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Muñiz Suárez, J. Subirá Ríos, P. Gayarre Abril, A. Montero Martorán, J.I. Hijazo Conejos, J. García Alarcón, J. García-Magariño Alonso, P. Medrano Llorente, M. Ramírez Fabián, F.X. Elizalde Benito, C. Murillo Pérez, M. Utrilla Ibuarben, A. Asensio Matas, C. Marín Zaldívar, R. Casans Francés, J.M. Ramírez Rodríguez, B. Blasco Beltrán, P. Carrera-Lasfuentes" "autores" => array:18 [ 0 => array:2 [ "nombre" => "L." "apellidos" => "Muñiz Suárez" ] 1 => array:2 [ "nombre" => "J." "apellidos" => "Subirá Ríos" ] 2 => array:2 [ "nombre" => "P." "apellidos" => "Gayarre Abril" ] 3 => array:2 [ "nombre" => "A." "apellidos" => "Montero Martorán" ] 4 => array:2 [ "nombre" => "J.I." "apellidos" => "Hijazo Conejos" ] 5 => array:2 [ "nombre" => "J." "apellidos" => "García Alarcón" ] 6 => array:2 [ "nombre" => "J." "apellidos" => "García-Magariño Alonso" ] 7 => array:2 [ "nombre" => "P." "apellidos" => "Medrano Llorente" ] 8 => array:2 [ "nombre" => "M." 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Romero Otero, J. Justo Quintas, E. García Rojo, R. Sopeña Sutil, E. Peña Vallejo, F. Lista Mateos, G. Bozzini, D. Saenz Calzada, A. Rodríguez Antolín, B. García Gómez" "autores" => array:10 [ 0 => array:4 [ "nombre" => "J." "apellidos" => "Romero Otero" "email" => array:1 [ 0 => "jromerootero@hotmail.com" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "J." "apellidos" => "Justo Quintas" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "E." 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"apellidos" => "Bozzini" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] 7 => array:3 [ "nombre" => "D." "apellidos" => "Saenz Calzada" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">e</span>" "identificador" => "aff0025" ] ] ] 8 => array:3 [ "nombre" => "A." "apellidos" => "Rodríguez Antolín" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 9 => array:3 [ "nombre" => "B." "apellidos" => "García Gómez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:5 [ 0 => array:3 [ "entidad" => "Servicio de Urología, Hospital Universitario HM Sanchinarro, HM Hospitales y ROC Clinic, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Facultad HM de Ciencias de la Salud, Universidad Camilo José Cela, Villafranca del Castillo, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Urología, Hospital Universitario HM Montepríncipe, HM Hospitales y ROC Clinic, Boadilla del Monte, Madrid, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Servicio de Urología, Hospital Sant’Anna, San Fermo della Battaglia, Como, Italy" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Servicio de Urología, Hospital Universitario HM Puerta del Sur, HM Hospitales y ROC Clinic, Móstoles, Madrid, Spain" "etiqueta" => "e" "identificador" => "aff0025" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Enucleación prostática con láser de fibra de tulio: experiencia inicial y análisis de los resultados intraoperatorios y a corto plazo en una cohorte prospectiva multicéntrica" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Benign prostatic hyperplasia (BPH) is a histopathological change in stromal and epithelial cells of the prostate. It is a natural process that develops with age, affecting to 8% of men in their fourth decade of life, 50% in the sixth decade, and 80% in the ninth decade.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Thereby, it was estimated that in 2019, 94 million men were affected by this condition worldwide, with a prevalence of 2480 (1940–3090) per 100,000 men. This data represents an increase of 70.5% from the 51.1 million cases estimated in 2000.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">BPH can cause lower urinary tract symptoms (LUTS), which management includes lifestyle advices, medical therapy, and surgery. Surgical treatment is one of the milestones of BPH management, and in recent years many technologies have been developed in order to provide safe and effective alternatives to traditional approaches.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Open prostatectomy is the oldest surgical procedure to treat large prostates (>70 cc), and its results are maintained for as long as six years.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> But in the last two decades, Holmium laser enucleation of the prostate (HoLEP) has rapidly become the gold standard for the surgical treatment of BPH, independently the size of the prostate, due to its efficacy and safety.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Also, laser enucleation of the prostate with Thulium laser (ThuLEP) has demonstrated better results to bipolar resection of the prostate in terms of blood loss, catheterization time, hospital stay and irrigation time.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Our group has wide experience performing HoLEP, and we already published our satisfactory experience with the first 1000 cases,<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> even in patients with anticoagulation/antithrombotic therapy,<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> and in those with bladder stones.