Pub Date : 2024-07-01DOI: 10.1097/ju9.0000000000000169
Nigel J. Parr, Timothy Dudderidge
Recently, biodegradable spacers have been introduced to reduce rectal wall toxicity during external beam radiotherapy for prostate cancer. Rectal wall damage with fistula formation is a major complication of primary and salvage prostate cryotherapy. In theory, biodegradable spacers can be used to protect the rectum from the damage associated with cryotherapy. We describe a case of rectal spacer insertion for primary cryotherapy in a patient with high-risk localized prostate cancer who was unsuitable for other radical treatments because of previous treatment of rectal cancer, detailing the rationale for spacer selection, technique, and outcomes. A 57-year-old man was referred, following a regional specialist multidisciplinary team discussion, for an opinion regarding possible primary prostate cryotherapy. He had a history of anterior resection with chemoradiotherapy, followed by local relapse treated with total colectomy with ileoanal pouch formation and suffering from major postoperative complications. After further assessment and because of concern regarding damage to the efferent pouch limb during freezing, the possibility of spacer insertion between the ileoanal segment was considered and discussed. A hyaluronic acid gel spacer was selected and offered “off licence” on a compassionate basis. The spacer was introduced immediately before cryotherapy. Recovery was uncomplicated apart from transient intermittent perineal pain, with good early functional and oncological outcomes. This is the first report of synchronous insertion of a hyaluronic acid gel spacer in prostate cryotherapy. We believe that the technique merits further investigation, with the potential to reduce complications and enhance freezing of the posterior aspect of the gland during cryotherapy.
{"title":"Synchronous Insertion of Hyaluronic Acid-Based Biodegradable Rectal Spacer for Primary Prostate Cryotherapy","authors":"Nigel J. Parr, Timothy Dudderidge","doi":"10.1097/ju9.0000000000000169","DOIUrl":"https://doi.org/10.1097/ju9.0000000000000169","url":null,"abstract":"\u0000 \u0000 Recently, biodegradable spacers have been introduced to reduce rectal wall toxicity during external beam radiotherapy for prostate cancer. Rectal wall damage with fistula formation is a major complication of primary and salvage prostate cryotherapy. In theory, biodegradable spacers can be used to protect the rectum from the damage associated with cryotherapy. We describe a case of rectal spacer insertion for primary cryotherapy in a patient with high-risk localized prostate cancer who was unsuitable for other radical treatments because of previous treatment of rectal cancer, detailing the rationale for spacer selection, technique, and outcomes.\u0000 \u0000 \u0000 \u0000 A 57-year-old man was referred, following a regional specialist multidisciplinary team discussion, for an opinion regarding possible primary prostate cryotherapy. He had a history of anterior resection with chemoradiotherapy, followed by local relapse treated with total colectomy with ileoanal pouch formation and suffering from major postoperative complications. After further assessment and because of concern regarding damage to the efferent pouch limb during freezing, the possibility of spacer insertion between the ileoanal segment was considered and discussed. A hyaluronic acid gel spacer was selected and offered “off licence” on a compassionate basis. The spacer was introduced immediately before cryotherapy.\u0000 \u0000 \u0000 \u0000 Recovery was uncomplicated apart from transient intermittent perineal pain, with good early functional and oncological outcomes.\u0000 \u0000 \u0000 \u0000 This is the first report of synchronous insertion of a hyaluronic acid gel spacer in prostate cryotherapy. We believe that the technique merits further investigation, with the potential to reduce complications and enhance freezing of the posterior aspect of the gland during cryotherapy.\u0000","PeriodicalId":74033,"journal":{"name":"JU open plus","volume":"15 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141713826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01DOI: 10.1097/ju9.0000000000000179
