Urology Journal最新文献

Purpose: With the recent increase in the use of artificial intelligence in the medical field, this study aimed to evaluate the accuracy and adequacy of ChatGPT's responses to questions related to female urology.

Methods: Intensive internet research was performed to prepare a frequently asked question (FAQs) list. Scientific questions were created in accordance with the European Urology Association (EAU) Non-neurogenic Female Lower Urinary Tract Symptoms Guidelines, EAU Chronic Pelvis Pain Guidelines, and EAU Neuro-Urology Guidelines. All answers by ChatGPT were analysed by two experienced urologists and each answer was scored between 1 and 4 by the physicians. A score of 1 was the highest and showed that the answer was completely true and sufficient. The reproducibility of ChatGPT answers was evaluated by asking each question twice using two different computers.

Results: A total of 96 (97.0%) ChatGPT answers about female urology were accurate and sufficient, and categorized as grade 1. Additionally, two (2.0%) answers were scored as grade 2, and one answer (1.0%) was scored as grade 3. None of ChatGPT's responses about female urology were classified as grade 4. In total, 83 questions were prepared according to EAU guidelines recommendations, and ChatGPT gave complete accurate and satisfactory answers for 68 (82.9%) questions. The reproducibility rate was highest for ChatGPT answers for questions related to urinary incontinence, pelvic organ prolapses, and pelvic pain syndromes, and reproducibility rate was 100% for each subgroup. The reproducibility rate for ChatGPT answers was lowest for CPG questions (84.1%).

Conclusion: For the first time our study revealed that ChatGPT had an excellent accuracy rate in answering questions related to female urology with 97% success rate. In addition, the outcomes of this study showed that ChatGPT accurately and satisfactorily answered 82.9% of questions about female urology based on EAU guidelines.

Purpose: Prostate-specific antigen (PSA) bounce is a common phenomenon that can be observed in patients of prostate cancer treated by radiotherapy. However, the clinical, pathological, or dosimetric predictors and clinical significance of PSA bounce in stereotactic body radiotherapy (SBRT) patients is still unknown.

Methods: Between August 2006 to December 2015, 74 prostate cancer patients were treated by SBRT with Cyberknife at two medical centers. The prescription dose was 35-37.5 Gy in 5 fractions. Follow-up PSA tests were more frequently performed in one hospital than the other (median 4 vs. 10 times for initial one year). PSA bounce was defined as a rise of 0.2 ng/mL followed by a decline to or below the previous nadir.

Results: A total of 74 patients, PSA bounce was observed in 41 patients (55.4%). On univariate analysis, the treated medical center (p = 0.02), PSA follow-up frequency (p = 0.01), patient age (p < 0.01), and total prescription dose (p = 0.03) were significant clinical factors in predicting the incidence of PSA bounce, while in multivariable analysis only the PSA follow-up frequency, and patient age remains significant.

Conclusion: PSA bounce was seen in a significant proportion of patients after Cyberknife SBRT. The PSA follow- up test frequency, and patient age were significant factors that were correlated with the incidence of PSA bounces in this study.

Purpose: This study aimed to assess postoperative pain, depression, and anxiety levels in infertile men who underwent microsurgical testicular sperm extraction (micro-TESE) for non-obstructive azoospermia (NOA) and compare results between patients with successful and unsuccessful sperm retrieval.

Material and methods: A total of 105 NOA patients participated, completing preoperative Beck Depression Inventory (BDI) and Situational and Transient Anxiety Inventory (SAI and TAI) questionnaires. Postoperatively, Visual Analog Scale (VAS) scores were recorded. Patients were categorized into primary and repeated micro- TESE groups, and scale scores, operation duration, and collected tubule count were compared. The relationship between micro-TESE outcomes, VAS scores, and additional analgesia needs was also examined.

Results: Successful sperm retrieval was achieved in 55.9% of patients. While BDI, SAI, and TAI scores showed no significant intergroup differences, micro-TESE (-) patients exhibited significantly higher mean VAS scores (p < 0.001). VAS scores positively correlated with BDI score, operation duration, and tubule count, while patient age inversely correlated with micro-TESE results.

Conclusion: Infertility, azoospermia, and unsuccessful sperm retrieval impact psychogenic status and pain levels in male patients. Additionally, a history of micro-TESE procedures and their outcomes elevate depression levels.

Purpose: Patients with kidney stones have a lower quality of life (QOL) than healthy patients; however, treatment guidelines neglect their QOL. Wisconsin stone QOL test (WIS-QOL) is the first specific questionnaire for urolithiasis patients. This study evaluated the reliability and validity of the translated Persian version of the WIS-QOL questionnaire in patients with kidney stones.

Material and methods: All patients (> 18 years old) with a history of urolithiasis were included in this cross-sectional. The WIS-QOL questionnaire was translated depending on Hutchinson's guideline. Effects of urolithiasis on the patient's social activity, emotions, disease, and vitality were evaluated. Pearson Correlation and Cronbach's alpha test were used to assess the validity and reliability of the questionnaire. All data were analyzed by SPSS software version 26.0.

