General anesthesia is associated with lower perioperative bleeding and better functional outcomes than spinal anesthesia for endoscopic enucleation of the prostate: a single-center experience.

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.

Is trans-sacral endoscopic laser decompression truly effective? Clinical and functional assessment of a single spine center.

Background: Herniated nucleus pulposus (HNP), without causing significant neurological deficit, is a more frequently occurring disease of the spine affecting the activities of daily living with chronic back pain and sometimes progressing to produce significant functional deficit. Trans-sacral epiduroscopic laser decompression (SELD) is being increasingly used as a treatment modality for these conditions and has been shown to give effective results. We present the clinical outcomes of the patients undergoing SELD in our institute for HNP. Methods: A retrospective study of 411 patients who underwent SELD for lumbar disc herniation was done, analyzing the clinical outcomes by measuring visual analog scale (VAS) scores for leg pain and back pain, Oswestry Disability Index (ODI) score, and Short form health survey (SF -36) scores and followed up for 6 months. Results: A total of 195 males and 216 females underwent SELD, with a mean age of 33.2 ± 0.9 years and a mean follow-up period of 7 ± 1.6 months. VAS scores for back pain and leg pain improved significantly from 6.9 ± 0.5 and 6.6 ± 0.6 preoperatively to 1.1 ± 0.5 (P > 0.05) and 0.4 ± 0.5 (P > 0.05) at 6 months. ODI score decreased from 28.2 ± 1.7 to 9.4 ± 1.7 at 6 months from the intervention (P < 0.05). SF-36 showed significant improvement in overall categories through 6 months of follow-up. Twenty-four patients had dural punctures, and four patients needed blood patches but recovered without any complications. One patient had aggravation of the disc herniation post-procedure, and was managed by endoscopic discectomy. Conclusion: SELD is a safe, accurate, and effective procedure in treating symptomatic lumbar disc herniation with excellent clinical outcomes and effective pain relief with minimal damage to paraspinal muscles with an easier learning curve, reproducible results, and high safety index.

Morphological Characterization of Tissue Destruction According to the Distance Between Holmium:YAG Laser Tip and Tissue Surface.

PURPOSE: Little is known about the soft tissue destruction by holmium laser clinically used for holmium laser enucleation of the prostate (HoLEP), subject to the distance between the laser fiber tip and the tissue surface. We aimed to investigate the impact of the distance between the laser fiber tip and the phantom surface (DLP) on a soft tissue phantom (STP) in relation to the surgical modes of HoLEP. METHODS: STP responses to the laser pulses produced by a commercial holmium:yttrium aluminum garnet (Holmium:YAG) laser at an output setting 2 J were observed at different values of the DLP (0, 1, 2, 3, and 4 mm) to look at (1) the single laser pulse-induced cavitation bubble and its penetration into the STP, (2) the STP destruction by a single pulse, (3) the STP destruction by 60 pulses repeated at 12 Hz, and (4) the thermal effect by the multiple pulses visualized on a thermosensitive bovine serum albumin (BSA) STP. RESULTS: We observed that the laser pulse produced a heated gas bubble in water centered at the laser fiber tip. The bubble shape depended on the DLP. The bubble completely penetrated into the STP at the DLP of 0 mm and the penetration decreased with the DLP. The size of the destruction of the STP by the laser pulses was shown to decrease as the DLP increased. Test with the BSA STP showed that, at the DLP of 3 mm, the destruction became insignificant while the thermal effects were still effective. CONCLUSION: We illustrated that soft tissue destruction by the Holmium:YAG laser is associated with cavitation effects. We provide for the first time experimental evidence for various surgical modes in HoLEP such as incision and hemostasis in relation to the DLP.

New frontiers in radioembolization.