Alfredo Aliaga, Mario I. Fernández
{"title":"Editorial Comment: Urinary Bladder Melanosis Diagnosed Simultaneously With Urothelial Carcinoma: A Case Report and Literature Review","authors":"Alfredo Aliaga, Mario I. Fernández","doi":"10.1097/ju9.0000000000000179","DOIUrl":"https://doi.org/10.1097/ju9.0000000000000179","url":null,"abstract":"","PeriodicalId":74033,"journal":{"name":"JU open plus","volume":"40 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141710586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01DOI: 10.1097/ju9.0000000000000166
Marwan Alkassis, Omer A. Raheem
{"title":"Editorial Comment: Using a Reconstructive Ladder for Surgical Reconstruction of Transplant Ureteral Stricture Disease","authors":"Marwan Alkassis, Omer A. Raheem","doi":"10.1097/ju9.0000000000000166","DOIUrl":"https://doi.org/10.1097/ju9.0000000000000166","url":null,"abstract":"","PeriodicalId":74033,"journal":{"name":"JU open plus","volume":"27 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141710914","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01DOI: 10.1097/ju9.0000000000000167
Paolo M. Muraira, Annie Chen, Lori B. Lerner, Steven A. Kaplan, Kevin T. McVary, Franco M. Muraira, Ricardo R. Gonzalez
Generative Pre-Trained Transformer 4 (GPT-4) or ChatGPT, an artificial intelligence language generator, has been used in multiple applications in medicine. We seek to evaluate ChatGPT’s ability to generate appropriate responses consistent with guidelines when asked patient-generated questions regarding benign prostatic hyperplasia (BPH). GPT-4 (Open AI) was queried to answer 20 of the most frequently asked questions regarding BPH according to Google’s search engine. Questions were subclassified into 5 categories: pathophysiology, diagnosis, behavioral modification, procedural interventions, and medical treatments. These responses were graded by expert urologists involved in generating the AUA BPH Clinical Guidelines on 3 domains: accuracy, comprehensiveness, and contemporaneousness. Of the responses generated, 70% were accurate, 73% were comprehensive, and 63% were contemporary. Seventeen percent of GPT-4 responses were inaccurate, incomprehensive, and noncontemporary. The highest scores were in diagnosis (88.9%), pathophysiology (83.3%), and relative medical treatment (70.4%) subcategories. The most inaccurate, incomprehensive, and noncontemporary category was procedural treatments (31.7%). When rated by guideline experts in management of male lower urinary tract symptoms attributed to BPH, GPT-4 has been shown to provide some accurate, comprehensive, and updated information exceeding 80% accuracy, comprehensiveness and contemporaneousness in the categories of diagnosis, and pathophysiology. GPT-4 can serve as an adequate revising tool for patients to learn the basics about BPH regarding diagnosis and pathophysiology, but the current version fails patients in other subcategories such as relative medical treatments and procedural treatments. Given the rise in GPT-4’s ubiquity, it is imperative that the urologic community critically examines all sources of patient information to identify areas of improvement.
{"title":"Limitations of ChatGPT for Patient Education Regarding Frequently Searched Questions About Benign Prostatic Hyperplasia","authors":"Paolo M. Muraira, Annie Chen, Lori B. Lerner, Steven A. Kaplan, Kevin T. McVary, Franco M. Muraira, Ricardo R. Gonzalez","doi":"10.1097/ju9.0000000000000167","DOIUrl":"https://doi.org/10.1097/ju9.0000000000000167","url":null,"abstract":"\u0000 \u0000 Generative Pre-Trained Transformer 4 (GPT-4) or ChatGPT, an artificial intelligence language generator, has been used in multiple applications in medicine. We seek to evaluate ChatGPT’s ability to generate appropriate responses consistent with guidelines when asked patient-generated questions regarding benign prostatic hyperplasia (BPH).\u0000 \u0000 \u0000 \u0000 GPT-4 (Open AI) was queried to answer 20 of the most frequently asked questions regarding BPH according to Google’s search engine. Questions were subclassified into 5 categories: pathophysiology, diagnosis, behavioral modification, procedural interventions, and medical treatments. These responses were graded by expert urologists involved in generating the AUA BPH Clinical Guidelines on 3 domains: accuracy, comprehensiveness, and contemporaneousness.