Enucleation is appropriate for the vast majority of patients with BPH, but certain patient profiles—including prior radiation, significant neurologic conditions, morbid obesity, and dementia—warrant caution or referral to specialists, whereas the most consistent technical failure among surgeons past their learning curve is inadequate apical tissue removal driven by discomfort with sphincter proximity, according to Amy E. Krambeck, MD.
Advances in laser technology, morcellator design, and anesthetic approach have substantially improved HoLEP efficiency and patient recovery over the past decade, while surgeon-owned procedural checklists and pre-morcellation hemostasis remain the most critical safety practices for avoiding morcellator injury.
Amy E. Krambeck, MD, explained that active suction provided by FANS helps reduce intrarenal pressure by continuously removing irrigation fluid.
Krambeck highlights that FANS combine enhanced maneuverability and effective fragment evacuation, leading to higher stone clearance rates and improved procedural outcomes in endourology.
Krambeck pointed to the growing importance of medical management in stone disease prevention.
Amy E. Krambeck, MD, discusses how to define success and how to determine the optimal timing for adding on a new partner.
Amy E. Krambeck, MD, recaps her talk from AUA 2025.
"I would also like us to be able to reliably use even smaller scopes, but keep them efficient," says Amy E. Krambeck, MD.
"[Urologists] really need to understand how big the prostate is and how big of a surgery that they're looking at," says Amy E. Krambeck, MD.
"I'm always trying new things. I feel like, once you decide that this is the way you have to do it and stick with that forever, that's when you immediately become irrelevant," says Amy E. Krambeck, MD.
"We really try to limit the amount of tissue we resect and what we do in patients who've had radiation," says Amy E. Krambeck, MD.
"Despite the fact that multiple new procedures have come to light, nothing has the same excellent outcomes as HoLEP," says Amy E. Krambeck, MD.
"I would say the fact that we performed 754 HoLEP procedures in 2024 is a reflection of the efficiency and the high quality of care that you receive at Northwestern," says Amy E. Krambeck, MD.