Radioembolization is a locoregional transarterial therapy that combines radionuclide and micron-sized beads to deliver radiation internally to the target tumors based on the arterial blood flow. While initially developed as a palliative treatment option, radioembolization is now used for curative intent treatment, neoadjuvant therapy, and method to downstage or bridge for liver transplant. Radioembolization has become increasingly utilized and is an important therapeutic option for the management of hepatocellular carcinoma and liver metastasis. This article provides an overview of the techniques, challenges, and novel developments in radioembolization, including new dosimetry techniques, radionuclides, and new target tumors.

Ultrasound-Guided Sialendoscopy Surgery for Parotid Sialolithiasis Using Yttrium Aluminum Garnet (YAG)-Holmium Laser: A Prospective Case Series.

BACKGROUND: Parotid sialolithiasis is a common condition in middle-aged individuals, with most cases occurring in the submandibular and sublingual glands, followed by the parotid glands and minor salivary glands. The treatment of salivary gland stones, particularly those of the parotid glands, remains challenging. Endoscopic surgery using a yttrium aluminum garnet (YAG)-holmium laser for parotid sialolithiasis is a minimally invasive approach that provides effective treatment for patients. This study aimed to evaluate the outcomes of the endoscopic laser treatment of parotid sialolithiasis a YAG-holmium laser. MATERIALS AND METHODS: A prospective case series study was conducted on 21 patients diagnosed with salivary gland stones in the parotid gland based on clinical features and imaging findings (including ultrasound and computed tomography scans), from March 2022 to March 2024. These patients underwent sialendoscopy surgery using a YAG-holmium laser and were evaluated for surgical results at 2, 4, and 12 weeks. RESULTS: Cases with completely reduced symptoms accounted for 90.5%, whereas cases with partially reduced symptoms accounted for 9.5%. The ultrasound image of the salivary gland after surgery was significantly improved compared to that before surgery. After three months of surgery, most patients (90.5%) were satisfied. The postoperative complication rate was 14.3%, which included scarring at the opening of the salivary gland and in the salivary duct. CONCLUSION: Sialendoscopic surgery using a YAG-holmium laser for parotid sialolithiasis is a minimally invasive surgical intervention that leaves no scarring, reduces the risk of complications as seen in open surgery, and shortens the postoperative care time for patients.

Propensity Score Matching Analysis of Differential Outcomes in Holmium Laser Enucleation of the Prostate vs. Robotic-Assisted Simple Prostatectomy.

Background & Objectives: Patients with bladder outlet obstruction (BOO) due to massive prostate enlargement have several surgical treatment options, such as robot-assisted simple prostatectomy (RASP) and holmium laser enucleation of the prostate (HoLEP). Postoperative outcomes may differ between those undergoing RASP and HoLEP. RASP has been associated with a lower incidence of transient stress urinary incontinence (SUI), while HoLEP allows for shorter catheterization times. Here, we report on our experience with both surgical modalities. Methods: Data were collected from prospectively maintained databases for 37 RASP patients and 181 HoLEP patients treated from July 2021 to November 2023. To control for selection bias, propensity score matching (PSM) was utilized based on age and prostate size. We compared patients' preoperative, perioperative, and postoperative outcomes both before and after applying PSM. Results: Before the PSM, the median prostate size was significantly lower in the HoLEP group (p < 0.001). The HoLEP group also had significantly shorter operative times (p ≤ 0.001) and lower weights of resected adenoma (p ≤ 0.001). After the PSM of 31 RASP and 31 HoLEP patients, all baseline patient characteristics were comparable. No significant differences were observed in operation time (p = 0.140) or in the weight of resected adenoma (p = 0.394) between the modalities. The median (IQR) length of catheterization was significantly shorter in the HoLEP group (1 [1-4] days) compared to the RASP group (7 [7-8] days), in both pre- and post-matching analyses (p ≤ 0.001 for both), reflecting the standard of practice. In contrast, in both pre- and post-PSM analyses, the average hospital stay was significantly shorter in the RASP cohort, as same-day discharge is standard in our center, whereas the HoLEP cohort required overnight stays due to routine continuous bladder irrigation before discharge (p < 0.001 for all). Notably, the SUI rates and American Urological Association (AUA) symptom scores were comparable at 3 months within both matched and unmatched cohorts (pre-PSM: p = 0.668, p = 0.083; post-PSM: p = 1, p = 0.152, respectively). Conclusions: Our comparative analysis indicates that both RASP and HoLEP yield similar outcomes, including SUI rates, at 3 months. While HoLEP provided shorter durations of postoperative catheterization, RASP offered shorter hospital stays.

