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T.S.: In addition to your accomplishments as a urological surgeon, you have demonstrated a notable talent for anatomical sketching. Do you find that creating these illustrations enhances your understanding of anatomy? In your opinion, are they effective educational tools, particularly for training younger urologists? I.K.G: It is extremely useful. Surgery has to do a lot about what you are looking and try to reproduce it. Drawing helps me both understand and explain anatomy, but it requires a natural talent. It is like painting. Sketching is something I inherited from my father, and it also relaxes me. I often draw what I see in the operating room, and this greatly reinforces learning. It’s an excellent educational tool, not just for residents but also for communicating with patients. Although I had some proposals, it is something that I don’t do in a professional level. However, I’ve even contributed illustrations to books and articles, which I am quite proud of. Seeing my drawings published is very rewarding. So, I think anatomical sketching is an extremely interesting tool.
T.S.: You have shown a particular interest in endoscopic enucleation of the prostate (EEP). What is your preferred technique for performing EEP? Which energy source and specific settings do you favor for this procedure?
I.K.G: Before answering directly this question, I have to clarify that Enucleation has been a fascinating journey for me. I began performing the EEP technique about 10 years ago with the bipolar energy, which was my first exposure and therefore remains my preference (of course I’ m a little bit biased because of this reason). It is a challenging but highly effective
procedure, and I have continued to refine my practice over the years. Later, about five years ago, I introduced lasers into my practice, because we used lasers also for lithotripsy. Honestly speaking, initially this was influenced by patient demand and marketing, but I soon found lasers to be versatile and effective. My current preference is the pulsed Thulium:YAG, which combines I think the advantages of the Holmium and the Thulium in terms of a smoother effect (not so violent to dissect) and better coagulation (hemostasis). So, you can perform a beautiful enucleation and all this is happening because of the wavelength of the pulsed Thulium:YAG laser, with the high absorption in the water and because of the peak power, which is not so violent. I’m not a big fan of TFL for enucleation. So, my two preferred energies for enucleation are the bipolar and the pulsed Thulium:YAG.
T.S.: As of 2025, what are your current indications for performing percutaneous nephrolithotomy (PCNL)? Which patient positioning do you prefer, and which energy source do you typically use? Are you a proponent of miniaturized PCNL techniques? I.K.G: In my center near Milan, we manage many complex stone cases, because it is a referral Center for stones. For stones larger than 15 mm, in accordance with the nomogram of the EAU Guidelines, our preference is PCNL and not flexible ureteroscopy. Because our aim is to achieve stone-free status in a single procedure. Flexible ureteroscopy is not always sufficient for this, so we rely more on PCNL than in the past. In experienced hands, the complication rated are very low too. We have ended up performing more PCNLs than flexible ureteroscopies. So, I strongly believe that still PCNL has a huge role and also for smaller stones, such as impacted upper ureteral stones, for example. The preferred position is supine. I was initially trained in the prone position, but around 2008 at the University of Milan, I transitioned to the supine position. At first, it was difficult to adopt, but we soon realized its advantages: reduced risk of colonic injury, faster and simpler patient positioning, and overall greater practicality. You can use a retrograde approach, if needed. Today, for these reasons, I prefer the supine position during PCNL. As for devices, my preferred energy are the latest lithotripters that combine ultrasonic and ballistic energy with suction. It can be Trilogy; it can be the ShockPulse. Their speed and efficiency allow us to
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