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Nomenclature in thulium laser treatment of benign prostatic hyperplasia: it’s time to pull the rabbit out of the hat

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Abstract

We performed a narrative review with the focus on laser settings and surgical procedure with thulium laser. Our primary goal was to define the most valid settings of each surgical procedure to overcome the inconsistency about nomenclature of thulium surgery and to ensure comparability of future publications. A literature search of articles on thulium laser treatment of benign prostatic hyperplasia (BPH) was conducted between 2009 and 2019. We proposed a new classification standard for laser settings and associated surgical procedure. Each article was analyzed and categorized as concordant or discordant referring to the new classification. In total, 74 papers were included in this narrative review. Overall, 43% and 42% of included studies reported discordant laser parameters and surgical description, respectively. Most of the studies on vaporization were categorized as discordant because they reported a medium/low laser setting instead of high power. Conversely, 93.3% of studies on enucleation were deemed as discordant for laser setting because they reported high power parameters instead of medium-low power setting. Most of the studies on laser enucleation and vapo/enucleation were considered discordant for surgical procedure since authors did not mention the use of mechanical vs. laser method for enucleation. The current literature lacks a uniform definition and standardization of the terminology of thulium laser settings and surgical techniques to guarantee comparability between different approaches. We found a huge heterogeneity in 10 years of surgery with thulium laser. We proposed a new classification of laser setting and procedural description for categorization of thulium laser surgery for BPH.

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Authors and Affiliations

  1. Department of Urology, Istituti Clinici Zucchi, Monza, Italy

    Serena Maruccia & Stefano Casellato

  2. Department of Pharmacy, Fondazione IRCCS Ca’ Granda – Ospedale Maggiore Policlinico, Milan, Italy

    Irene Fulgheri

  3. Department of Urology, Fondazione IRCCS Ca’ Granda – Ospedale Maggiore Policlinico, University of Milan, Via della Commenda 15, 20122, Milan, Italy

    Emanuele Montanari & Luca Boeri

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  1. Serena Maruccia
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  2. Irene Fulgheri
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  3. Emanuele Montanari
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  4. Stefano Casellato
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  5. Luca Boeri
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Serena Maruccia: project development, data management, manuscript editing

Irene Fulgheri: project development, data management, manuscript editing

Stefano Casellato: project development, data management, manuscript editing

Emanuele Montanari: project development, data management, manuscript editing

Luca Boeri: project development, data management, data analysis, manuscript writing/editing

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Correspondence to Luca Boeri.

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The current study has been approved by the ethics committee of IRCCS Ca’ Granda – Ospedale Maggiore Policlinico. Data collection followed the principles outlined in the Declaration of Helsinki.

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Maruccia, S., Fulgheri, I., Montanari, E. et al. Nomenclature in thulium laser treatment of benign prostatic hyperplasia: it’s time to pull the rabbit out of the hat. Lasers Med Sci 36, 1355–1367 (2021). https://doi.org/10.1007/s10103-020-03227-4

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