Lim Meng Shi

MBBS,MS,FRCS (Urol). Urologist. AEEP,En Bloc TURBT, Supine PCNL, LARP, RARP,LA TPBx

[Lim Meng Shi @DrLimms]

@WenchangYue …recovery, I think it is ok to start ADT first for a few month for this to recover before starting RT.

[Lim Meng Shi @DrLimms]

@WenchangYue It is also important to mention that the decision for early salvage RT is not PSMA-PET guided. The treatment decision can change if PSMA-PET happens to detect distant mets but negative does not mean no need to treat. If there is early BCR or PSA persistence before continence …

[Lim Meng Shi @DrLimms]

@WenchangYue Good summary. 9 monthly PSA monitoring is inappropriate. I do 3 monthly routinely - even if SM-. I already incorporate PSA follow up as part of my pre-op counseling. If it was unexpected high ISUP and SVI, I would review the pre-op MRI-these should have had RT,ADT,Abi (StampedeM)

[Lim Meng Shi @DrLimms]

@Bober_smart How do I get a good local folder with all the essential data to produce this outcome? If starting on a blank slate…

[Lim Meng Shi @DrLimms]

@AlGhurair_Ahmad Because surgeons got tired after 1.5 cm?

[Lim Meng Shi @DrLimms]

@fgomsan @amy_krambeck For someone who does BiPoLEP, I agree also. Works equally as well for “hot” prostate. Have done a few of these using BiPoLEP and it is often more complete and easy especially if they have not been on dual therapy (less fibrosis). Definitely better than TURP.

[Lim Meng Shi @DrLimms]

@Mohamedendourol @DocGauhar @GRUrology @Endo_Society @Endo_Sec_Eua @endouro @sbinhamrii @fgomsan @uroksarica @StefaniaFerret @RomanCarvajal What scope is used?

[Lim Meng Shi @DrLimms]

@jryckman3 It is high time an RCT is carried out for these. I would like to see HIFU and cryo tested separately in order to have cleaner data.

[Lim Meng Shi @DrLimms]

@adeelanwaar3 Lucky you have the working channel coming out at the correct angle. What if the scope has working channel coming out at 3 o'clock?

[Lim Meng Shi @DrLimms]

@lfredosanchez Fibre size? Laser settings for stone vs prostate?

[Lim Meng Shi @DrLimms]

@katy_beckermann @urotoday Why no chemoRT (mitomycin + 5FU)?

[Lim Meng Shi @DrLimms]

@paulscons0808 @adeelanwaar3 @ShenzhenHugeMed Looks like fragmentation mode from the “vibration”. In fragmentation mode the pulse width is short. More interested in how you irrigate and suck. Next time can show you external set up?

[Lim Meng Shi @DrLimms]

@paulscons0808 @adeelanwaar3 @ShenzhenHugeMed 0.5 x 25 =12.5 W. So you don’t need a high power laser. Play with the pulse width, total power to get the effect. Important is the inflow and suction balance to maintain view/distension at the same time maintain adequate suction of the FANS.

[Lim Meng Shi @DrLimms]

@paulscons0808 @adeelanwaar3 @ShenzhenHugeMed I use the LithoEVO 35. The longest pulse with the dusting mode is 1100ms. Magneto is 2000ms. Would be interesting to compare the difference in the same stone (and always interesting to experiment- stones don’t come with a manual). Above stone looks like has a monohydrate shell.

[Lim Meng Shi @DrLimms]

@adeelanwaar3 @quanta_system @ShenzhenHugeMed What’s the laser settings?

[Lim Meng Shi @DrLimms]

@ProtonStorey Thanks for spotting this. It should not be a typo. Even if PSA persistence is >0.02, it is not what is commonly used.

[Lim Meng Shi @DrLimms]

@APCCC_Lugano It is reassuring that the OS benefit is still present when PSA >= 0.5 and miT0N0M0. But can you please show the K-P curve for PSA < 0.5 miT0N0M0. I fear the message of doing SRT before PSA reaches 0.5 may be lost. The higher the PSA, the more likely a signal will show on mi.

[Lim Meng Shi @DrLimms]

@mdstifelman @BoxLineBox Thank you for sharing.

[Lim Meng Shi @DrLimms]

@APCCC_Lugano I see that the CCTG-PR21 trial, phase 2 but well-designed with a proper comparator arm, is not referenced and presumed not considered.

[Lim Meng Shi @DrLimms]

@Cairo_xprsk 55