En-bloc resection of non-muscle invasive urinary bladder tumors using low power Holmium laser-A new promise.

INTRODUCTION: Urinary bladder tumors are one of the most common urological malignancies. Traditionally, it has been initially managed with conventional trans-urethral resection of urinary bladder tumors (cTURBT) which has certain drawbacks and complications. Efforts have been made to find newer methods for management. In this study, we have used low power Holmium laser en-bloc resection and have assessed its safety, efficacy and feasibility. MATERIALS AND METHODS: Forty patients have been included in this prospective observational study who underwent low power Holmium laser en-bloc resection of urinary bladder tumor after taking Institutional ethical committee clearance and informed consent from all the patients. Intra-operative and post-operative data were collected. RESULTS: The average tumor size was 21.68 ± 9.55 mm. Out of those, 65% of the patients had a tumor less than 3 cm in size. Fourteen patients (35%) had tumors at multiple sites. The average duration of resection per tumor was 24.84 ± 6.83 min. None of the cases required conversion to cTURBT. There was no obturator reflex or urinary bladder perforation in any of the cases. Detrusor muscle was present in the histopathology reports of 92.5% patients. The average duration of catheterization was 1.82 ± 0.61 days. CONCLUSION: For NMIBC's, low power Holmium laser en-bloc resection is a safe procedure with minimum risk of complications. High rate of detrusor-positive specimens indicates its efficacy and feasibility.

Study on the electrochemical and spectroscopic characteristics of holmium ion and its interaction with DNA.

Metal ion-DNA interactions play a crucial role in modulating the structure and function of genetic material in the natural environment. In this study, we report on the favorable electrochemical activity of holmium(III) (Ho3+) on a glassy carbon electrode (GCE) and its interaction with double-stranded DNA. The interaction between DNA and Ho3+ was investigated for the first time using cyclic voltammetry and differential pulse voltammetry. The electrochemical behavior of Ho3+ ions on a GCE exhibited a reversible electron transfer process, indicative of its redox activity. A linear correlation between the peak current and the square root of the scan rate was observed, suggesting a diffusion-controlled kinetic regime for the electrochemical process. Additionally, fluorescence and absorption spectroscopy were employed to confirm the binding of Ho3+ to DNA. Our findings demonstrate that, at pH 7.2, specific DNA bases and phosphate groups can interact with Ho3+ ions. Moreover, electrochemical measurements suggest that Ho3+ ions bind to DNA via a groove binding mode, with a calculated binding ratio of 1:1 between Ho3+ and DNA. Notably, under optimal conditions, an increase in the amount of DNA leads to a significant reduction in the current intensity of Ho3+ ions.

Efficiency of HoLEP in patients with detrusor underactivity and renal dysfunction secondary to BPO.

