In 2005, the high power thulium laser was introduced for the surgical treatment of benign prostatic obstruction. It has several properties that confer theoretical advantages over other lasers used for the same indication, such as technical versatility and a relatively small zone of thermal damage. Studies using the 70-150 W thulium laser systems demonstrate good efficacy of these procedures with low morbidity and few complications even in higher risk patients. Different techniques have been employed to treat the prostate with this technology, including enucleation, vapoenucleation, vaporization and resection. Comparative studies have been published comparing thulium laser prostatectomy to monopolar transurethral resection of prostate (TURP), bipolar TURP and holmium laser enucleation of prostate (HoLEP). In this review we discuss the current literature on the safety and efficacy of various thulium techniques for the treatment of benign prostatic hyperplasia and examine comparative studies.
Since the first reported case of the novel coronavirus disease 2019 in Washington State, 1 the United States has become the global epicenter of the pandemic. With many predicting critical shortages of hospital beds, ventilators, and health care providers in New York City (NYC), the NewYork-Presbyterian Hospital and Columbia University Irving Medical Center (CUIMC) quickly implemented system-wide changes to prepare our response. As of May 26, 2020, NYC itself had 204,111 cases and 20,795 deaths, the latter only surpassed by 5 countries outside the United States. 2 In this correspondence, we summarize the CUIMC Department of Urology's experience at the global epicenter of COVID-19 to guide other departments in the response to this and future pandemics.
CLINICAL EXPERIENCE RedeploymentIn early March 2020, our department held twice-weekly phone conferences to address the spread of COVID-19 to NYC. All urology faculty, residents, and administrative personnel participated, allowing all parties to ask questions and give input regarding the frequent changes in protocols. These calls ensured immediacy, transparency, and fidelity of information during a rapidly evolving situation. The volume of COVID-19 patients was quickly increasing and many front-line providers were being quarantined for symptoms and/or exposure. It was clear that redeployment of our staff was imminent.To increase available personnel, equipment, and physical space, all elective surgical cases at CUIMC were suspended on March 13. On the evening of March 25, our chairman called an emergency phone conference. Hospital leadership had declared that our emergency rooms (ERs) were overrun and in need of assistance − redeployment had been activated.
Aims: Recommendations for the management of women with suspected uncomplicated lower urinary tract infections (UTIs) include presumptive antibiotics with or without obtaining a urine culture (UCx). However, with increasing antibiotic resistance, efforts to decrease antibiotic usage are vital.Therefore, the objective of this study was to determine if the presumptive treatment of women with suspected uncomplicated UTIs is contributing to unnecessary antibiotic usage. Methods: We retrospectively reviewed all nonpregnant female patients presenting to our student health services clinic with UTI symptoms from December 2016 to May 2017 who had UCx sent. Clinical information, symptoms, office urine dip, and UCx results were reviewed. Patients with positive and negative UCx were compared. Results: A total of 67 patients were included for analysis. Presenting symptoms included dysuria (59/60, 98%), frequency (41/45, 91%), and urgency (27/27, 100%). Office urine dip was performed on 33 of 67 (49%) patients. Dips were positive for leukocytes (88%), blood (79%), and nitrites (18%). All patients in the study were prescribed antibiotics, most commonly nitrofurantoin (82%). Culture results were negative in 29 of 67 (43%). There were no significant differences in duration of symptoms, presenting symptoms, or urine dip results between patients with a negative UCx and those with a positive UCx.
Conclusions:In our study, we found a significant negative UCx rate in women with symptoms of uncomplicated UTI, representing a cohort of patients who were exposed to antibiotics unnecessarily. In addition, we found no difference in presenting symptoms or urine dip results to help distinguish patients with a positive UCx.
K E Y W O R D Santibiotic resistance, antimicrobial stewardship, student health services, urinary tract infection
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