Comparison of Long-term Effect and Complications Between Holmium Laser Enucleation and Transurethral Resection of Prostate: Nations-Wide Health Insurance Study.

OBJECTIVE: To investigate and compare the postoperative efficacy and complications of the transurethral resection of prostate (TURP) and holmium laser enucleation (HoLEP) using the nationwide insurance database of Korea. METHODS: We created a cohort of benign prostatic hyperplasia (BPH) patients treated with TURP and HoLEP between 2011 and 2017 from the nationwide database of reimbursement. We compared the postoperative effects between the two surgical groups. RESULTS: We retrieved a total of 58,346 patients (TURP 38,308 and HoLEP 20,038 patients). The mean follow-up duration was 51.6 and 47.6 months, respectively. The rate of reoperation was significantly higher in the TURP group (4.50%) than in the HoLEP group (1.27%) (P < .01). The postoperative use of alpha-blockers and dutasteride/finasteride was significantly higher in the TURP group until 24 months postoperatively. The rate of the postoperative use of medications for symptoms of overactive bladder was lower in the TURP group than in the HoLEP group until 12 months postoperatively, but it did not differ after 12 months postoperatively. Overall, urethral surgeries were less frequently performed in the TURP group than in the HoLEP group (P < .05); however, more severe cases required surgeries under general anesthesia in the TURP group (P < .05). Postoperative surgery for stress incontinence was performed in 0.10% and 0.31% of patients after TURP and HoLEP, respectively (P < .01). CONCLUSION: This study showed the superiority of HoLEP compared to TURP in terms of postoperative efficacy and its inferiority in terms of complications of stress incontinence in real life practice.

Patient preferences of a resect and discard paradigm.

BACKGROUND: Resect and discard is a new paradigm for management of diminutive polyps. It is unknown whether patients will embrace this new paradigm in which small polyps would not be sent for histopathologic review. OBJECTIVE: To determine whether patients would be willing to pay for pathology costs with their own money and which factors influence patients' decisions to pay or not pay for pathology costs with their own money. DESIGN: Single-center, prospective, survey study. SETTING: Hospital outpatient endoscopy center. PATIENTS: Adults undergoing colonoscopy for screening or routine polyp surveillance. INTERVENTIONS: Patient survey. MAIN OUTCOME MEASUREMENTS: Willingness to pay out-of-pocket for pathology costs when a diminutive polyp is found and factors that influence patients' decisions to pay or not pay for pathology costs with their own money. RESULTS: A total of 500 participants completed the survey. A total of 360 respondents (71.9%) indicated a hypothetical willingness to pay out-of-pocket for histopathologic polyp analysis if this interpretation was not covered by insurance. Patient factors significantly associated with willingness to pay for polyp analysis included higher income and education and female sex. LIMITATIONS: Single center, hypothetical situation. CONCLUSION: Over two-thirds of patients were willing to pay to have their diminutive polyp sent for pathologic evaluation if their insurance carrier would not pay the cost. Factors associated with willingness to pay included higher income, higher education, and female sex. Patients who were unwilling to pay raised concerns about cost and are less concerned about cancer risk compared with those willing to pay. ( CLINICAL TRIAL REGISTRATION NUMBER: NCT02305251.).

An initial assessment of haptics in preclinical operative dentistry training.

AIM: The purpose of this study was to assess novice student perception of haptic-based manual dexterity training. The short-term impact of haptic training in the early phase of preclinical operative dentistry education was also investigated. METHODS: Dental students performed a class II amalgam and a class III resin tooth preparation in a typodont model at baseline. The experimental group performed exercises on the manual dexterity module of the IDEA™ software using a haptic device. The exercises required removing the maximum amount of three-dimensional geometric shapes within a predetermined width and depth. Tooth preparations were repeated 2 weeks later. A questionnaire survey was given to assess the subjective evaluation of the haptic simulation exercise. RESULTS: Tooth preparations were scored regarding external outline, internal form, and integrity of adjacent tooth. Improvement of overall tooth preparation scores post-haptic use was not statistically significant compared to controls (P > 0.05). However, students found the game-feature of the haptic device made the learning experience more fun and interesting. CONCLUSION: The haptic exercises with the manual dexterity module software were not superior in improving the dexterity of students for tooth cavity preparations in short-term. Benefits of ease of use and fun learning experience can be further investigated in future studies.