Bipolar Transurethral Enucleation of the Prostate: Is it a size-independent endoscopic treatment option for symptomatic benign prostatic hyperplasia?

Carolina Bebi; Matteo Turetti; Elena Lievore; Francesco Ripa; Lorenzo Rocchini; Matteo Giulio Spinelli; Elisa De Lorenzis; Giancarlo Albo; Fabrizio Longo; Franco Gadda; Paolo Guido Dell’Orto; Andrea Salonia; Emanuele Montanari; Luca Boeri

doi:10.1371/journal.pone.0253083

Peer Review History

Original SubmissionFebruary 17, 2021
9 Apr 2021 Decision Letter - Henry Woo, Editor PONE-D-21-05323 Bipolar Transurethral Enucleation of the Prostate: is it a size-independent endoscopic treatment option for symptomatic benign prostatic hyperplasia? PLOS ONE Dear Dr. Boeri, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript by May 24 2021 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. 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Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: Yes ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: Yes ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes ****** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: This study aimed to assess the relation between prostate size and surgical outcomes after Bipolar Transurethral Enucleation of the Prostate (B-TUEP). According to the conclusions of the authors, prostate volume was not associated with postoperative functional outcomes and complication rates. Thus, the current study may extend the current knowledge regarding the surgical outcomes of B-TUEP based on baseline prostatic volumes. However, there are still some major problems which need to be addressed. 1. In the Abstract, there is no description about comparison of efficacies of B-TUEP according to the baseline prostatic volumes. Please, add it in the Result section of the Abstract. 2. The introduction section of this manuscript needs to be clearer and more focused. Thus, the introduction section of this manuscript needs to be improved. 3. Also, the Discussion section needs to be further improved and summarized, focusing on the major findings of the study. Reviewer #2: Bipolar Transurethral Enucleation of the Prostate: is it a size-independent endoscopic treatment option for symptomatic benign prostatic hyperplasia? Abstract: Retrospective study of 172 patients undergoing bipolar transurethral enucleation of the prostate (B-TUEP), aim of the study was to assess relationship between prostatic size and surgical outcomes following this technique. Should change classification from quartiles to tertiles give that there’s only 3 groups (<60, 61-110, >110) Outcomes of interest – efficiency (weight/time), complication rates, urinary/sexual function, LOS Introduction: I’d specify which laser energies (holmium, thulium etc) have been previously demonstrated as size-independent and I’d include Humpreys et al - Holmium Laser Enucleation of the Prostate—Outcomes Independent of Prostate Size? (2008) as another study for size independence. Materials and Methods: Small spelling error – ultrasonography and uroflowmetry (line 86) Utilization of standardized metrics is helpful for cross study comparisons Would specify which antibiotic was commonly used Surgical Technique: Intra-operative images or illustrations would be very helpful I’d include a new header for postoperative care and data analysis to separate from the surgical technique section. Again groups are better described as tertiles Results: Table 1 could be presented more cleanly if not across 2 pages (same for Table 2) Discussion Agree that part of the difficulty with small gland enucleation is probably represents a more challenging operation from an efficacy standpoint. Clinical homogeneity of the patient population should be included as a potential weakness in the discussion. ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). 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Revision 1
10 Apr 2021 Author Response Dr Emily Chenette Deputy Editor-in-Chief, PLOS ONE Dr Henry Woo Academic Editor PLOS ONE Milan, April 10th, 2021 Dear Dr Emily Chenette, Dear Dr Henry Woo, please find enclosed the revised version of the manuscript titled “Bipolar Transurethral Enucleation of the Prostate: is it a size-independent endoscopic treatment option for symptomatic benign prostatic hyperplasia?” (PONE-D-21-05323- Authors: Carolina Bebi, et al) to be considered for publication in PLOS ONE. We are very grateful to the Reviewers for their insightful comments to our paper. List of the changes made in the manuscript: REVIEWER #1 COMMENT#1. In the Abstract, there is no description about comparison of efficacies of B-TUEP according to the baseline prostatic volumes. Please, add it in the Result section of the Abstract. A1. We thank the Reviewer#1 for this important comment. We have revised the Abstract accordingly. COMMENT#2. The introduction section of this manuscript needs to be clearer and more focused. Thus, the introduction section of this manuscript needs to be improved A2. We thank the Reviewer#1 for this comment. We have revised the Introduction section of the manuscript accordingly. COMMENT#3. Also, the Discussion section needs to be further improved and summarized, focusing on the major findings of the study A3. We thank the Reviewer#1 for this comment. We have revised the Discussion section of the manuscript accordingly. REVIEWER #2 COMMENT#1. Should change classification from quartiles to tertiles give that there’s only 3 groups (<60, 61-110, >110) A1. We thank the Reviewer#2 for this important comment. We have revised the text accordingly. COMMENT#2. I’d specify which laser energies (holmium, thulium etc) have been previously demonstrated as size-independent and I’d include Humpreys et al - Holmium Laser Enucleation of the Prostate—Outcomes Independent of Prostate Size? (2008) as another study for size independence. A2. We thank the Reviewer#2 for this important comment. The Introduction section of the manuscript has been revised accordingly. COMMENT#3. Small spelling error – ultrasonography and uroflowmetry (line 86) Utilization of standardized metrics is helpful for cross study comparisons Would specify which antibiotic was commonly used A3. We thank the Reviewer#2 for this comment. We have revised the Methods section as suggested. COMMENT#4. Surgical Technique: Intra-operative images or illustrations would be very helpful A4. We thank the Reviewer#2 for this comment. We have included Figures 1 to 3 in the new version of the manuscript COMMENT#5. I’d include a new header for postoperative care and data analysis to separate from the surgical technique section. Again groups are better described as tertiles A5. We thank the Reviewer#2 for this comment. We have revised the Methods section as suggested. COMMENT#6. Table 1 could be presented more cleanly if not across 2 pages (same for Table 2) A6. We thank the Reviewer#2 for this comment. We have revised the Results section as suggested. COMMENT#7. Agree that part of the difficulty with small gland enucleation is probably represents a more challenging operation from an efficacy standpoint. Clinical homogeneity of the patient population should be included as a potential weakness in the discussion. A7. We thank the Reviewer#2 for this comment. We have revised the Discussion section as suggested. We hope that the paper is now suitable to be considered for publication in the Original Articles section of PLOS ONE. Sincerely yours, Luca Boeri on behalf of all the authors Luca Boeri, M.D., IRCCS Foundation Ca’ Granda, Ospedale Maggiore Policlinico, Department of Urology University of Milan Via della Commenda 15, 20122 Milan, Italy Tel. +39 02 55034501; Fax +39 02 50320584 Email: dr.lucaboeri@gmail.com https://doi.org/10.1371/journal.pone.0253083.r002
28 May 2021 Decision Letter - Henry Woo, Editor Bipolar Transurethral Enucleation of the Prostate: is it a size-independent endoscopic treatment option for symptomatic benign prostatic hyperplasia? PONE-D-21-05323R1 Dear Dr. Boeri, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Henry Woo Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0253083.r003
Formally Accepted
1 Jun 2021 Acceptance Letter - Henry Woo, Editor PONE-D-21-05323R1 Bipolar Transurethral Enucleation of the Prostate: is it a size-independent endoscopic treatment option for symptomatic benign prostatic hyperplasia? Dear Dr. Boeri: I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org. If we can help with anything else, please email us at plosone@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Henry Woo Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0253083.r004

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