Patterns and Predictors of Optimal Surgical and Functional Outcomes after Holmium Laser Enucleation of the Prostate (HoLEP): Introducing the Concept of “Trifecta”

Purpose: The present study sought to provide reproducible and patient-oriented metrics to assess the rate of “successful” outcomes (Trifecta) following holmium laser enucleation of the prostate (HoLEP). Clinical and surgical predictors of failure to achieve Trifecta were investigated. Materials and Methods: We queried our prospectively collected database of all patients treated with HoLEP between March 2017 and January 2021. Trifecta was defined as the contemporary presence of: (1) no postoperative complication within 3 months; (2) no urinary incontinence at 3-months follow-up; and (3) 3-month postoperative max flow-rate >15 mL/s. Cases were grouped according to Trifecta achievement. All surgical procedures were carried out by a single surgeon. Surgical experience was divided into two different eras according to the number of procedures conducted (surgical era). Multivariate logistic regression analysis was performed to assess predictors of Trifecta failure. Results: Overall 305 patients were included. Of these, 192 patients (63.0%) achieved Trifecta. Preoperative patient-related features were comparable between the two groups, except for a higher post-void residual (PVR) in non-Trifecta patients (median 180 vs. 130 mL, p=0.003). A significant proportion of Trifecta patients (88.5%) were treated in the second surgical era and in 126 (65.6%) cases an en-bloc enucleation was performed. Multivariate analysis confirmed PVR ≥250 mL, first surgical era and standard three-lobes enucleation technique as independent predictors of Trifecta failure. Conclusions: In our experience the rate of “successful” HoLEP, defined according to our newly introduced Trifecta metric, was 63.0%. We demonstrated that surgical strategy together with rising experience and baseline PVR are key elements to forecast the outcomes

From struggle to exchange: a group of students proposes a dialogue on practical traineeship

This paper comes from the work of a group of eighteen students attending the master’s degree course "Clinical Psychology of the person, of organizations and of the community" at the Faculty of Medicine and Psychology of the University of Rome “Sapienza". We have set up a laboratory on the role of practical traineeship with the chair of the Professor R.M. Paniccia, with the aim of treating this complex and controversial topic that connects reality and several social actors: agencies, Order of Psychologists, University and students. Our goal has been thinking over training in psychology and the figure of clinical psychologist, focusing a specific time we consider relevant in our training: practical traineeship, seen as a critical event on the way that leads from the student role to the professional one. We understand the complexity of practical traineeship if we connect it with the specificity of training in clinical psychology, where training and profession path goes through the implication in one’s experience, which allows to integrate psychological theory and practice by re-thinking the emotions experienced in relation to different contexts using clinical psychology categories. We have decided to deal with this topic from different points of view: in the first part we introduce the reader to the current context that characterizes the practical traineeship in psychology. We present the political/normative context, then we define the methodology that we used and, at last, we discuss the characteristics of the process in which our group has been involved. This premise allows the reader to then switch to a second part referred to the exploration of the relational dynamics established in the relationship between trainee and organization by analyzing our practical traineeship experiences. In the last part, we offer some points of discussion on the trainee’s clinical psychology function and on critical situations in meeting with agencies