Adequate Mentorship Program for Holmium Laser Enucleation of the Prostate (HoLEP) Leads to Satisfactory Short-Term Outcomes in the Early Learning Curve of Young Urologists: First-Year Outcomes of a Newly Established Mentorship Training in Mexico.

Introduction Benign prostatic hyperplasia (BPH) is one of the most common causes of lower urinary tract symptoms in men. Holmium Laser Enucleation of the Prostate (HoLEP) has been recommended by international guidelines as an alternative to transurethral resection of the prostate (TURP). HoLEP's learning curve and the lack of adequate mentorship remains an obstacle for the worldwide adoption of this technique. Objective To report the first-year learning curve of a newly established mentorship program in young urologists without any previous HoLEP experience. Methods We report a cohort of patients with BPH, with prostate size ≥70 grams, treated with HoLEP, analyzed for perioperative data and complications, and short-term postoperative complications and functional outcomes, at three and six months after surgery. Results A total of 47 patients were managed with HoLEP. Mean total operative time was 149.8 ± 42.9 minutes. We experienced five (10.6%) intraoperative complications, including one intravesical resection of the prostate with bipolar energy, three conversions to TURP and one conversion to open prostatectomy. We experienced four postoperative complications, all of them Clavien-Dindo ≤2. Median International Prostate Symptom Score (IPSS) decrease at six months was -17 points from baseline. Mean post-void residual volume and prostate-specific antigen significantly decreased by the third postoperative month. Multiple linear regression showed that prostate size is directly related to increased surgical time during the early learning curve. Discussion Our experience adequately reflects the importance of HoLEP mentorship in young urologists seeking training in this technique. Both surgeons had perioperative and postoperative outcomes deemed satisfactory based on previously published learning curves. Conclusions HoLEP is a technically difficult procedure, however, adequate mentorship leads to satisfying short-term outcomes since the early stages of the learning curve in young urologists with no previous training on this technique.

Fluorescence Guided Cholecystectomy by a Single Group: Initial 47 Procedures Experience in Mexico.

Introduction: Fluorescence guided surgery (FGS) for biliary surgery uses indocyanine green (ICG), a specific dye that is eliminated almost exclusively by the liver and biliary system, making it very useful for an adequate and safe visualization of biliary tract structures. Methods: We present our experience with FGS for cholecystectomy multiport and single port, including all patients older than 18 years of age, with diagnosis of cholecystitis (acute and chronic), from October 18, 2018 to December 30, 2021. Results: A total of 47 patients were managed with FGS cholecystectomy, mean age was 61.2 (± 17.7) years, 31 (65.9%) were female and 16 (34.1%) males. Twenty-four (51.1%) were emergency procedures, due to acute cholecystitis, of which 10 (41.7%) presented with an infected gallbladder (Parkland 3 to 5) and three (12.5%) presented with related acute pancreatitis, the remaining 23 (48.9%) cases were elective surgeries, due to chronic cholecystitis. Visualization of laparoscopic fluorescence of the biliary ducts was achieved in 45 of the 47 patients (95.7%). Mean time for biliary tract structures visual identification was 8 minutes and 40 seconds (± 7 minutes, 20 seconds), fluorescence allowed the visualization of biliary tract anatomical variants in two patients. Discussion: The reported rate of biliary structures visualization using ICG is relatively variable, ranging from 25% to 100%, in our group it was 95.7% due to our protocol. Conclusions: ICG utilization for cholecystectomy is very useful and helps for a safe procedure even in difficult surgeries, we believe that it should be used in everyday practice.

Localized genitourinary tract Aspergillus infection in an immunocompetent patient: Bladder and epidydimal aspergillosis.

Invasive bladder Aspergillosis has only been reported in six publications so far. A 74-year-old male, presented to the emergency department with fever, abdominal pain, and right testicular enlargement. Abdominal computed tomography concluded a bladder tumor and testicular ultrasound reported right epididymitis. Cystoscopy showed a bladder fungal mass, which was extracted with cystotomy. Pathological findings reported Aspergillus species. The patient was successfully treated with 4-week oral Isovuconazole. The first bladder Aspergillosis was published in 1978. The most recent case was published in 2020. Aspergillosis infection is extremely rare disease, treatment with Isavuconazole is efficient.