OBJECTIVE: Traditionally, bilateral urolithiasis treatment involved staged interventions due to safety concerns. Recent studies have shown that same-sitting bilateral retrograde intrarenal surgery (SSB-RIRS) is effective, with acceptable complication rates. However, there\'s no clear data on the optimum laser for the procedure. This study aimed to assess outcomes of SSB-RIRS comparing thulium fiber laser (TFL) and high-power holmium:yttrium-aluminum-garnet (Ho:YAG) laser in a multicenter real-world practice.
METHODS: Retrospective analysis was conducted on patients undergoing SSB-RIRS from January 2015 to June 2022 across 21 centers worldwide. Three months perioperative and postoperative outcomes were recorded, focusing on complications and stone-free rates (SFR).
RESULTS: A total of 733 patients were included, with 415 in group 1 (Ho:YAG) and 318 in group 2 (TFL). Both groups have similar demographic and stone characteristics. Group 1 had more incidence of symptomatic pain or hematuria (26.5% vs. 10.4%). Operation and lasing times were comparable. The use of baskets was higher in group 1 (47.2% vs. 18.9%, p<0.001). Postoperative complications and length of hospital stay were similar. Group 2 had a higher overall SFR. Multivariate regression analysis indicated that age, presence of stone at the lower pole, and stone diameter were associated with lower odds of being stone-free bilaterally, while TFL was associated with higher odds.
CONCLUSIONS: Our study shows that urologists use both lasers equally for SSB-RIRS. Reintervention rates are low, safety profiles are comparable, and single-stage bilateral SFR may be better in certain cases. Bilateral lower pole and large-volume stones have higher chances of residual fragments.

暂无摘要。

Laser lithotripsy mechanisms can cause the chemical decomposition of stone components and the emergence of different end products. However, the potentially toxic end products formed during thulium fiber laser (TFL) lithotripsy of cystine stones have not been sufficiently investigated. The aim of our in vitro study is to analyze the chemical content of the gas products formed during the fragmentation of cystine stone with TFL. Human renal calculi consisting of 100% pure cystine, calcium oxalate monohydrate, or uric acid were fragmented separately with TFL in experimental setups and observed for gas release. After the lithotripsy, only the cystine stones showed gas formation. Gas chromatography-mass spectrometry was used to analyze the gas qualitatively, and scanning electron microscopy with energy-dispersive X-ray spectroscopy (SEM-EDX) and X-ray diffraction was used to examine the dried cystine stone fragments. Fragmentation of the cystine stones released free cystine, sulfur, hydrogen sulfide, and carbon disulfide gas. The SEM-EDX and X-ray diffraction analyses revealed that the free cystine in the dried fragments contained 43.1% oxygen, 28.7% sulfur, 16.1% nitrogen, and 12.1% carbon atoms according to atomic weight. The detection of potentially toxic gases after lithotripsy of cystine stones with TFL indicates a risk of in vivo production. Awareness needs to be increased among healthcare professionals to prevent potential inhalation and systemic toxicity for patients and operating room personnel during TFL lithotripsy of cystine stones.

OBJECTIVE: We aim to report here the first clinical series of patients treated with AEEP using a novel hybrid thulium:yttrium-aluminium-garnet (Tm:YAG) laser generator (RevoLix HTL, LISA Laser Products, Germany), i.e. capable of emitting both in pulsated and continuous-wave.
METHODS: We included 39 consecutive patients who underwent hybrid Tm:YAG AEEP (hybrid ThuLEP) at a single center starting from July 2022 and were followed-up until 3 months after surgery. Complete baseline, intraoperative, and follow-up demographic and clinical data were collected. The International Prostatic Symptoms Score (IPSS) questionnaire was used to quantify urinary symptoms at baseline and during follow-up. Post-operative follow-up further included a PSA test, uroflowmetry with post-void residual volume (PVR) measurement. Clavien-Dindo classification was used to classify complications.
RESULTS: Median (IQR) age at surgery and prostate volume were 68 (IQR 63-74) years and 85 (60-105) cc. Both en-bloc or two-lobes technique enucleation were performed according to the intraoperative and endoscopic anatomy, with a median operative time of 85 (63-108) minutes. Bladder catheter was removed in all cases on postoperative day two. Intraoperative bleeding requiring conversion to bipolar enucleation was observed in two patients. After discharge, one patient developed arm phlebitis which was treated with anticoagulants leading to new onset haematuria requiring short term catheterisation (Clavien-Dindo grade II) and two more patients had a single episode of acute urinary retention (Clavien-Dindo grade I). Median pre- vs postoperative Qmax and IPSS were 8.0 (7.0-9.4) vs. 25.0 (22.5-32.5) ml/s and 22 (20-28) vs. 1 (0-2), whereas PVR decreased from 70 (50-115) to 0 (0-26) ml.
CONCLUSIONS: Hybrid ThuLEP is a feasible and effective surgical procedure for the management of benign prostatic obstruction.