PURPOSE: The purpose of this study was to assess the bladder and renal functional outcomes of holmium laser enucleation of the prostate (HoLEP) in patients with benign prostatic obstruction (BPO) complicated by detrusor underactivity (DU) and secondary renal dysfunction. METHODS: Thirty-one patients were included in this prospective study. Eligible patients had urinary retention, a bladder outlet obstruction index (BOOI) greater than 40, a bladder contractility index (BCI) less than 100, abnormal renal function at the initial diagnosis (serum creatinine > 132 µmol/L) and a renal pelvis anteroposterior diameter (PRAPD) > 1.5 cm bilaterally. All patients underwent HoLEP in a routine manner and were evaluated preoperatively and at 1, 3 and 6 months after surgery. The baseline characteristics of the patients, perioperative data, postoperative outcomes and complications were assessed. RESULTS: Significant improvement was observed in the international prostate symptom score (IPSS), quality of life (QoL) score, maximal urinary flow rate (Qmax), post-void residual volume (PVR), Scr and RPAPD at the 6-month follow-up. Bladder wall thickness (BWT) exhibited a decreasing trend but did not significantly differ from the preoperative values. No grade 3 or higher adverse events occurred, and grade 3 and lower complications were treated conservatively. Three patients required reinsertion of indwelling catheters, and they were able to void spontaneously after two weeks of catheterisation training and medication treatment. CONCLUSION: HoLEP is an effective treatment for men with BPO accompanied by DU and consequent renal function impairment. Patients are able to regain spontaneous voiding. Both bladder and renal functions were preserved and improved.

The application of intravenous general anesthesia under nasopharyngeal airway assisted ventilation undergoing ureteroscopic holmium laser lithotripsy: A prospective, single-center, controlled trial.

To observe the effect of intravenous general anesthesia under nasopharyngeal airway-assisted ventilation on patients undergoing ureteroscopic holmium laser lithotripsy. One hundred and twenty patients who underwent ureteroscopic holmium laser lithotripsy in our hospital were selected and randomly divided into nasopharyngeal airway group (research group) and laryngeal mask group (control group). These patients, respectively, received intravenous anesthesia under nasopharyngeal airway and laryngeal mask-assisted ventilation. The following evaluation indexes were compared and analyzed between the two groups, including anesthetic effect, hemodynamics, stress response, postoperative recovery, adverse reactions, etc. There were no significant differences in Visual Analog Scale, hemodynamics, and stress response between the two groups at each time point (P > 0.05). There were no significant differences in residence time and postoperative recovery time between the two groups (P > 0.05). The difference in airway establishment time between the two groups was statistically significant (P < 0.05), and cases with blood in the research group was significantly lower than those in the control group (P < 0.05). Patient satisfaction in research group was significantly higher than those in the control group (P < 0.05). The clinical effect of intravenous general anesthesia under nasopharyngeal airway-assisted ventilation in ureteroscopic holmium laser lithotripsy is significant, which helps to stabilize patients' hemodynamics, reduce their stress response and adverse reactions, and improve the satisfaction rate of patient.

Accuracy of holmium-166 SPECT/CT quantification over a large range of activities.

BACKGROUND: Quantitative imaging is a crucial step for dosimetry in radionuclide therapies. Traditionally, SPECT/CT imaging is quantified based on scanner-specific conversion factors or self-calibration, but recently absolute quantification methods have been introduced in commercial SPECT reconstruction software (Broad Quantification, Siemens Healthineers). In this phantom study we investigate the accuracy of three quantification methods for holmium-166 SPECT/CT imaging, and provide recommendations for clinical dosimetry. METHODS: One cylindrical phantom, filled with a homogeneous holmium-166-chloride activity concentration solution, was imaged at one time point to determine a scanner-specific conversion factor, and to characterize the spatial dependency of the activity concentration recovery. One Jaszczak phantom with six fillable spheres, 10:1 sphere-to-background ratio, was imaged over a large range of holmium-166 activities (61-3130 MBq). The images were reconstructed with either an ordered subset expectation maximization (OSEM, Flash3D-reconstruction; scanner-specific quantification or self-calibration quantification) or an ordered subset conjugate gradient (OSCG, xSPECT-reconstruction; Broad Quantification) algorithm. These three quantification methods were compared for the data of the Jaszczak phantom and evaluated based on whole phantom recovered activity, activity concentration recovery coefficients (ACRC), and recovery curves. RESULTS: The activity recovery in the Jaszczak phantom was 28-115% for the scanner-specific, and 57-97% for the Broad Quantification quantification methods, respectively. The self-calibration-based activity recovery is inherently always 100%. The ACRC for the largest sphere (Ø60 mm, ~ 113 mL) ranged over (depending on the activity level) 0.22-0.89, 0.76-0.86, 0.39-0.72 for scanner-specific, self-calibration and Broad Quantification, respectively. CONCLUSION: Of the three investigated quantification methods, the self-calibration technique produces quantitative SPECT images with the highest accuracy in the investigated holmium-166 activity range.

