Holmium Laser Enucleation of the Prostate

Introduction: Holmium laser enucleation of the prostate (HoLEP) offers superior voiding outcomes to traditional transurethral resection and less morbidity than open simple prostatectomy. Likewise, HoLEP has been determined to result in excellent outcomes regardless of gland size. We present a step-by-step surgical approach to HoLEP describing both the traditional enucleation technique and a modified “top-down” surgical technique. Materials and Methods: In this video, two techniques are presented that were performed by two (A.E.K., J.E.L.) surgeons at our institution. Results: In the examples of the two enucleation techniques mentioned, outcomes are similar with regard to surgical and functional outcomes. Conclusions: HoLEP as a treatment for BPH with associated lower urinary tract symptoms (LUTS) results in excellent patient outcomes and can be offered to patients regardless of prostate volume

The Effect of Silver Nanofibers on the Deformation Properties of Blood Vessels: Towards the Development of New Nanotechnologies to Prevent Rupture of Aneurysms

An aneurysm is the result of a widening or ballooning of a portion of a blood vessel. The rupture of an aneurysm occurs when the mechanical stress acting on the inner wall exceeds the failure strength of the blood vessel. We propose an innovative approach to prevent the rupture of an aneurysm based on the use of nanotechnology to improve the strength of the blood vessel. We present results on the effect of silver nanofibers on the resistance toward deformation of blood vessels. The silver nanofibers are grown on the surface of the blood vessels. The nanofibers are 120±30 nm in diameter and 2.7±0.8 μm in length. The deformation per applied force of blood vessels was found to decrease from 0.15 m/N in control blood vessels to 0.003 m/N in blood vessels treated with the nanofibers. This represents an increase in the resistance towards deformation of a factor of 50. The increase in the resistance towards deformation is clinically significant since blood pressure increases by factors slightly larger than one in the human body. Treatment of blood vessels with silver nanofibers is a potential translational clinical tool for preventing rupture of aneurysms in a clinical setting

A Survey of Morcellator Preference and Cost Comparison of the Lumenis VersaCut and Wolf Piranha Morcellators

Objective To evaluate operating room (OR) costs associated with the 2 available morcellators in the United States in a matched cohort and to determine benign prostatic hyperplasia surgeon's morcellator preference. Materials and Methods Patients from 2013, the last year our institution exclusively used the VersaCut device, were matched 1:1 with the most recent patient cohort, utilizing the Wolf Piranha morcellator. Cost of morcellation including the expense of OR time and disposable instrument costs were calculated. A survey to the Endourological Society e-mail listserv was sent to determine morcellator preference. Results We identified 142 patients who underwent holmium laser enucleation of the prostate in 2013. When compared with the VersaCut group, morcellation efficiency (4.4 vs 7.0 g/min, P <.01) and expense of OR time ($1420.80 vs$992.21, P <.005) both favored the Piranha morcellator system even when the costs of disposable instruments were factored into the analysis ($1338.81 vs$1637.50, P <.05). A total of 126 urologists responded to the survey. Of these, 56 (44.5%) perform transurethral prostate enucleations, which included 48 (86%) holmium. More endourologists use the VersaCut (n = 33, 59%) than the Piranha (n = 24, 43%) morcellator. Qualities that impacted the preference of morcellator included the preferred device is safer, faster, easier to use, reusable, and less expensive. Conclusion We identified a significant improved efficiency and improved cost savings utilizing the Piranha morcellator even when controlling for disposable costs. Of the endourologists who responded to the survey, less than half perform transurethral enucleation. Morcellator preference is largely based on safety, efficiency, and ease of use, whereas cost and reusablility were of lesser importance

Comparison of newly optimized Moses technology vs standard holmium: YAG for endoscopic laser enucleation of the prostate

Introduction: The purpose of this study was to describe our initial experience of using a newly optimized Moses technology that is part of the second-generation Moses platform specifically designed for holmium laser enucleation of the prostate (M2-HoLEP) and compare it with patients undergoing HoLEP using standard holmium:YAG technology (S-HoLEP). Materials and Methods: We retrospectively collected data on patients who underwent M2-HoLEP and compared it with the last 50 patients in whom we performed S-HoLEP. Specifically, we compared preoperative symptom scores for lower urinary tract symptoms (LUTS) and erectile dysfunction (ED), preoperative objective voiding metrics, as well as intraoperative characteristics, perioperative characteristics, postoperative complications, postoperative symptom scores for LUTS and ED, and postoperative objective voiding metrics. Additionally, we evaluated the ability for same-day discharge following surgery in the M2-HoLEP group. Results: We included 104 total patients for analysis. We compared the first 54 patients undergoing M2-HoLEP with 50 patients undergoing S-HoLEP. Both groups had similar age, body mass index, use of anticoagulation medication, LUTS and ED scores, and objective voiding metrics. Operations performed with M2-HoLEP had faster mean hemostasis time (8.7 vs 10.6 ± 6 minutes, p = 0.03) as well as hemostasis rate (0.13 vs 0.30 min/g, p = 0.01). Same-day discharge was achieved in 69.4% of patients in the M2-HoLEP group. Postoperatively, both groups also had similar and low rates of urinary retention and complications. At follow-up, both groups had similar symptom scores for LUTS and ED, as well as similar objective voiding metrics. Conclusions: The newly optimized Moses pulse modulation technology is safe and efficient for the treatment of benign prostate hyperplasia. Such technologic improvements in the laser have greatly enhanced the feasibility of same-day discharge of patients undergoing HoLEP

