Real-world experience with the new pulsed solid-state Thulium: YAG laser (Thulio) for endoscopic enucleation of the prostate.

PURPOSE: The solid-state Thulium laser (Tm: YAG) is a novel alternative to the widely used Holmium laser for endoscopic enucleation of the prostate (EEP) due to its relatively high peak power. The aim of this study was to examine the efficacy and safety of a new pulsed Tm: YAG laser in its first application in humans. METHODS: Data were retrospectively collected for the first 103 patients who underwent EEP with a new pulsed solid-state Tm: YAG laser (Thulio®, Dornier MedTech Systems GmbH, Weßling, Germany). Peri- and postoperative data were assessed. Procedure-specific complications were graded using Clavien-Dindo Classifications (CDC). Patients were interviewed 15 months after the surgery to evaluate functional and long-term outcomes. Statistical analysis was performed with Statistical Package for the Social Sciences (SPSS®). RESULTS: The mean preoperative prostate volume was 105.6 ± 55.0 ml. Median enucleation speed was 4.1 g per minute (range 1.1-9.7). Short-term postoperative complications occurred in 21 patients (20.4%), but no high-grade complications (CDC ≥ IV) were observed. Five patients suffered gross haematuria and required reintervention (CDC IIIb; 4.9%). After 15 months, 76 patients (73.8%) participated in the follow-up interview, where seven patients (9.2%) reported complications, including two reinterventions for urethral strictures (CDC IIIb; 2.6%). Most patients reported an improvement in continence (54.0%) and urine stream (93.4%), but no difference in erectile function (81.6%). No persistent dysuria was reported. Patient satisfaction with the surgery results was very high (96.1%). CONCLUSION: Endoscopic enucleation of the prostate with the new pulsed solid-state Tm: YAG laser is a safe and effective option for surgical BPH treatment. TRIAL REGISTRATION: German Clinical Trials Register number: DRKS00031676. Registration date: 10 May 2023, retrospectively registered.

[Report template from the German Society of Urology and the German Radiological Society for standardized, structured reporting of native computed tomography scans in the diagnosis of urinary stones]. / Befundvorlage der Deutschen Gesellschaft für Urologie e. V. und der Deutschen Röntgengesellschaft zur standardisierten strukturierten Befundung von nativen Computertomographien in der Harnsteindiagnostik.

Standardized structured radiological reporting (SSRB) has been promoted in recent years. The aims of SSRB include that reports be complete, clear, understandable, and stringent. Repetitions or superfluous content should be avoided. In addition, there are advantages in the presentation of chronological sequences, tracking and correlations with structured findings from other disciplines and also the use of artificial intelligence (AI)-based methods. The development of the presented template for SSRB of native computed tomography for urinary stones followed the "process for the creation of quality-assured and consensus-based report templates as well as subsequent continuous quality control and updating" proposed by the German Radiological Society (DRG). This includes several stages of drafts, consensus meetings and further developments. The final version was published on the DRG website ( www.befundung.drg.de ). The template will be checked annually by the steering group and adjusted as necessary. The template contains 6 organ domains (e.g., right kidney) for which entries can be made for a total of 21 different items, mostly with selection windows. If "no evidence of stones" is selected for an organ in the first query, the query automatically jumps to the next organ, so that the processing can be processed very quickly despite the potentially high total number of individual queries for all organs. The German, European, and North American Radiological Societies perceive the establishment of a standardized structured diagnosis of tomographic imaging methods not only in oncological radiology as one of the current central tasks. With the present template for the description of computed tomographic findings for urinary stone diagnostics, we are presenting the first version of a urological template. Further templates for urological diseases are to follow.

[Extracorporeal shock wave lithotripsy]. / Extrakorporale Stoßwellenlithotripsie.