Assessment of Holmium:YAG, Pulsed-Thulium:YAG and Thulium Fiber Lasers for Urinary Stone Ablation. In Vitro Study.

Objective: To evaluate the ablation speed (AS), laser efficiency and direct thermal lesions during urinary stone lithotripsy with the current available laser technologies: Holmium:YAG (Ho:YAG), pulsed-Thulium:YAG (p-Tm:YAG) and thulium fiber laser (TFL) in vitro using different laser settings. Materials and Methods: Ho:YAG, p-Tm:YAG, and TFL laser system were used in an in vitro ureteral model with a volume of 125 mm3 Begostone. The following parameters were tested across all laser devices: 0.6J/10 Hz (6 W), 0.6 J/20 Hz (12 W), 1.5 J/10 Hz (15 W), and 1.5 J/20 Hz (30 W), employing short pulse width for all lasers and long pulse width for Ho:YAG and p-Tm:YAG. Ten participants conducted the experimental setup during 3-minutes laser on time, combining the laser technology, settings, and pulse widths, with a total of 20 different combinations. The efficiency, AS and ureteral damage resulting from each intervention were analyzed. Results: p-Tm:YAG and TFL demonstrated significantly higher efficiency compared with Ho:YAG (0.049 ± 0.02 Δgr/KJ and 0.042 ± 0.01 Δgr/KJ vs 0.029 ± 0.01 Δgr/KJ; p < 0.05). In all laser sources, as the power increases, the AS also increases (p < 0.05). Furthermore, only at high-energy settings (1.5 J) higher frequency led to increase AS (p < 0.05). Both, p-Tm:YAG and TFL exhibited higher AS compared to Ho:YAG (0.64 ± 0.33 Δgr/s and 0.62 ± 0.31 Δgr/s vs 0.44 ± 0.22 Δgr/s; p < 0.05). Regarding ureteral injuries, as the power increases, there is a higher chance of ureteral damage (p = 0.031). No differences were observed between laser technologies (p = 0.828). Conclusions: Both, p-Tm:YAG and TFL exhibited superior performances during laser lithotripsy compared with Ho:YAG, as they demonstrated higher efficiency and ablation speed. Thermal damage did not appear to be associated with specific laser equipment, but higher grades of lesions are described by increasing power.

Holmium laser enucleation of the prostate with transurethral intraprostatic anesthesia using Schelin catheter: a preliminary communication.

Introduction: This study was aimed to evaluate the feasibility, safety, and advantages of the use of transurethral intraprostatic anesthesia (TUIA) using Schelin CatheterTM (SC) in patients undergoing holmium laser enucleation of the prostate (HoLEP). Material and methods: TUIA was performed using SC, a catheter equipped with an operative channel with a retractile needle, a standard drainage outlet, and a balloon port. After inserting the SC into the patient's urethra and filling the balloon to anchor it in the bladder neck, four target injections with local anesthetic were performed, one in each quadrant in the base area of the prostate. After injections, the catheter was removed and the HoLEP procedure started. During the procedure, patients also received moderate sedation/analgesia. Results: We selected two 63-year-old patients with good performance status. Prostate volume was 40 ml for the first patient and 31 ml for the second. TUIA and HoLEP operative times were 68 minutes in the first patient and 42 minutes in the second.During the procedure, patients complained of only minimal discomfort, and during hospitalization patients' numeric rating scale (NRS) pain score ranging from 1 to 0, with no need for additional analgesics. No complications were reported perioperatively and 15 days after the procedure. Conclusions: This is the first report on TUIA via SC in patients undergoing HoLEP. In our preliminary experience, TUIA via SC was safe and feasible, showing complete perioperative pain control. Further studies are needed to confirm these promising results and better define the category of patients eligible for this type of treatment.

