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Item Determination of Face and Content Validity of Cadaveric Model for Holmium Anatomic Endoscopic Enucleation of the Prostate Training: An ESUT AEEP Group Study(ELSEVIER, 2021-01-01) Tunc, Lutfi; Bozzini, Giorgio; Scoffone, Cesare Marco; Guven, Selcuk; Hermann, Thomas; Porreca, Angelo; Misrai, Vincent; Ahyai, Sascha; Zor, Murat; Aksoy, Emin; Gozen, Ali S.Background: Bench and virtual reality nonbiological simulator models for anatomic endoscopic enucleation of the prostate (AEEP) surgery have been reported in the literature. These models are acceptable but have limited practical applications. Objective: To validate a fresh-frozen human cadaver model for holmium AEEP training and assess its content validity. Design, setting, and participants: Holmium AEEP operations on fresh-frozen cadavers performed by an experienced surgeon were recorded, and a video, including the main steps of the operation, was produced. Outcome measurements and statistical analysis: The video and an accompanying questionnaire were subsequently distributed electronically to ESUT AEEP study group experts and associates (N = 32) for assessment of the AEEP training model. A ten-point Likert global rating scale was used to measure the content validity. Results and limitations: A total of 26 answers were returned (81\%). The experts agreed on the model's suitability for AEEP training (mean Likert score: 8). According to the responses, ``identifying anatomic structures and landmarks{''} was the most valuable aspect of the model in terms of AEEP training (median Likert score: 9). Conversely, the experts found the model's ability, in terms of demonstrating laser and tissue reactions, to be weak (median Likert score: 6) Conclusions: Based on the content validity assessment, the fresh-frozen cadavertraining model for laser AEEP seems to be a promising model for demonstrating and learning the correct prostate enucleation technique. Patient summary: An increasing number of researchers have proposed that anatomic endoscopic enucleation of the prostate (AEEP) should replace transurethral resection of the prostate surgery and become the gold standard for treatment of bladder outlet obstruction due to benign prostatic hyperplasia. AEEP requires anatomic familiarity for enucleation, technical knowledge, and a solid training program before starting with the first cases. This is the first cadaver study to assess the content validity of a fresh-frozen human cadaver model for AEEP training. (C) 2021 The Authors. Published by Elsevier B.V. on behalf of European Association of Urology.Item Impact of diabetes mellitus on urinary continence after holmium laser enucleation of the prostate due to lower urinary tract symptoms: a retrospective study(POLISH UROLOGICAL ASSOC, 2021-01-01) Acikgoz, Onur; Yilmaz, Mehmet; Aybal, Halil Cagri; Yilmaz, Sercan; Gazer, Eymen; Yalcin, Serdar; Duvarci, Mehmet; Kaya, Engin; Miernik, Arkadiusz; Tunc, LutfiIntroduction Diabetes mellitus (DM) is known as a risk factor of stress urinary incontinence after Holmium laser enucleation of the prostate (HoLEP). We aimed to compare the postoperative continence status of patients with and without DM, after HoLEP surgery. Material and methods A total of 214 patients who underwent HoLEP between January 2017 and January 2020 were retrospectively assessed. Functional outcomes, perioperative total operation time (TOT) (min), enucleation time (ET)(min), enucleation efficiency (EE)(g/min), enucleated tissue weight (ETW)(g), morcellation efficiency (ME)(g/min), morcellation time (MT)(min), continence status, intraoperative and postoperative complications according to Clavien-Dindo classification were recorded. Results A total of 96 patients had DM additional to benign prostate hyperplasia (BPH) (Group 1), while 118 patients had only benign prostate hyperplasia without DM (Group 2). When comparing preoperative and postoperative functional outcomes, a statistically significant improvement was observed in both groups from baseline to the 1st and 6th month follow-up (p <= 0.001). There were no statistically significant differences between groups in postoperative stress urinary incontinence at postoperative months 1 and 6 (1.7\% vs 2.1\%, p = 1 and 0.8\% vs 1\%, p = 1Item Comparison of outcomes of Holmium enucleation of the prostate for small- and moderate-sized prostates(WILEY, 2021-01-01) Yilmaz, Sercan; Yalcin, Serdar; Yilmaz, Mehmet; Acikgoz, Onur; Aybal, Halil cagri; Gazel, Eymen; Kaya, Engin; Tunc, LutfiThere is an ongoing discussion in the literature on the surgical treatment option for small prostate size benign prostate hyperplasia (BPH) patients. This