Peter DiStefano

"Plumbing Supplier"

[Dr Ahmad H AlGhurair @AlGhurair_Ahmad]

BPH surgery may be quietly treating something nobody's checking for.

🔹 30.3% had a clinically meaningful (≥20%) testosterone rise post-op
🔹 Rise occurred even with 'normal' baseline T
🔹 Exploratory cutoff ~4.5 ng/mL predicted who benefited (OR 4.35)

Uncontrolled, no comparator, hypothesis-generating.

💡 Not enough to change practice. yet relieving the symptoms improving sleep and quality of life can lead to alot of good things.

https://t.co/8BUB7BXfmm

#HoLEP #BPH #Urology

[Peter DiStefano @TheWolfRep]

FANS is more efficient < ——-> compared to ^ . Suction efficiency horizontal compared to vertical.

[Peter DiStefano @TheWolfRep]

Less Ureter damage than w/ traditional single use flexible ureteroscopes .

[Peter DiStefano @TheWolfRep]

@NFL_DovKleiman Lamar

[Peter DiStefano @TheWolfRep]

@DrValladaresP @urojavo @uroledezma @MSGONZALEZURO @fgomsan @BernardoNor9 @RomanCarvajal @FCAFigueiredo 24Fr outer diameter is the sweet spot .

[Fernando GomezSancha @fgomsan]

Retrospective comparison. Authors conclude: "With meticulous surgical planning, HoLEP represents a safe and effective salvage procedure following TURP, maintaining functional outcomes comparable to primary intervention."

https://t.co/8OzbGMb571

[Perry Xu @perryjxu]

Amazing work by @ReemKhondakar showcasing our work with hemi-holep and morcellation efficiency at #NCSAUA2026 in sunny Maui 🏝️ @NM_Urology

[Peter DiStefano @TheWolfRep]

@NFLTodayX Drew Bledsoe

[Peter DiStefano @TheWolfRep]

@NFLTodayX Hugh Millen

[Fernando GomezSancha @fgomsan]

A great talk by @PeterGilling reflecting on the evolution of HoLEP since its inception. A true legend. Respect!

[Balaji Kalyanaraman @docbala]

@fgomsan Such an important concept that I came to understand as I did more and more holeps. The larger glands are taller, longer and wider but the apex remains more or less the same size. Another reason to focus on a good apical dissection because once I have that, rest is automatic.

[Fernando GomezSancha @fgomsan]

Why is HoLEP size-independent? Simple geometry.

From 30 to 500 cc we remove 48× more adenoma, but the enucleation plane grows only 13×. A median lobe adds only its base.

Interactive 3D model + free slides in 8 languages:
https://t.co/JBSZYYuVbo

#HoLEP #Urology
https://t.co/JBSZYYuVbo
#HoLEP #Urology

[Fernando GomezSancha @fgomsan]

Pooled Incidental Prostate Cancer rate after endoscopic enucleation: 8%.
The number that matters is PSA kinetics: mean reduction of 82% in BPH vs 68.2% in IPCa.

https://t.co/M1NDSbEcuL

[Peter DiStefano @TheWolfRep]

@BTB8387899101 @Utah_Nole @SchumiNole Dude greiner threw a dime to hicks for a td.

[Peter DiStefano @TheWolfRep]

@BurghBeliever Looks right knee in the walk off photo

[Peter DiStefano @TheWolfRep]

@JayPinceSMG @WindhamAthletic @WHSWarriorFB1 Boys had a let down after their big EHS win.

[Peter DiStefano @TheWolfRep]

@FenwayNation My issue is we got in return for sale , not the trade . Sale was a pain of glass during his Red Sox tenure.

[Nitesh Kumar @niteshkuro]

Prone vs Supine PCNL — think beyond “posterior calyx.”

In prone PCNL, access is predominantly through the posterior calyx, which usually lies closer to the horizontal access line.

In supine PCNL, we gain something valuable: flexibility to choose either an anterior or posterior calyx, depending on renal rotation and the shortest, straightest tract.

My practical decoding of renal anatomy:

In a Brödel-type kidney, the posterior calyces lie more horizontally and closer to the lateral convex border. They are therefore readily approachable within roughly ±15° of a straight horizontal tract.

In a Hodson-type kidney, the anterior calyces lie closer to this horizontal trajectory and may provide the more favorable access.

And an important geometric principle:
Enter through the more lateral calyx → easier alignment and navigation toward the medial calyces.

In supine PCNL, don’t choose anterior vs posterior by convention—choose the calyx that lies closest to your straight-line trajectory.

#SupinePCNL #PCNL #Endourology #Urolithiasis

[DR CARVAJAL @RomanCarvajal]

When the ureteral orifices sit close to the bladder neck in a large, broad-based, congested prostate, visibility and traction can become challenging.

A useful HoLEP strategy: split the adenoma in two. Better visualization, less traction, and easier identification of the ureteral orifices.

This case: 120 cc prostate, urinary retention, and metastatic prostate cancer.

#HoLEP #Urology #Endourology #BPH #ProstateCancer