Prospective results of the minimally invasive laser enucleation of the prostate (MiLEP).

BACKGROUND: The objective of the present study is to prospectively analyze the prostate enucleation procedure with Holmium Laser using the minimally invasive technique (MiLEP), comparing the outcomes and their variables pre- and postoperatively. METHODS: We studied men aged 40 years or over, with prostate volumes greater than or equal to 35 cm³ with lower urinary tract symptoms due to BPH. We performed flowmetry and administered the IPSS questionnaire before and 6 months after the MiLEP procedure. The patients were operated on with a 60 W Holmium Laser (Cyber-Ho Quanta System®) using 54 W of power (energy 1.8 J and frequency of 30 Hz). Enucleation was performed using the en bloc technique with early sphincter release. After enucleation, the tissue was morcellated using a 22 Fr morcescope (RZ-Medizintechnik GmbH, Tuttlingen, Germany) and Piranha (Richard Wolf) morcellator. The final Hemostasis after morcelation was made using laser with 30wW power, energy at 1,0 joules and frequency at 30 Hertz. Student's T test and Man-Whitney was used to statistical analysis (p < 0.05). RESULTS: After selection we submitted 73 patients (mean age= 68.2 years) to MiLEP procedure with a follow up of 6 months. The prostate volume presented an average of 94.53 cm³ (65 to 112 cm³, SD = 5.363) preoperatively. The urinary continence rate after the procedure was greater than 95% after 1 week and 99% in the 1st month. All patients were continent after 6 months. The IPSS questionnaire before (mean = 21.18 points/SD = 6.557) and after (mean = 7.92 points/SD = 2.408) the MiLEP had statistical significance (p < 0.001). The flowmetry(ml/s) before (9.02/SD = 2.842) and after (21.07/SD = 6.228) the MiLEP had statistical significance (p < 0.001). The average time of the procedure was 78.5 min and the bladder catheter was removed after 18 h in mean. In 4 patients (5.8%) we observed hematuria and in 1 case (1.47%) the patient needs urinary catheterization. CONCLUSION: MiLEP is a safe and effective procedure, with significant improvement in urinary flow and symptoms in the short term. Although the results of this study were satisfactory and the urinary incontinence rate was lower compared to HoLEP data found in the literature, multicenter studies with longer follow-up are needed to confirm these findings.

In Vitro Comparison of Pulsed-Thulium:YAG, Holmium:YAG, and Thulium Fiber Laser.

Objective: To characterize the pulse characteristics and risk of fiber fracture (ROF) of the pulsed-Thulium:YAG (p-Tm:YAG) laser and to compare its ablation volumes (AVs) against Holmium:Yttrium-Aluminium-Garnet (Ho:YAG) laser and Thulium fiber laser (TFL). Materials and Methods: p-Tm:YAG (100 W-Thulio, Dornier-Medtech©, Germany) was characterized using single-use 272 µm core-diameter-fibers. p-Tm:YAG characterization included pulse shape, duration, and peak power (PP) studies. ROF was assessed after 5 minutes of continuous laser activation (CLA) at five decreasing fiber bend radii (1, 0.9, 0.75, 0.6, and 0.45 cm). p-Tm:YAG, Ho:YAG (120 W-Cyber-Ho, Quanta®, USA), and TFL (60 W-TFLDrive, Coloplast®, Denmark) AVs were compared using a 20-mm linear CLA at 2 mm/second velocity in contact with 20 mm3 hard stone phantoms (HSP) and soft stone phantoms (SSP) (15:3 and 15:5 water to powder ratio, respectively) fully submerged in saline at 0.5 J-20 Hz or 1 J-10 Hz. After CLA, phantoms underwent three-dimensional (3D) micro-scanning (CT) and subsequent 3D segmentation to estimate the AVs, using 3DSlicer©. Each experiment was performed in triplicate. Results: p-Tm:YAG presents a uniform pulse profile in all of the available preset modes. PP ranged from 564 to 2199 W depending on pulse mode. No laser fiber fracture occurred at any bend radius. p-Tm:YAG achieved similar mean AVs to TFL and Ho:YAG for HSP (8.96 ± 3.1 vs 9.78 ± 1.1 vs 8.8 ± 2.8 mm3, p = 0.67) but TFL was associated with higher AVs compared with p-Tm:YAG and Ho:YAG (12.86 ± 1.85 vs 10.12 ± 1.89 vs 7.56 ± 2.21 mm3, p = 0.002) against SSP. AVs for HSP increased with pulse energy for p-Tm:YAG and Ho:YAG and (11.56 ± 1.8 vs 6.36 ± 0.84 mm3 and 11.27 ± 1.98 vs 6.34 ± 0.55 mm3, p = 0.03 and p = 0.02), whereas AVs for SSP were similar across laser settings for all laser sources. AVs with TFL were similar across laser settings for both phantom types. Conclusion: p-Tm:YAG combines intermediate PP between Ho:YAG and TFL, a uniform pulse profile, no ROF with increasing deflection and effective ablation rates. Further clinical studies are needed to confirm these in vitro results.