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> However, laser technologies for medical use continues to evolve, and in the latest years, super-pulsed thulium fiber laser (TFL) has become as an important player for surgical stone management,<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> due to its improvement in stone-free rate, shorter operative time, and shorter laser utilization time. TFL has also been postulated as an effective and safety alternative for prostate enucleation, with specific settings from the main manufactures, although the evidence in the literature is still scarce.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11,12</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The aim of this study is to describe our initial experience with the TFL for endoscopic enucleation of the prostate (ThuFLEP), particularly in terms of operative times, presence of complications, and hospital stay, in order to provide wider evidence of the efficacy and safety of this new technique.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Material and methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Patient selection</span><p id="par0020" class="elsevierStylePara elsevierViewall">Since January to October 2022, all patients proposed to ThuFLEP for treating their LUTS due to BPH were included prospectively in the analysis, regardless their prostate volume, catheter status and severity of symptoms, with the aim to obtain a representative selection of the general population. Patients with previous prostatic surgery for BPH were excluded, as long as those with a previous diagnosis of prostate cancer, concomitant bladder stones, or urethral stricture. If PSA elevated, a prostatic multiparametric magnetic resonance (MRI) was performed and if suspicious lesions observed, a fusion biopsy was performed. Patients with a negative histopathologic result were also considered for inclusion. The procedures were performed in three centers from Madrid, Spain (Hospital Universitario HM Montepríncipe, Sanchinarro, and Puerta del Sur), by the same three experienced surgeons (JRO, BGG and ARA). Only patients with at least 3 months of follow-up were considered for this study.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Surgical procedure</span><p id="par0025" class="elsevierStylePara elsevierViewall">The ThuFLEP procedure was divided in three different surgical times, as usually done by the main surgeon: enucleation of prostatic lobes, coagulation of the capsule, and morcellation of the lobes. For the enucleation, <span class="elsevierStyleItalic">en-bloc</span> technique as described by Saredi et al.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> was performed: both lobes were dissected separately, with an incision at 6 o’clock, and preserving an apical flap of urethral mucosa to avoid damage of the sphincter. If a median lobe was present, it was taken out along with the left or right lobe of the patient.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Technology and settings</span><p id="par0030" class="elsevierStylePara elsevierViewall">The laser dispositive used was Soltive Premium® (Olympus Europa SE & Co. KG, Hamburg, Germany) for the enucleation and coagulation times, and the MultiCut Solo® (Asclepion Laser Technologies GmbH, Jena, Germany) for the morcellation. Laser settings for the enucleation were 0.5 J of energy, a frequency of 120 Hz, with a short pulse (1/3), making a total power of 60 W. For the coagulation time, laser settings were 1 J of energy, 20 Hz of frequency, and a long pulse (3/3), making a total power of 20 W. Morcellator was set into two different modes, depending on the size of the lobes: 1800 revolutions per minute (rpm) and 2.5 oscillations when they were bigger, and 800 rpm with no oscillation when they became smaller, in order to prevent the formation of ‘beach balls’, always at maximum suction. The dry tissue resected is systematically weighted with the same scale.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Variables</span><p id="par0035" class="elsevierStylePara elsevierViewall">The preoperative variables analyzed were: catheterization status, prostate volume (as measured with abdominal ultrasound or MRI), maximum urinary flow (Qmax), post-void residual volume (PVR), severity of symptoms (as measured by the International Prostate Symptom Score –IPSS–), erectile function (as measured by the International Index of Erectile Function –IIEF–), prostate specific antigen (PSA) level, and American Society of Anaesthesiologists (ASA) anesthetic risk.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> Previous use of medication for BPH and anticoagulation or antiplatelet therapy was collected.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Intraoperative variables considered were: total surgical time, enucleation, coagulation, and morcellation times, enucleation and morcellation efficiency (g/min) intraoperative complications (bladder or capsule perforation) and necessity of reconversion.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Immediate postoperative variables considered were: time of catheterization and hospital stay (hours). Patients were evaluated at months 1 and 3, when emergency room visits, acute urinary retention (AUR) and infection rates, and necessity of hospitalization were recorded. Also, PSA level, Qmax, PVR and IPSS and IIEF scores were analyzed at 3-month visit.