The tolerance of tourism and the transformation of a traditional festival: attitudes of the local population

El artículo que se presenta a continuación expone los resultados de una investigación en la que se utilizó un enfoque cualitativo a través del registro etnográfico de una fiesta tradicional en un poblado mexicano. A esta fiesta, en los últimos años, empezaron a concurrir cientos de jóvenes, motivados por la bebida tradicional –pulque–, que en ella se “regalaba”. Se describen los problemas surgidos a partir de su llegada, así como los impactos percibidos por los pobladores locales y sus actitudes hacia los visitantesLa investigación de los impactos positivos o negativos de la actividad turística ha transitado por diferentes etapas, sin embargo, hasta el presente las investigaciones sólo se han limitado a mencionar los impactos y sus características cuantitativas sin lograr una comprensión profunda sobre su génesis y evolución. En el presente documento se expone cómo el uso de la etnografía, como método, puede posibilitar el entender y explicar las actitudes y comportamiento de la población residente de una comunidad del Estado de México con respecto a una celebración que ha logrado atraer la atención de un número significativo de jóvenes. El método ha permitido explicar cómo un fenómeno cuyo impacto podría calificarse como negativo para la población, se percibe, en los hechos, como positivo, ya que no altera o modifica los valores tradicionales de la población receptora

Participación ciudadana y medidas de protección en la Ley 30364 – ley contra la violencia familiar, Rímac, 2022

El presente estudio tiene por objetivo analizar la repercusión de la participación ciudadana para el cumplimiento de las medidas de protección en la Ley 30364.Recurriendo al uso del método general inductivo, hermenéutico ya que se trata de una investigación de enfoque cualitativo con un tipo de investigación aplicada cuyo diseño fue la investigación acción utilizando la técnica de la entrevista que posibilito que el estudio se aproxime a la verdad del problema desde el punto de vista propio de los entrevistados profesionales del derecho sobre la participación ciudadana y su inclusión en la Ley N° 30364 para contrarrestar la violencia familiar en todas las modalidades en razón de que nos permitió la expansión de conocimientos y generar respuestas concretas al problema planteado por los investigadores. El resultado obtenido fue que la participación ciudadana contribuye de manera eficiente a la prevención de la violencia de género, se concluye que existe una incidencia positiva de la participación ciudadana a través de agrupaciones vecinales tanto a nivel social como comunitaria acorde a la ley 30364 para una adecuada ejecución y cumplimiento de las medidas de protección en mujeres víctimas de violencia familiar

Stone free outcomes of flexible ureteroscopy for renal calculi utilizing CT imaging

Objectives To assess stone free rates following URS for renal calculi at our institution using low dose renal only CT (LDCT). Methods A retrospective review of patients undergoing flexible URS for renal stones only with subsequent CT scan within 3 months. Meticulous basketing of all stone fragments was performed whenever possible. A “true” zero fragment SFR was determined by reviewing the CT scan and radiologist's report. Patients with nephrocalcinosis (as determined by visual inspection of papilla at the time of URS) were assigned the “stone free” category. Results Flexible URS was performed in 288 renal units of 214 patients with renal calculi from 2013 to 2016. Median pre-operative stone size was 6.2mm with the average kidney containing 6.4 stones. An access sheath was used in 92% of cases. A total of 73% (209/288) renal units were completely stone free by CT assessment. Patients with residual fragments were as follows: 1mm in 2% (7/288), 2-4 mm in 16% (46/288), and >4 mm in 9% of kidneys (26/288). Conclusions The true stone free rate in patients undergoing flexible URS for renal calculi utilizing active basketing of fragments as determined by strict CT assessment was 73%. In patients with residual fragments, the majority are 2-4 mm in size making URS a treatment option for renal calculi with excellent stone free results

Changes in employment and income of Mexican rural households, 2002-2007

En este artículo se analizan los cambios en el mercado laboral rural en México, mediante la identifcación de las fuentes principales de empleo e ingreso de los hogares rurales para el periodo 2002-2007. El análisis cuantitativo se basa en datos panel de la Encuesta nacional a hogares rurales de México; los resultados confrman que la industria, el comercio y los servicios son la mayor fuente de ingreso del sector rural. Estos hallazgos constatan las proyecciones señaladas por la literatura respecto a la pérdida de relevancia del sector agropecuario como generador de ingreso, que detonen el desarrollo de las comunidades rurales mexicanas. La falta de agrupación de los hogares por estrato de ingreso fue una limitación para examinar con mayor detalle el peso de las actividades no agropecuarias para cada grupo de ellos.This article analyzes changes in Mexico’s rural labor market by identifying the main sources of employment and income of rural households for the 2002-2007 period. Quantitative analysis is based on panel data from the Mexico National Rural Household Survey; the results confrm that industry, trade and services are the most important source of income for the rural sector. These fndings confrm projections made in literature concerning the loss of relevance of agricultural sector as an income generator, encouraging development of Mexican rural communities. Households were no grouped by income level, which was a constraint for examining in more detail the weight of non-agricultural activities for each group