Construction of a Risk Prediction Model for Ureteral Stricture after Ureteroscopic Holmium Laser Lithotripsy.

Introduction: To analyze the influencing factors of ureteral stenosis after ureteroscopic holmium laser lithotripsy. Methods: The clinical data of 427 patients treated with ureteroscopic holmium laser lithotripsy were selected, and the patients were divided into two groups based on the presence or absence of ureteral stenosis after the operation. Univariate and multivariate logistic regression were used to analyze the independent risk factors for postoperative ureteral stenosis, and R software and regression coefficients were used to construct a predictive model. Results: After a 1-year follow-up of 427 patients, 28 patients (6.56%) developed ureteral stenosis; univariate analysis showed that the occurrence of ureteral stenosis after subureteral holmium laser lithotripsy was related to stone diameter, stone incarceration, degree of hydronephrosis, holmium laser injury of mucosa, and operation time (p < 0.05); further logistic regression analysis showed that a large stone diameter, stone incarceration, and moderate to severe hydronephrosis were independent risk factors for ureteral stenosis after ureteroscopic holmium laser lithotripsy (p < 0.05); According to H-L deviation degree and area under receiver operating characteristic curve test, the results show that the model has high accuracy (χ2 = 2.475, p = 0.613) and differentiation (0.875 [95% confidence interval or CI: 0.817-0.919]), and the external verification of the nomogram prediction model was carried out by the verification group. The results showed that the prediction probability of the calibration curve was close to the actual probability and had a good consistency (area under the curve: 0.873 [95 CI: 0.822-0.914]). Conclusion: The established nomogram model exhibits high accuracy and discriminative ability. It can effectively identify high-risk groups, enabling timely prevention of ureteral stenosis and minimizing the risk of postoperative ureteral stenosis.

Comparison of Moses laser and Raykeen laser in patients with impacted upper ureteral stone undergoing flexible ureteroscopic holmium laser lithotripsy.

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.

Renal artery pseudoaneurysm presenting in a single functioning kidney with prior partial nephrectomy following flexible ureterorenoscopy: a case report.

Renal artery pseudoaneurysm (RAP) formation following flexible ureterorenoscopy (FURS) with laser lithotripsy is rare. Previous kidney surgery places patients at an increased risk due to potential vascular injury associated with renal intervention. In our case, a 62-year-old man with a single functioning right kidney and a history of right partial nephrectomy presented 10 days following FURS with holmium laser lithotripsy, complaining of gross hematuria. Attempted conservative management failed. Renal arteriography was done, which revealed a RAP that was managed with selective angioembolization. RAP following FURS can be serious if not managed properly. Most cases present with late gross hematuria. RAP can usually be demonstrated on renal arteriography. Selective angioembolization is the definitive treatment.