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Complications during the study period were collected using the Clavien-Dindo classification.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Statistical analyses</span><p id="par0055" class="elsevierStylePara elsevierViewall">Data collection and statistical analyses were performed using SPSS® version 26.0 (IBM®, Chicago, IL, USA) software. Continuous data were presented in mean or median along with range or standard deviation (SD), as specified for each variable, and compared with the Mann–Whitney U test. The p value considered significant is <0.05.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Ethics</span><p id="par0060" class="elsevierStylePara elsevierViewall">The research protocol was approved by the Ethics Committee of the participating centres. Approval number/ID: CEIm code: 21.03.1816-GHM.</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Results</span><p id="par0065" class="elsevierStylePara elsevierViewall">Sixty patients met the inclusion criteria in the period analyzed, with a median follow-up of 8 months.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3–11</span></a> Of them, two were excluded because they previously had prostatic surgery, one had urethral stricture, and other one bladder stones, so the remaining fifty-six patients were analyzed. Mean age was 68.7 years (54–85), and the mean prostatic volume was 88.9 ml (36–220). 36/58 (62%) of the patients were ASA II, whereas 11/58 (19%) were ASA ≥ 3. The main pre and postoperative characteristics of the patients are resumed in <a class="elsevierStyleCrossRefs" href="#tbl0005">Tables 1 and 3</a>.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">Results referring to operative times and variables are resumed in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>.</p><p id="par0075" class="elsevierStylePara elsevierViewall">No patient needed reconversion to transurethral bipolar resection (TUBR) or open prostatectomy, whereas in two cases a capsular perforation was noted, and in another one a double uretheral meatus damage was described (enucleation of both of them with the adenoma). In four cases, an injury of the vesical mucosa without perforation was noted during morcellation time. No patient needed additional surgery, a prolonged hospital stay, or a longer catheterization time for these reasons. Median hospital stay was 1 night (range: 1–5), and mean catheterization time was 32.3 h (standard deviation –SD– 12.48). Five patients were discharged with the bladder catheter on due to an AUR after the first attempt to its removal. In all cases, the catheter was removed after 5 days in the outpatient clinic.</p><p id="par0080" class="elsevierStylePara elsevierViewall">During the first postoperative month, 9 patients (16.1%) presented in the emergency room (ER) because of complications related to the surgery. In two of them the cause was hematuria that needed hospital readmission with catheterization and bladder washout. However, none of them required blood transfusion. In five cases, the cause of ER visit was AUR, treated conservatively with additional 7 days of bladder catheter; and in the remaining two cases the reason was uncomplicated urinary tract infection.</p><p id="par0085" class="elsevierStylePara elsevierViewall">At the 3-month visit, no patient was catheterized and the main functional variables compared with the baseline are resumed in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>. At this visit, only 2 patients referred very mild stress incontinence that required the use of one security pad daily. Due to the small amount of loss, no pad test collection was possible. Overall, no significant changes in erectile function were detected. Besides, no urethral stricture was diagnosed in this period.</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Discussion</span><p id="par0090" class="elsevierStylePara elsevierViewall">TFLs have been widely used in Urology for stone treatment, where they have demonstrated that they achieve better stone free rates, with shorter laser and overall operative times, in contrast to Holmium lasers.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> Due to their characteristics, there have also been successful experiences in the treatment of upper urinary tract carcinoma,<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> and in the <span class="elsevierStyleItalic">en-bloc</span> resection of bladder tumors.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">Very recently, evidence about their suitability for prostate enucleation has arisen. Since the first case described in the literature in 2021,<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> some other groups have published their satisfactory experience with the ThuFLEP. Bozzini et al.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> compared a cohort of 110 patients randomized to prostate enucleation with a standard 200 W thulium laser, or a 60 W TFL, but set in continuous wave mode, finding no relevant differences in perioperative outcomes. Petov et al.