Current Opinion in Urology最新文献

Purpose of review: The integration of artificial intelligence (AI) into healthcare has significantly impacted the way healthcare is delivered, particularly with generative AI-powered chatbots. This review aims to provide an analysis of the application, benefits, challenges and future of generative AI-powered chatbots in Urology.

Recent findings: Recent advancements in AI have led to significant improvements in chatbot performance and applicability in healthcare. Generative AI chatbots have shown promise in patient education, symptom assessment, administrative tasks, and clinical decision-making in urology. Studies demonstrate their ability to reduce clinic burden, improve patient satisfaction, and enhance accessibility. However, concerns remain about accuracy, data privacy, and integration into clinical workflows.

Summary: Increasing number of studies have shown the ability of generative AI to enhance urological practice. As technology advances, generative AI is likely to integrate into multiple aspects of urological practice. Concerns with generative AI will need to be examined before safe implementation.

Purpose of review: Artificial intelligence (AI) chatbots are increasingly used as a source of information. Our objective was to review the literature on their use for patient education in urology.

Recent findings: There are many published studies examining the quality of AI chatbots, most commonly ChatGPT. In many studies, responses from chatbots had acceptable accuracy but were written at a difficult reading level without specific prompts to enhance readability. A few studies have examined AI chatbots for other types of patient education, such as creating lay summaries of research publications or generating handouts.

Summary: Artificial intelligence chatbots may provide an adjunctive source of patient education in the future, particularly if prompted to provide results with better readability. In addition, they may be used to rapidly generate lay research summaries, leaflets or other patient education materials for final review by experts.

Purpose of review: Explore the current state of artificial intelligence in the Men's Health space.

Recent findings: Artificial intelligence is emerging in the field of Men's Health with recent publications highlighting a role for optimization of male infertility diagnostics and treatment, clinical predictive tools, patient education, and improvements in clinical workflow.

Summary: Artificial intelligence is set to be a prime instrument in the advancement of both patient care and patient education in the Men's Health space.

Purpose of review: We reviewed the latest articles in patient-reported outcomes as it relates to genital gender-affirming surgery (GGAS) and provide a narrative summary of each article.

Recent findings: The current landscape of patient-reported outcomes measures (PROMs) within GGAS largely consists of various ad hoc questionnaires. Within the last two years, one new PROM, validated within the transgender and gender-diverse (TGD) community, have been described.

Summary: Patient-reported outcomes measures seek to elucidate the questions and answers of particular interest to patients and stakeholders of a particular population. To date, within GGAS, surgeon-reported outcomes and nonvalidated patient-reported outcomes comprise the bulk of the literature on the subject. However, there is growing interest in PROMs developed with TGD collaboration within all phases of the research process. Three new PROMs designed with and for the TGD community, are described which provides hope for continued progression of the field toward patient-centered and patient-collaborative research.

Purpose of review: To review the evidence for metastasis-directed therapy (MDT) in oligometastatic (OM) prostate cancer (PC) and future directions in this clinical setting.

Recent findings: The indications for radiotherapy in PC have significantly increased over the last decade. The treatment of OM disease has been gaining popularity thanks to new molecular imaging techniques that allow more accurate identification of OM patients who may benefit from MDT. stereotactic body radiation therapy can offer potentially curative treatment with low toxicity rates. Although most published MDT studies focus on hormone-sensitive (HS) PC in the setting of recurrence, promising results have emerged in recent years even in patients with castration resistance.

Summary: MDT has emerged as an effective treatment option for OM PC patients with favorable oncological outcomes and a low toxicity profile. Evidence suggests that MDT can be used to delay androgen deprivation therapy or in combination with systemic therapy to potentially improve efficacy outcomes. Molecular stratification is needed to determine who will benefit from treatment intensification with MDT +/- systemic therapies.

Purpose of review: By leveraging models such as large language models (LLMs) and generative computer vision tools, generative artificial intelligence (GAI) is reshaping cancer research and oncologic practice from diagnosis to treatment to follow-up. This timely review provides a comprehensive overview of the current applications and future potential of GAI in oncology, including in urologic malignancies.

Recent findings: GAI has demonstrated significant potential in improving cancer diagnosis by integrating multimodal data, improving diagnostic workflows, and assisting in imaging interpretation. In treatment, GAI shows promise in aligning clinical decisions with guidelines, optimizing systemic therapy choices, and aiding patient education. Posttreatment, GAI applications include streamlining administrative tasks, improving follow-up care, and monitoring adverse events. In urologic oncology, GAI shows promise in image analysis, clinical data extraction, and outcomes research. Future developments in GAI could stimulate oncologic discovery, improve clinical efficiency, and enhance the patient-physician relationship.

