Re: 180W-LBO GreenLight XPS Laser Vaporization for Benign Prostatic Hyperplasia: .

available at http://www.ncbi. nlm.nih. gov/pubmed/28832313 Editorial Comment: The number of new technologies for minimally invasive and surgical treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia introduced during the last 2 decades is staggering. Most have not survived the test of time. Variations of the GreenLight laser have been similarly introduced, with each iteration being the latest and greatest. While the number of GreenLight procedures being performed in the United States has decreased considerably since peaking, there are still many being done, particularly with the later XPS devices by advocates of this technology. There is little doubt that the results are as good as any reported for other techniques, including holmium, thulium and bipolar electrovaporization. These results reflect who is doing the procedure rather than what technology is used. That said, there clearly is a learning curve associated with new technologies. The authors report the learning curve of a single surgeon with considerable experience using GreenLight 80 watt and 120 watt XPS. Using benchmarks of energy delivered per prostate volume of 4 kJ/gm and a 6-month prostate specific antigen reduction of 50%, proficiency was attained after 195 and 155 cases, respectively. That is an honest examination and frankly an unsurprising number of cases that need to be performed. Nevertheless, it is a lot of cases. One could reasonably surmise that GreenLight enthusiasm has waned because it takes so long to learn how to do it well and because of the ensuing need for repeat treatment. It is noteworthy that while the authors report various postoperative events, they do not tabulate rates of ejaculatory dysfunction. The bottom line is that the more tissue that is removed, the more likely this phenomenon will occur. Ultimately the question arises, if a technique is developed that leads to efficient results with a significantly decreased learning curve, will that become a predominant player in the field of benign prostatic hyperplasia? Advocates for water-jet ablation therapy are banking that it will. Steven A. Kaplan, MD Suggested Reading Hueber PA, Bienz MN, Valdivieso R et al: Photoselective vaporization of the prostate for benign prostatic hyperplasia using the 180 watt system: multicenter study of the impact of prostate size on safety and outcomes. J Urol 2015; 194: 462. Re: The Association between Triglyceride High Density Lipoprotein Cholesterol Ratio and Benign Prostate Hyperplasia in Non-Diabetic Patients: A Cross-Sectional Study H. Besiroglu, M. Dursun, A. Otunctemur and E. Ozbek Departments of Urology, Catalca Ilyas Cokay State Hospital, Bahcelievler State Hospital, Okmeydani Training and Research Hospital, and Istanbul Training and Research Hospital, Istanbul, Turkey Aging Male 2017; 20: 198e204. doi: 10.1080/13685538.2017. 1303828 Abstract available at http://www.ncbi. nlm.nih. gov/pubmed/28332908available at http://www.ncbi. nlm.nih. gov/pubmed/28332908 Editorial Comment: Inflammation, by whatever definition du jour, has been touted as the root cause of much of the evil in our bodies. In virtually every specialty there are scores of articles associating some inflammatory process with accelerated aging, tumor growth and development, and pain. So, too, in urology, where prostate, bladder and kidney cancer, pelvic pain and benign BENIGN PROSTATIC HYPERPLASIA 203 Copyright © 2019 American Urological Association Education and Research, Inc. Unauthorized reproduction of this article is prohibited. enlargement of the prostate have been correlated to some degree of inflammation. Given our Western diet, increased weight and stress, these are not unimportant attributes that can be ignored. In this study of more than 400 Turkish men being evaluated for lower urinary tract symptoms secondary to benign prostatic hyperplasia it appears that the ratio of serum triglycerides to high density lipoprotein is most correlated to total prostate volume. This finding makes sense in that larger prostates have been associated with higher degrees of inflammation as manifested by prostate size and other proxies such as expression of interleukin-8. However, despite the plethora of articles expressing these types of findings, what is the clinical conjugate that could ensue? Can we target the prostate with anti-inflammatory compounds? This approach has been used in the past with little effect on lower urinary tract symptoms and/or total prostate volume. Unfortunately progress in translating this hope into clinical reality has been disappointing. Recently it has been postulated that coronary artery disease may be as much related to inflammation as it is to low density lipoprotein. Compounds such as canakinumab, which changes C-reactive protein levels via an interleukin-1 receptor, have been shown to offer hope that targeting inflammation may indeed be of benefit in patients with established coronary disease. Perhaps these types of approaches will benefit our urological patients as well. Steven A. Kaplan, MD Suggested Reading Martin S, Lange K, Haren MT et al: Risk factors for progression or improvement of lower urinary tract symptoms in a prospective cohort of men. J Urol 2014; 191: 130. Diagnostic Urology, Urinary Diversion and Perioperative Care Re: Ureteroileal Bypass: A New Technic to Treat Ureteroenteric Strictures in Urinary Diversion G. P. Padovani, M. F. Mello, R. F. Coelho, L. L. Borges, A. Nesrallah, M. Srougi andW. C. Nahas Divisão de Urologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil Int Braz J Urol 2018; 44: 624e628. doi: 10.1590/S1677-5538.IBJU. 2017.0014 Abstract available at http://www.ncbi. nlm.nih. gov/pubmed/29211394available at http://www.ncbi. nlm.nih. gov/pubmed/29211394 Editorial Comment: Open revision of a ureterointestinal anastomotic stricture following urinary diversion is among the most challenging operations in urology. The general technique involves the surgeon identifying the ureter and dissecting it down to the original anastomotic site, transecting the ureter, excising the strictured ureter, dissecting back to healthy ureter and selecting another site for the new anastomosis. These authors describe a novel bypass technique where the urologist identifies the ureter but does not do extensive dissection. Rather, a lateral-to-lateral (ureter-to-small bowel diversion) anastomosis is performed proximal to the strictured area. The ureter is not dissected out or transected, and the strictured area is not excised. The authors also performed 1 case using the robotic technique. This article should be reviewed by urologists who perform urinary diversion as it offers a technical modification that may be of benefit to the surgeon performing this challenging operation. David S. Wang, MD 204 DIAGNOSTIC UROLOGY, URINARY DIVERSION AND PERIOPERATIVE CARE Copyright © 2019 American Urological Association Education and Research, Inc. Unauthorized reproduction of this article is prohibited.