Actas urologicas espanolas最新文献

Introduction and objective

Generative artificial intelligence makes it possible to ask about medical pathologies in dialog boxes. Our objective was to analyze the quality of information about the most common urological pathologies provided by ChatGPT (OpenIA), BARD (Google), and Copilot (Microsoft).

Methods

We analyzed information on the following pathologies and their treatments as provided by AI: prostate cancer, kidney cancer, bladder cancer, urinary lithiasis, and benign prostatic hypertrophy (BPH). Questions in English and Spanish were posed in dialog boxes; the answers were collected and analyzed with DISCERN questionnaires and the overall appropriateness of the response. Surgical procedures were performed with an informed consent questionnaire.

Results

The responses from the three chatbots explained the pathology, detailed risk factors, and described treatments. The difference is that BARD and Copilot provide external information citations, which ChatGPT does not. The highest DISCERN scores, in absolute numbers, were obtained in Copilot; however, on the appropriacy scale it was noted that their responses were not the most appropriate. The best surgical treatment scores were obtained by BARD, followed by ChatGPT, and finally Copilot.

Conclusions

The answers obtained from generative AI on urological diseases depended on the formulation of the question. The information provided had significant biases, depending on pathology, language, and above all, the dialog box consulted.

Introduction

Holmium laser enucleation of the prostate has rapidly become the gold standard for the surgical treatment of benign prostate hyperplasia, although thulium fiber laser (TFL) has also been postulated as an effective and safe alternative for prostate enucleation. The aim of this study is to describe our initial experience with the TFL for endoscopic enucleation of the prostate.

Material and methods

All patients proposed to TFL prostate enucleation were included in the analysis, regardless their prostate volume, catheter status and severity of symptoms, in 3 centers. Preoperative characteristics, intraoperative times and functional 3-months follow-up variables were collected, along with complications.

Results

Fifty-six patients were available, with a mean age of 68.7 years. Enucleation and morcellation efficiencies were 2.04 and 7.47 g/min, respectively. Median hospital stay was one day. Comparable functional data, pre and 3-month post-surgery was: mean prostate volume 88.9 vs 21.3 g, maximum urinary flow 13.2 vs 27.3 ml/s, post-void residual volume 149 vs 7.8 ml, prostatic specific antigen level 11.2 vs 1 ng/ml, and International Prostate Symptom Score score 20.75 vs 3.96. Fourteen out of 56 (25%) patients presented with complications grade ≤ 2, according to the Clavien-Dindo classification.

Discussion

With wider evidence for other urological indications, very recent evidence about the suitability of TFL for prostate enucleation has arisen, since the first case described in 2021. Our results seem to back up these previous successful experiences as long as we obtained good intraoperative and short term follow-up functional results. However, there is still a need of longer follow-up data.

Conclusions

TFL represents a novel technology for prostate enucleation, with a good intraoperative and short follow-up functional results, and a safety profile similar to the observed for those techniques that have been wider used for this indication. Further studies with longer follow-up periods and comparative with these other techniques are necessary.

Appropriate professional practice includes the diagnostic and treatment process of urologic pathology, as well as patient information and respect for patient autonomy in decision making. Informed consent is the gradual process of providing information to the patient and their subsequent decision making. The Informed Consent Document (ICD), when required, demonstrates that information has been provided sufficiently in advance to allow for the patient's deliberation. The dual need for simple yet complete documents make the preparation of adequate ICDs extremely difficult. If the information process is not carried out properly, the professional may incur a medical malpractice liability that is treated as a loss of opportunity. To avoid such situations, the work of scientific societies in the preparation, accessibility, and dissemination of ICD models is fundamental.

Introduction

In testicular cancer, the positive effect of early diagnosis on survival has been known for many years. In this study, we aimed to determine the diagnostic features of testicular cancer patients, to examine the effect of duration of diagnosis delay (DD) on tumor size, tumor stage, and serum tumor markers, and to reveal the possible benefits of early diagnosis.

