Cuaj-Canadian Urological Association Journal最新文献

Introduction: ChatGPT has been shown to provide accurate and complete responses to clinically focused questions, although its ability to successfully answer common pediatric urology-based questions remains unexplored. Furthermore, the concordance of ChatGPT's answers with association recommendations has yet to be analyzed.

Methods: A list of common pediatric urology questions of varying difficulty was developed in association with publicly available guidelines and resources from the Canadian Urological Association (CUA), American Urological Association (AUA), and the European Association of Urology (EAU). Questions were administered individually using three separate functions, and responses were evaluated for comprehensiveness and accuracy using a Likert scale. Descriptive statistics and analysis of variance were used for statistical analysis.

Results: ChatGPT performed best in the domain of phimosis (mean ± standard deviation: 2.32/3.00±0.57) and VUR (2.11/3.00±0.63), and worst in acute scrotal pathology (1.90/3.00±0.58) and cryptorchidism (1.92/3.00±0.56) (p=0.031). "Easy" questions (2.31/3.00±0.09) had greater comprehensiveness scores compared to "medium" (1.92/3.00±0.07, p=0.003) and "difficult" questions (1.86/3.00±0.101, p=0.003). Definition-based questions had greater comprehensiveness scores across all guidelines. ChatGPT was more accurate and in concordance with EAU-based information (2.10±0.41) compared to AUA (1.95±0.41, p=0.04).

Conclusions: ChatGPT answered questions with high levels of appropriateness and comprehensiveness. ChatGPT performed best in the areas of phimosis and VUR and worst in acute scrotal pathology. While ChatGPT performed well across all question domains, it performed best when referenced to EAU and CUA compared to AUA.

Introduction: Approximately three-quarters of patients newly diagnosed with bladder cancer have non-muscle-invasive disease (NMIBC). Among these patients, those with high-risk (HR) features should be managed more aggressively in an attempt to circumvent the elevated risk of recurrence/progression. Population-based data on the incidence of HR-NMIBC and receipt of guideline-recommended care are limited.

Methods: This retrospective, observational study gathered data from multiple linked provincial (Alberta) healthcare databases to describe baseline characteristics, treatment patterns, and survival outcomes in a population of individuals diagnosed with HR-NMIBC from 2010-2020. Data for all patients aged >18 years with T1, Tis, or high-grade Ta NMIBC ("high-risk") were analyzed using basic statistics, multivariate regression analyses, and the Kaplan-Meier method.

Results: Of 6837 de novo NMIBC patients identified, 3874 (57%) were categorized as HR-NMIBC. The majority (82%) were male with a median age of 72 years, and approximately half had a Charlson comorbidity index score ≥1. Following initial transurethral resection of bladder tumor (TURBT), 61% of the cohort received no adjuvant bacillus Calmette-Guérin (BCG) or chemotherapy, while 36% received BCG, 3% gemcitabine, and 1% mitomycin C. Patients underwent a median of four TURBT procedures. 'Adequate BCG' (≥5 induction doses + ≥2 maintenance doses) was received by 32% of BCG-treated and 12% of all HR-NMIBC patients. Survival was improved in patients receiving adequate BCG.

Conclusions: Data from this large, real-world population highlights poor use of induction/maintenance BCG therapy following TURBT among patients with HR-NMIBC.

Introduction: We examined the effects of the COVID-19 pandemic on the incidence of kidney stone acute care visits and interventions.

Methods: We conducted a retrospective, population-based cohort study using linked administrative healthcare data in the province of Ontario, Canada. We included all patients who, between March 1, 2018, and September 30, 2021, presented to an emergency department (ED) or were admitted to hospital with renal colic (RC), as well as patients who underwent stenting, nephrostomy tube (NT) insertion, shockwave lithotripsy (SWL), ureteroscopy (URS), or percutaneous nephrolithotomy (PCNL). Using univariate and multivariable analyses, outcomes of interest were compared before and after the onset of COVID-19.

Results: Our cohort included 149 006 unique patients; there were 74 994 pre- vs. 94 067 peri-COVID RC episodes (p=0.74). Peri-pandemic patients were more likely to be sicker, female, and from marginalized communities. Mean time from temporizing to definitive intervention increased in the first three months of the pandemic (17.9 vs. 32 days), but no statistically significant effect on the overall proportion of patients undergoing definitive intervention was observed. The onset of COVID-19 was associated with a 29.5% reduction in SWL and a 7.9% and 5.4% increase in URS and NT use, respectively. Hospital admissions for RC increased by 10.9%, while intensive care unit admissions decreased by 25% during the pandemic.

Conclusions: RC incidence and intervention rates were similar before and during the pandemic; however, patient demographics and morbidity differed. Understanding these trends can inform protocols for streamlining care in response to analogous strains on publicly funded healthcare systems.