Objective• To describe a protocol for transperineal sector biopsies (TPSB) of the prostate and present the clinical experience of this technique in a UK population. Patients and Methods• A retrospective review of a single-centre experience of TPSB approach was undertaken that preferentially, but not exclusively, targeted the peripheral zone of the prostate with 24-38 cores using a 'sector plan' . Procedures were carried out under general anaesthetic in most patients.• Between January 2007 and August 2011, 634 consecutive patients underwent TPSB for the following indications: prior negative transrectal biopsy (TRB; 174 men); primary biopsy in men at risk of sepsis (153); further evaluation after low-risk disease diagnosed based on a 12-core TRB (307). Results• Prostate cancer was found in 36% of men after a negative TRB; 17% of these had disease solely in anterior sectors.• As a primary diagnostic strategy, prostate cancer was diagnosed in 54% of men (median PSA level was 7.4 ng/mL).• Of men with Gleason 3+3 disease on TRB, 29%were upgraded and went on to have radical treatment.• Postoperative urinary retention occurred in 11 (1.7%) men, two secondary to clots. Per-urethral bleeding requiring hospital stay occurred in two men. There were no cases of urosepsis. Conclusions• TPSB of the prostate has a role in defining disease previously missed or under-diagnosed by TRB. The procedure has low morbidity.

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Introduction: Holmium Laser enucleation of the prostate (HoLEP) is an effective treatment, yet the learning curve is considered difficult. We propose the trimodal approach of Holmium Laser ablation (HoLAP), then ablation with resection (HoLARP) and finally enucleation (HoLEP) during the development of surgical competence. Methods: A centre experienced in Holmium Laser (HoL) prostatectomy evaluated ablation techniques in prostates less than 50cc as a training modality. Prospective data were collected and outcomes compared with controls who had HoLEP. Subsequently a HoL prostatectomy service was introduced to a new centre and evaluated prospectively during the initial experience of two surgeons mentored by another trained in the trimodal staged approach. Results: Outcomes following HoLAP were comparable to HoLEP in prostate volumes under 50 cm 3 . The new HoL service was evaluated over 6 months. 70 cases were carried out, 42 HoLAP and 28 HoLEP. Outcomes were compared prospectively with 30 TURPs by another surgeon. A decrease in catheterisation time and hospital stay was noted in the laser group. Conclusion:The staged progression from HoLAP, then HOLARP and finally to HOLEP with morcellation appears a safe and reproducible way to introduce HoL prostatectomy into standard urological practice.

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