Jonas Herrmann

@GuidoGiusti @RebecaEscobarM @OlympusMedEMEA Well done, Guido, interesting case and perfect demonstration as usual 👍

Today together with my ex 🇨🇴 fellow @rebecaescobarM I performed a successful LIVE #supinePCNL @ #EAU25 at 12 Octubre Hospital in Madrid endorsed by @OlympusMedEMEA whose team was just fantastic in supporting me throughout the surgery. I just want to express my gratitude to @Uroweb @AlbertoBreda1 for giving me this tremendous opportunity to share #ETCE way to treat risky infected stone in the most important live surgery meeting worldwide & local doctors and nurses for making us feeling comfortable from the very first moment!🙏🏻

I want to share a gift i got today from a happy patient with artistic talent 😊. Posted with permisson. (Translation: the wonder of HoLEP, before and after)

I need to chose a system for lithotripsy in PCNL beside lasers for very large stones and staghorn stones. Efficiency is what i am looking for. In your experience: which one should i chose and why? @sbinhamrii @VicentiniUro @GuidoGiusti @UrologoEdgar @MartinCKanne @DrVCMohan

@AustenSlade Great video! Beautiful technique and clear explanations 👍

I enjoyed presenting on #MiLEP and #HoLEP at this year's Western Section AUA meeting. This video demonstrates the use of the 21Fr Wolf scope and 18Fr Myosure morcellation to keep instrument size and urethral trauma to a minimum.

Comparing the Performance of Digital Rectal Examination and Prostate-specific Antigen as a Screening Test for Prostate Cancer: A Systematic Review and Meta-analysis - European Urology Oncology euoncology.europeanurology.com/article/S2588-…

Delighted and honored to join the EAU Section of Endourolgy led by @OTRAXER as an associate member of the Prostate Group led by @trwherrmann. 🙏🙏🙏

@EricLiUro @amy_krambeck @NM_Urology Good publication. This is helpful 👍

🚨New Publication🚨 -12.8% iPCa, 4.4% >GG2 (n=811) -PHI >55 associated with iPCa -Pre op PIRADS 4-5, neg biopsy with 95% NPV for iPCa -Most iPCa is low volume GG1 managed with active surveillance, n=3 further PCa treatment doi.org/10.1002/pros.2… @amy_krambeck @NM_Urology

@mahmoudlaimon @lfredosanchez @fgomsan @Dmitry_Enikeev @DocGauhar @drabhaymahajan @RRGonzalezMD @KarinLehrich In those very large glands it is common not to reach the bladder in the beginning. Usually you can reach the bladder ventrally at 12 ' in enbloc technique. Perineostomy is the last ressort if that fails (happened to me only once, Patient was obese and had a 300g gland)

Large prostate 270 ml. The s ope wasn't reaching the bladder. Is it safer to do perineal urethrotomy in these cases ?? Or start distally till finding our way to the bladder?? #HoLEP @lfredosanchez @fgomsan @Dmitry_Enikeev @DocGauhar @drabhaymahajan @RRGonzalezMD @KarinLehrich

We finished the month of july with 91 HoLEP procedures. Thanks to all my team and keep up the good work! 🙏🙏🙏 Blessed to be at #ULZB at #AVKBerlin

@Dmitry_Enikeev @MUN_journal @AndreyOMorozov @vs_petov @E_Laukhtina @jteoh_hk @nirmishsingla @trwherrmann @DrShariat Nice! Unfortunately i dont have access to the full text. Did you fragment or morcellate the larger tumors?

Breaking the stereotypes! Finally our study on en bloc #ERBT for large tumours (>3 cm) is online in @MUN_journal. Conclusion: it is feasible, effective and safe. @AndreyOMorozov @vs_petov @E_Laukhtina @jteoh_hk @nirmishsingla @trwherrmann @DrShariat minervamedica.it/en/journals/mi…

@TFL_URO_APIS @wjurol I think resection has not been the gold standard for many years. The reference standard at best. Read the study. After 100 cases the average OR time was 54 min for 90g prostate. No transfusions in 500 cases, clavien grade 3b in 1,4%. This is not possible with resection IMO.