\u0000 \u0000 \u0000 \u0000 Of the responses generated, 70% were accurate, 73% were comprehensive, and 63% were contemporary. Seventeen percent of GPT-4 responses were inaccurate, incomprehensive, and noncontemporary. The highest scores were in diagnosis (88.9%), pathophysiology (83.3%), and relative medical treatment (70.4%) subcategories. The most inaccurate, incomprehensive, and noncontemporary category was procedural treatments (31.7%).\u0000 \u0000 \u0000 \u0000 When rated by guideline experts in management of male lower urinary tract symptoms attributed to BPH, GPT-4 has been shown to provide some accurate, comprehensive, and updated information exceeding 80% accuracy, comprehensiveness and contemporaneousness in the categories of diagnosis, and pathophysiology. GPT-4 can serve as an adequate revising tool for patients to learn the basics about BPH regarding diagnosis and pathophysiology, but the current version fails patients in other subcategories such as relative medical treatments and procedural treatments. Given the rise in GPT-4’s ubiquity, it is imperative that the urologic community critically examines all sources of patient information to identify areas of improvement.\u0000","PeriodicalId":74033,"journal":{"name":"JU open plus","volume":"2011 32","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141706920","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01DOI: 10.1097/ju9.0000000000000152
Susan M. MacDonald
{"title":"Editorial Comment: Complex Buccal Graft Urethroplasty Combined With HoLEP in the Setting of Concomitant Urethral Stricture Disease and Severe Benign Prostatic Hyperplasia: A Case Report","authors":"Susan M. MacDonald","doi":"10.1097/ju9.0000000000000152","DOIUrl":"https://doi.org/10.1097/ju9.0000000000000152","url":null,"abstract":"","PeriodicalId":74033,"journal":{"name":"JU open plus","volume":"127 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141708614","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01DOI: 10.1097/ju9.0000000000000165
W. Z. So, Collin Elijah Rui Hung Ho, Kenneth Leung, S. Ong, Hong Min Peng, Nicholas Hoi Pong Wong, Ho Yee Tiong
{"title":"Artificial Intelligence–Generated Patient Information Videos for Partial Nephrectomy by Medical Students With Expert Validation: A Pilot Study","authors":"W. Z. So, Collin Elijah Rui Hung Ho, Kenneth Leung, S. Ong, Hong Min Peng, Nicholas Hoi Pong Wong, Ho Yee Tiong","doi":"10.1097/ju9.0000000000000165","DOIUrl":"https://doi.org/10.1097/ju9.0000000000000165","url":null,"abstract":"","PeriodicalId":74033,"journal":{"name":"JU open plus","volume":"100 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141695679","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01DOI: 10.1097/ju9.0000000000000172
Natalie Mainland, Alyssa Lange, Firas G. Petros
{"title":"Editorial Comment: Artificial Intelligence—Generated Patient Information Videos for Partial Nephrectomy by Medical Students With Expert Validation: A Pilot Study","authors":"Natalie Mainland, Alyssa Lange, Firas G. Petros","doi":"10.1097/ju9.0000000000000172","DOIUrl":"https://doi.org/10.1097/ju9.0000000000000172","url":null,"abstract":"","PeriodicalId":74033,"journal":{"name":"JU open plus","volume":"50 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141711932","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-01DOI: 10.1097/ju9.0000000000000159
Rajvi Goradia, Alexander J. Skokan, M. Hehemann
Collagenase Clostridium histolyticum (CCH) is frequently used as first-line therapy for patients with Peyronie’s disease. It was United States Food and Drug Administration approved in 2013 and since then, has been widely accepted as a safe and effective treatment option with most adverse effects being minor and amenable to conservative management. We report an unusual and previously unreported complication after CCH (Xiaflex) injection: avulsion of a dorsal penile artery, which required surgical exploration and ligation. This article seeks to inform urologists about an unexpected complication that should be considered in the differential diagnosis for severe penile hematoma after CCH injection and discusses our strategy for surgical management.
