BJU International最新文献

Objective: To contextualise the national population-based temporal surgical trends in the management of benign prostatic hyperplasia (BPH) in Australia.

Methods: Google Trends (GT) was used to analyse the level of patients' online interest in various surgical options for the treatment of BPH. Analysis of variance was performed and the average rates of change in GT popularity score was calculated for the period from 1 January 2010 to 31 October 2022. Data regarding surgical volume were extracted from the Medicare Benefits Schedule and the Australian Institute of Health and Welfare databases, and population-adjusted rates of BPH procedures performed were calculated accordingly.

Results: The level of online interest in Australia was highest for transurethral resection of the prostate (TURP) and population data also showed that TURP remained the most utilised procedure across the study period. Nationwide, there was an increased uptake of photovaporisation of the prostate, accounting for 7.6% of BPH procedures in 2020-2021, with correspondingly lower rates of TURP and simple prostatectomies performed. Holmium laser enucleation of the prostate (HoLEP) appeared to be underutilised and had the lowest mean popularity score, while prostatic urethral lift (PUL) and transurethral water vapour ablation (TUWA) showed strong uptake in the more recent years. The average rates of change were highest for TURP at +1.59/year (P < 0.001), followed by PUL at +0.56/year (P < 0.001) and TUWA at +0.50/year (P = 0.004), while the lowest was for HoLEP at +0.09/year (P = 0.116).

Conclusion: Differences were found between GT analysis and actual BPH procedures performed at a population level. This study highlights that clinicians need to adapt and provide better patient counselling to ensure a shared decision-making process when choosing the treatment procedure for BPH/male LUTS.

Objective: To assess the oncological outcomes of patients with high-risk (HR) and very high-risk (VHR) non-muscle-invasive bladder cancer (NMIBC) treated with upfront radical cystectomy (RC) vs Bacillus Calmette-Guérin (BCG) instillations from a contemporary European multicentre cohort.

Patients and methods: We conducted a retrospective analysis of 1491 patients diagnosed with HR- or VHR-NMIBC from a European multicentre database between 2015 and 2024. Patients were included if they received either upfront RC or at least five doses of BCG. A 1:1 propensity score matching (PSM) according to clinically relevant variables was applied. Progression was defined as muscle-invasive or metastatic disease. Cumulative incidence plots and multivariable competing risk regression models addressing cancer-specific mortality (CSM) were fitted.

Results: Among the 1221 patients with HR- (n = 1221 [90%]) or VHR-NMIBC (n = 121 [10%]), 87 (7.1%) underwent upfront RC. The median follow-up was 2.6 years. After PSM (87 vs 87 patients), the 5-year CSM rate was similar in patients treated with BCG (13%) vs their upfront RC counterparts (16%) (hazard ratio: 1.77, 95% confidence interval [CI] 0.66-4.73; P = 0.3). Of the 1134 patients who initially received BCG, 73 (6.6%) eventually required delayed RC, with 34 (47%) progressing to muscle-invasive bladder cancer before delayed RC. The 3-year CSM rate was comparable in upfront RC (13%) vs delayed RC (11%) among non-progressing patients (P = 0.3). However, patients who progressed before delayed RC had worse 3-year CSM relative to those who did not (13% vs 31%, hazard ratio: 0.32, 95% CI 0.13-0.83; P = 0.018).

Conclusion: Within a European cohort of patients with HR- and VHR-NMIBC, upfront RC was rarely performed. Patients treated with BCG did not exhibit a CSM disadvantage relative to their upfront RC counterparts. After matching, long-term CSM was similar between BCG therapy and upfront RC. Delayed RC, led to worse outcomes if performed after progression, but matched upfront RC when performed before progression, underscoring importance of timely surgery.

Objectives: To explore the interaction of real-world patients with a chatbot in a clinical setting, investigating key aspects of medical information provided by large language models (LLMs).

Patients and methods: The study enrolled 300 patients seeking urological counselling between February and July 2024. First, participants voluntarily conversed with a Generative Pre-trained Transformer 4 (GPT-4) powered chatbot to ask questions related to their medical situation. In the following survey, patients rated the perceived utility, completeness, and understandability of the information provided during the simulated conversation as well as user-friendliness. Finally, patients were asked which, in their experience, best answered their questions: LLMs, urologists, or search engines.

Results: A total of 292 patients completed the study. The majority of patients perceived the chatbot as providing useful, complete, and understandable information, as well as being user-friendly. However, the ability of human urologists to answer medical questions in an understandable way was rated higher than of LLMs. Interestingly, 53% of participants rated the question-answering ability of LLMs higher than search engines. Age was not associated with preferences. Limitations include social desirability and sampling biases.

Discussion: This study highlights the potential of LLMs to enhance patient education and communication in clinical settings, with patients valuing their user-friendliness and comprehensiveness for medical information. By addressing preliminary questions, LLMs could potentially relieve time constraints on healthcare providers, enabling medical personnel to focus on complex inquiries and patient care.