@JnsHerrmann @wjurol Eneucleation can't b a gold standard : it's more than 30yrs:still learning: Resection will remain "gold standard" because its universal:we need to look into how Resection can b made more refined "future LASER RESECTION will b new gold standard" Safest and fast learning procedure

Mastering HoLEP is challenging initially, but how long do we keep improving after the initial learning curve? Our recent single-surgeon series published in @wjurol shows no plateau even after 500 cases. link.springer.com/article/10.100…

@FCAFigueiredo @uroledezma @wjurol Thank you 🙏 Staying humble and striving to improve is definately part of it, but i believe HoLEP is a unique surgery with a lot of intangible skills that take a long time to develop. I find this fascinating and i dont see it in other procedures, even compex ones.

@JnsHerrmann @uroledezma @wjurol I completely agree. But I believe this continuous improvement is merit of the surgeon, not necessarily of the HoLEP en bloc The humility to acknowledge the imperfection of your surgery and the drive to keep improving your technique is the reason for no plateau in your curve 😉

@wjurol The good news for beginners: improvments were seen only enucleation efficiency, not functional outcomes or complications. Also, average OR time was below 1 hr after the first 100 cases. You dont need 500 cases to perform a safe holep with good outcome, but you will get faster...

@wroclawski_uro @scoffonecesare @AmerUrological @Uroweb @CAU_URO @sbuoficial @SIU_urology @Endo_Society @docmeetings Risk of incontinence is higher, but not because of HoLEP but in general. I think we unterstimate the risk of long term catheterisation. We see so many geriatric patients with catheter associated infections, that may be lifethreatening.

@scoffonecesare @AmerUrological @Uroweb @CAU_URO @sbuoficial @SIU_urology @Endo_Society @docmeetings Agree…. But do you think these very old patients may have more complications, such as incontinence?

94y/o🚹, ECOG 0 (completely independent) Stent 8 ya - ASA No other comorbidities, PSA 1 Moderate LUTS (IPSS 12) - tansul+5ARi ↗️PVR (1L) - see graph MRI PIRADS2, 134g, IPP 1.4cm, lt urinary tract dilatation UD: BOO (Qmax 7/ PdetQmax 70) How would you manage this case? #UroSoMe

@wroclawski_uro @AmerUrological @Uroweb @CAU_URO @sbuoficial @SIU_urology @Endo_Society @docmeetings HoLEP that was in case anyone wonders.

@wroclawski_uro @AmerUrological @Uroweb @CAU_URO @sbuoficial @SIU_urology @Endo_Society @docmeetings Funny I just operated a very similar case, 96 years old, no meds, inependent. Does not want to live with catheter. PV Was 80g. Spinal anesthesia, operation took 34 min. Cath until tomorow discharge on friday if all goes smothely.

@AustenSlade @FCAFigueiredo @TheWolfRep This is my experience as well. I stopped doing BNI only of retrograde ejaculation is not an issue. Its a completely different story compared to TUR-P, the risk is so much lower.

@FCAFigueiredo @TheWolfRep I work to the outer edge of the circular fibers to allow for the largest anatomic opening possible. It hasn’t been infallible, I’ve experienced a 0.5% BNC rate

HoLEP is often thought about for large prostates, but it's a delight for small glands too. This 40cc prostate was 25 min from start to finish, patient left 1 hour after surgery without a catheter and he essentially has a 2% lifetime risk of reintervention. For those thinking about jumping on the HoLEP bandwagon, you totally should, lots of opportunities to learn! #HoLEP #AEEP

Schonend, blutungsarm, gründlich: Das sind Vorteile einer Holmium-Laser-Enukleation bei einer gutartigen #Prostatavergrößerung. Mehr zur #HoLEP Methode und für wen sie geeignet ist im aktuellen Blog-Interview mit @JnsHerrmann: is.gd/Ce8QUR