Retrospective study of ureteral stenosis after holmium laser lithotripsy.

OBJECTIVE: To identify the factors influencing postoperative ureteral stenosis following holmium laser lithotripsy. METHODS: A retrospective study was conducted of 106 patients who underwent ureteroscopic holmium laser lithotripsy. The effects of variables including stone location, stone size, the duration of surgery, water intake, disease duration, and stone-associated polyps were investigated. RESULTS: Logistic regression analysis revealed significant associations of ureteral stenosis with stone location, stone size, duration of surgery, water intake, disease duration, and stone-associated polyps. Patients with proximal stones, with large stones, who underwent long surgical procedures, who drank a large amount of water, who had long-term disease, and who had stone-related polyps were more likely to develop postoperative ureteral stenosis. CONCLUSION: Significant perioperative complications of holmium laser lithotripsy are associated with prolonged disease, large ureteral stones, long incarceration periods, and the presence of polyps. Surgeons should consider these risk factors during the preoperative evaluation of patients and surgical planning to minimize the risk of postoperative ureteral stenosis.

Results of Adjustable Trans-Obturator Male System for Stress Urinary Incontinence after Transurethral Resection or Holmium Laser Enucleation of the Prostate: International Multicenter Study.

Background: Male stress urinary incontinence (SUI) after surgical treatment of benign prostatic enlargement (BPE) is an infrequent but dreadful complication and constitutes a therapeutic challenge. The efficacy and safety of the adjustable trans-obturator male system (ATOMS®) in these patients is rather unknown, mainly due to the rarity of this condition. We aimed to assess the results of ATOMS to treat SUI after transurethral resection (TURP) or holmium laser enucleation (HoLEP) of the prostate. Methods: Retrospective multicenter study evaluating patients with SUI after TURP or HoLEP for BPE primarily treated with silicone-covered scrotal port (SSP) ATOMS implants in ten different institutions in Europe and Canada between 2018 and 2022. Inclusion criteria were pure SUI for >1 year after endoscopic treatment for BPE and informed consent to receive an ATOMS. The primary endpoint of the study was a dry rate (pad test ≤ 20 mL/day after adjustment). The secondary endpoints were: the total continence rate (no pads and no leakage), complication rate (Clavien-Dindo classification) and self-perceived satisfaction (Patient Global Impression of Improvement (PGI-I) scale 1 to 3). Descriptive analytics, Wilcoxon's rank sum test and Fisher's exact test were performed. Results: A total of 40 consecutive patients fulfilled the inclusion criteria, 23 following TURP and 17 HoLEP. After ATOMS adjustment, 32 (80%) patients were dry (78.3% TURP and 82.4% HoLEP; p = 1) and total continence was achieved in 18 (45%) patients (43.5% TURP and 47% HoLEP; p = 0.82). The median pad test was at a 500 (IQR 300) mL baseline (648 (IQR 650) TURP and 500 (IQR 340) HoLEP; p = 0.62) and 20 (IQR 89) mL (40 (IQR 90) RTUP and 10 (IQR 89) HoLEP; p = 0.56) after adjustment. Satisfaction (PGI-I ≤ 3) was reported in 37 (92.5%) patients (95.6% TURP and 88.2% HoLEP; p = 0.5). There were no significant differences between patients treated with TURP or HoLEP regarding the patient age, radiotherapy and number of adjustments needed. After 32.5 (IQR 30.5) months, median follow-up postoperative complications occurred in seven (17.5%) cases (two grade I and five grade II; three after TURP and four HoLEP) and two devices were removed (5%, both HoLEP). Conclusions: ATOMS is an efficacious and safe alternative to treat SUI due to sphincteric damage produced by endoscopic surgery for BPE, both TURP and HoLEP. Future studies with a larger number of patients may identify predictive factors that would allow better patient selection for ATOMS in this scenario.