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Introduction: Aquablation of the prostate is a novel robotic-assisted procedure that uses a powerful ultrasound and cystoscopic guided water jet for the treatment of benign prostatic hyperplasia (BPH).

Aims: To assess the efficiency and safety of the Aquablation procedure for the treatment of BPH among patients treated in our institution.

Methods: A retrospective analysis of the first 50 cases was performed in our institution between 10/2022 and 05/2023. We gathered demographic information, surgical and post-surgical course, and office follow-up 1,3 and 6 months after surgery, including the evaluation of urination parameters and sexual function.

Results: Fifty patients were included in the study, with a median age of 69 years and median prostate volume of 74 ml (range 31-138 ml). Thirteen patients carried a urethral catheter or used clean intermittent catheterization due to urinary retention. The median duration of surgery was 51 minutes (intra-quadrate range 38-57). In all patients, the surgery was completed as planned with no intra-operative complications. The average drop in hemoglobin level after surgery was 1.2 mg/dL only. Two patients (4%) were given a blood transfusion due to a symptomatic drop in hemoglobin levels. None of the patients were taken to the operating room (OR) for an urgent hemostasis surgery. The IPSS (international prostate symptoms score) improved by an average of 13 points, with quality-of-life questions improving by 2.25 points. The functional outcomes were stable over 6 months after surgery. All patients with pre-operative urinary retention eventually had their catheter removed (one patient required another procedure - transurethral resection of the prostate (TURP)). Significant urinary incontinence was not reported by any of the 50 patients.

Conclusions: Aquablation of the prostate is a novel surgical technique, which is accurate, efficient, with a low rate of complication and side effects, and is performed over a short duration of time. The procedure may be performed on prostates up to 150 ml in volume. The rate of complication and auxiliary procedures is very low in the short term, and the functional outcomes are very good in the short term. This procedure has a place in the first line of modern BPH surgeries.

Introduction: Artificial intelligence has burst into our lives with great vigor in recent years. We encounter it in all areas of life, as well as in the field of medicine. The article refers to medical ethics in two areas: One field is medicine based on Mega Data and the other is the chatbot or ChatGPT. These two fields basically operate in three stages: collecting data, building a logarithm and drawing conclusions and a course of action. During the data collection phase, as doctors we must not forget to preserve the autonomy and medical confidentiality of the patient. Despite all the technology and innovations, in the end, the doctor makes decisions with the cooperation of the patient and the discretion on whether to use the diagnosis, treatment and knowledge which remains in the hands of the doctor. In the realm of research in reviewing materials and writing articles, when artificial intelligence is used, caution and criticality should be exercised, since the results obtained when using artificial intelligence can be doubly misleading.

Introduction: Ileocolic intussusception is the most common cause of acute intestinal obstruction in infancy. Without rapid diagnosis and intervention, as well as collaboration among physicians from multiple disciplines, the patient's condition can deteriorate significantly, leading to ischemia and bowel necrosis. This position paper is the work of a committee of the Israel Pediatric Association, the Israel Pediatric Surgery Association, the Israel Radiological Association (Pediatric Imaging Section), and the Israel Association of Emergency Medicine (Pediatric Emergency Medicine Section) with the aim of establishing guidelines and thereby improving the treatment of children. The paper discusses the principles of clinical evaluation, sonographic diagnosis, non-surgical treatment by pneumatic (air enema) or hydrostatic (fluid enema) reduction, and the possible complications of this treatment. Other topics discussed in this paper include sedation to reduce the pain and distress associated with the reduction procedure, post-procedure monitoring, and surgical treatment principles in cases where pneumatic or hydrostatic reduction fails.

Introduction: Primary (AL) systemic amyloidosis is an uncommon disorder in which immunoglobulin light chains are deposited in the tissues as amyloid, resulting in organ dysfunction. The initial symptoms are frequent fatigue and weight loss, and common manifestations include nephrotic syndrome, cardiomyopathy, peripheral neuropathy or hepatomegaly. Histological examination reveals some degree of amyloid deposition in virtually every organ system except the central nervous system (CNS). In contrast to the absence of CNS involvement, peripheral neuropathy is present in 17-36% of AL cases. The typical presentation of AL neuropathy is numbness in the feet, burning and aching pains with lancinating electrical sensations and loss of pain and thermal sensation in the distal limbs. Carpal tunnel syndrome may also co-exist in up to 21% of AL amyloidosis patients. A predominant effect of the disease on small-diameter sensory fibers is consistent with painful and autonomic symptoms. We present a unique case of clinical motor axonal neuropathy predating systemic amyloidosis. The patient provided his informed consent to the study.

Objectives: To describe and evaluate the gaps in cancer survivors' treatment in Israel and suggest possible methods of meeting their needs.

Methods: This narrative review explores cancer survivors' unmet needs and global methodologies aiming at meeting them within various health systems.

