Alim Dymov

V11-11 THULIUM LITHOTRIPSY: FROM EXPERIMENT TO CLINICAL PRACTICE

INTRODUCTION AND OBJECTIVES: Mini-percutaneous nephrolithotomy (mini-PCNL) was initially described in the late 1990s. Many variations on the technique have been described since that time focusing on differing access sizes. Lithotripsy through a mini-PCNL tract has traditionally been accomplished through laser or electro-hydraulic/ pneumaticenergy.Wesought toexplore the feasibility of lithotripsy through a mini-PCNL tract with the Olympus ShockPulse-SE Lithotripter which combines both ultrasonic and mechanical energy to optimize lithotripsy. METHODS: A 58 year male patient with a 2.5 cm left lower pole stone was identified as the initial candidate for our technique. He was positioned in the standard prone position and access was obtained into his lower pole with an 18-gauge Cook LS access needle. We proceeded to dilate a 16-French tract using a one-step dilator with the Storz Modular Minimally Invasive PCNL (MIP) System. With the Storz MIP M nephroscope and a 1.5 mm Olympus ShockPulse-SE probe, we then broke the stone into minute fragments which were initially suctioned and collected with the StoneCatcher (Boston Scientific) system. Remaining fragments were removed with an endoscopic grasper and a nitinol stone basket. The procedure was performed tubeless with a stent. After five days, a follow-up plain film was obtained and the stent removed. RESULTS: The dual modality lithotripter was efficient with stone fragmentation and extraction through suction. The total operative time was 110 minutes. The patient was discharged on post-operative day one after an uncomplicated stay of 30 hours total duration. Postoperatively, his hemoglobin declined 2.3 g/dl and his creatinine rose 0.2 mg/dl. On return, his large 2.5 cm stone showed good clearance on KUB though dust like fragments (< 2 mm) remained in his lower pole. CONCLUSIONS: This is the first report of using integrated ultrasonic and mechanical energy lithotripsy in a mini-PCNL. The combination of the Olympus ShockPulse-SE Lithotripter with the Storz MIP system proved efficient in terms of operative duration and stone breakdown. It was also effective at clearing a large stone burden through a small 16-French tract. This method is feasible and provides an alternative to laser or pneumatic lithotripsy and offers the benefits of suction.

RETROSPECTIVE ANALYSIS OF SHORT-TERM OUTCOMES AFTER MONOPOLAR VERSUS LASER ENDOSCOPIC ENUCLEATION OF THE PROSTATE: A SINGLE CENTER EXPERIENCE

INTRODUCTION Endoscopic enucleation of the prostate (EEP) has been recognized as a viable treatment modality for men with benign prostatic hyperplasia (BPH). The aim of our study was to compare the efficacy and functional outcomes of three different techniques of EEP, including monopolar enucleation (MEP), holmium laser enucleation of the prostate (HoLEP), and thulium laser enucleation of the prostate (ThuLEP). METHODS The study consisted of a retrospective comparison of pre- and postoperative parameters in men undergoing three types of EEP: MEP, HoLEP, and ThuLEP. Functional parameters were evaluated before and 6 months after surgery, which included the International Prostate Symptom Score, maximum flow rate, postvoid residual volume, prostate volume, and sodium levels of all patients. RESULTS A total of 551 men with the mean age of 67.1 years were included in the study. Of these, MEP was performed on 95 patients, HoLEP was performed on 254 patients, and ThuLEP on 202 patients. The mean mass of morcellated tissue obtained during the three techniques did not differ significantly (p > 0.05). Mean procedure times of ThuLEP and HoLEP were shorter than MEP demonstrating 72, 76, and 86 minutes, respectively (p < 0.01). The mean catheterization time following laser EEPs was shorter than MEP as shown by 1.3, 1.3, and 3.8 days, respectively (p < 0.01). Hospital stay times of HoLEP and ThuLEP were shorter than MEP demonstrated by 3.3, 3.4, and 6.9 days, respectively (p < 0.01). Patients after MEP had significant decrease in postoperative hemoglobin and sodium levels. All the groups showed statistically significant improvement in the aforementioned parameters following treatment. CONCLUSIONS Both techniques of laser enucleation proved to be efficacious in the management of BPH. MEP of the prostate seems to be a highly promising addition to the list of enucleation techniques and was determined to be an effective and acceptable procedure, despite a higher complication rate.

New laser radiation hydrodynamic effect in endoscopic urological surgery

Authors describe new effect of laser radiation in endoscopic urological surgery (BPH enucleation, en-bloc removal of bladder cancer, stricture endotomy): two-phase jet - a result of superintensive boiling in the area of laser radiation absorption and consisting of steam-gas microbubbles and hot water. In this case, the area of thermal influence appears significantly more, than thickness of a layer in which laser radiation is absorbed. Cutting soft tissue, the jet coagulates section walls due to heat generated at steam condensation. The same jet is formed behind the macrobubble, which is formed in liquid (Moses effect), because of boiling.

Safety and efficacy of thulium transurethral en block resection with fiber laser “Urоlaz” for treatment of non-muscle-invasive bladder cancer

Background. The high recurrence rate after conventional transurethral resection (cTUR) for bladder cancer (BC) requires search for more effective methods of surgical treatment. Objective: to evaluate the feasibility, safety, and efficacy of cTUR versus thulium laser en bloc resection of bladder tumors using new fiber laser “Urolaz”. Materials and methods. 129 patients, who underwent surgical treatment for BC between 2015–2017 in urological department of I.M. Sechenov First Moscow State Medical University were included in the study. The cTUR were performed for 58 patients, 71 patients underwent thulium laser en bloc resection of bladder tumors. Results. The presence of detrusor muscle in specimen was 58.62 % in cTUR group and 91.55 % in thulium laser en bloc resection group respectively. Obturator nerve reflex, bladder perforation, and bleeding in thulium laser en bloc resection group were absent, therefore immediate instillation of chemotherapy was made in all these cases. Recurrence rate after 12 and 18 months after surgery in the group of en bloc resection was statistically lower compared to the cTUR group. Conclusion. The results, obtained in our study shows that thulium en bloc resection using thulium fiber laser “Urolaz” is feasible, effective and safe procedure for patients with BC. Thulium en bloc resection has a number of advantages over the cTUR: absence of obturator nerve reflex, high quality of specimen for pathological examination (presence of detrusor muscle in specimen was 91.55 %) and low recurrence rate.

PD23-07 EFFECT OF HOLMIUM LASER ENUCLEATION OF THE PROSTATE (HOLEP) ON THE SEXUAL FUNCTION

IPSS, Qmax, residual volume) were recorded preoperatively and at each follow-up visit. RESULTS: Median initial prostate volume was not significantly different between the groups (LV: 44.1ml, TURP: 44.8ml; p1⁄40.47). After catheter removal, the relative prostate volume reduction (RVR) was significantly lower following LV (table). Six weeks and six months after LV RVR increased significantly (both p<0.001). However, RVR remained significantly lower after LV throughout the entire 3-year observation period (table). All clinical outcome parameters improved significantly and remained so for 3 years without relevant differences between the groups. No significant differences in overall re-treatment rates were observed (LV: 5 (5.1%), TURP: 5 (6.5%), p1⁄40.75) CONCLUSIONS: After 3 years, prostate volume reduction remained inferior after 120W greenlight LV compared to TURP. However, as yet the lower volume reduction did not translate into inferior functional outcome or higher retreatment rates. Further follow-up of our cohort will reveal if the extent of tissue ablation impacts the long-term outcome of the procedures.