Zusammenfassung Bei der En-Bloc-Resektion von Blasentumoren (ERBT) erfolgt die Abtragung von Tumoren nicht fragmentiert, sondern sie werden in einer Schicht präpariert und, wenn möglich, in toto extrahiert. Diese Methode repräsentiert einen Paradigmenwechsel in der Behandlung nicht muskelinvasiver Blasentumore und bietet gegenüber der konventionellen transurethralen Resektion der Blase (TUR-B) diverse Vorteile. Insbesondere erlauben die so gewonnen histologischen Präparate eine genauere Aufarbeitung, was eine präzisere Stadieneinteilung ermöglicht. Zudem wird häufiger Detrusormuskulatur im Präparat nachgewiesen, was auf eine komplettere Tumorentfernung hindeutet. In den letzten Jahren festigt sich eine stabile Datenbasis, die die Vorteile dieser Technik bekräftigt. So wurde kürzlich in einer multizentrischen, prospektiv-randomisierten Studie erstmals ein signifikanter Vorteil hinsichtlich der Rezidivrate nach 12 Monaten im Vergleich zur TUR-B nachgewiesen. Versierte Endourologen sollten sich mit dieser Technik befassen, da sie sich mittelfristig zum Standard entwickeln könnte. Die Technik ist zu gut und zu elegant, um ignoriert zu werden.

As life expectancy increases and there is growing demand for BPH treatments, innovative technologies have been developed, allowing for swift recovery, symptom relief, low complication rates, and the possibility of performing procedures on an outpatient basis, often under local anaesthesia. This review aims to describe the outcomes of newly developed minimally-invasive surgical therapies (MIST) for BPH treatment in terms of functional voiding parameters and sexual function. These therapies are categorized into primarily ablative (Aquablation [Aquabeam]), non-ablative (Prostatic Urethral Lift (PUL, Urolift), temporary implantable devices [iTind]), and secondarily ablative procedures (convective water vapor ablation, Rezum, Prostate Artery Embolization [PAE]). All MIST technologies have advanced the medical care of patients with BPH while preserving ejaculation. However, there is a shortage of long-term data specifically addressing re-intervention rates and the preservation of functional voiding parameters. Although there is promising data from regulatory trials and randomized studies, all MIST therapies are potentially associated with severe complications. Patients considering such methods must be thoroughly informed about their inferiority compared with established transurethral procedures like TUR-P and enucleation.

ZusammenfassungDer Holmium:YAG-Laser war in den letzten drei Jahrzehnten der Goldstandard für die Laserlithotripsie und seit Ende der 1990er Jahre auch für die Enukleation der Prostata. Nachdem die gepulsten Thulium-Faserlaser (TFL) ihre Wirksamkeit in in-vitro Experimenten demonstriert haben, wurden sie vor einigen Jahren auf dem Markt eingeführt. Die ersten klinischen Ergebnisse zu dem TFL für die Lithotripsie und die Enukleation sind sehr erfolgsversprechend. Neben dem TFL wurde auch ein gepulster Thulium:YAG-Festkörperlaser eingeführt, zu dem allerdings noch wenige klinische Daten vorliegen. Dieser Artikel zielt darauf ab, die wichtigsten technologischen Unterschiede zwischen dem Ho:YAG-Laser und den gepulsten Thuliumlaser zu überprüfen und die ersten klinischen Ergebnisse zur Steinlithotripsie und zur Laserenukleation gegenüberzustellen bzw. zu diskutieren.In-vitro-Studien zeigen eine technische Überlegenheit des TFL im Vergleich zum Ho:YAG-Laser. Da der TFL jedoch noch eine neue Technologie ist, stehen derzeit nur begrenzte Studien zur Verfügung und die optimalen Einstellungen für die Lithotripsie sind noch nicht festgelegt. Bei der Enukleation scheinen die Unterschiede des TFL zu einem Hochleistungs-Ho:YAG-Laser klinisch nicht relevant zu sein. Erste Studien zum gepulsten Tm:YAG-Laser zeigen zwar vielversprechende Ergebnisse, jedoch liegen noch keine vergleichenden Studien vor.Die gepulsten Thuliumlaser haben das Potenzial, eine Alternative zum Ho:YAG-Laser zu sein. Es sind jedoch noch weitere Studien erforderlich, um den optimalen Laser für die Enukleation und die Lithotripsie von Harnsteinen unter Berücksichtigung aller Parameter, einschließlich Wirksamkeit, Sicherheit und Kosten, zu bestimmen.

