Evaluation of ChatGPT for Patient Counseling in Kidney Stone Clinic: A Prospective Study.

Introduction: The potential of large language models (LLMs) is to improve the clinical workflow and to make patient care efficient. We prospectively evaluated the performance of the LLM ChatGPT as a patient counseling tool in the urology stone clinic and validated the generated responses with those of urologists. Methods: We collected 61 questions from 12 kidney stone patients and prompted those to ChatGPT and a panel of experienced urologists (Level 1). Subsequently, the blinded responses of urologists and ChatGPT were presented to two expert urologists (Level 2) for comparative evaluation on preset domains: accuracy, relevance, empathy, completeness, and practicality. All responses were rated on a Likert scale of 1 to 10 for psychometric response evaluation. The mean difference in the scores given by the urologists (Level 2) was analyzed and interrater reliability (IRR) for the level of agreement in the responses between the urologists (Level 2) was analyzed by Cohen's kappa. Results: The mean differences in average scores between the responses from ChatGPT and urologists showed significant differences in accuracy (p < 0.001), empathy (p < 0.001), completeness (p < 0.001), and practicality (p < 0.001), except for the relevance domain (p = 0.051), with ChatGPT's responses being rated higher. The IRR analysis revealed significant agreement only in the empathy domain [k = 0.163, (0.059-0.266)]. Conclusion: We believe the introduction of ChatGPT in the clinical workflow could further optimize the information provided to patients in a busy stone clinic. In this preliminary study, ChatGPT supplemented the answers provided by the urologists, adding value to the conversation. However, in its current state, it is still not ready to be a direct source of authentic information for patients. We recommend its use as a source to build a comprehensive Frequently Asked Questions bank as a prelude to developing an LLM Chatbot for patient counseling.

Chengai Nomogram: A Comprehensive Study of Uroflow Parameters and Characteristics in Healthy Adult Males From South India.

Introduction Uroflowmetry is a widely accepted non-invasive diagnostic modality used in the evaluation of lower urinary tract dysfunction. While various nomograms have been established for different populations and races, there has been a lack of studies that focus on the South Indian populations. Consequently, the objective of the study was to investigate the urinary flow parameters in a healthy adult male South Indian population using uroflowmetry and identify the variations in flow rates. Additionally, the study sought to assess the influence of age and voided volume (VV) on flow rates and create a representative nomogram. Methods A total of 500 uroflowmetry tests were prospectively performed on healthy adult males. The gravimetric method was utilized for uroflowmetry. Flow charts and parameters were analyzed for correlation and linear regression models, and statistical calculations were employed to generate uroflow nomograms. Results The mean age of the participants was 37.77±9.91 years. The mean values for maximum flow rate (Qmax), average flow rate (Qavg), and VV were 23.42±6.64 mL/s, 11.71±3.77 mL/s, and 229.90±59 mL, respectively. A significant correlation was observed between flow rates (Qmax and Qavg) and VV, which indicated that increased VV leads to higher flow rates. Additionally, a significant negative correlation between the flow rates and age was noted. Conclusion The findings provide insight into the uroflow parameters of the South Indian adult male population and contribute to the development of nomograms, establishing normal reference ranges for flow rates across varying VVs. As a tribute to the hospital and the study participants, the nomogram was named the "Chengai Nomogram."

Role of Posterior Acoustic Shadow Width in Ultrasound in Determining Stone Size in Urolithiasis.

Introduction Ultrasound (US) is frequently the initial diagnostic tool for urolithiasis, though computed tomography (CT) remains the imaging modality of choice. However, due to potential overestimations, the accuracy of US in gauging stone size has been a point of contention. This study aims to compare the accuracy of stone size measurements in US, specifically evaluating the utility of the posterior acoustic shadow (PAS) width, against the CT measurements. Methods We conducted a cross-sectional study where 120 adult patients (aged >18 years) with confirmed urolithiasis through CT participated. Stone sizes were assessed via both CT and US, with the PAS width also being measured in the latter. Statistical analysis compared stone size discrepancies between both CT and US measurement techniques. Results The study enrolled 73 males and 47 females with various stone locations. The average stone sizes were 15.93 ± 4.59 mm (CT), 18.60 ± 4.80 mm (US), and 16.69 ± 4.61 mm (PAS width). There was a mean difference of 2.67 mm (p < 0.0001) between CT and US sizes, whereas the difference between the PAS width and CT sizes was only 0.75 mm (p = 0.203). Stone size miscalculation by US was 16.77%, whereas it was only 4.77% for PAS width. Conclusion US tends to significantly overestimate stone size when compared to CT. Conversely, the measurement of the PAS width in US presents a more aligned estimation to CT outputs. Integrating PAS width into routine US reporting can enhance the accuracy of stone size estimation, optimizing urolithiasis management and patient counseling.