Summary: Integration of GAI into oncology has shown some ability to enhance diagnostic accuracy, optimize treatment decisions, and improve clinical efficiency, ultimately strengthening the patient-physician relationship. Despite these advancements, the inherent stochasticity of GAI's performance necessitates human oversight, more specialized models, proper physician training, and robust guidelines to ensure its well tolerated and effective integration into oncologic practice.

Purpose of review: To evaluate the role of extirpative surgery for the primary tumor in metastatic upper tract urothelial carcinoma (mUTUC).

Recent findings: The PubMed, Web of Science, and Cochrane Library were searched on July 2024 to identify relevant studies according to the Preferred Reporting Items for Systematic Review (PRISMA) statement. Studies were eligible for analysis if they compared oncologic outcomes between mUTUC patients who underwent surgical resection of the primary tumor and patients who did not. Cancer-specific survival (CSS) and overall survival (OS) were assessed using multivariate logistic regression analyses. We identified 2686 reports, of which 11 articles comprising 12 833 records were selected for this systematic review. Eight and three studies used Surveillance Epidemiology and End Results (SEER) and National Cancer Database (NCDB) databases, respectively. Surgical resection of the primary tumor was significantly associated with better CSS and OS in patients with mUTUC. Among the 5353 mUTUC patients included in our meta-analysis, radical nephroureterectomy (RNU) was independently associated with better OS with a pooled hazard ratio (HR) of 0.62 [95% confidence interval (CI) 0.54-0.72, P  < 0.05]. Subgroup analyses of studies restricted to mUTUC patients with distant lymph node metastasis ( n  = 1372) revealed RNU to be independently associated with better OS with pooled HR: 0.44 (95% CI 0.28-0.67, P  < 0.05) together with systemic chemotherapy, primary tumor site in the ureter, lower T stage, and no locoregional lymph node involvement.

Summary: Surgical resection of the primary tumor offers oncologic survival benefits in select patients with mUTUC. However, in the absence of data from prospective randomized studies, it is essential to evaluate each patient individually as part of a collaborative multidisciplinary shared decision working with the patient.

Purpose of review: Advancements in immune-oncology treatments and metastasis-directed therapy (MDT) techniques have significantly transformed treatment paradigms for patients with oligometastatic clear cell renal cell carcinoma (ccRCC). Within this evolving therapeutic landscape, the role of cytoreductive nephrectomy remains a topic of debate. This review aims to synthesize recent literature regarding the role of cytoreductive nephrectomy for patients with oligometastatic ccRCC in the contemporary immune-oncology era.

Recent findings: While no prospective data are available regarding the role of cytoreductive nephrectomy for patients with oligometastatic ccRCC in the new immune-oncology (IO) era, results from recent retrospective studies suggest that careful patient selection remains critical. Apart from patients with symptomatic primary tumors, cytoreductive nephrectomy may still play a role in the treatment of oligometastatic patients with favorable clinical features, such as no immediate need for systemic therapy, absence of adverse metastatic sites, or oligometastatic lesions amenable to MDT. Deferred cytoreductive nephrectomy may have a rationale in patients with a deep response to IO at oligometastatic sites. Prognostic biomarkers to assess the biological behavior of oligometastatic disease and identify patients most suitable for cytoreductive nephrectomy are currently lacking. Novel imaging remains under investigation, with its treatment implications in oligometastatic RCC yet to be established.

Summary: Notwithstanding the lack of prospective evidence, cytoreductive nephrectomy may still play a role for selected patients with oligometastatic ccRCC. Future research efforts should aim to identify prognostic tools aiding tailored decision-making in this setting.

Purpose of review: The present study reviews contemporary literature focused on uterine transplantation and tissue substitutes for the purposes of transfeminine genital gender affirming surgery (GAS). Additional background is provided for both topics to provide a more comprehensive understanding of the modern applications.

Recent findings: Uterine transplant remains an experimental procedure in cisgender patients who wish to avoid surrogacy. A natural extension might be to apply these techniques to GAS. Technical barriers include anatomic differences and alterations to gender-affirming hormone administration protocols. Ethically, resource allocation, elective immunosuppression, societal response to organ donation, legal ramifications of parenthood as well as the potential, under-studied effects that such an elective procedure may have on the patient's offspring must be further investigated.Tissue substitutes have long been used in urologic reconstruction but more recently applied to gender affirmation surgery which has traditionally relied on autografting to line the neovaginal canal both in the context of primary and revision vaginoplasty. However, the advent of off-the-shelf xenografts have recently been posited to be safe and efficacious alternatives to autografts. Longer term studies are needed to validate whether these proposed methods are indeed noninferior to traditional approaches.

Summary: The field of feminizing gender affirmation surgery remains an exciting frontier for surgeons and patients alike. Given the relative nascency of the specialty and its propensity to draw techniques from various surgical disciplines there exists a unique opportunity for rapid innovation to overcome challenging problems posed by these complex procedures as evidenced by discussions around applying uterine transplantation and the use of novel tissue grafting techniques.