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> recently published their experience with a large sample of 1328 patients who underwent TFL enucleation of the prostate, finding good results and low incidence of complications at 3-year analysis, irrespectively the age of the patients or prostate volume.</p><p id="par0100" class="elsevierStylePara elsevierViewall">Our results seem to back up these previous successful experiences. The characteristics of our sample, with a mean age of 68.7 years, a mean prostate volume of 88.9 g, and a rate of almost 25% of the patients catheterized (<a class="elsevierStyleCrossRefs" href="#tbl0005">Tables 1 and 3</a>), are very representative those observed in real life clinical settings. Our group have large experience in HoLEP, and our results with the first 1000 patients were already published some years ago, including those from our learning curve.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Since then, our experience has grown and our results improved, a fact that can be observed in the present analysis. In our series, we observed an enucleation efficiency of 2.04 g/min, and a median hospital stay of 1 day. Comparing these results with other papers from the literature, they seem to be superior. For instance, in the paper by Bozzini et al.,<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> they obtained a enucleation efficiency of 0.80 and 0.79 g/min for thulium and TFL, respectively, and with a mean hospital stay of 2.82 and 2.95, higher than the observed for our patients, with no clinical significant differences for the functional variables (IPSS, Qmax and PVR). More similarly to our study, the one by Elmansy et al.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> compared to cohort of patients operated with the Soltive® TFL to other performed with the Lumenis 120 W holmium laser with MOSES® technology (Boston Scientific™, Malborough, USA). They found enucleation efficiencies of 1.4 g/min vs 1.6 g/min, respectively, both under the limit we found in our series.</p><p id="par0105" class="elsevierStylePara elsevierViewall">Regarding morcellation, we used for these series a novel dispositive (MultiCut Solo®) with no available results in the literature. With a great hallmark of 7.47 g/min achieved in the morcellation efficiency, it seems to be clearly superior to those previously described in other studies. Accordingly, a recent review by Franz et al.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> of several papers on the issue including over 5000 patients, found morcellation efficiencies of 5.29 g/min for the Piranha® device (Richard Wolf GmbH, Knittlingen, Germany), 3.95 g/min for the VersaCut® (Boston Scientific™, Malborough, USA), and 5.3 g/min for the DrillCut X® (Karl Storz SE&Co, Tuttlingen, Germany). Although promising, our data may be interpreted cautiously, as long as given the limited size of the sample, and the high experience of the surgeons involved, it is not possible to draw any definitive conclusion about the superiority of the device.</p><p id="par0110" class="elsevierStylePara elsevierViewall">Regarding safety, 14 (25%) of our patients presented with some complication during the follow-up period, being the most common (10/56) AUR with the need of catheterization for 5–7 additional days, followed by hematuria (2/56), but with only two patients in need of re-catheterization, bladder washout and hospital readmission. These rates are comparable with those described in the literature,<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> and represent a level ≤2 according to the Clavien-Dindo classification.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> However, the short hospital stay shown in our series, with a median of only one night, may be related to the relatively high rate of patients presenting AUR.</p><p id="par0115" class="elsevierStylePara elsevierViewall">This study has its limitations. First, and most important, the short follow-up period, and secondly, the limited size of the sample, although representative given the novelty of the technique. However, the main endpoint of this work was to describe the feasibility and safety of this technology for prostate enucleation, an aim that we consider fulfilled with the data we present. We keep updating the database with larger number of patients and longer follow-up period, in order to establish its long term functional and safety results.</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Conclusion</span><p id="par0120" class="elsevierStylePara elsevierViewall">TFL represents a novel technology for prostate enucleation, with good intraoperative and short follow-up functional results, and a safety profile. Further studies with longer follow-up periods and comparative with these other techniques remain imperative to draw definitive conclusions about this technology.