OBJECTIVE: To compare thulium laser enucleation of the prostate (ThuLEP) with plasma kinetic resection of the prostate (PKRP) in the treatment of BPH.
METHODS: We retrospectively analyzed the medical records of 160 cases of BPH treated by ThuLEP (the observation group, n = 80) or PKRP (the control group, n = 80) in our hospital from January 2021 to December 2023. We recorded the operation time, bladder irrigation time, catheter retention time, hospitalization time, postoperative complications, and pre- and postoperative maximum urinary flow rate (Qmax), residual urine volume (PVR), prostate-specific antigen (PSA) and prostate volume, followed by comparison of the data obtained between the two groups of patients.
RESULTS: Compared with the controls, the patients of the observation group showed significantly shorter operation time (［67.25 ± 7.24］ vs ［60.10 ± 5.15］ min, P< 0.05), bladder irrigation time (［46.90 ± 10.77］ vs ［43.24 ± 6.65］ h, P< 0.05), catheterization time (［5.60 ± 1.31］ vs ［5.03 ± 1.24］ d, P< 0.05) and hospitalization time (［7.31 ± 2.00］ vs ［6.55 ± 1.67］ d, P< 0.05), higher Qmax (［18.50 ± 1.24］ vs ［20.68 ± 1.45］ ml/s, P< 0.05), lower PVR (［12.10 ± 3.53］ vs ［10.82 ± 3.10］ ml, P< 0.05), PSA (［4.60 ± 0.78］ vs ［3.38 ± 0.40］ μg/L, P< 0.05) and prostate volume (［25.35 ± 6.46］ vs ［20.12 ± 5.13］ ml, P< 0.05) at 3 months after surgery, but no statistically significant difference in the total incidence of postoperative complications (7.50% ［6/80］ vs 5.00% ［4/80］, P > 0.05).
CONCLUSIONS: ThuLEP, with its advantages of notable effect, short operation and hospitalization time, significant improvement of urinary flow dynamics and prostate function, deserves clinical promotion for the treatment of BPH.

OBJECTIVE: To investigate the clinical effect of pulsed thulium laser (PTL) combined with triamcinolone acetonide injection in the treatment of failed posterior urethral anastomosis (FPUA).
METHODS: This retrospective study included 35 male patients treated in Gongli Hospital for failed posterior urethral anastomosis from January 2018 to December 2023. All the patients underwent direct-vision internal urethrotomy (DVIU) with transurethral PTL (the PTL group, n = 15) or transurethral plasma (the TUP group, n = 20), and all received intralesional injection of triamcinolone acetonide. We followed up the patients for a median of 21 months, recorded the age, length of urethral stricture, operation time, pre- and post-operative maximum urinary flow rate (Qmax), postoperative complications and recurrence of urethral stricture, and compared the data obtained between the two groups.
RESULTS: All the patients smoothly completed the treatment procedures. No statistically significant differences were observed in the age, length of urethral stricture, operation time and postoperative complications between the two groups (P > 0.05). The median follow-up time for the thulium laser group and plasma group was 21.0 months (IQR 16.0－24.0) and 21.0 months (IQR 17.0－25.0), respectively, with a statistically significant difference observed in the maximum urine flow rate before and after surgery at the 12-month mark (P < 0.01). No significant disparity was found in terms of relapse-free survival between the two groups (P = 0.398) Conclusion: Pulsed thulium laser combined with triamcinolone acetonide injection can effectively maintain a short-term cicatricial stability of the urethral stricture and satisfactory urethral patency, obviously superior to plasmotomy as a remedial treatment of urethral stricture after failed posterior urethral anastomosis.

Background and Objectives: In the surgical treatment of benign prostatic hyperplasia (BPH), laser enucleation of the prostate is recommended as an alternative to transurethral resection (TURP) and open prostatectomy (OP). The thulium fiber laser, with its superficial penetration depth, can offer a rapid learning process by causing less heat injury and capsule damage. This study compares the first 60 cases of an endourologist performing thulium fiber enucleation of the prostate (ThuFLEP) without a mentor to the results of OP and TURP performed by experienced surgeons. It also identifies the case number at which the operation time for ThuFLEP starts to plateau. Materials and Methods: Between 1 November 2021 and 1 November 2023, the initial 60 ThuFLEP cases of an endourologist with no prior enucleation experience were compared with TURP and OP operations performed by experienced surgeons. Since the first 60 ThuFLEP cases involved 80-120 cc prostates, TURP and OP operations within this size range performed during the same period were included in the study. The groups were assessed for age, preoperative and postoperative prostate volume, PSA levels, the IPSS, the IPSS Quality of Life (QoL), and maximum urinary flow (Qmax). The 60 consecutive ThuFLEP cases were divided into three groups of 20 (Groups 1, 2, and 3) and compared for operation time, IPSS, and Qmax. Results: The operation time for TURP was shorter than for ThuFLEP and OP (p < 0.001). There was no significant difference between ThuFLEP and OP in postoperative Qmax and IPSS, while TURP had lower values than the other two methods. For ThuFLEP, the operation time was longer in the first 20 cases but plateaued in groups 2 and 3 (p < 0.001). Postoperative Qmax and IPSS values showed no significant differences among the three ThuFLEP groups (p > 0.05). Conclusions: For large prostates, ThuFLEP provides better postoperative results than TURP and offers shorter catheterization and hospital stay times than OP. Its short learning curve makes it a preferable method for treating BPH compared to other laser techniques.