Die operativen Therapieansätze der benignen Prostatahyperplasie (BPH) wurden in den letzten Jahrzenten weiterentwickelt und diversifiziert. Während die Wirksamkeit der operativen Verfahren bei moderaten Prostatagrößen in zahlreichen Studien dokumentiert wird, bleibt die Datenlage bei großen Prostatavolumina >200 ml unzureichend. Hierdurch bleiben wichtige Fragen hinsichtlich ihrer Effektivität und Sicherheit offen. Aufgrund dessen ist die Auswahl und Anpassung der geeigneten Therapieoptionen für diese spezielle Patientengruppe oft eine große Herausforderung. In dieser Übersichtsarbeit werden nach einer umfassenden Literaturrecherche die aktuellen Erkenntnisse zu den operativen Therapiemöglichkeiten bei großen Prostatavolumina >200 ml zusammengefasst und diskutiert. Die operative Behandlung von Prostatavolumina >200 ml ist unabhängig von der gewählten Operationsmethode eine Herausforderung. Minimalinvasive Ansätze sollten heutzutage Standard sein. Die anatomische endoskopische Enukleation ist das Verfahren mit der geringsten Morbidität und ist prinzipiell größenunabhängig durchführbar. Da das Verfahren auch in Spinalanästhesie durchführbar ist, ist es auch für Patienten mit erhöhtem Narkoserisiko geeignet. Bei extremen Prostatavolumina stellt dieses Verfahren aber auch erfahrene Operateure vor Herausforderungen. Besonders in Kombination mit einer Adipositas sollte der Operateur verschiedene Exit-Strategien kennen. Die roboterassistierte Adenomenukleation bietet eine minimalinvasive Alternative, mit welcher begleitende Pathologien (Divertikel oder große Blasensteine) mitbehandelt werden können. Allerdings sind die Invasivität und das Narkoserisiko durch den abdominellen Zugang vergleichsweise höher. Jede Klinik und jeder Operateur sollte individuell entscheiden, in welcher Methode die größte Expertise vorliegt und welche Option für den jeweiligen Fall am besten geeignet ist. Sollte die Expertise begrenzt sein, ist es ratsam, den Patienten einem Zentrum mit entsprechender Spezialisierung zuzuweisen.

Introduction: Before holmium laser enucleation of the prostate (HoLEP), many patients have undergone short-term prostate biopsy (PB) to rule out the presence of prostate cancer. The aim of this study is to determine whether a short-term PB before HoLEP has an impact on the perioperative outcomes or complications of HoLEP. Methods: In total, 734 consecutive patients treated with HoLEP at a tertiary care university hospital between January 2021 and July 2023 were retrospectively enrolled. Patients who had PB within 6 months before HoLEP were matched to patients who underwent PB more than 6 months or had no PB before HoLEP using propensity score matching (PSM) based on age, prostate volume (PV), prostate-specific antigen (PSA), preoperative urinary tract infection (UTI), and surgeon. Perioperative parameters, such as operation time (OT), enucleation efficiency (EF), as well as complications according to the Satava classification, the Clavien-Dindo classification (CDC), and the Comprehensive Complication Index (CCI) were evaluated. Results: In total, 206 patients were matched. Age, PV, PSA, as well as the presence of a preoperative UTI and surgeons did not differ significantly between both groups after PSM. There were no significant differences in mean OT (75 vs. 81 minutes, p = 0.28) and EF (2.13 vs. 2.13 g/min, p = 0.99). No differences were noted regarding intraoperative (16 vs. 25, p = 0.16) or postoperative complications graded by CDC (p = 0.53) and CCI (p = 0.92). Conclusion: PB within 6 months preoperatively before HoLEP showed no effect on perioperative outcomes or intra- and postoperative complications.