</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Authors’ contributions</span><p id="par0125" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">JRO</span> project development, manuscript writing. <span class="elsevierStyleBold">JJQ</span> protocol/project development. <span class="elsevierStyleBold">EGR</span> protocol/project development, data analysis, manuscript writing. <span class="elsevierStyleBold">RSS</span> protocol/project development and manuscript editing. <span class="elsevierStyleBold">EPV</span> data collection. <span class="elsevierStyleBold">FLM</span> protocol/project development. <span class="elsevierStyleBold">GB</span> protocol/project development and manuscript editing. <span class="elsevierStyleBold">DSC</span> data management. <span class="elsevierStyleBold">ARA</span> protocol/project development and manuscript editing. <span class="elsevierStyleBold">BGG</span> protocol/project development, manuscript writing, data collection.</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Funding</span><p id="par0130" class="elsevierStylePara elsevierViewall">All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or nonfinancial interest in the subject matter or materials discussed in this article.</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Conflicts of interests</span><p id="par0135" class="elsevierStylePara elsevierViewall">None of the authors has conflicts of interest.</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Disclosure</span><p id="par0140" class="elsevierStylePara elsevierViewall">The research protocol was approved by the Ethics Committee of the participating centres. Approval number/ID: CEIm HM Hospitales code: 21.03.1816-GHM. All patients in the study have signed an informed consent for their participation prior to their inclusion.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:14 [ 0 => array:3 [ "identificador" => "xres2158303" "titulo" => "Abstract" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Discussion" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1831404" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres2158304" "titulo" => "Resumen" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0030" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0045" "titulo" => "Discusión" ] 4 => array:2 [ "identificador" => "abst0050" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1831403" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Material and methods" "secciones" => array:6 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Patient selection" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Surgical procedure" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Technology and settings" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Variables" ] 4 => array:2 [ "identificador" => "sec0035" "titulo" => "Statistical analyses" ] 5 => array:2 [ "identificador" => "sec0040" "titulo" => "Ethics" ] ] ] 6 => array:2 [ "identificador" => "sec0045" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0050" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0055" "titulo" => "Conclusion" ] 9 => array:2 [ "identificador" => "sec0060" "titulo" => "Authors’ contributions" ] 10 => array:2 [ "identificador" => "sec0065" "titulo" => "Funding" ] 11 => array:2 [ "identificador" => "sec0070" "titulo" => "Conflicts of interests" ] 12 => array:2 [ "identificador" => "sec0075" "titulo" => "Disclosure" ] 13 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2023-11-03" "fechaAceptado" => "2023-12-09" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1831404" "palabras" => array:6 [ 0 => "Thulium fiber laser" 1 => "Benign prostate hyperplasia" 2 => "ThuFLEP" 3 => "Prostate" 4 => "Enucleation" 5 => "Laser" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1831403" "palabras" => array:6 [ 0 => "Láser de fibra de tulio" 1 => "Hiperplasia benigna de próstata" 2 => "ThuFLEP" 3 => "Próstata" 4 => "Enucleación" 5 => "Láser" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Holmium laser enucleation of the prostate has rapidly become the gold standard for the surgical treatment of benign prostate hyperplasia, although thulium fiber laser (TFL) has also been postulated as an effective and safe alternative for prostate enucleation. The aim of this study is to describe our initial experience with the TFL for endoscopic enucleation of the prostate.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and methods</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">All patients proposed to TFL prostate enucleation were included in the analysis, regardless their prostate volume, catheter status and severity of symptoms, in 3 centers. Preoperative characteristics, intraoperative times and functional 3-months follow-up variables were collected, along with complications.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Fifty-six patients were available, with a mean age of 68.7 years. Enucleation and morcellation efficiencies were 2.04 and 7.47 g/min, respectively. Median hospital stay was one day. Comparable functional data, pre and 3-month post-surgery was: mean prostate volume 88.9 vs 21.3 g, maximum urinary flow 13.2 vs 27.3 ml/s, post-void residual volume 149 vs 7.8 ml, prostatic specific antigen level 11.2 vs 1 ng/ml, and International Prostate Symptom Score 20.75 vs 3.96. Fourteen out of 56 (25%) patients presented with complications grade ≤2, according to the Clavien-Dindo classification.