{"title":"Dorsal Penile Artery Avulsion After Collagenase Clostridium histolyticum (Xiaflex) for Peyronie’s Disease: A Case Report","authors":"Rajvi Goradia, Alexander J. Skokan, M. Hehemann","doi":"10.1097/ju9.0000000000000159","DOIUrl":"https://doi.org/10.1097/ju9.0000000000000159","url":null,"abstract":"Collagenase Clostridium histolyticum (CCH) is frequently used as first-line therapy for patients with Peyronie’s disease. It was United States Food and Drug Administration approved in 2013 and since then, has been widely accepted as a safe and effective treatment option with most adverse effects being minor and amenable to conservative management. We report an unusual and previously unreported complication after CCH (Xiaflex) injection: avulsion of a dorsal penile artery, which required surgical exploration and ligation. This article seeks to inform urologists about an unexpected complication that should be considered in the differential diagnosis for severe penile hematoma after CCH injection and discusses our strategy for surgical management.","PeriodicalId":74033,"journal":{"name":"JU open plus","volume":"19 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141391852","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-01DOI: 10.1097/ju9.0000000000000155
Vivitha Mani, Amanda Banaag, S. S. T. Miura, Satish Munigala, Christian L Coles, Andrew J. Schoenfeld, T. Koehlmoos
PSA testing is the primary method of screening for prostate cancer, although recommendations are varied. The COVID-19 pandemic diverted resources away from preventive screenings. We sought to examine alterations in PSA screening among TRICARE beneficiaries in the Military Health System (MHS) over the course of the pandemic. Using data from the MHS Data Repository, we executed a retrospective open cohort study of male TRICARE Prime beneficiaries aged 40 to 64 years during fiscal years 2018 to 2022. The study period was separated into 3 subperiods: prepandemic (October 1, 2017-February 28, 2020), early pandemic (March 1, 2020-September 30, 2020), and late pandemic (October 1, 2020-September 30, 2022). We found a 73% reduction in PSA screenings in the early pandemic and 14% decrease in the late pandemic compared with prepandemic rates. Compared with White men aged 50 to 54 years, men younger than 50 years in all racial groups were less likely to receive screening. In both pandemic periods, all racial groups, except for Black men, were overall more likely than White men to receive screening. Men were more likely to seek PSA screening in the private sector during the pandemic compared with prepandemic times (early pandemic: 1.21 RR, 1.20-1.22 95% confidence interval [CI]; late pandemic: 1.20 RR, 1.19-1.20 95% CI). We found significant reductions in PSA screening over the course of the COVID-19 pandemic among TRICARE beneficiaries. While disparities appear less pronounced when compared with other preventive testing, targeted outreach is still necessary for certain sociodemographic groups.
{"title":"Reductions in Prostate-Specific Antigen Screening During the COVID-19 Pandemic in a Universally Insured American Health System","authors":"Vivitha Mani, Amanda Banaag, S. S. T. Miura, Satish Munigala, Christian L Coles, Andrew J. Schoenfeld, T. Koehlmoos","doi":"10.1097/ju9.0000000000000155","DOIUrl":"https://doi.org/10.1097/ju9.0000000000000155","url":null,"abstract":"\u0000 \u0000 PSA testing is the primary method of screening for prostate cancer, although recommendations are varied. The COVID-19 pandemic diverted resources away from preventive screenings. We sought to examine alterations in PSA screening among TRICARE beneficiaries in the Military Health System (MHS) over the course of the pandemic.\u0000 \u0000 \u0000 \u0000 Using data from the MHS Data Repository, we executed a retrospective open cohort study of male TRICARE Prime beneficiaries aged 40 to 64 years during fiscal years 2018 to 2022. The study period was separated into 3 subperiods: prepandemic (October 1, 2017-February 28, 2020), early pandemic (March 1, 2020-September 30, 2020), and late pandemic (October 1, 2020-September 30, 2022).\u0000 \u0000 \u0000 \u0000 We found a 73% reduction in PSA screenings in the early pandemic and 14% decrease in the late pandemic compared with prepandemic rates. Compared with White men aged 50 to 54 years, men younger than 50 years in all racial groups were less likely to receive screening. In both pandemic periods, all racial groups, except for Black men, were overall more likely than White men to receive screening. Men were more likely to seek PSA screening in the private sector during the pandemic compared with prepandemic times (early pandemic: 1.21 RR, 1.20-1.22 95% confidence interval [CI]; late pandemic: 1.20 RR, 1.19-1.20 95% CI).\u0000 \u0000 \u0000 \u0000 We found significant reductions in PSA screening over the course of the COVID-19 pandemic among TRICARE beneficiaries. While disparities appear less pronounced when compared with other preventive testing, targeted outreach is still necessary for certain sociodemographic groups.\u0000","PeriodicalId":74033,"journal":{"name":"JU open plus","volume":"61 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141415740","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-01DOI: 10.1097/ju9.0000000000000151
Jeremy Kurnot, Deborah R. Kaye
{"title":"Reply to Editorial Comment: Physician Perspectives on the Nonclinical Factors That Contribute to Decision-Making for Advanced Prostate Cancer Care: A Qualitative Study","authors":"Jeremy Kurnot, Deborah R. Kaye","doi":"10.1097/ju9.0000000000000151","DOIUrl":"https://doi.org/10.1097/ju9.0000000000000151","url":null,"abstract":"","PeriodicalId":74033,"journal":{"name":"JU open plus","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141399286","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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