High-power holmium laser versus thulium fiber laser for endoscopic enucleation of the prostate in patients with glands larger than 80 ml: Results from the Prostate Endoscopic EnucLeation study group

Background

Endoscopic enucleation of the prostate (EEP) has gained acceptance as an equitable alternative to transurethral resection of the prostate for benign prostate hyperplasia (BPH). Our primary aim is to compare peri-operative outcomes of EEP using thulium fiber laser (TFL) against high-power holmium laser (HPHL) in hands of experienced surgeons for large prostates (≥80 ml in volume). Secondary outcomes were assess complications within 1 year of follow up.

Materials and Methods

We retrospectively reviewed patients with benign prostatic hyperplasia who underwent EEP with TFL or HPHL in 13 centers (January 2019-January 2023). Patients with prostate volume ≥80 ml were included, while those with concomitant prostate cancer, previous prostate/urethral surgery, and pelvic radiotherapy were excluded.

Results

Of 1,929 included patients, HPHL was utilized in 1,459 and TFL in 470. After propensity score matching (PSM) for baseline characteristics, 247 patients from each group were analyzed. Overall operative time (90 [70, 120] vs. 52.5 [39, 93] min, P < 0.001) and enucleation time (90 [70, 105] vs. 38 [25, 70] min, P < 0.001) were longer in the TFL group, with comparable morcellation time (13 [10, 19.5] vs. 13 [10, 16.5] min, P = 0.914). In terms of postoperative outcomes, there were no differences in 30-day complications such as acute urinary retention, urinary tract infection or sepsis. In the PSM cohort, univariable analyses showed that higher age, lower preoperative Qmax, higher preoperative PVRU, and longer operation time were associated with higher odds of postoperative incontinence, while 2-lobe enucleation had lower odds of incontinence compared to 3-lobe enucleation.

Conclusions

This real-world study reaffirms that HPHL and TFL in large prostates are equally efficacious in terms of 30-day complications. TFL with the en-bloc technique has a shorter operative time which significantly improves short- and medium-term functional outcomes.

Comparing CxBladder to Urine Cytology as Adjunct to Cystoscopy in Surveillance of Non-muscle Invasive Bladder Cancer-A Pilot Study

Purpose: Guidelines advocate cystoscopy surveillance (CS) for non-muscle invasive bladder cancer (NMIBC) post-resection. However, cystoscopy is operator dependent and may miss upper tract lesions or carcinoma in-situ (CIS). Urine cytology is a common adjunct but lacks sensitivity and specificity in detecting recurrence. A new mRNA biomarker (CxBladder) was compared with urine cytology as an adjunct to cystoscopy in detecting a positive cystoscopy findings during surveillance cystoscopy in our center.

Materials and Methods: Consented patients older than 18, undergoing CS for NMIBC, provide paired urine samples for cytology and CxBladder test. Patients with positive cystoscopy findings would undergo re-Trans Urethral Resection of Bladder Tumor (TURBT).

Results: Thirty-five patients were enrolled from April to June 2019. Seven contaminated urine samples were excluded. The remaining cohort of 23 (82%) and 5 (18%) females had a mean age of 66.69 (36–89). Eight (29%) patients with positive cystoscopy finding underwent TURBT. All 8 patients also had positive CxBladder result. This shows that CxBladder has a sensitivity and negative predictive value (NPV) of 100%, specificity of 75% and positive predictive value (PPV) of 62% in predicting a positive cystoscopy finding. TURBT Histo-pathological findings showed Low-grade Ta NMIBC in one patient (4%), and 7 (25%) patients had inflammatory changes. Urine cytology was only positive in one patient with a positive cystoscopy finding. This led to a sensitivity of merely 13% and NPV of 74%, while specificity and PPV was 100% in predicting a positive cystoscopy finding.

Conclusion: CxBladder had high NPV and sensitivity which accurately predicted suspicious cystoscopy findings leading to further investigation. It has great potential for use as adjunct to cystoscopy for surveillance of NMIBC.

How occupational therapy practitioners use virtual communities on the Facebook social media platform for professional learning: A critical incident study

BACKGROUND

As the use of social media to mediate learning in the occupational therapy profession gains increasing recognition, calls for tangible guidance with concrete and platform-specific examples have also become prominent.

AIMS

This study aims to describe and analyse the various learning activities qualified occupational therapy practitioners engage with in professional communities known as 'groups' on the Facebook social media platform.

METHOD

Forty-nine (n = 49) practitioners eligible for registration with the Health and Care Professions Council in the United Kingdom completed online questionnaires to produce one-hundred and ten (n = 110) critical incident reports. Data were thematically analysed.

RESULTS

Six learning activities were inductively identified: (1) Acquisition of New Ideas; (2) Reinforcement of Existing Knowledge; (3) Adjustments to Existing Knowledge; (4) Learning about Resources; (5) Learning related to Career Advancement; (6) Learning related to Hidden Curriculum.

CONCLUSION

This study showcases the varied ways occupational therapy practitioners learn through Facebook Groups, evidencing the utility of this professional learning environment.

SIGNIFICANCE

Findings enable occupational therapy practitioners to better evaluate which activities to engage in on Facebook Groups for learning and development of higher-quality professional practice. Further research examining the utility of Facebook Groups for professional learning in contrast to other social media platforms is recommended.

Adaptation and external validation of the European randomised study of screening for prostate cancer risk calculator for the Chinese population

BACKGROUND

To adapt the well-performing European Randomized Study of Screening for Prostate Cancer (ERSPC) risk calculator to the Chinese setting and perform an external validation.

METHODS

The original ERSPC risk calculator 3 (RC3) for prostate cancer (PCa) and high-grade PCa (HGPCa) was applied to a development cohort of 3006 previously unscreened Hong Kong Chinese men with initial transrectal biopsies performed from 1997 to 2015, age 50-80 years, PSA 0.4-50 ng ml^-1 and prostate volume 10-150 ml. A simple adaptation to RC3 was performed and externally validated in a cohort of 2214 Chinese men from another Hong Kong hospital. The performance of the models were presented in calibration plots, area under curve (AUC) of receiver operating characteristics (ROCs) and decision curve analyses.

RESULTS

PCa and HGPCa was diagnosed in 16.7% (503/3006) and 7.8% (234/3006) men in the development cohort, and 20.2% (447/2204) and 9.7% (214/2204) men in the validation cohort, respectively. The AUCs using the original RC3 model in the development cohort were 0.75 and 0.84 for PCa and HGPCa, respectively, but the calibration plots showed considerable overestimation. In the external validation of the recalibrated RC3 model, excellent calibration was observed, and discrimination was good with AUCs of 0.76 and 0.85 for PCa and HGPCa, respectively. Decision curve analyses in the validation cohort showed net clinical benefit of the recalibrated RC3 model over PSA.

CONCLUSIONS

A recalibrated ERSPC risk calculator for the Chinese population was developed, and it showed excellent discrimination, calibration and net clinical benefit in an external validation cohort.