ABSTRACT
The presence of women in medicine and urology has been increasing. However, there is a large disparity in leadership positions. In 2017, women constituted 3.3% of chairs, 4.5% of vice-chairs, and 7.9% of division directors in the United States,[1] similar positions in Colombia. It is unclear why this deep gender gap exists in urology. Multifactorial and specialty-specific factors may include lack of mentorship, sponsorship, and limited female role models in leadership positions.[2] According to the Association of Medical Colleges (AAMC), many women do not find mentors in surgical specialties. This lack of mentorship may limit women from accessing similar opportunities to their male counterparts.
La presencia de mujeres en la medicina y la urología ha ido en aumento. Sin embargo, existe una gran disparidad en los puestos de liderazgo. En 2017, las mujeres constituían el 3,3% de las cátedras, el 4,5% de las vicepresidencias y el 7,9% de los directores de división en Estados Unidos,[1] cargos similares en Colombia. No está claro por qué existe esta profunda brecha de género en urología. Según la Asociación de Facultades de Medicina (AAMC), muchas mujeres no encuentran mentores en las especialidades quirúrgicas. Esta falta de mentores puede limitar el acceso de las mujeres a oportunidades similares a las de sus homólogos masculinos.
Subject(s)
Humans , Female , Specialties, Surgical , Gender Identity , Leadership , Association , Schools, MedicalABSTRACT
ABSTRACT Introduction: Thulium laser VapoEnucleation of the prostate (ThuVEP) is an evolving surgical technique for BPH. Most studies have focused on outcomes in small to medium sized prostates and have originated from Europe and Asia. We sought to describe our experience with ThuVEP for very large prostates in a North American cohort. Materials and Methods: From December 2010 to October 2014, 25 men underwent ThuVEP using the CyberTM® (Quantastem, Italy) thulium laser, all with prostate volume >75mL. Data collected included patient demographics, comorbidities, intraoperative parameters, complications, and post-operative outcomes including maximum flow rate (Qmax), post-void residual (PVR), International Prostate Symptom Score (IPSS), and quality of life score (QoL) in one year of follow-up. Statistical analysis was done using Wilcoxon signed-rank test. Results: At baseline, mean age was 70±9 years and prostate size was 163±62g. Most patients (84%) were in retention and 10 (40%) patients were on anticoagulation. Seven (28%) patients went home the day of surgery (mean hospital stay: 1.2±1.2d). There were 2 intraoperative complications (8%), both cystotomies related to morcellation. Nine patients (36%) experienced a complication, all within 30 days. There were no Clavien ≥III complications. Significant improvements were seen in Qmax, PVR, IPSS, and QoL score at each time interval to 12-months following surgery (all p<0.05). Of 21 patients initially in retention, all were voiding at last follow-up. Conclusions: Our findings suggest that ThuVEP is an effective treatment for BPH in patients with large prostates with sustained results for one year.
Subject(s)
Humans , Male , Aged , Aged, 80 and over , Prostatectomy/methods , Prostatic Hyperplasia/surgery , Thulium/therapeutic use , Laser Therapy , Lasers, Solid-State/therapeutic use , Organ Size , Prospective Studies , Treatment Outcome , Middle AgedABSTRACT
ABSTRACT Purpose: Decision-making regarding surgery for post-prostatectomy incontinence (PPI) is challenging. The 24-hour pad weight test is commonly used to objectively quantify PPI. However, pad weight may vary based upon activity level. We aimed to quantify variability in pad weights based upon patient-reported activity. Materials and Methods: 25 patients who underwent radical prostatectomy were prospectively enrolled. All patients demonstrated clinical stress urinary incontinence without clinical urgency urinary incontinence. On three consecutive alternating days, patients submitted 24-hour pad weights along with a short survey documenting activity level and number of pads used. Results: Pad weights collected across the three days were well correlated to the individual (ICC 0.85 (95% CI 0.74–0.93), p<0.001). The mean difference between the minimum pad weight leakage and maximum leakage per patient was 133.4g (95% CI 80.4–186.5). The mean increase in 24-hour leakage for a one-point increase in self-reported activity level was 118.0g (95% CI 74.3–161.7, p<0.001). Pad weights also varied significantly when self-reported activity levels did not differ (mean difference 51.2g (95% CI 30.3–72.1), p<0.001). Conclusions: 24-hour pad weight leakage may vary significantly on different days of collection. This variation is more pronounced with changes in activity level. Taking into account patient activity level may enhance the predictive value of pad weight testing.