The Holmium:YAG laser has been the gold standard for laser lithotripsy over the past three decades and, since the late 1990s, also for prostate enucleation. Pulsed thulium fibre lasers (TFL) demonstrated their efficacy in in-vitro experiments and were introduced to the market a few years ago. Initial clinical results for TFL in lithotripsy and enucleation are very promising. In addition to TFL, a pulsed Thulium:YAG solid-state laser has been introduced, but clinical data for this laser are currently limited. This article aims to review the key technological differences between Ho:YAG lasers and pulsed thulium lasers and compare/discuss the initial clinical results for stone lithotripsy and laser enucleation.In-vitro studies have demonstrated the technical superiority of TFL compared with Ho:YAG lasers. However, as TFL is still a new technology, only limited studies are available to date, and optimal settings for lithotripsy have not been established. For enucleation, the differences of TFL compared with a high-power Ho:YAG laser seem to be clinically irrelevant. Initial studies on pulsed Tm:YAG lasers show good results, but there continues to be a lack of comparative studies.Based on the current literature, pulsed thulium lasers have the potential of being an alternative to Ho:YAG lasers. However, further studies are necessary to determine the optimal laser technology for enucleation and lithotripsy of urinary stones, considering all parameters, including efficacy, safety, and cost.

Zusammenfassung Aufgrund der steigenden Lebenserwartung und der wachsenden Nachfrage nach BPH-Behandlungen wurden innovative Technologien entwickelt, die eine zügige Erholung, Symptomlinderung, geringe Komplikationsraten sowie die Durchführung des Eingriffs ambulant und teilweise unter lokaler Betäubung ermöglichen. Das Ziel dieser Übersichtsarbeit ist es, die Ergebnisse der funktionellen Miktionsparameter und der sexuellen Funktion neu entwickelter minimalinvasiver chirurgischer Therapien (MIST) zur Behandlung der BPH zu beschreiben. Diese werden in primär ablative (Aquaablation [Aquabeam]), nicht-ablative (Prostata-Harnröhren-Lifting-Verfahren [PUL, Urolift], temporär implantierbare Körbchen [iTind]), und sekundär ablative Verfahren (konvektive Wasserdampfablation, Rezum, Prostataarterienembolisation [PAE]) unterschieden. Alle MIST-Technologien haben die medizinische Versorgung der BPH mit der Erhaltung der Ejakulation vorangetrieben. Langzeitdaten, die sich speziell mit Reinterventionsraten und den Erhalt der funktionellen Miktionsparameter beschäftigen, sind derzeit jedoch noch eine Seltenheit. Trotz vielversprechender Daten aus den Zulassungsstudien sowie aus randomisierten Studien, zeigen alle MIST-Therapien auch schwerwiegende Komplikationen. Patienten, die für eine solche Methode vorstellig werden, müssen über die Unterlegenheit im Gegensatz zu den etablierten transurethralen Verfahren wie die TUR-P und die Enukleation umfassend aufgeklärt werden.

To evaluate perioperative parameters, clinical outcomes, and the learning curve of holmium laser enucleation of the prostate (HoLEP) of a single surgeon in 500 consecutive cases. Demographic parameters, outcomes, and adverse events were evaluated. The learning curve for HoLEP in en-bloc technique of the first 500 consecutive patients was analyzed in clusters of 100 (clusters 1–5) using the Wilcoxen rank test, Chi² test and Kruskal Wallis test. Enucleation weight was similar in the clusters 1,2,3, and 5 (62 g, 63 g, 61 g, 61 g), in cluster 4 it was slightly higher at 73 g. There was a significant reduction in operating time from 67 min (cluster 1) to 57 min (cluster 2), 46 min (cluster 3), 53 min (cluster 4), and 43 min (cluster 5), p < 0.001. Enucleation efficiency (g/min) showed a steady increase (1.72, 2.24, 2.79, 2.92 vs. 2.99, p < 0.001). Laser energy efficiency also improved (2.17 vs. 2.12 vs. 1.71 vs. 1.65 vs. 1.55; p < 0.001). There was no measurable learning curve regarding the length of hospital stay (mean 2.5 days), catheterization time (1.9 days), hemoglobin drop (approx. 1 g/dl) or complications (p > 0.1). HoLEP using the en-bloc technique is a safe and highly effective method. Over time, a slight but steady learning curve and improvement in operation time, enucleation efficiency and laser energy efficiency were shown even for an experienced surgeon - after 500 cases, still no plateau was reached. There was no measurable learning curve regarding blood loss, complications, length of hospital stay, and catheterization time.