Results: Among 154 urolithiasis patients, 94 (61%) were males, and 60 (39%) were females. The mean age was 50.4 years (SD: ± 13.6), and the mean QOL score was 84.7 (SD: ± 21.8). For each question, the numerical value of the Pearson Correlation Coefficient has been compared with the numerical value, and the validity of the questionnaire was confirmed. The overall Cronbach's alpha was 0.94 for all four areas of the questionnaire, so the reliability of the questionnaire in Persian was confirmed.

Conclusion: The present study showed the reliability and validity of the Persian version of the WIS-QOL questionnaire in symptomatic urolithiasis patients. The present study showed the status and impact of urolithiasis on QOL however, longitudinal and prospective studies should be done to specify changes over time.

Purpose: To investigate the efficacy and safety of 177Lu-PSMA-617 in combination with radical prostatectomy and bilateral orchiectomy in adult male patients with castrate-sensitive metastatic prostate cancer.

Methods: This pilot study included 12 men with metastatic prostate cancer who underwent radical prostatectomy and received 177Lu-PSMA-617 in combination with hormonal therapy. The primary endpoint was the proportion of patients who achieved a PSA response, defined as a ≥ 50% reduction in PSA levels at first follow up from baseline. Secondary endpoints were the proportion of patients who achieved a PSA response, defined as a ≥ 50% reduction in PSA levels at the second follow up from the first one and progression in pain severity that was defined as an increase in score of 30% or greater from baseline without a decrease in analgesic use based on Brief Pain Inventory-short Form (PBI-SF).

Results: The PSA levels of 9(75.0%) patients were reduced after the first course of 177Lu-PSMA-617, additional reduction was observed in 7(58.3%) patients after receiving the 2nd course of treatment. Of the 12 patients, 3(25.0%) achieved a PSA response (≥ 50% reduction in PSA levels) at first follow up visit and 3(25.0%) patients had PSA response at second follow up, 6 patients (50.%) had a pain response. The most common adverse events were Mouth dryness and fatigue, which were manageable with supportive care.

Conclusion: This pilot study suggests that radical prostatectomy and hormonal therapy in combination with 177Lu-PSMA-617 is a safe and effective treatment option and may have a role in the management of select patients with castrate-sensitive metastatic prostate cancer. Further studies are needed to confirm these findings and determine the optimal use in this setting.

Purpose: The management of complicated and irreparable urethral strictures can be challenging, and continent urinary diversion has emerged as a viable option. This study aims to investigate the complications associated with continent urinary diversion using the Mitrofanoff principle in patients with complex urethral strictures that cannot be corrected through urethroplasty surgery.

Materials and methods: A total of 22 patients were included in this study, who underwent continent urinary diversion surgery using the Mitrofanoff technique. The patients were monitored for post-surgical complications over an average follow-up period of 28.36±14.26 months. Surgical failure was defined as the inability to completely and regularly empty urine from the new urinary tract.

Results: Half of the patients experienced surgical complications, with only one case resulting in surgery failure. The most common complication observed was stoma stenosis. Two patients reported slight urinary leakage from the stoma site. Notably, all patients except one, regained control over their urine after the procedure. Early therapeutic interventions were classified according to the Clavien-Dindo grading system, showed that none of the patients experienced severe complications (grade 4 or 5).

Conclusion: The study examines the outcomes of continent urinary diversion using the Mitrofanoff technique in adults with complex urethral strictures, providing realistic expectations of complications. Overall, the study shows that this approach is a viable option with a high success rate and manageable complication for individuals with complex urethral strictures that cannot be corrected through urethroplasty surgery.

Purpose: Evaluating pseudomotor performance can be a valuable tool for investigating the peripheral autonomic nervous system in diabetic patients. Sudoscan, a simple and non-invasive method for assessing pseudomotor performance, has been developed in recent years. This study aimed to investigate autonomic neuropathy using Sudoscan in diabetic patients with lower urinary tract symptoms (LUTS) of unknown cause.

Materials and methods: In this cross-sectional study conducted from April 2022 to April 2023, we included 195 patients with type 2 diabetes who were referred to the urology clinic. We extracted demographic, clinical, and laboratory data from the patient files and evaluated urinary symptoms using the International Prostate Symptom Score (IPSS) questionnaire. Patients underwent Sudoscan testing to evaluate autonomic neuropathy in the physical medicine and rehabilitation clinic. To further assess urinary irritative symptoms, patients underwent urodynamic studies (UDS) and ultrasonography.

Results: The Sudoscan test results showed that autonomic neuropathy was present in 77 patients (40%), with 43 (22.1%) having moderate and 44 (22.6%) having severe neuropathy. Patients with autonomic neuropathy were found to be older, had longer diabetes durations, higher average blood glucose levels, and higher creatinine levels. Additionally, we found a significant correlation between autonomic neuropathy and signs of high post-void residue on ultrasound and detrusor contraction disorders on UDS (p-value < 0.05).

