Luigi Candela

Purpose Lower urinary tract symptoms (LUTS) associated with bladder outlet obstruction (BOO) are prevalent among men, notwithstanding being self-underreported. We aimed to assess the predictors for BOO during first visit. Methods Data from 1045 analyzed men older than 40 years attending a single urological institution from 2010 to 2021. The men diagnosed with BOO, prostate cancer or any treatment for BOO were excluded. The patients completed the International Prostatic Symptoms Score (IPSS) and were investigated with prostate-specific antigen (PSA), trans-rectal ultrasound to measure prostate volume (PV) and free uroflowmetry. Logistic regression analysis tested the association between parameters and BOO. The area under the curve compared the diagnostic accuracy of predictors. The Youden-index analysis defined the cut-off predicting LUTS. Results Of 1045 patients, the median (IQR) age was 62 (51–69) years. A total of 773 (74%) had moderate LUTS. Both PV (OR: 1.16; 95%CI 1.04–1.3; p = 0.005) and IPSS (OR: 1.06; 95%CI 1.03–1.08; p < 0.001) were associated with BOO after adjusting for age. They showed a predictive accuracy with an AUC of 0.69 (0.60–0.77) and 0.63 (0.59–0.67) for PV and IPSS, respectively. A PV of 43 mL emerged as the cut-off point to define the risk of BOO. Therefore, a 60-year man with a PV ≥ 43 mL showed an 84% (70–90) risk of BOO as compared with 59% (50–68) for a same age man with lower PV. Conclusion Men older than 40 years should be screened for LUTS associated with BOO since they are highly prevalent. User-friendly parameters such as PV and IPSS could guide further investigation of BOO.

Pozzi E, et al. World J Mens Health. 2024 Jun;42:e63. https://doi.org/10.5534/wjmh.240069

Negri F, et al. World J Mens Health. 2025 Jan;43(1):134-141. https://doi.org/10.5534/wjmh.230298

To compare the pulsed-Thulium: YAG(p-Tm: YAG) and Thulium Fiber(TFL) lasers in terms of efficiency and safety profiles during flexible ureteroscopy(fURS) and endocorporeal laser lithotripsy(ELL). A prospective single-center open-label comparative study included consecutive patients with ureteral and renal stones who underwent fURS using Thulio(p-Tm: YAG, Dornier©,Germany) or TFL Drive(TFL, Coloplast©,Danemark), with 270 μm and 150/200μm laser fibers(LF), respectively. fURS were performed by a single operator in each group. Demographics, stone size, stone density, laser-on time(LOT) and laser settings were recorded. Ablation speed(mm³/s), energy consumption(J/mm³) values for each procedure were also assessed. Stone-free rate(SFR, p = 0,005), anatomical abnormalities(8vs33%,p = 0,03), lower pole(8vs26%,p = 0,04) and pelvic stones(25vs13%,p = 0,04) for p-Tm: YAG and TFL, respectively. The median stone maximum diameter was higher in the p-Tm: YAG group(17.3vs13.8 mm, p = 0,001) but stone volume was similar among groups(1514vs1347mm³,p = 0,6). Laser settings were similar among groups(0,6–15 Hz,10–12 W). Shorter LOT(< 0,001) and lower UAS insertion(0,01) rates were reported for TFL compared to p-Tm: YAG. The median J/mm³ was similar(14vs17,p = 0,2) but p-Tm: YAG presented higher ablation speed(0,91vs0,73mm³/s, p = 0,04). SFR were similar among groups(75vs77%,p = 0,8) but ZFR was higher in TFL group(39vs64%,p = 0,008). No difference in complications was reported. Both p-Tm: YAG and TFL are safe and effective for ELL during fURS. SFR were similar between TFL and p-Tm: YAG but the latter presented lower ZFR, traducing its lower ability to dust. Using 200 μm laser fibers with p-Tm: YAG could nuance these findings.

Introduction and objectives Medical device companies have introduced new TFL machines, including Soltive (Olympus, Japan), Fiber Dust (Quanta System, Italy), and TFLDrive (Coloplast, France). The primary objective of this study is to compare our initial clinical experiences with TFL using those devices. Through this historical comparison of Thulium Fiber Laser systems for stone lithotripsy, we aim to advance our understanding and approach toward achieving safe and effective TFL parameters. Materials and methods The data for this comparative analysis were extracted from three distinct prospective series that were previously published, outlining our initial clinical experience with the Soltive (Olympus, Japan), FiberDust laser (Quanta System, Italy), and TFLDrive laser (Coloplast, France). Parameters such as stone size, stone density, laser-on time (LOT), and laser settings were meticulously recorded. Additionally, we assessed critical variables such as ablation speed (expressed in mm³/s) and Joules/mm³ for each lithotripsy procedure. Results A total of 149 patients were enrolled in this study. Among them, 120 patients were subjected to analysis concerning renal stones. Statistically significant differences were observed in the median (IQR) stone volume: 650 (127–6027) mm³ for TFLDrive, 1800 (682.8–2760) mm³ for Soltive, and 1125 (294–4000) mm³ for FiberDust (p: 0.007); while there were no differences regarding stone density among the groups. Significant variations were identified in median (IQR) pulse energy, frequency, and total power. The Soltive group exhibited lower energy levels (0.3 J vs. 0.6 J, p: 0.002) but significantly higher pulse frequency (100 Hz vs. 17.5 Hz, p: 0.003) and total power (24 W vs. 11W, p: 0.001) compared to the other groups. Laser-on time showed no substantial differences across all three groups. Additionally, a statistically significant difference was observed in median J/mm3, with the TFLDrive group using higher values (24 J/mm3, p: 0.001), while the Soltive group demonstrated a higher median ablation speed of 1.16 mm3/s (p: 0.001). The overall complication rate remained low for all groups, with comparable stone-free rates. Conclusion By reducing pulsed frequency, we improved laser efficiency, but smaller volumes lead to decreased efficiency due to increased retropulsion and fragment movement. Further studies are needed to identify and establish the appropriate laser settings for this new technology.

Introduction Both Holmium:yttrium–aluminium–garnet (Ho:YAG) laser and Thulium Fiber Laser (TFL) can effectively treat all urinary stone types. This in vitro study evaluated the ablation volume per pulse (AVP) and required energy needed to ablate 1mm³ (RE, J/mm³) of various stone types at different laser settings with TFL. Methods 272-µm core-diameter laser fibers (Boston Scientific^©) were connected to a 50 Watts TFL generator (IPG^®). An experimental setup immerged human stones of calcium oxalate monohydrate (COM), uric acid (UA), and cystine (CYS) with a single pulse lasing emission (0.5/0.8/1 J), in contact mode. Stones were dried out before three-dimensional scanning to measure AVP and deduce from the pulse energy (PE) and AVP the RE. A direct comparison with known Ho:YAG’s AVP and RE was then carried out. Results AVP for COM stones was significantly greater than those for CYS stones and similar to UA stones (p = 0.02 and p = 0.06, respectively). If AVP increased with PE against COM and UA stones, AVP decreased against CYS stones. 1 J PE resulted in a threefold lower RE compared with other PE for COM stones. On the contrary, RE for CYS increased with PE, whereas PE did not had influence on RE for UA. TFL was associated with greater AVP for COM, but lower for UA and CYS stones compared to Ho:YAG laser. Conclusion This in vitro study firstly describes the ablation volume per pulse and required energy to treat a cubic millimeter of three frequent human stone types, and suggest TFL could not be suited for cystine. Therefore, stone composition could be considered when choosing the laser source for lithotripsy.