Interventional treatment of stones essentially consists of three treatment modalities. Extracorporeal shockwave lithotripsy (ESWL), in addition to uterorenoscopy (URS) and percutaneous nephrolitholapaxy (PCNL) is an essential treatment pillar and is the only noninvasive therapy option for the treatment of urinary stones. After a long period of ESWL being the leading choice in stone treatment, the number of SWL interventions diminished in recent years in favor of the other two treatment modalities (URS and PCNL). This article describes the indications, surgical technique and management of complications of SWL.

[Ureterorenoscopy]. / Ureterorenoskopie.

Ureterorenoscopy (URS) is a minimally invasive treatment option for removal of kidney stones, which has gained importance in this field over the past two decades. This technique has replaced extracorporeal shock wave lithotripsy (ESWL) stone surgery for many indications. It is also particularly important in the diagnostics and treatment for tumors of the upper urinary tract. This article describes the indications, surgical technique and management of complications of URS.

[Urinary Stone Analysis - What does the Future Hold in Store?] / Harnsteindiagnostik ­ Was bringt uns die Zukunft?

Analysis of the composition of a urinary stone is one of the most important steps in the clinical management of patients with urolithiasis. Fourier transform infrared spectroscopy, X-ray diffractometry and petrographic microscopy are the techniques currently used. Novel technical developments in recent years - such as Raman spectroscopy and hyperspectral imaging - have resulted in new approaches to improve urinary stone analysis. In future, table-top portable systems may be used that allow stones to be rapidly examined directly after the operation. These systems may even be integrated into lithotripsy laser systems.

[Stone treatment tomorrow and the day after]. / Steintherapie morgen und übermorgen.

Urological and surgical treatment of urinary stones are highly technological and technology-driven disciplines in present-day surgery. German medical engineering has always been recognized for its technical innovations in endoscopic surgery. Current and future trends are indicative of further miniaturization and automation of surgical instruments and assist systems to facilitate endourological procedures as well as improvements in the quality of results and ergonomics. These technologies include, e. g. 3D-tracking to facilitate access to the pelvicaliceal system for percutaneous nephrolithotomy (PNL) or robotic master-slave systems for endourology. The aim of all future stone treatment should be complete stone removal. This could be achieved by improved stone fragmentation ("micron-sized debris") or complete removal of fragments (e. g. using a "stone glue"). Integration of diagnostic procedures and treatments will constitute a key aspect of future developments in medical engineering. Intelligent laser systems may be capable of distinguishing stones from mucosa and artificial surfaces and may be used for immediate stone analysis during surgery. A simpler and faster availability of metabolic ("metabolomics") and genetic ("genomics") diagnostics will help to facilitate and improve individual metaphylaxis, e. g. in patient self-management. Nanotechnology and microrobots that may be used for endoluminal diagnostics and treatment of the urinary tract are already in development.

[Operative technique for percutaneous nephrolithotomy]. / Operative Technik der perkutanen Steintherapie.

Percutaneous nephrolithotomy (PCNL) is a well-established minimally invasive treatment option for removal of kidney stones. This technique has now replaced open stone surgery for virtually all indications. This article describes the indications, the surgical technique and the complication management of PCNL.

[Urotechnology: a new interdisciplinary platform for promoting and managing of technical innovations in urology]. / Urotechnologie : Neue Plattform zur Förderung und zum Innovationsmanagement der medizintechnischen Forschung in der Urologie.

The innovative power in medical engineering and technology development requires a close cooperation between universities and non-university research institutions and a collaboration with industrial partners. German knowledge in the fields of video and micro-optics, microsystem technology and of informational technology and software applications seem to be highly competitive at international level. Germany's previous leadership in the development of technical equipment will be challenged by today's requirements and difficulties in medical engineering. Research and expenses demands for the development of novel medical instruments, products and applications will increase continuously. Transparency and coordinated collaboration between universities and industrial partners will contribute to a substantial improvement in surgical therapy. Medical technology of the future, including urotechnology, requires professional structures and coordination and will have to be based on evidence.