Conclusion: Our study found a higher prevalence of autonomic neuropathy in diabetic patients with LUTS using Sudoscan (40%). Longer diabetes duration and poor glycemic control were associated with an increased risk of autonomic neuropathy linked with LUTS, such as urge incontinence.

Purpose: To share our recent experience of the pattern and demography of endemic bladder calculi in children and the outcomes of current management strategies for the removal of bladder calculi in a peri-urban setting.

Material and methods: This retrospective longitudinal study was carried out at a dedicated urology centre. All patients with endemic bladder stones from January 2020 to December 2021 managed at our centre were included in this study. After discharge, each patient was followed up for 1 year. Data analysis was carried out with IBM SPSS v23. Mean and standard deviation were calculated for normally distributed continuous variables; for non-normally distributed continuous variables, median and IQR were calculated; frequency and percentage were calculated for categorical variables.

Results: This study included 254 patients, with a male-to-female ratio of 10.5:1. The mean age of the patients was 4.80 ± 2.86 years. Ninety-one percent of the patients belonged to rural areas. Open cystolithotomy (OC) was performed in 11 (4.3%) patients, transurethral cystolithotripsy (TUCL) in 165 (65.0%), and percutaneous cystolithotomy (PCCL) in 78 (30.7%). The mean operative time was 48.8 ± 4.34 minutes for TUCL, 36.18 ± 7.4 minutes for open cystolithotomy, and 38.6 ± 5.2 minutes for PCCL. The most common stone composition was ammonium urate + calcium phosphate (33.1%). The complication rate was 4.8% in TUCL, 12.8% in PCCL, and 27.3% in open cystolithotomy. Stone clearance was 98.1% for TUCL and 100% for both PCCL and OC.

Conclusion: Paediatric bladder calculus is still endemic in rural areas of Sindh with poor socioeconomic backgrounds. Timely diagnosis and early intervention with preventive measures can lead to better outcomes and fewer complications. Minimally invasive methods of cystolithotomy have a shorter hospital stay, are more cost-effective, and have fewer complications as compared to open cystolithotomy.

Purpose: This study aims to assess the utility of the CONUT (Controlling Nutritional Status) Score and R.E.N.A.L. (Renal Nephrometry Score) Score in predicting tumor recurrence in patients with kidney cancer. Additionally, we investigated which parameters contributed to these scores.

Materials and methods: In total, 115 patients who underwent partial nephrectomy between January 2015 and August 2023 at a single tertiary center were enrolled. After the exclusion criteria, data from 88 patients were analyzed. Age, gender, body mass index (BMI), comorbidities (hypertension, diabetes), smoking status, tumor characteristics, CONUT Scores, and R.E.N.A.L. scores were retrospectively recorded. Statistical analyses were performed, and significant p was p < 0.05.

Results: The presence of diabetes and hypertension showed a statistically significant association with tumor recurrence (p = 0.033 and p = 0.003, respectively). A high BMI significantly increased the risk of recurrence (p < 0.05). There was a strong positive relationship between the high tumor stage and positive surgical margins with recurrence (p < 0.001). Patients with high R.E.N.A.L. Scores and high CONUT Scores had a higher risk of recurrence (42.1% and 8.7%, respectively), and this difference was statistically significant (p < 0.001).

Conclusion: CONUT and R.E.N.A.L. scores may be used to predict tumor recurrence after partial nephrectomy. Additionally, diabetes, hypertension, high BMI, and positive surgical margin rate might affect surgical success rate for recurrences. Clinicians should consider all these parameters and coring systems to gather more successful results after partial nephrectomy.

Background: Our study aims to address two pivotal questions: "What are the recent advancements in understanding the etiology of urological tumors through Mendelian Randomization?" and "How can Mendelian Randomization be more effectively applied in clinical settings to enhance patient health outcomes in the future?"

Methods: In our systematic review conducted in April 2023, we utilized databases like PubMed and Web of Science to explore the influence of Mendelian Randomization in urological oncological diseases. We focused on studies published from January 2018, employing keywords related to urological tumors and Mendelian Randomization, supplemented with MeSH terms and manual reference checks. Our inclusion criteria targeted original research studies, while we excluded reports and non-relevant articles. Data extraction followed a PICO-based approach, and bias risk was independently evaluated, with discrepancies resolved through discussion. This systematic approach adhered to PRISMA guidelines for accuracy and thoroughness in reporting.

Results: From the initial 457 publications, we narrowed down to 43 full-text articles after screening and quality assessments. A deeper understanding of Mendelian Randomization can help us explore risk factors with a clear causal relationship to urological tumors. This insight may pave the way for future research in early diagnosis, treatment, and management of associated diseases.

Conclusion: Our review underscores the value of MR in urogenital tumor research, highlighting its efficacy in establishing causality and its potential to clarify disease mechanisms. Despite challenges like large sample sizes and variant identification, MR offers new perspectives for understanding and managing these tumors, suggesting a trend towards more inclusive and diverse research approaches.