Holmium laser enucleation of the prostate (HoLEP) is an established option in the surgical treatment of benign prostatic hyperplasia. Pulse modulation, such as MOSES® technology, has recently been introduced and may offer potential advantages in HoLEP. Perioperative data from 117 patients who underwent MOSES® laser enucleation of the prostate (MoLEP) were collected. Propensity score matching using prostate volume, age, body mass index (BMI), and anticoagulant intake was performed using a database of 237 patients treated with HoLEP. In total, 234 patients were included in the analysis. Prostate volume (104 vs. 102 ml), age (70 vs. 71 years), BMI (27 vs. 27), and anticoagulant intake (34 vs. 35

Surgical approaches for benign prostatic hyperplasia have evolved and diversified over the past decades. While numerous studies document the efficacy of surgical procedures for moderate prostate sizes, there remains insufficient data for large prostate volumes >200 ml, leaving important questions unanswered regarding their effectiveness and safety. Consequently, selecting and adapting suitable therapeutic options for this specific patient group often poses a significant challenge. In this context, this review comprehensively summarizes and discusses current insights into surgical treatment options for large prostate volumes (>200 ml) following an extensive literature review. In summary, the surgical treatment of prostate volumes >200 ml is a challenge regardless of the chosen surgical method. Minimally invasive approaches should be considered standard practice today. Anatomical endoscopic enucleation of the prostate is a size-independent method and has the lowest morbidity. As it may be performed in spinal anaesthesia, endoscopic enucleation is feasible in patients with an increased anaesthetic risk. In extremely large prostate glands, the procedure poses challenges even for highly experienced surgeons. Especially in obese patients, the surgeon should be familiar with different exit strategies. Robot-assisted simple prostatectomy provides a minimally invasive alternative that may also treat pathologies such as diverticula or large bladder stones in the same surgical session. Due to its transabdominal approach, the morbidity and anaesthetic risk is comparatively higher. Each centre and surgeon should individually decide in which method they have the greatest expertise and which option is best suited for the specific case. In cases of limited expertise, it is advisable to refer patients to a centre with appropriate specialization.

In En-Bloc Resection of Bladder Tumours (ERBT), tumours are not removed in fragments, but are dissected in one layer and, if possible, extracted in one piece. This method represents a significant shift in the surgical management of non-muscle-invasive bladder tumours, providing multiple benefits over the traditional transurethral resection of the bladder (TUR-B). The histological analysis of ERBT specimens is more accurate, enhancing diagnostic precision. Additionally, the presence of detrusor muscle in ERBT specimens is more frequent, indicating a more complete removal of the tumours. Recent years have seen the consolidation of a robust evidence base emphasizing the advantages of ERBT. Notably, a multicentric, prospective randomized trial has recently revealed a significant reduction in recurrence rates at 12 months follow-up compared with TUR-B. Experienced endourologists should explore this technique, as it may soon become the standard of care. The technique's elegance and effectiveness make it too important to be ignored.

Introduction: The aim of this study was to investigate and compare clinical safety and efficiency of Thulium laser enucleation of the prostate (ThuLEP) and robot-assisted simple prostatectomy (RASP) for the treatment of large gland benign prostatic hyperplasia in a tertiary care center. Methods: Perioperative data of 39 patients who underwent RASP in our institution from 2015 to 2021 was collected. Propensity score matching using prostate volume, patient age, and body mass index (BMI) was performed from a database of 1,100 Patients treated by ThuLEP from 2009 to 2021. A total of 76 patients were matched. Preoperative parameters such as BMI, age, and prostate volume, as well as intra- and postoperative parameters such as operation time, resection weight, transfusion rate, postoperative catheterization time, length of hospital stay (LoS), hemoglobin drop, postoperative urinary retention (PUR), Clavien-Dindo Classification (CDC), and the Combined Complication Index (CCI), were evaluated. Results: There was no difference in mean hemoglobin drop (2.2 vs. 1.9 g/dL, p = 0.34), yet endoscopic surgery showed superiority in mean operation time (109 vs. 154 min, p < 0.001), mean postoperative catheterization time (3.3 vs. 7.2 days, p < 0.001), and mean LOS (5.4 vs. 8.4 days, p < 0.001). Complication rates evaluated by CDC (p = 0.11) and CCI (p = 0.89) were similar in both groups. Within the documented complications, transfusion rate (0 vs. 3, p = 0.08) and the occurrence of PUR (1 vs. 2, p = 0.5) showed no significant difference. Conclusion: ThuLEP and RASP show similar perioperative efficacy and a low rate of complications. ThuLEP had shorter operation times, shorter catheterization time, and a shorter LoS.

