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In this special edition, the focus is on how technological innovations in endourological management for urolithiasis and benign prostatic hypertrophy have influenced global real-world clinical practice. The key focus of these innovations is to ensure surgical interventions ensure maximum efficacy while being minimally invasive in an effective way. An unmet need was to see how different health systems have adopted flexible ureteroscopy (FURS) into their practice and what are the preferred approaches in managing renal stones. This was very well addressed by the creation of the FLEXOR registry, the first of its kind global multicenter database [1]. Information from this first of its kind registry highlights the pros, cons, and nuances of practice in different health systems and how it has a bearing on outcomes of surgery. It opens up avenues for furthering research in RIRS. Double J Stents have always been a urologist's friend and often a nightmare when patients suffer from stent symptoms. Many propositions have been studied including stent design, material, indwelling time, ease of insertion, and removal aimed at improving stent experience of a patient [2]. One such innovative study highlights how intraoperative insertion of a magnetic stent post-ureteroscopy allows for an easier removal in the outpatient setting. This is easily done ultrasound guided and is simple to learn even for novices [3]. In renal urolithiasis management, the key considerations are rendering the patients stone free in a single stage, with negligible complications to improve patients quality of life. One such area is patients with calyceal diverticular stones. Percutaneous nephrolithotomy approach (PCNL) has been the standard of care but with advancement in lasers and laser technology, slimmer ureteroscopes and better understanding of the nuances of retrograde intrarenal surgery (RIRS) has also shown to be efficacious. An excellent practical real-world insight has been provided in this edition. Renal stones can cause many problems and xanthogranulomatous pyelonephritis(XGP) is one such disease with an aggressive and often morbid course. Counseling patients on factors associated with higher surgical complications is quintessential when managing this disease as was shown by Robles-Torres JI et al. when analyzing data from ten centers worldwide [4].
Ever since Herrmann TR [5] declared that enucleation is enucleation is enucleation, several studies have looked at different energy sources and techniques to improve anatomical endoscopic enucleation of the prostate (AEEP) surgery, both from a surgeons and patients perspective. Recently in this field, holmium laser with MOSES technology (MoLEP) and thulium fiber laser enucleation of the prostate (ThuFLEP) have generated much interest. There is paucity of real-world multicenter study that compares results in terms of surgical and functional outcomes. Castellani D et al. [6] have shown interesting midterm study outcomes in a propensity score match paired analysis (PSM), comparing the above two lasers from patients enrolled in a retrospective analysis who underwent either procedure in five centers. The study highlights clearly how AEEP is continuously evolving. While surgical interventions for BPH are the mainstay, minimally invasive surgical therapies (MIST) have also garnered a place in management. Prostatic stents have seen a resurgence and a scoping review by Nguyen AV et al. [7] on office-based prostatic stents highlights the past, present, and future of these devices in BPH management.
Indeed the scope of published articles clearly represents that BPH and stone surgery continues to be at the forefront of daily practices and innovations and new technologies are pushing the boundaries. Real-world studies provide an insight into how surgeons adapt, adopt, and improvise these developments constantly aiming toward better patient outcomes.
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Gauhar, V. Technological innovations and evolving trends in endourological management for urolithiasis and benign prostatic hypertrophy. World J Urol 41, 2879–2880 (2023). https://doi.org/10.1007/s00345-023-04692-6
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DOI: https://doi.org/10.1007/s00345-023-04692-6