Objectives To explore the perspective of urological patients on the possibility to defer elective surgery due to the fear of contracting COVID-19. Methods All patients scheduled for elective urological procedures for malignant or benign diseases at two high-volume Centres were administered a questionnaire, through structured telephone interviews, between 24 th and 27 th April 2020. The questionnaire included three questions: 1) In light of the COVID-19 pandemic, would you defer the planned surgical intervention? 2) If yes, when would you be willing to undergo surgery? 3) What do you consider potentially more harmful for your health: the risk of contracting COVID-19 during hospitalization or the potential consequences of delaying surgical treatment? Results Overall, 332 patients were included (51.5% and 48.5% in the oncology and benign groups, respectively). Of these, 47.9% patients would have deferred the planned intervention (33.3% vs 63.4%; p<0.001), while the proportion of patients who would have preferred to delay surgery for more than six months was comparable between the groups (87% vs 80%). These answers were influenced by patient age and ASA score (in the Oncology group) and by the underlying urological condition (in the benign group). Finally, 182 (54.8%) patients considered the risk of COVID-19 potentially more harmful than the risk of delaying surgery (37% vs 73%; p<0.001). This answer was driven by patient age and the underlying disease in both groups. Conclusions Our findings reinforce the importance of shared decision-making before urological surgery, leveraging patients’ values and expectations to refine the paradigm of evidence-based medicine during the COVID-19 pandemic and beyond.

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ObjectiveTo date, several ultra-minimally-invasive surgical techniques are available for the treatment of male LUTS due to benign prostatic obstruction (BPO). Herein we report our preliminary experience with SoracteLite™ TPLA for the treatment of carefully selected patients with LUTS due to BPO.MethodsData from all consecutive patients undergoing TPLA at our institution between April 2021 and February 2022 were prospectively collected in a specific database. Data regarding functional and sexual outcomes evaluated by validated questionnaires and uroflowmetry were analyzed. All the procedure were performed in an outpatient setting, under local anesthesia and conscious sedation, using EchoLaser device, a multisource diode laser generator.ResultsOverall, 38 patients underwent TPLA at our institution during the study period. The median prostate volume was 46 ml (IQR 38-71). The median time to complete the procedure was 31 min (IQR 28-37). All patients but one were discharged within 8 hours of hospital stay. No perioperative Clavien-Dindo grade ≥2 complications were recorded. Median improvement in Qmax was 17%, 24% and 32% at 1 month, 3 months and last follow-up after surgery; as a result, the median postoperative IPSS at 1 month, 3 months and at last follow-up decreased by -14%, -36% and -35%, respectively. All patients preserved ejaculatory and sexual function. Two patients (5%), catheter carriers before the procedure, experienced acute urinary retention after TPLA treatment and required replacement of an indwelling catheter.ConclusionsTPLA can be a feasible, safe and effective ultra-minimally-invasive procedure for carefully selected patients with LUTS due to BPO.

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