study aimed to evaluate the efficacy of Holmium laser enucleation of the prostate (HoLEP) surgery in small (<30 ml) and moderate (30-80 ml) prostate size as accepted in European Association of Urology guideline. We retrospectively analysed our database between May 2016 and May 2019 and patients who underwent HoLEP surgery. Patients who have prostate size <80 ml were included the study. These patients were divided into two group: group 1 with prostate size <30 ml (n: 64) and group 2 with prostate size 30-80 ml (n: 101). Enucleation time (ET), morcellation time (MT), total operation time (OT), enucleation efficiency (EE), morcellation efficiency (ME), intra- and post-operative complications were analysed. While EE and Hb drop were better in favour of group 2Item Laser enucleation for prostates larger than 100 mL: Comparison of HoLEP and ThuLEP(WILEY, 2021-01-01) Kaya, Engin; Yilmaz, Sercan; Acikgoz, Onur; Aybal, Halil Cagri; Yilmaz, Mehmet; Gazel, Eymen; Yalcin, Serdar; Suarez-Ibarrola, Rodrigo; Tunc, LutfiRecently, with the advancements in laser technology, Holmium laser enucleation of the prostate (HoLEP) and Thulium laser enucleation of the prostate (ThuLEP) have come to the fore in the surgical treatment of benign prostatic hyperplasia (BPH). We aimed to evaluate and compare the outcomes of HoLEP and ThuLEP in patients with >100 ml prostate volume. Patients who underwent HoLEP and ThuLEP between July 2017 and March 2020 were reviewed retrospectively. The patients were divided into two groups as HoLEP (Group 1, n = 121) and ThuLEP (Group 2, n = 104). Perioperative parameters, functional outcomes, continence status, intra and post-operative complications were compared between groups in the post-operative 1st and 6th month. No significant difference was found in terms of total laser energy (TLE), morcellation efficiency (ME), enucleated tissue weight (ETW), complication rates (CR) and continence status of patients between both groups (p > .05). In favour of ThuLEP group, there were statistically significant differences regarding total operation time (TOT), laser efficiency (LE), enucleation time (ET) and enucleation efficiency (EE) between groups (p <= .05). HoLEP and ThuLEP can be used safely and effectively in prostates larger than 100 ml.Item The role of laparoscopic experience on the learning curve of HoLEP surgery: A questionnaire-based study(AVES, 2020-01-01) Gazel, Eymen; Kaya, Engin; Yalcin, Serdar; Tokas, Theodoros; Yilmaz, Sercan; Aybal, Halil Cagri; Aydogan, Tahsin Batuhan; Tunc, LutfiObjective: Holmium laser enucleation of the prostate (HoLEP) is an established method for treating benign prostatic obstruction. Nonetheless, its steep learning curve limits its wide distribution. The purpose of the present study was to demonstrate the impact of laparoscopic experience on HoLEP learning curve by evaluating the association between learning curves of surgeons performing both laparoscopy and HOLEP surgery. Material and methods: A questionnaire was prepared to identify surgeon's experience on laparoscopy and HoLEP, as well as their learning curves. This questionnaire was then distributed via e-mail to 110 urologists who are actively involved in endourology/laparoscopy. Results: Of the 110 urologists, 80 (72.7\%) responded and completed the questionnaire. Of the 80 surgeons, 47 (58.8\%) reported that they had completed the HoLEP learning curve with <20 cases. Moreover, 33 (41.2\%) reported that they were able to complete the learning curve by performing >20 cases. Completion of the HoLEP learning curve in <20 cases was reached at 1.3\%, 13.8\%, and 43.8\% by beginner, moderate skilled, and experienced laparoscopists, respectively (p<0.001). Conclusion: Laparoscopic experience appears to be beneficial for surgeons while learning HoLEP. Highly experienced laparoscopic surgeons have a shorterHOLEP learning curve.Item Impact of metabolic syndrome on pre- and postoperative parameters in patients undergoing a HoLEP surgery(AVES, 2019-01-01) Aydogan, Tahsin Batuhan; Kaya, Engin; Gazel, Eymen; Yalcin, Serdar; Aybal, Halil Cagri; Tunc, LutfiObjective: We aimed to investigate the safety and success of the holmium laser enucleation of prostate (HoLEP) surgery in patients with metabolic syndrome (MS) versus those without MS who have similar prostate sizes. Material and methods: Data from 120 patients who underwent HoLEP by a single surgeon between November 2015 and January 2018 were prospectively analyzed. Group 1 (n=40) and Group 2 (n=80) consisted of patients with and without MS, respectively. Preoperative-and postoperative third month control variables that were compared between the groups included hemoglobin (Hb) level