Methods

A total of 71 patients who underwent inguinal orchiectomy due to suspicion of testicular cancer and whose pathology was found to be the germ cell tumor were included in the study. The relationship between the duration of diagnosis delay and tumor size, level of tumor markers, TNM stage, presence of LAP, and presence of metástasis were examined.

Results

Seminoma was detected in 39 (54.9%) patients and non-seminoma tumor was detected in 32 (45.1%) patients. In the correlation analysis between the markers, a significant and positive correlation was found between DD and radiological tumor size, pathological tumor size, retroperitoneal LAP detection rate, LDH and AFP levels, and N stage (respectively; r = 0.345 p = 0.003, r = 0.324 p = 0.006, r = 0.244 p = 0.041, r = 0.286 p = 0.015, r = 0.244 p = 0.040, r = 0.238 p = 0.046). It was determined that a 1-day increase in DD caused an increase of 0.431 mm in the pathological size of the tumor.

Conclusion

Duration of diagnosis delay is an issue that still keeps its importance for testicular tumors. Delay in diagnosis not only leads to an increase in tumor size but also negatively affects tumor stage and prognostic factors.

Objective

Our objective was to assess the impact of video-animated information on the anxiety levels of patients undergoing ureteral stent removal under local anesthesia.

Method

The study was designed as a randomized prospective trial. The one group received only verbal and written information before the surgery, while the other group received video-animated information in addition to the written and verbal instructions. The patients’ anxiety levels were assessed using the STAI-S and STAI-T questionnaires, while their pain scores were evaluated using VAS scores. Tolerability and satisfaction scores were also evaluated on a 5-point likert scale.

Results

The video-group (Group 1) consisted of 74 patients, while the non-video group (Group 2) consisted of 82 patients. The mean pre-information STAI-T score was 34.4 ± 3.7 in Group 1 and 35.2 ± 3 in the Group 2 (p = 0.113). In the video group, pre-information STAI-S scores was 34.8 ± 3.3 and post-information STAI-S scores was 33.8 ± 3 (p < 0.001). In the non-video group, pre-information STAI-S score was 35.6 ± 2.6 and post-information STAI-S score was 35.5 ± 2.7 (p = 0.260). The mean VAS score of Group 1 is 5.7 ± 1.2 and Group 2 is 5.7 ± 1.4 (p = 0.608). The mean tolerability scores of Group 1 and Group 2 were 3.7 ± 0.9 and 2.7 ± 1, respectively. The mean satisfaction scores of Group 1 and Group 2 were 4.1 ± 0.9 and 2.6 ± 1, respectively. Both tolerability score and satisfaction score improved statistically significantly after video information (p < 0.001).

Conclusion

Providing video-animated information in addition to written and verbal information before removing the ureteral stent reduces patients’ preoperative anxiety. Furthermore, patient tolerance and satisfaction are higher when informative videos are included.

Introduction and objective

Among the many treatments for erectile dysfunction, implantation of a penile prosthesis has been associated with high patient satisfaction rates. However, patients with coexistent Peyronie's disease (PD) and refractory erectile dysfunction and/or severe deformities may show different results. The aim of our study was to assess and to compare the level of satisfaction, with an inflatable penile prosthesis (IPP), in men with/without coexistent PD.

Material and methods

A survey study based on a 5-item satisfaction questionnaire was submitted to all those live patients implanted in the period 1992-2022 at our center (n = 570) and their partners. Ninety-two percent of implants were three component inflatable devices. Surgeries were mainly performed by 2 surgeons. The main outcome measure used was the level of patient and partner satisfaction with sexual intercourse after IPP.