This study is aimed to determine whether postoperative low dose computed tomography (LDCT) imaging is necessary after percutaneous nephrolithotomy (PCNL), or the surgeon's intraoperative assessment of residual fragments (RF) is sufficient and avoidance of postoperative imaging with reduction of radiation exposure can be achieved. Data of all 610 patients who underwent PCNL in prone position in our institution from February 2009 to September 2020 was collected. Parameters such as age, gender, BMI, ASA-Classification, stone related parameters and the surgeon’s assessment of stone-free status were analyzed. The LDCT performed postoperatively was compared to the intraoperative assessment of the surgeon regarding RF. The mean age of patients was 52.82 years; the mean BMI was 28.18 kg/m 2 . In 418 cases, the surgeon made a clear statement about the presence of RF and postoperative LDCT was carried out. The discrepancy between the two methods (surgeon´s assessment vs. LDCT) was significant at p < 0.0001. The sensitivity, specificity, positive and negative predictive value of the surgeon when assessing RF were 24.05%, 99.45%, 98.28% and 50%. Stone free rate (SFR) after primary PCNL was 45.57%. The overall SFR at discharge was 96.23%. Although the surgeon´s assessment of RF was reliable, postoperative LDCT imaging should still be performed if endoscopic stone clearance is suspected due to the high false negative rate and the low negative predictive value. The optimal timing of postoperative imaging following PCNL remains unclear.

Context: Robot-assisted simple prostatectomy (RASP) and endoscopic enucleation of the prostate (EEP) are two minimally invasive alternatives to simple prostatectomy, which is considered the standard treatment in large prostate glands. It remains unclear which of the two is superior in terms of outcome and complications. Objective: To compare perioperative and functional outcomes of RASP vs EEP. Evidence Acquisition: A systematic review and meta-analysis was conducted according to the recommendations of the Cochrane Collaboration and in line with the PRISMA criteria. The database search included clinicaltrials.gov, Medline (via PubMed), CINAHL, and Web of Science and was using the PICO criteria. All comparative trials were considered. Risk of bias was assessed with the revised ROBINS-I tool. Evidence Synthesis: Seven hundred sixty studies were identified, 4 of which were eligible for qualitative and quantitative analysis, reporting on a total of 901 patients with follow-up up to 24 months. Hemoglobin drop (mean difference [MD] confidence interval [CI]: 0.34 g/dL [0.09–0.58]), the rate of blood transfusions (odds ratio [OR] [CI]: 5.01 [1.60–15.61]) catheterization time (MD [CI]: 3.26 days [1.30–5.23]), and length of hospital stay (LoS) (MD [CI]: 1.94 days [1.11–2.76]) were significantly lower in EEP. No significant differences were seen in operating time and enucleation weight. No significant differences were observed in the incidence of postoperative urinary retention, postoperative transient incontinence, and complications graded according to the Clavien-Dindo classification. Functional results were similar, with no significant differences in International Prostate Symptom Score and maximum urinary flow rate at follow-up. Conclusion: Both EEP and RASP offer excellent improvement of symptoms due to prostatic hyperplasia. EEP has lower blood loss, shorter catheterization time, and LoS and should be the first choice if available. RASP remains an attractive alternative for extremely large glands, in concomitant diseases, or whenever EEP is not available. Review Registration Number (PROSPERO): CRD42021226901

