ObjectivesTo evaluate the impact of COVID-19 on clinical and surgical practice, educational activities, health and lifestyle behavior of Brazilian urology residents.Materials and MethodsA web-based survey was sent to 468 Brazilian urology residents from postgraduate years (PGY) 3 to 5 to collect data on clinical practice and training after 4 months of COVID-19. We also assessed health-related and behavior changes, rate of infection by SARS-CoV-2, deployment to the front line of COVID-19, residents’ concerns, and access to personal protective equipment (PPE).ResultsMassive reductions in elective and emergency patient consultations, diagnostic procedures and surgeries were reported across the country, affecting PGY 3 to 5 alike. Most in-person educational activities were abolished. The median damage to the urological training expected for 2020 was 6.0 [3.4 -7.7], on a scale from 0 to 10, with senior residents estimating a greater damage (P< 0.001). Educational interventions developed included online case-based discussions, subspeciality conferences and lectures, and grand rounds. Most senior residents favored extending residency to compensate for training loss and most younger residents favored no additional training (p< 0.001). Modifications in health and lifestyle included weight gain (43.8%), reduced physical activity (68.6%), increased alcoholic intake (44.9%) and cigarette consumption (53.6%), worsening of sexual life (25.2%) and feelings of sadness or depression (48,2%). Almost half were summoned to work on the COVID-19 front-line and 24.4% had COVID-19. Most residents had inadequate training to deal with COVID-19 patients and most reported a shortage of PPE. Residents’ concerns included the risk of contaminating family members, being away from residency program, developing severe COVID-19 and overloading colleagues.ConclusionsCOVID-19 had a massive impact in Brazilian urology residents’ training, health and lifestyle behavior, which may reflect what happened in other medical specialties. Studies should confirm these findings to help developing strategies to mitigate residents’ losses.
Objectives: To evaluate the impact of COVID-19 on clinical and surgical practice, educational activities, health and lifestyle behavior of Brazilian urology residents. Materials and Methods: A web-based survey was sent to 468 Brazilian urology residents from postgraduate years (PGY) 3 to 5 to collect data on clinical practice and training after 4 months of COVID-19. We also assessed health-related and behavior changes, rate of infection by SARS-CoV-2, deployment to the front line of COVID-19, residents' concerns, and access to personal protective equipment (PPE). Results: Massive reductions in elective and emergency patient consultations, diagnostic procedures and surgeries were reported across the country, affecting PGY 3 to 5 alike. Most in-person educational activities were abolished. The median damage to the urological training expected for 2020 was 6.0 [3.4 -7.7], on a scale from 0 to 10, with senior residents estimating a greater damage (P< 0.001). Educational interventions developed included online case-based discussions, subspeciality conferences and lectures, and grand rounds. Most senior residents favored extending residency to compensate for training loss and most younger residents favored no additional training (p< 0.001). Modifi cations in health and lifestyle included weight gain (43.8%), reduced physical activity (68.6%), increased alcoholic intake (44.9%) and cigarette consumption (53.6%), worsening of sexual life (25.2%) and feelings of sadness or depression (48,2%). Almost half were summoned to work on the COVID-19 front-line and 24.4% had COVID-19. Most residents had inadequate training to deal with COVID-19 patients and most reported a shortage of PPE. Residents' concerns included the risk of contaminating family members, being away from residency program, developing severe COVID-19 and overloading colleagues. Conclusions: COVID-19 had a massive impact in Brazilian urology residents´ training, health and lifestyle behavior, which may refl ect what happened in other medical specialties. Studies should confi rm these fi ndings to help developing strategies to mitigate residents' losses.
Numerous surgical techniques are approved for the surgical treatment of benign prostatic obstruction (BPO). They include minimally invasive procedures such as the newly introduced prostatic urethral lift and water vapor thermal therapy, transurethral resection, vaporization or enucleation of the prostate and open or laparoscopic/robotic assisted prostatectomy and have been recommended by the guidelines of the most distinguished scientific organizations (1, 2). In clinical practice for many decades, transurethral resection of the prostate (TURP) remains the standard by which subsequent surgical modalities for the treatment of BPH have been compared. Guidelines recommend that either monopolar or bipolar TURP may be used, for patients with a moderately enlarged prostate, of up to 80 cc, depending on the surgical expertise of the practitioner (1, 2). In bipolar TURP (B-TURP), the energy does not travel through the body to reach a skin pad, as is the case for monopolar TURP (M-TURP). It is confined between the active and passive poles situated on the resectoscope tip (resection loop) (3). It may be performed in 0.9% NaCl solution and does not require the use of isoosmolar solutions (mannitol, glycine), greatly reducing the risk for acute dilutional hyponatremia and the TUR syndrome. This is especially important for larger prostates requiring prolonged surgery (4). Many studies have been published in recent years exploring the use of B-TURP and comparing it with M-TURP. Systematic reviews have also compared the two techniques, confirming comparable efficacy for both and a reduced risk for acute dilutional hyponatremia and TUR syndrome for B-TURP (5, 6). Although some studies indicate a reduced risk for blood transfusion and clot retention with B-TURP, the evidence is not strong to make a recommendation in this regard (2, 7). There are different bipolar resection devices and no evidence in favor of a specific system (3). In the present study, Otaola-Arca H. et al. (8) used the Plasma KineticTMSuperpulse generator as the energy source for bipolar TURP (PK-TURP) and prospectively compared it with M-TURP. They included patients with refractory LUTS and/or complications associated with BPO and a prostate volume < 80 cc. Of 100 randomized patients, 84 were included in the final analysis. Patients were evaluated after 1, 3, 6 and 12 months and the efficacy variables were improvement in the International Prostate Symptom Score (IPSS), quality of life question of the IPSS, Qmax, postvoid residue, prostate volume and sexual function measured by the IIEF-5. The authors showed comparable efficacy and safety outcomes for the two methods. The only difference observed was a greater improvement of the QoL score in patients who underwent PK-TURP, which was minor and considered clinically insignificant. The efficacy results of this study are in accordance with a recent meta-analysis by Cornu et al. that showed no differences comparing the two techniques (9). However, the meta-analysis showed an increased risk for dilutional hyponatremia...
Introduction and hypothesis The objective was to characterize the impact of the COVID-19 pandemic on the surgical treatment of female stress urinary incontinence (FSUI) in Brazil. Methods This study was conducted with population-based data from the Brazilian public health system database. We obtained data on the number of surgical procedures for FSUI in 2019 (before the coronavirus disease [COVID-19] pandemic), 2020, and 2021 (during the pandemic) in each of the 27 Brazilian states. We included official Brazilian Institute of Geography and Statistics (IBGE) data on the population, Human Development Index (HDI), and annual per capita income of each state. Results A total of 6,718 surgical procedures for FSUI were performed in the Brazilian public health system in 2019. The number of procedures was reduced by 56.2% in 2020, and an additional reduction of 7.2% was seen in 2021. The distribution of procedures by state showed important differences, ranging from 4.4 procedures/1,000,000 inhabitants in Paraíba and Sergipe to 67.6 procedures/1,000,000 inhabitants in Paraná ( p <0.01) in 2019. The number of surgical procedures was higher in states with a higher HDI ( p =0.0001) and per capita income ( p =0.042). The decrease in the number of surgical procedures affected the whole country and its rate did not correlate with HDI ( p =0.289) or per capita income ( p =0.598). Conclusion The impact of the COVID-19 pandemic on the surgical treatment of FSUI in Brazil was significant in 2020 and persisted in 2021. Access to surgical treatment of FSUI varied according to geographic region, HDI, and per capita income, even before COVID-19.
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