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Discussion</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">With wider evidence for other urological indications, very recent evidence about the suitability of TFL for prostate enucleation has arisen, since the first case described in 2021. Our results seem to back up these previous successful experiences as long as we obtained good intraoperative and short term follow-up functional results. However, there is still a need of longer follow-up data.</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusions</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">TFL represents a novel technology for prostate enucleation, with a good intraoperative and short follow-up functional results, and a safety profile similar to the observed for those techniques that have been wider used for this indication. Further studies with longer follow-up periods and comparative with these other techniques are necessary.</p></span>" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Discussion" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Introducción</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Aunque la enucleación prostática con láser de holmio se ha convertido en poco tiempo en el patrón oro para el tratamiento quirúrgico de la hiperplasia prostática benigna, el láser de fibra de tulio (TFL) se ha propuesto como otra alternativa eficaz y segura para la enucleación prostática. El objetivo de este estudio es describir nuestra experiencia inicial con el TFL para la enucleación endoscópica de la próstata.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Material y métodos</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron en el análisis todos los pacientes con indicación de enucleación prostática con TFL, independientemente del volumen prostático, el uso de catéter y la gravedad de los síntomas, en 3 centros. Se recogieron las características preoperatorias, el tiempo intraoperatorio, las variables funcionales a los 3 meses de seguimiento y las complicaciones.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Resultados</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron 56 pacientes con una edad media de 68,7 años. La eficiencia de enucleación y morcelación fue de 2,04 y 7,47 g/min, respectivamente. La mediana de estancia hospitalaria fue de un día. Los datos funcionales comparables, antes de la cirugía y 3 meses después, fueron: volumen prostático medio 88,9 vs. 21,3 g, flujo urinario máximo 13,2 vs. 27,3 ml/s, volumen residual posmiccional 149 vs. 7,8 ml, nivel de antígeno prostático específico 11,2 vs. 1 ng/ml, y puntuación del International Prostate Symptom Score 20,75 vs. 3,96. Del total de 56 pacientes, 14 (25%) presentaron complicaciones de grado ≤ 2 según la clasificación de Clavien-Dindo.</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Discusión</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Aunque existen más pruebas en otras indicaciones urológicas, desde el primer caso de enucleación prostática descrito en 2021 han surgido datos que avalan la idoneidad del TFL para la enucleación prostática. A la luz de los buenos resultados intraoperatorios y funcionales obtenidos en nuestro seguimiento a corto plazo, nuestro estudio parece corroborar las experiencias satisfactorias previas. Sin embargo, todavía se necesitan resultados del seguimiento a largo plazo.</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conclusiones</span><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">El TFL representa una tecnología novedosa para la enucleación prostática, con resultados intraoperatorios y funcionales a corto plazo satisfactorios, y un perfil de seguridad similar al observado en las técnicas más utilizadas para esta indicación. Se requieren más estudios con periodos de seguimiento más largos que comparen sus resultados con los de técnicas previamente utilizadas.</p></span>" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0030" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0045" "titulo" => "Discusión" ] 4 => array:2 [ "identificador" => "abst0050" "titulo" => "Conclusiones" ] ] ] ] "multimedia" => array:3 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">SD: standard deviation; ASA: American Society of Anesthesiologists; 5-ARIs: 5-alpha-reductase-inhibitors.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Age (mean, range) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">68.7 years (54–85) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ASA (median, SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (0.68) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Catheterized (n, %) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 (21.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Alpha-blockers therapy (n, %) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">35 (62.5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5-ARIs therapy (n, %) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18 (32.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Antimuscarinic therapy (n, %) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 (8.9) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Anticoagulation therapy (n, %) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 (8.9) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Antiplatelet therapy (n, %) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 (16.