Results: Cancer survivorship has become a topic of great interest in the past few years. Cancer survivors often face physical, emotional, and spiritual challenges after completing treatment. Many share concerns regarding disease or treatment-related side effects and fear of disease recurrence. There is a significant need to provide information regarding treatment options and lifestyle changes that may prevent the recurrence of the disease and improve the quality of life and survival. Complementary and integrative medicine, including nutrition, supplements, lifestyle changes, complementary treatment and treatments that affect the triad of mind- body-spirit, have a major function in addressing these unmet needs of patients. These treatments may prevent the recurrence of the disease and improve the quality of life and survival.

Conclusions: Improving the treatment provided to cancer survivors is essential, promoting their recovery and thriving after their cancer journey. There is a need to figure out how healthcare providers and support organizations, including integrative medicine services, can help survivors thrive. Integrative medicine services provided in the oncology settings can fulfill the diverse needs of cancer survivors and aid them in coping with challenges affecting their physical, mental, and spiritual well-being.

Introduction: The Evolution of Medical Practice: Book Review.

Aims: The SARS-CoV-2 (COVID-19) pandemic has changed emergency department (ED) referral trends worldwide.

Objectives: We aim to investigate inpatient consultation in the ED of a pediatric otolaryngology-head and neck surgery service during the COVID-19 pandemic compared to two preceding years.

Methods: A retrospective chart review of children under 18 years who had an otolaryngology consultation in Schneider Children's Hospital ED from 2018-2020.

Results: Of the 4,213 patients who underwent otolaryngology consultations in the ED, infection pathogenesis was the leading cause, presenting in 51.1% of the patients during the three-year study period. During the year 2020, the proportion of patients admitted to the ED who were referred to otolaryngology-head and neck consultations was significantly higher than in previous years (p<0.001), especially during the summer (p=0.001). In addition, increased rates were observed of trauma, foreign body pathogenesis, and mastoiditis (16% vs. 13%, p=0.03; 13% vs. 8%, p<0.001; and 2.4% vs. 0.9%, p = 0.01, respectively).

Conclusions: During the COVID-19 pandemic, otolaryngology consultations in the emergency department increased substantially. Improvements in community clinics service may alleviate this increased burden.

Introduction: Immersion in cold or ice water, either passively or actively by swimming, has become very popular. Many people use this method for health promotion, both mentally and physically, as well as an extreme environment for competitive swimming. Nevertheless, despite the popularity of this phenomenon, professional knowledge, science and practical regulations are lacking. On one hand, research findings tend to generally support ice water immersion or swimming for health and resilience, but on the other hand, it involves significant exposure to stress, which may expose participants to major risks, especially in the occurrence of certain risk factors. Studies in this field describe many different protocols, conditions, definitions and populations, making further quality and in-depth research necessary in order to develop a set of criteria for a useful, healthy, and safe practice. Assuming this phenomenon is here to stay, it is of great importance to educate medical staff and introduce up to date basic physiological and medical data, which is required for proper professional guidance, support and risk management.

Introduction: Sex- and Gender-Conscious Medicine aims to raise awareness among the general public and among professionals to the phenomenon that the function of all body systems in women and men can be different. The differences may be small but significant for the health and disease and also affect pharmacokinetics and pharmacodynamics. Since medications are still studied mostly in men and the results are applied to women, pharmacokinetics and pharmacodynamics of men have actually become the "gold standard", which is applied in practice to both sexes. This is the case, despite the fact that the body weight of women is usually lower than that of men and the compartmental distribution of fat, muscle and water is different between the sexes. In addition, metabolism and clearance of drugs through the kidneys can differ between them. As a result, women sometimes find themselves undertreated or over-treated with regard to various medications and suffer twice as much from adverse drug reactions than men. Even the involvement of regulatory institutions such as the FDA in the USA was not enough to change the situation decisively. In this review, I will discuss various aspects of the problem, present examples of different groups of drugs and will especially refer to the problem of the side effects of medications in women.

Introduction: In recent decades, the recognition of the importance of sex, gender and their interrelationship for health research and for the practice of medicine has grown. Accordingly, the move to include gender medicine in medical school curricula has gained momentum in many countries. This article reviews the challenges of integrating this subject into medical school curricula and details the recent initiative to mainstream gender medicine into the six-year curriculum of the Hadassah-Hebrew University Medical School in Jerusalem, Israel. The program is spiral, i.e. in the first year a theoretical foundation is laid, which is later expanded and supplemented by practical knowledge in order to consolidate the knowledge acquired in the previous phases. The second principle is "from the general to the particular". This means moving from understanding what is already known in the previously published studies to applying it in the cases that the students will face during their clinical studies and examining how the knowledge and its application can be incorporated in the students' professional behavior as future physicians.