Purpose To compare intra and perioperative parameters between HoLEP and ThuLEP in the treatment of benign prostatic hyperplasia and to evaluate clinical and functional outcomes of the two procedures with a 12-month follow-up. Methods A prospective randomized study was performed on 236 consecutive patients who underwent ThuLEP (n = 115), or HoLEP (n = 121) in three different centers. Intra and perioperative parameters were analyzed: operative time, enucleated tissue weight, irrigation volume, blood loss, catheterization time, hospital stay and complications. Patients were evaluated preoperatively and 3 and 12 months postoperatively with the international prostate symptom score (IPSS), the quality of life (QoL) score, post-void residual volume (PVR), PSA and maximum flow rate (Q max ). Results Preoperative variables in each study arm did not show any significant difference. Compared to HoLEP, ThuLEP showed similar operative time (63.69 vs 71.66 min, p = 0.245), enucleated tissue weight (48.84 vs 51.13 g, p = 0.321), catheterization time (1.9 vs 2.0 days, p = 0.450) and hospital stay (2.2 vs 2.8 days, p = 0.216), but resulted in less haemoglobin decrease (0.45 vs 2.77 g/dL, p = 0.005). HoLEP presented a significantly higher number of patients with postoperative acute urinary retention and stress incontinence. No significant differences were found in PSA, Q max , PVR, IPSS and QoL score during follow-up. Conclusion ThuLEP and HoLEP both relieved lower urinary tract symptoms equally, with high efficacy and safety. ThuLEP detemined reduced blood loss and early postoperative complications. Catheterization time, enucleated tissue, hospital stay, operative time and follow-up parameters did not show any significant difference.

Purpose To compare reusable and disposable flexible ureteroscopes in terms of efficacy and safety for patients undergoing Retrograde Intrarenal Surgery (RIRS). Patients and Methods Patients with a renal stone eligible for RIRS were enrolled in this multicenter, randomized, clinical trial study. Patients were randomized into two groups: group A (90 patients) underwent RIRS with a reusable flexible ureteroscope and group B (90 patients) were treated with a disposable one. Results The patients’ demographics, stone features and pre-operative urine cultures were comparable between the groups. The Stone Free Rates (SFRs) were not significantly different (86.6% and 90.0% for group A and group B, respectively, p=0.11) and the mean cost for each procedure was comparable (2321 € in group A vs 2543 € in group B, p=0.09). However, the days of hospitalization and of antibiotic therapy were higher in group A (p ≤ 0.05). The overall complication rate in group A was 8.8% whilst in group B it was 3.3% (p ≤ 0.05); in particular, group A exhibited a greater number of major complications (Clavien score IIIa-V). The overall postoperative infection rate was 16.6% in group A and 3.3% in group B (p ≤ 0.05). Furthermore, none of the patients in group B developed urosepsis or had a positive blood culture, while 3 patients in group A did (p<0.05). Conclusion The use of disposable ureteroscopes is characterized by significantly lower post-operative complications and infection rates, while having comparable costs and SFRs vis à vis reusable ureteroscopes. Clinical Trial Registration Number: ISRCTN92289221.

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Purpose To assess the effects of a new ejaculation-sparing thulium laser enucleation of the prostate (ES-ThuLEP) technique on sexual functions and micturition, in patients with lower urinary tract symptoms secondary to benign prostatic hyperplasia (BPH) and to evaluate how the surgical technique of ES-ThuLEP can lead to ejaculation preservation. Methods A prospective study was carried out between January 2015 and January 2018 on patients with surgical indication for BPH, who wished to preserve ejaculation. The patients were treated with ES-ThuLEP and were evaluated before and 3 and 6 months after surgery. Three validated questionnaires (ICIQ-MLUTSsex, IIEF-5 and IPSS) were used to assess changes in ejaculation, erectile function and urinary symptoms. Uroflowmetry (Qmax and Qavg), post-void residual volume and voided volume were also evaluated, to assess micturition improvement. Patients with moderate to severe erectile dysfunction were excluded. Statistical analysis was performed with the Student's t test, Chi-square test and logistic regression analysis. Results Two hundred and eighty three patients were enrolled. Ejaculation was spared in 203 and 219 patients at 3 and 6 months after surgery. No significant differences were observed between erectile function before and after surgery: baseline IIEF-5 = 16.2 ± 4.47 vs 16.7 ± 2.9 (p = 0.419) and 17.7 ± 3.2 (p = 0.410) at 3 and 6 months. Significant improvement in urinary symptoms was achieved: baseline IPSS = 19.4 ± 7.24 vs 5.8 ± 4.3 (p = 0.032) and 3.9 ± 4.1 (p = 0.029) at 3 and 6 months. Conclusion ES-ThuLEP effectively preserved ejaculation in over two thirds of the patients without compromising micturition improvement or erectile function. ES-ThuLEP could be a valid treatment option for BPH in young and sexually active men.

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Introduction: The vapor tunnel (VT) technology is a result of the pulse modulation during holmium laser emission: it consists of a single specific long pulse, using the minimum peak power in accordance with selected output settings. The first part of the pulse creates a vapor channel, whereas the remaining energy is discharged immediately after, passing straight through the previously created tunnel. This particular emission allows to reduce stone retropulsion. We herein present the outcomes of this new technology in the treatment of ureteral stones in an urgent setting. Materials and Methods: In total, 210 patients with ureteral stones, renal colic, and indication to undergo urgent stone lithotripsy, according to the inclusion criteria presented by Picozzi et al., 1 were randomly assigned to holmium laser lithotripsy with or without the VT technology (105 patients per group). The 100 W Cyber-Ho laser generator (Quanta System) was used for all cases performed with the VT; the 35 W Litho laser generator was used for all regular dusting mode (RDM) procedures. A 365 lm fiber was used in both groups. Energy and frequency settings were 1 J and 12 Hz in both groups. All procedures were performed by three experienced urologists. After the procedures, a ureteral stent was always positioned and removed 20 days later. We compared dusting time, total procedural time, and stone retropulsion, graded on a Likert scale from 0 (no retropulsion) to 3 (maximum retropulsion). We also compared postoperative ureteral lesions with the Posturetroscopic Lesion Scale (PULS), 2 the success rates of the two techniques based on stone-free rate at 1 month (defined as absence or presence of maximum 1 mm stone fragments at a computed tomographyscan) and postoperative ureteral strictures. The study was approved by our institutional review board and patients signed the informed consent. Results: The RDM and VT groups were comparable in terms of age and mean preoperative stone size (1.1 vs 1.0 cm, p > 0.05). The VT technology was associated with significantly lower (p > 0.05) dusting time (15.3 vs 9.7 minutes), total procedural time (37.2 vs 25.7 minutes), total delivered energy (19.9 vs 7.7 kJ), and retropulsion (Likert score 3 vs 0). Patients in the RDM group required stone fragments' retrieval with a Tipless Basket (Kobot Filter; RocaMed) and presented a higher rate of PULS-1 ureteral lesions than the VT group: 37 (35.2%) vs 8 (7.6%) patients p < 0.05. Whereas the VT setting allowed complete dusting of the stones. We registered six cases (5.7%) of postoperative ureteral strictures in the RDM group vs no cases in the VT group, p < 0.05. Stone-free rate at 1 month was comparable between the two groups (88.6 vs 93.4%, p < 0.05). Conclusions: The VT technology is associated with significantly lower dusting time and total procedural time, because of reduced retropulsion of the stone, which makes it more precise, quicker, and easier to perform. It also allows complete dusting, with no need for fragments' retrieval, reducing ureteral lesions, because...

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