A comprehensive update on urinary tract lithiasis management.

In the past decade, the field of urology has been one of the most rapidly progressing in applied technological advancements at the level of both medical diagnostics and treatment. The introduction of modern robotic laparoscopy has changed the face of minimally invasive surgery. For endourology specialists, stone surgery continues to be in the forefront of daily practice and innovations and new technologies are constantly being developed, aiming towards ever higher stone free rates and earlier recovery for the patient. But, is there a price? Indeed, in addition to advances in conservative treatment and prevention, modern endourology and stone disease management in particular enjoys a large variety of sophisticated new equipment and disposables, used either alone or in combination, developed from various companies at considerable cost. It is more than often that even expert professionals are not totally familiar with the whole range of treatment options and devices that are available in the market, as they commonly bear different names despite being used for the same purpose. Furthermore, a question of integrity might arise when using newly developed equipment directly in the operating theatre, with respect to the efficacy of the device as well as the learning curve required by the operator. In this review, we shall outline the latest advances in interventional lithotripsy technology and also demonstrate the most effective ways to use each particular modality efficiently and safely, with respect to the latest published guidelines and evidence-based recommendations.

Three-Tesla dynamic contrast-enhanced MRI: a critical assessment of its use for differentiation of renal lesion subtypes.

PURPOSE: To evaluate the ability of dynamic contrast-enhanced (DCE) 3-T MRI for preoperative differentiation between benign and malignant renal tumors and RCC subtypes. METHODS: Sixty consecutive patients undergoing preoperative DCE 3-T MRI of the kidney were evaluated in this retrospective IRB-approved evaluation. Fifty-four malignant tumors and 17 benign tumors upon surgical verification were included. Relative enhancement values of complete lesions and the most enhancing part of the lesions (hotspot) were measured using four repetitions: precontrast, arterial, venous, and delayed. RESULTS: Mean relative enhancement patterns between malignant and benign lesions did not differ significantly during any postcontrast phase (p > 0.05). The highest mean enhancement during all postcontrast phases was identified in clear cell RCC followed by chromophobic RCC. The enhancement pattern in papillary RCC was significantly less than that of non-papillary RCC lesions. Arterial enhancement was an independent predictor for RCC subtypes (papillary vs. non-papillary, p = 0.008). The diagnostic accuracy for differentiation of papillary from non-papillary RCC based on ROC analysis was 76.4% [95% CI 62.2-87.2%]; p < 0.0001. CONCLUSIONS: Dynamic contrast-enhanced MRI at 3 T showed intermediate diagnostic capability for differentiation between papillary and non-papillary RCC subtypes but could not differentiate between benign and malignant renal lesions.

[Freiburg index of patient satisfaction: interdisciplinary validation of a new psychometric questionnaire to describe treatment-related patient satisfaction]. / Freiburger Index für Patientenzufriedenheit: Interdisziplinäre Validierung eines psychometrischen Instrumentes zur Erfassung behandlungsbezogener Patientenzufriedenheit.

BACKGROUND: The recently introduced Freiburg index of patient satisfaction (FIPS) is a new questionnaire to assess treatment-related patient satisfaction after surgery and interventional procedures. The questionnaire had first been tested psychometrically in a mixed population of urology patients. The current study describes the results of an interdisciplinary validation. In addition, an English version is presented. METHODS: The questionnaire was used in two cohorts of cardiology (n = 120) and surgical (n = 127) patients. The evaluation included a comprehensive methodological and statistical evaluation including validation in comparison to the ZUF-8 questionnaire. RESULTS: The psychometric evaluation showed good results. The analyzed samples showed no missing values or ceiling effects. Furthermore, a high reliability (Cronbach's alpha 0.82), unidimensionality, sufficient distribution of values and validity (high correlation to the ZUF-8, r = 0.65, p < 0.001) of the questionnaire could be confirmed. CONCLUSIONS: The FIPS constitutes an interdisciplinary validated questionnaire to evaluate treatment-related patient satisfaction which can be used to objectify and compare results from clinical studies and quality in patient care. Colleagues of English-speaking countries are invited to participate in the validation of the hereby presented English version.

