treatment of benign prostatic obstruction (BPO). The need for medical and or surgical retreatment for recurring or residual BPO as well as their predictors will be assessed.METHODS: After IRB approval, a prospectively maintained database was established for patients with BPO for whom greenlight laser photoselective vaporization (PVP) and vapoenucleation (PVEP) of the prostate were carried out between August 2014 to March 2018. Patients' perioperative data and urinary functional outcome parameters and postoperative complications were depicted. The need for retreatment was assessed and its predictors retreatment were evaluated.RESULTS: This study included 248 patients, 157 (63.3%) and 91(36.7%) patients underwent PVP and PVEP with mean prostate volume (60AE18 and 100AE22 ml) respectively. Mean AESD follow up duration was 62AE9 months. At last point follow up, mean AESD percentage of improvement in IPSS was 61AE28 and 78AE20 p[0.03, median (range) percentage of improvement in Q max was 119(-13-549) and 123(-13-649) % p[0.2 and median (range) percentage of PSA reduction was 63(-172-99) and 65(-75-97) % p[0.7 for PVP and PVEP groups respectively. Overall retreatment rate (medical and surgical) was 23% (57 patients), 38 (24.2%) after PVP and 19 (20.9%) after PVEP, p[0.5. The need surgical retreatment was statistically significant more after PVP (table 1). Median (range) time to event (defined as medical or surgical re-intervention) was 20 (1-60) for all cases, 3.5 (0-42) and 30 (18-60) months p[ 0.7 for PVP and PVEP groups respectively. On multivariate analysis, only percent reduction of one-year postoperative PSA was a significant predictor of need for retreatment (surgical/ medical) of recurring or residual BPO (P 0.021, 95% CI 0.018-0.024). The cutoff point was 64.2% (58.2% sensitivity, 73.4% specificity, AUC 0.647, 95% CI 0.52-0.76) above it there is less probability for having BPO retreatment.CONCLUSIONS: Greenlight laser prostatectomy using XPS-180Watt is an effective and versatile tool in treating BPO. Durability of the outcome is predictable with more postoperative PSA reduction.

No abstract

(1) Introduction and Objective: Upper tract urothelial carcinoma (UTUC) is an uncommon disease, only accounting for 5–10% of all urothelial carcinomas. Current clinical practice guidelines encourage a risk-adapted approach to UTUC management, including lymph node dissection (LND) in patients with muscle-invasive or high-risk tumors. If pathological characteristics could be more accurately predicted from preoperative data, we could optimize perioperative management strategies and outcomes. The aim of this article is to present a detailed revision of preoperative predictors for muscle-invasive UTUC, locally advanced or advanced UTUC, as well as current indications, technique variations, and the reasons as to why LND should be offered to these patients. (2) Methods: We included any kind of studies related to information concerning UTUC, nephroureterectomy, LND, risk factors for recurrence, prediction tools and models for risk stratification. A literature search was conducted following medical subject headings (MeSh), Emtree language, Decs, and text words related. We searched through MEDLINE (OVID), EMBASE (Scopus), LILACS, and the Cochrane Central Register of Controlled Trials (CENTRAL) from inception to May 2021. Evidence acquisition was presented according to the PRISMA diagram. (3) Results: Preoperative risk factors for either muscle-invasive UTUC (≥pT2), extra urothelial recurrence (EUR), locally advanced disease, or high-risk UTUC can either be derived from ureteroscopic (URS) findings, urine cytology, URS biopsy, or from preoperative radiologic findings. It seems reasonable that LND may provide not only staging and prognostic information but also play a therapeutic role in selected UTUC patients. The patients who benefit the most from LND appear to be those with ≥ pT2 disease, because patients with tumors ≤ pT1 rarely metastasized to LNs. UTUC has characteristic patterns of lymphatic spread that are dependent on tumor laterality and anatomical location. Choosing the right patients for LND, designing and standardizing LND templates based on tumor location and laterality is critical to improve LN yield, survival outcomes, and to avoid under-staging or overtreatment. (4) Conclusions: Patients with muscle-invasive or non-organ-confined UTUC have an extremely high risk for disease recurrence and cancer-specific mortality (CSM). Preoperative factors and prediction models must be included in the UTUC management pathway in our clinical practice to improve the accurate determination of high-risk groups that would benefit from LND. We recommend offering LND to patients with ipsilateral hydronephrosis, cHG, cT1 at URS biopsy and renal sinus fat or periureteric fat invasion. The role of lymphadenectomy in conjunction with radical nephroureterectomy (RNU) is still controversial, given that it may result in overtreatment of patients with pTa-pT1 tumors. However, a clear benefit in terms of recurrence-free survival (RFS) and cancer-specific survival (CSS) has been reported in patients with ≥pT2. We try to avoid LND in patients with cLG, cTa, and no ipsilateral hydronephrosis if the patient is expected to be compliant with the follow up schedule. There is still plenty of work to do in this area, and new molecular and non-invasive tests are necessary to improve risk stratification.

No abstract