Zusammenfassung Hintergrund Immun-Checkpoint-Inhibitoren (ICI) sind seit wenigen Jahren in der Uroonkologie zugelassen. Real-world -Erfahrung zu Nutzen und Risiken bei neuartigen Nebenwirkungen liegt kaum vor. Material und Methoden In einer retrospektiven Analyse wurden an zwei Krankenhäusern in Deutschland von 2016–2021 Patienten erfasst, die aufgrund eines metastasierten Nierenzell- (NCC) oder Urothelkarzinoms (UCA) eine ICI-Therapie erhielten. Es wurde das radiologische Ansprechen, das progressionsfreie Überleben (PFS) sowie Nebenwirkungen, die zu einer Therapieunterbrechung führten, erhoben. Das onkologische Ansprechen wurde den Zulassungsstudien gegenübergestellt. Ergebnisse Bei 145 Patienten (111 Männer [77 %] und 34 Frauen [23 %]) wurden 1185 ICI-Zyklen appliziert. 64 (44,1 %) Patienten mit NCC und 81 (55,9 %) Patienten mit UCA erhielten eine ICI-Therapie. Von 141 Patienten mit Verlaufsbildgebung wurde ein objektives Ansprechen bei 21,3 % ( n = 13) der Patienten mit NCC und 20,0 % ( n = 16) mit UCA beobachtet (mediane Ansprechdauer 14,9 (3,0–51,3) Monate). Das PFS betrug bei Patienten mit NCC im Median 5,3 Monate und mit UCA 4,8 Monate. ICI-assoziierte Nebenwirkungen mit der Notwendigkeit einer Therapieunterbrechung wurden bei 17,2 % der NCC- und 20,9 % der UCA-Patienten beobachtet. Hierbei handelte es sich am häufigsten um renale (5,5 %: Nephritis) und gastrointestinale (4,8 %: Kolitis, Diarrhö) Nebenwirkungen. 22 (15,1 %) Patienten mussten deshalb hospitalisiert werden. Schlussfolgerung Diese Real-world -Erfahrung kann die patientenzentrierte Beratung in der Therapieentscheidung unterstützen. Weitere Studien zu prognostischen Faktoren sind notwendig. Therapieunterbrechungen sind häufig und das Nebenwirkungsspektrum erfordert eine interdisziplinäre Behandlung.

Context: Holmium (HoLEP) and thulium laser enucleation of the prostate (ThuLEP) are the two methods most commonly applied for endoscopic enucleation of the prostate. It remains unclear which of the two is superior in terms of outcome and complications. Objective: To compare perioperative and functional outcomes between HoLEP and ThuLEP. Evidence acquisition: A systematic review and meta-analysis were performed according to the recommendations of the Cochrane Collaboration and in line with the PRISMA criteria. A comprehensive database search including MEDLINE, Web of Science, CINAHL, Clinical-Trials.gov , and CENTRAL was conducted according to the PICO criteria. Only randomized controlled trials (RCTs) were considered. All review steps were conducted by two independent reviewers. Risk of bias was assessed using the revised Cochrane tool for RCTs. Evidence synthesis: The search identified 556 studies, of which four were eligible for qualitative and quantitative analysis, reporting on a total of 579 patients with follow-up of up to 18 months. No significant differences in operating time, enucleation weight, catheterization time, or hospital stay were observed between ThuLEP and HoLEP. The decrease in hemoglobin was significantly lower for ThuLEP (mean difference -0.54 g/dl, 95% confidence interval [CI] -0.93 to -0.15; p < 0.001), but with low certainty of evidence. Transient urinary incontinence was more common for HoLEP (odds ratio 0.56, 95% CI 0.32-0.99; p = 0.045), again with low certainty of evidence. Furthermore, no significant differences were observed for other complications or for functional measures and symptom scores. Conclusions: ThuLEP and HoLEP offer comparable improvement in symptoms and postoperative voiding parameters. Both procedures are safe and major complications are rare. ThuLEP showed minor advantages for blood loss and the incidence of transient incontinence. This should be interpreted with caution owing to the low certainty of evidence. Therefore, treatment choice should be based on surgeon expertise and local conditions. Patient summary: We reviewed four clinical trials that compared holmium and thulium lasers for treatment to reduce the size of the prostate gland. Our review assessed outcomes and complications. We found that both laser techniques are safe and suitable for reducing symptoms due to an enlarged prostate. Blood loss and short-lasting urinary incontinence were slightly lower after thulium compared to holmium laser treatment. (C) 2021 European Association of Urology. Published by Elsevier B.V. All rights reserved.