Results

Of the 570 eligible patients, 479 (84%) completed the survey (393 non-PD: group 1; 70 non-complex PD: group 2; 16 complex PD: group 3). Eighty-six percent of patients in group 1 reported satisfactory sexual intercourse (very or moderately satisfied). Non-complex PD implanted patients (group 2) reported a global 81% satisfactory sexual intercourse (very or moderately satisfied) (p > 0.05). However, when we evaluated the PD subgroup of patients with severe PD who require incision/excision/grafting at the time of implant (group 3, n = 20), only 61% reported satisfactory sexual intercourse (p < 0.01) with predominance of moderately satisfied patients over very satisfied: 78 vs. 22%). Additionally, 84% (group 1), 80% (group 2) and 54% (group 3) of partners reported satisfactory intercourses, respectively (p < 0.01). Overall, 84% of group 1 implants and 79% of group 2 reported that they would undergo the procedure again if the IPP failed (p > 0.05; ns). Only 50% of group 3 patients would do it again. With regard to cosmetic aspects, 48% of the group 3 implant reported penile shortness or soft glans as the main causes of their dissatisfaction. Only 2.4% of total IPP patients expressed difficulty in manipulating the device.

Conclusions

The presence of PD alone may not impact IPP patient and partner satisfaction, but patients with more severe baseline deformity who require incision/grafting may be less satisfied with outcomes including penile length and glans sensation.

Introduction

Although urinary incontinence (UI) does not cause mortality, it is a global health problem that adversely affects the quality of life and health of women.

Objective

The aim of this study was to conduct a systematic review and meta-analysis of the studies investigating the effect of telehealth given to women with UI on the severity of incontinence.

Method

The literature review for this systematic review was conducted between August-Semptember 2023 using 5 electronic databases. Y-based articles were scanned using MeSH-based keywords. Randomized controlled trials conducted over the last decade were included in the screening.

Results

The analysis included 6 studies involving 826 women with UI. After telehealth intervention, there was a significant difference in UI symptom severity (MD: −2.14; 95% CI: −2.67 to −1.62; Z = 8.03; p < 0.00001) and quality of life (SMD: −2.14; 95% CI: −2.67 to 1.62; Z = 8.03; p < 0.00001) compared to the control groups. It had no effect on sexuality (SMD: −4.65; 95% CI: −9.60 to 0.30; Z = 1.84; p = 0.07), and anxiety (SMD: −0.15; 95% CI: −0.38 to 0.08; Z = 1.27; p = 0.21).

Conclusion

In this analysis, it was found that telehealth interventions performed on women with UI increased the quality of life while reducing the severity of incontinence in women, but had no effect on sexuality, and anxiety.

Objective

The aim of this review is to summarize the current evidence and future perspectives of bladder-sparing treatment for MIBC.

Methods

A non-systematic literature search in Medline/Pubmed was performed in October 2023 with the following keywords ‘bladder cancer’, ‘bladder-sparing’, ‘trimodal therapy’, ‘chemoradiation’, ‘biomarkers’, ‘immunotherapy’, ‘neoadjuvant chemotherapy’, ‘radiotherapy’.

Results

Urology guidelines recommend radical cystectomy as the standard curative treatment for muscle-invasive urothelial bladder cancer, reserving radiotherapy for patients who are unfit or who want to maintain their bladder. Given the morbidity and mortality of cystectomy and its impact on quality of life and bladder function, modern oncologic therapies are increasingly geared toward organ preservation and maximizing functional outcomes while maintaining treatment efficacy. Trimodal therapy, which incorporates maximal transurethral resection followed by radiotherapy with concurrent radiosensitizing chemotherapy, is an effective regimen for bladder function preservation in well-selected patients. Despite the absence of comparative data from randomized trials, the two approaches seem to provide comparable oncologic outcomes.

Studies are evaluating the expansion of eligibility criteria for trimodal therapy, the optimization of radiotherapy and immunotherapy delivery to further improve outcomes, and the validation of biomarkers to guide bladder preservation.

Conclusions

Trimodal therapy has shown acceptable outcomes for bladder preservation; therefore, it provides a valid treatment option in well-selected patients.