Consensus statement addressing controversies and guidelines on pediatric urolithiasis.

PURPOSE: We aimed to investigate controversial pediatric urolithiasis issues systematically, integrating expert consensus and comprehensive guidelines reviews. METHODS: Two semi-structured online focus group meetings were conducted to discuss the study's need and content, review current literature, and prepare the initial survey. Data were collected through surveys and focus group discussions. Existing guidelines were reviewed, and a second survey was conducted using the Delphi method to validate findings and facilitate consensus. The primary outcome measures investigated controversial issues, integrating expert consensus and guideline reviews. RESULTS: Experts from 15 countries participated, including 20 with 16+ years of experience, 2 with 11-15 years, and 4 with 6-10 years. The initial survey identified nine main themes, emphasizing the need for standardized diagnostic and treatment protocols and tailored treatments. Inter-rater reliability was high, with controversies in treatment approaches (score 4.6, 92% agreement), follow-up protocols (score 4.8, 100% agreement), and diagnostic criteria (score 4.6, 92% agreement). The second survey underscored the critical need for consensus on identification, diagnostic criteria (score 4.6, 92% agreement), and standardized follow-up protocols (score 4.8, 100% agreement). CONCLUSION: The importance of personalized treatment in pediatric urolithiasis is clear. Prioritizing low-radiation diagnostic tools, effectively managing residual stone fragments, and standardized follow-up protocols are crucial for improving patient outcomes. Integrating new technologies while ensuring safety and reliability is also essential. Harmonizing guidelines across regions can provide consistent and effective management. Future efforts should focus on collaborative research, specialized training, and the integration of new technologies in treatment protocols.

The low power effect on holmium laser enucleation of prostate (HoLEP); A comparison between 20W and 37,5W energy regarding apical enucleation efficacy and patient safety.

INTRODUCTION: The Holmium laser has proven to be an invaluable tool for endoscopic prostate enucleation. The proper energy selection, during the different steps of the procedure, has always been a matter of debate. In this work we compare the effectiveness of the Holmium laser, using two different low-power energy settings, during enucleation and hemostasis (20W and 37.5W). METHODS: One hundred and sixty patients underwent a HoLEP procedure with a 50Hz and 2J (100W) setting. During enuleation and hemostasis, two different low-power settings were applied (20W vs. 37.5W). In both groups, only the prostatic tissue in the bladder neck and enucleated tissue far away from the apex, were cut with a setting of 50Hz and 2J (100W). RESULTS: The mean enucleation efficiency (0.78 vs. 1.2g/min-p:001) was significantly higher by utilizing 37.5W energy (group 2). Additionally, the mean enucleation rate (0.64 vs. 0.88%-P:0.001) and laser efficiency (2.07 vs. 2.12 joule/g-P:0.003) were significantly higher in group 2. The enucleation time was significantly shorter (54 vs. 75.5 mins-P:0.002), while the mean catheter removal time (27 vs. 42 hrs-P:0.008) and Hb decrease (0.5 vs. 0.6g/dl--P:0.019) were significantly lower in group 2. CONCLUSIONS: HoLEP can be performed efficiently with 100 W-37.5W settings. Enucleation and hemostasis can be performed successfully with 37.5W, while the use of 100W during bladder neck dissection shortens the duration of the procedure. LEVEL OF EVIDENCE: 3.

[Prostate biopsy: Procedure in the clinical routine]. / Prostatabiopsie : Durchführung im klinischen Alltag.

Over the last decade there has been a 25% decrease in the mortality rates for prostate cancer. The reasons for this significant decrease are most likely associated with the application of urological screening tests. The main tools for early detection are currently increased public awareness of the disease, prostate-specific antigen (PSA) tests and transrectal ultrasound (TRUS) guided topographically assignable biopsy sampling. Together with the histopathological results these features provide essential information for risk stratification, diagnostics and therapy decisions. The evolution of prostate biopsy techniques as well as the use of PSA testing has led to an increased identification of asymptomatic men, where further clarification is necessary. Significant efforts and increased clinical research focus on determining the appropriate indications for a prostate biopsy and the optimal technique to achieve better detection rates. The most widely used imaging modality for the prostate is TRUS; however, there are no clearly defined standards for the clinical approach for each individual biopsy procedure, dealing with continuous technical optimization and in particular the developments in imaging. In this review the current principles, techniques, new approaches and instrumentation of prostate biopsy imaging control are presented within the framework of the structured educational approach.