BACKGROUND:Thulium laser enucleation of the prostate (ThuLEP) is an established treatment option for benign prostatic enlargement (BPE), but long-term outcomes have not yet been reported. OBJECTIVE:To prove the durability of ThuLEP by investigating its long-term efficacy and morbidity. DESIGN, SETTING, AND PARTICIPANTS:All patients who underwent ThuLEP at a German tertiary referral center between 2009 and 2021 were retrospectively followed up for reinterventions for persistence or regrowth of prostate adenoma (ReIP) or long-term complications (ReIC). INTERVENTION:ThuLEP. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS:We calculated the cumulative incidence for ReIP and ReIC at 10 yr. Univariate and multivariate Cox regression models were constructed to identify predictors of ReIP and ReIC. RESULTS AND LIMITATIONS:Overall, 1097 patients underwent ThuLEP. The median overall follow-up was 6.0 yr (interquartile range [IQR] 2.4-9.2). For one-third of patients (n = 369), median follow-up of 10 yr (IQR 9.1-11.2) was available. A total of 42 patients (3.8%) underwent ReIP after a median of 2 yr (IQR 0.3-4.9). The rate of long-term ReIC was 2.6% (n = 29) and the median time to ReIC was 0.5 yr (IQR 0.3-1.7). The most frequent ReIC was urethrotomy (n = 16, 1.5%). The cumulative incidence of ReIP and ReIC at 10 yr was estimated at 5.6% and 3.4%, respectively. Enucleation weight ≥60 g was a significant predictor of ReIP (hazard ratio 1.2, p = 0.014). The retrospective study design and the lack of functional outcomes are the main limitations. CONCLUSIONS:ThuLEP is a durably effective and safe procedure with low reintervention rates within 12 yr. PATIENT SUMMARY:This study investigated long-term outcomes of thulium laser enucleation of the prostate for benign enlargement of the prostate (BPE). Low rates of repeat treatment for BPE recurrence or for other complications were observed. Our results show the safety and efficacy of this treatment over a period of 12 years.

Purpose Advances in therapy of metastatic castration-refractory prostate cancer (mCRPC) resulted in more therapeutic options and led to a higher need of predictive/prognostic biomarkers. Systemic inflammatory biomarkers could provide the basis for personalized treatment selection. This study aimed to assess the modified Glasgow Prognostic Score (mGPS), the neutrophile-to-lymphocyte ratio (NLR), the platelet-to-lymphocyte ratio (PLR) and the systemic immune-inflammation index (SII) in men with mCRPC under docetaxel. Methods Patients with mCRPC and taxane chemotherapy at a tertiary care centre between 2010 and 2019 were screened retrospectively. The biomarkers mGPS, NLR, PLR and SII were assessed and analyzed for biochemical/radiologic response and survival. Results We included 118 patients. Of these, 73 (61.9%) had received docetaxel as first-line, 31 (26.2%) as second-line and 14 (11.9%) as third-line treatment. For biochemical response, mGPS (odds ratio (OR) 0.54, p = 0.04) and PLR (OR 0.63, p = 0.04) were independent predictors in multivariable analysis. SII was significant in first-line cohort only (OR 0.29, p = 0.02). No inflammatory marker was predictive for radiologic response. In multivariable analysis, mGPS and NLR (hazard ratio (HR) 1.71 and 1.12, both p < 0.01) showed significant association with OS in total cohort and mGPS in the first-line cohort (HR 2.23, p < 0.01). Haemoglobin (Hb) and alkaline phosphatase (AP) showed several significant associations regarding 1 year, 3 year, OS and biochemical/radiologic response. Conclusions Pre-treatment mGPS seems a promising prognostic biomarker. A combination of mGPS, NLR and further routine markers (e.g., Hb and AP) could yield optimized stratification for treatment selection. Further prospective and multicentric assessment is needed.

OBJECTIVES:To assess the predictive and prognostic value of changes in longitudinal neutrophile-to-lymphocyte (NLR) ratios in men receiving taxane-based chemotherapy for metastatic prostate cancer (PC).METHODS:Retrospective, unicentric cohort study of patients treated with either docetaxel for metastatic hormone-sensitive PC (mHSPC) or docetaxel or cabazitaxel for metastatic castration-refractory PC (mCRPC) at a tertiary referral hospital between 2010 and 2019. NLR ratios were calculated for each cycle. Next, slopes over the first three (NLR3) and over six cycles (NLR6) were calculated and analysed for biochemical/radiologic response and survival.RESULTS:A total of 36 mHSPC (docetaxel), 118 mCRPC (docetaxel) and 38 mCRPC (cabazitaxel) patients were included. NLR3 was significantly associated with 1-year-survival, radiographic and biochemical response in mCRPC (docetaxel) in uni- and multivariable analyses. In mCRPC (docetaxel), positive NLR3s were associated with favourable 1-year-survival.CONCLUSION:This study demonstrated NLR3 as a prognostic marker in men receiving docetaxel for mCRPC. NLR3 might be a clinical tool to reflect the individual's response to taxane-based chemotherapy. Thereby, NLR3 could complement existing biomarkers and help to early identify treatment failure before complications arise. Further prospective and multicentric studies are needed to extend and confirm the presented results.