Purpose:Medical schools are increasingly aware of the ways in which physician empathy can have a profound impact on patients’ lives and have developed humanities initiatives to address this concern. Reflective writing in particular is more commonly promoted in medical curricula, but there is limited research on the impact of reflective writing on medical student empathy levels. It aims to find the emotional effects of reflective writing interventions on medical and healthcare students by systemic review.Methods:Two investigators independently reviewed educational publications for critical analysis. This review focused systematically on quantitative papers that measure the impact of reflective writing on empathy.Results:Of the 1,032 studies found on Medline and CINAHL, only 8 used quantitative measures pre- and postwritten reflection to measure any impact on empathy outcomes. The outcomes measured included impact of reflective writing exercises on student wellness, aptitude, and/or clinical skills. Of these studies, a significant change in student empathy was observed in 100% of the studies, demonstrating a significant change in outcomes.Conclusion:Although the lack of homogeneity in outcome measurement in the literature limits possible conclusion from this review, the overwhelmingly positive reporting of outcomes suggests that reflective writing should be considered in any medical curriculum.

Purpose:Holmium laser enucleation of the prostate has proven to be efficacious and safe for the treatment of benign prostatic hyperplasia. New laser technologies, such as the MOSES™ pulse laser system, improve energy delivery and may improve operative times. We sought to prospectively evaluate holmium laser enucleation of the prostate using MOSES technology in a double-blind randomized controlled trial.Materials and Methods:This is a single-center, prospective, double-blind, randomized controlled trial comparing holmium laser enucleation of the prostate using MOSES technology to holmium laser enucleation of the prostate. Patients were randomized in a 1:1 fashion. The study was powered to evaluate for a difference in operative time. Secondary end points included enucleation, morcellation, and hemostasis times, as well as blood loss, functional outcomes and complications 6 weeks postoperatively.Results:A total of 60 patients were analyzed without difference in preoperative characteristics in either group (holmium laser enucleation of the prostate using MOSES technology: 30/60, 50%, holmium laser enucleation of the prostate: 30/60, 50%). Shorter total operative time was seen in the holmium laser enucleation of the prostate using MOSES technology group compared to the holmium laser enucleation of the prostate group (mean: 101 vs. 126 minutes, p <0.01). This difference remained significant on multiple linear regression. Additionally, the holmium laser enucleation of the prostate using MOSES technology group had shorter enucleation times (mean: 68 vs. 80 minutes, p=0.03), hemostasis time (mean: 18 vs. 29 minutes, p <0.01), and less blood loss (mean: −6.3 vs. −9.0%, p=0.03), measured by a smaller change in hematocrit postoperatively, compared to the traditional holmium laser enucleation of the prostate. There was no difference in functional or safety outcomes at followup.Conclusions:We report the results of a prospective, double-blind, randomized controlled trial comparing holmium laser enucleation of the prostate using MOSES technology to traditional holmium laser enucleation of the prostate. MOSES technology resulted in an improvement in operative time and a reduction in blood loss with comparable functional outcomes and complications compared to traditional holmium laser enucleation of the prostate.

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Background The development of benign prostatic hyperplasia (BPH) and medication‐refractory lower urinary tract symptoms (LUTS) remain poorly understood. This study attempted to characterize the pathways associated with failure of medical therapy for BPH/LUTS. Methods Transitional zone tissue levels of cholesterol and steroids were measured in patients who failed medical therapy for BPH/LUTS and controls. Prostatic gene expression was measured using qPCR and BPH cells were used in organoid culture to study prostatic branching. Results BPH patients on 5‐α‐reductase inhibitor (5ARI) showed low levels of tissue dihydrotestosterone (DHT), increased levels of steroid 5‐α‐reductase type II (SRD5A2), and diminished levels of androgen receptor (AR) target genes, prostate‐specific antigen (PSA), and transmembrane serine protease 2 (TMPRSS2). 5ARI raised prostatic tissue levels of glucocorticoids (GC), whereas alpha‐adrenergic receptor antagonists (α‐blockers) did not. Nuclear localization of GR in prostatic epithelium and stroma appeared in all patient samples. Treatment of four BPH organoid cell lines with dexamethasone, a synthetic GC, resulted in budding and branching. Conclusions After failure of medical therapy for BPH/LUTS, 5ARI therapy continued to inhibit androgenesis but a 5ARI‐induced pathway increased tissue levels of GC not seen in patients on α‐blockers. GC stimulation of organoids indicated that the GC receptors are a trigger for controlling growth of prostate glands. A 5ARI‐induced pathway revealed GC activation can serve as a master regulator of prostatic branching and growth.

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