OBJECTIVE: To evaluate the stone ablation rate and direct thermal damage from thulium fiber laser (TFL) lithotripsy using continuous (C) and burst (B) lasing techniques on an in vitro ureteral model.
METHODS: The TFL Drive (Coloplast, Humlebaek, Denmark) was used in an in vitro saline-submerged ureteral model. Ten participants, including five junior and five experienced urologists, conducted the experimental setup with 7 different settings comparing two lasing techniques: steady-state lasing (0.5 J/10 Hz = 5W for 300 s and 0.5 J/20 Hz = 10W for 150 s) and burst, intermittent 5 s on/off lasing (0.5 J/20 Hz, 0.5 J/30 Hz, 0.5 J/60 Hz, 0.1 J/200 Hz, and 0.05 J/400 Hz) with a target cumulative energy of 1500 J using cubic 125 mm3 phantom BegoStonesTM. Ureteral damage was graded 1-3 based on the severity of burns and holes observed on the surface of the ureteral model.
RESULTS: The were no significant differences in stone ablation mass neither between C and B lasing techniques, nor between expertise levels. At C lasing technique had only mild ureteral lesions with no significant differences between expertise levels (p: 0.97) or laser settings (p: 0.71). At B lasing technique, different types of thermal lesions were found with no expertise (p: 0.11) or setting (p: 0.83) differences. However, B laser setting had higher grade direct thermal lesions than C (p: 0.048).
CONCLUSIONS: Regarding efficacy, C and B lasing techniques achieve comparable stone ablation rates. Safety-wise, B lasing mode showed higher grade of direct thermal lesions. These results should be further investigated to verify which of the lasing mode is the safest in vivo. Until then and unless proven otherwise, a C mode with low frequency should be recommended to avoid ureteral wall lesions.

UNASSIGNED: To compare the efficacy and safety of thulium fiber laser (TFL) and holmium:yttrium-aluminum-garnet (Ho:YAG) laser for ureteric stone management with semi-rigid ureteroscopy.
UNASSIGNED: In a prospective study from January 2020 to December 2021, we compared 40 patients in each group who underwent semi-rigid ureteroscopic lithotripsy with TFL and that with Ho:YAG laser. Stone volume, stone density, stone fragmentation rates, total lasing time, total operative time, endoscopic vision, retropulsion and stone free rates were analyzed in both groups and compared.
UNASSIGNED: Mean stone volume was comparable in the TFL group and the Ho:YAG laser group (282.45 [standard deviation, SD 139.79] mm3 vs. 279.49 [SD 312.52] mm3; p=0.964). Mean stone density was also comparable in the TFL group and the Ho:YAG laser group (1135.30 [SD 317.04] Hounsfield unit vs. 1131.75 [SD 283.03] Hounsfield unit; p=0.959). The mean stone fragmentation rates calculated as stone volume divided by lasing time were 25.85 (SD 10.61) mm3/min and 21.37 (SD 14.13) mm3/min in the TFL group and the Ho:YAG laser group, respectively (p=0.113). The mean total lasing time (10.15 [SD] 4.69 min vs. 11.43 [SD 4.56] min; p=0.222), mean operative time (25.13 [SD 9.51] min vs. 25.54 [SD 10.32] min; p=0.866), and mean total hospital stay (2.62 [SD 0.77] days vs. 2.61 [SD 0.84] days; p=0.893) were comparable in the TFL group and in the Ho:YAG group. The vision was better and retropulsion was less in the TFL group. The stone-free rate at 1 month postoperatively was slightly better in the TFL group (100% vs. 90%; p=0.095).
UNASSIGNED: TFL technology was associated with the comparable total surgical time, total lasing time, and stone fragmentation rate with Ho:YAG laser. However, TFL had better endoscopic vision, lesser stone retropulsion, and slightly better stone-free rates.

CO2 reduction photocatalysts are favorable for obtaining renewable energy. Enriched active sites and effective photogenerated-carriers separation are keys for improving CO2 photo-reduction. A thulium (Tm) single atom tailoring strategy introducing carbon vacancies in porous tubular graphitic carbon nitride (g-C3N4) surpassing the ever-reported g-C3N4 based photocatalysts, with 199.47 µmol g-1 h-1 CO yield, 96.8% CO selectivity, 0.84% apparent quantum efficiency and excellent photocatalytic stability, is implemented in this work. Results revealed that in-plane Tm sites and interlayer-bridged Tm-N charge transfer channels significantly enhanced the aggregation/transfer of photogenerated electrons thus promoting CO2 adsorption/activation and contributing to *COOH intermediates formation. Meanwhile, Tm atoms and carbon vacancies both benefit for rich active sites and enhanced photogenerated-charge separation, thus optimizing reaction pathway and leading to excellent CO2 photo-reduction. This work not only provides guidelines for CO2 photo-reduction catalysts design but also offers mechanistic insights into single-atom based photocatalysts for solar fuel production.