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3556308.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Main preoperative characteristics of the patients included for the analysis.</p>" ] ] 1 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">SD: standard deviation.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Enucleation time (mean, SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">29.39 min (14.46) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Laser coagulation time (mean, SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6.39 min (3.74) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Morcellation time (mean, SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8.02 min (4.86) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Resected prostatic tissue (mean, SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">59.91 g (36.38) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Enucleation efficiency \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.04 g/min \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Morcellation efficiency \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7.47 g/min \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3556310.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Main operative times and variables for the analyzed patients.</p>" ] ] 2 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">PSA: prostatic specific antigen; Qmax: maximum flow, PVR: post-urinary residual volume; IPSS: International Prostate Symptoms Score; IIEF: International Index of Erectile Function.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Variable \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Preoperatively \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">3-month visit \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p Value \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Prostate volume (mean, range) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">88.9 g (36–220) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">21.3 g (11–40) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.05 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">PSA level (mean, SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11.2 ng/ml (4.71) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 ng/ml (0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.05 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Q max (mean, SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13.2 ml/s (8.59) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">27.3 ml/s (11.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.05 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">PVR (mean, range) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">149 ml (8–446) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7.8 ml (0–19) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.05 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">IPSS score (mean, SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20.75 (8.44) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.96 (3.35) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.05 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">IIEF score (mean, SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">35.83 (23.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">29.25 (18.57) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.36 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3556309.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Comparative analysis of functional variables.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:21 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The development of human benign prostatic hyperplasia with age" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "S.J. Berry" 1 => "D.S. Coffey" 2 => "P.C. Walsh" 3 => "L.L. 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Original article
Initial experience with thulium fiber laser for prostate enucleation: Analysis of the intraoperative and short-term outcomes in a prospective, multicenter cohort
Enucleación prostática con láser de fibra de tulio: experiencia inicial y análisis de los resultados intraoperatorios y a corto plazo en una cohorte prospectiva multicéntrica
J. Romero Oteroa,b,
, J. Justo Quintasa,b, E. García Rojoa,b, R. Sopeña Sutilc, E. Peña Vallejoa, F. Lista Mateosb,c, G. Bozzinid, D. Saenz Calzadae, A. Rodríguez Antolína, B. García Gómezc
Autor para correspondencia
a Servicio de Urología, Hospital Universitario HM Sanchinarro, HM Hospitales y ROC Clinic, Madrid, Spain
b Facultad HM de Ciencias de la Salud, Universidad Camilo José Cela, Villafranca del Castillo, Madrid, Spain
c Servicio de Urología, Hospital Universitario HM Montepríncipe, HM Hospitales y ROC Clinic, Boadilla del Monte, Madrid, Spain
d Servicio de Urología, Hospital Sant’Anna, San Fermo della Battaglia, Como, Italy
e Servicio de Urología, Hospital Universitario HM Puerta del Sur, HM Hospitales y ROC Clinic, Móstoles, Madrid, Spain