firing and irrigation to reduce the thermal injury to the “ureter” during the ureteroscopic holmium laser lithotripsy in vitro. Methods: An in vitro lithotripsy was performed using a modified catheter (5 Fr) as the entrance for the irrigation and the holmium laser fiber while using the remaining space in the ureteroscopic channel as an outlet. Different laser power settings (10 W, 20 W, and 30 W) with various firing times (3 s, 5 s, and 10 s) and rates of irrigation (15 mL/min, 20 mL/min, and 30 mL/min) were applied in the experiment. Temperature changes in the “ureter” were recorded with a thermometer during and after the lithotripsy. Results: During the lithotripsy, the local highest mean temperature was 60.3 °C and the lowest mean temperature was 26.7 °C. When the power was set to 10 w, the temperature was maintained below 43 °C regardless of laser firing time or irrigation flow. Regardless of the power or firing time selected, the temperature was below 43 °C at the rate of 30 mL/min. There was a significant difference in temperature decrease when continuous 3 s drainage after continuous firing (3 s, 5 s, or 10 s) compared to with not drainage (p

Purpose: To evaluate the effect of urinary retention (UR) on holmium laser enucleation of the prostate (HoLEP) in patients with benign prostatic hyperplasia (BPH) and lower urinary tract symptoms. Materials and Methods: A retrospective analysis of a prospective cohort of patients who underwent HoLEP between January 2010 and December 2016 was performed. The perioperative factors, including the International Prostate Symptom Score, Overactive Bladder Symptom Score, prostate-specific antigen, urodynamic study results, uroflowmetry results, transrectal ultrasound prostate volume, operative time, morcellation time, enucleation weight, and complications, were evaluated. Postoperative evaluation was performed at 2, 3, and 6 months. Results: Overall, 903 patients were identified. The mean age and follow-up were 68.3 years and 6 months, respectively. Among the patients, 135 (15.0%) patients had a history of acute UR (AUR), and 36 patients (4.0%) had chronic UR (CUR). The mean detrusor pressures at maximum flow were 64.4, 74.3, and 77.7 cmH2O (p

To assess the role of laparoscopic laser ovarian drilling in surgical management of polycystic ovary syndrome (PCOS) in comparison to other surgical techniques. The study involved 60 women diagnosed with polycystic ovary syndrome (clinical symptoms of the disease, as well as pelvic ultrasound scans and serum hormone levels, were assessed before and after surgery). Depending on the type of surgery, all patients were divided into groups: group № 1 (30 patients) underwent laparoscopic laser ovarian drilling using holmium laser, group № 2 (30 patients) underwent laparoscopic ovarian cautery using needle electrode. Group № 1 patients showed significantly higher rate of ovulation recovery and reproductive success in the program of assisted reproductive technologies (ART) when compared to group № 2 patients. When timely referred to the ART program after surgery, PCOS patients have a significantly higher chance of success in attaining and maintaining pregnancy. Ключевые слова. Синдром поликистозных яичников, лазерный дриллинг, гольмиевый лазер, электронож.

Abstract Background Holmium laser enucleation of the prostate (Holep) is a safe, effective, and prostate size-independent procedure for benign prostatic hyperplasia treatment (BPH). Holep has demonstrated comparable long-term outcomes with historical BPH mainstay treatments, namely open prostatectomy or transurethral resection of the prostate, as well as straightforward evidence of its low morbidity. In this study, we aimed to report our 3-year Holep experience based on 173 patients. Methods We conducted a retrospective descriptive single center study utilizing medical charts of 173 patients who underwent Holep between 2017 and 2020. Peri and postoperative measures included prostate volume, peak urinary flow rate (Qmax), prostate specific antigen, catheterization time, hospital stay, and complications. Results The mean age and mean prostate weight at baseline were 71.3 ± 7.8 years and 64.2 g (17 and 380 g), respectively. Holep was associated with a short catheterization time and hospital stay (2.7 and 3 days, respectively). Qmax significantly improved after Holep (8.1 vs 20.4 ml/s, p

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]