Incidence of balanitis xerotica obliterans in boys younger than 10 years presenting with phimosis.

OBJECTIVE: Evaluation of the true incidence of balanitis xerotica obliterans (BXO) among boys younger than 10 years. METHODS: In a period of 13 months, 75 boys younger than 10 years were treated for phimosis. Suspicion of BXO was raised in phimosis grade 2 or 3 (classification by Kikiros). Patients were offered primarily either circumcision or conservative therapy and circumcision secondarily (if treatment failed in the conservative group). Each circumcision specimen was examined histopathologically. RESULTS: Circumcision was primarily performed in 29 and secondarily in 17 patients. The mean age was 3.7 years (range 1-10). BXO, chronic inflammation, and normal histological results were found in 8/26/12 (17.4/56.5/26.1%) cases, respectively. The mean follow-up was 8.1 months. No recurrences were reported. CONCLUSIONS: The incidence of BXO appears to be higher than previously reported. The clinical appearance in children may be confusing. The preoperative BXO suspicion did not correlate with the final histopathological results.

[Modern urinary stone therapy: is the era of extracorporeal shock wave lithotripsy at an end?]. / Moderne Steintherapie : Ist die Ära der extrakorporalen Stoßwellenlithotripsie zu Ende?

BACKGROUND: Treatment of urolithiasis saw major changes with the introduction of extracorporeal shock wave lithotripsy (ESWL) and percutaneous and ureteroscopic techniques in the 1980s. Since then these minimally invasive treatment modalities have continuously been developed further. RESULTS: For years ESWL has been the treatment of choice. However, recent years have seen a significant shift towards endoscopic therapies. This can be attributed to the evolving surgical experience in the use of these techniques, but even more to major improvement in the technical equipment. This trend is not backed sufficiently by high-level data (RCTs). Some of the newer data on endoscopic techniques are presented in cohort studies, but most studies are case series. Accordingly, recommendations of the German and international guidelines still focus on ESWL as first-line therapy for most locations and sizes of urinary stones. CONCLUSION: The analysis of treatment data of our institution confirms these trends and demonstrates high treatment efficiency in modern stone management and a consecutive significant lowering of socio-clinical expenses.

[The Freiburg Index of Patient Satisfaction: introduction and validation of a new questionnaire]. / Der Freiburger Index für Patientenzufriedenheit. Vorstellung eines neuen Instruments und seiner psychometrischen Eigenschaften.

BACKGROUND: In the era of evidence-based medicine health-related quality of life measurements are recognized as valuable indicative factors. Because there was no generally applicable questionnaire addressing patient satisfaction after interventional or surgical procedures, the Freiburg Index of Patient Satisfaction was developed and psychometrically evaluated. METHODS: A preliminary version was evaluated and optimized through structured interviews with 20 patients (qualitative pre-study). The final questionnaire was then applied to 257 urological patients and a comprehensive statistical analysis including validation to a matching questionnaire (ZUF-8, Kriz 2008) was performed. RESULTS: All psychometric qualities scored well. The examined sample showed no missing values and no ceiling effect as otherwise found frequently: the most positive answer categories accounted for 43.6 % of cases. Reliability (Cronbach's Alpha = 0.84, discriminatory power = 0.50) was high. Furthermore the results of a factor analysis proofed unidimensionality of the questionnaire. Validity was shown by a close correlation between FIPS and ZUF-8 scores (r = 0.747, p < .001). CONCLUSION: The Freiburg Index of Patient Satisfaction is a generally applicable questionnaire to evaluate treatment satisfaction after interventional or surgical procedures. The questionnaire can be used to objectify results and increase comparability of clinical studies and quality in health care.