Beyond the Breaking Point: A Unique Case Report of a Penile Fracture With a Distal Urethral Injury.

A penile fracture is a rare urological emergency, often resulting from blunt trauma to the erect penis. This case report describes a 30-year-old male who presented with penile swelling during sexual intercourse, raising suspicion of a penile fracture. The patient underwent surgical exploration, revealing a rent in the tunica albuginea and an additional laceration in the corpus spongiosum with the Foley catheter exposed. The lacerations were closed using Vicryl sutures over a Foley catheter. The patient experienced an uneventful postoperative course, and follow-up assessments showed satisfactory healing of the urethra. This case underlines the need for clinicians to consider the possibility of urethral involvement in cases of penile fracture, as timely surgical intervention can prevent long-term sequelae such as erectile dysfunction and urethral strictures. By sharing this case, we hope to further emphasize the need for vigilance and swift action when faced with potential penile fractures in clinical practice.

An Unusual Case of Inflammatory Pseudotumor of Paratesticular Region.

Inflammatory pseudotumors (IPT) are rare benign tumors that can develop in various regions of the body. Notably, IPTs have been uncommonly described in the Genitourinary system including occasional reports from the paratesticular region. This origin from this area is significant because of the ambiguity in differentiating this pathology from malignant lesions arising from the testis. We would like to report a case of a 32-year-old male who presented with a painless left scrotal mass for two years. Ultrasonography was done followed by a radical orchidectomy and histopathological examination of the excised lesion showed features suggestive of inflammatory pseudotumor from the paratesticular region. We feel this case merits reporting owing to the rarity of IPT occurring in the paratesticular region and the essential need for increased awareness and differentiation from the malignant counterparts.

A Comparison Between Silodosin and Tamsulosin for Medical Expulsive Therapy of Distal Ureteric Calculus.

INTRODUCTION: Medical expulsive therapy (MET) is an established treatment option for distal ureteric stones. Tamsulosin, a selective alpha-1 blocker, has been used for MET with good results, while silodosin, a more selective alpha-1a blocker, is more effective than tamsulosin for MET. Thus, this study aimed to compare the efficacy of silodosin with tamsulosin. METHODS: This prospective randomized study was conducted at the Department of Urology, Government Chengalpattu Medical College Hospital, Tamil Nadu, India. Eighty patients who presented with ureteric colic and were radiologically diagnosed with distal ureteric calculus of size <10mm were included. Participants in the silodosin group received tablet silodosin 8mg OD until the passage of the stone, not more than two weeks, and analgesics as per demand. And participants in the tamsulosin group received tablet tamsulosin 0.4mg OD until the passage of the stone, not more than two weeks, and analgesics as per demand. RESULTS: A total of 80 patients were included in the study. Forty patients in the silodosin group and forty patients in the tamsulosin group were included. In the silodosin group, out of 40 patients, 38 expelled the calculus. In the tamsulosin group, out of 40 patients, 28 expelled the calculus. The silodosin group had a significantly higher rate of expulsion, with a p-value of 0.003. Stone expulsion time was shorter in the silodosin group when compared with the tamsulosin group (10.15 vs. 13.4 days). Analgesic usage during medical expulsive therapy was lower in the silodosin group (5.68 vs. 8.4). We observed significant differences in comparing the outcome, stone expulsion time, and analgesic requirement between the silodosin and tamsulosin groups. We observed no significant difference between the groups for age-wise and gender-wise comparisons. Furthermore, non-expulsion of calculus in four patients and pain in eight patients were the reasons for intervention in the tamsulosin group. The reason for intervention in the silodosin group was the non-expulsion of calculus in two patients. CONCLUSION: Using silodosin for MET of distal ureteric calculus, we found to have a better stone expulsion rate, early expulsion time, and reduced analgesic requirement.

Tamsulosin Versus Mirabegron in Relieving Ureteric Stent-Related Symptoms: A Prospective, Double-Blinded, Randomized Controlled Trial.

Introduction Alpha-adrenergic blockers like tamsulosin are widely used in the treatment of stent-related symptoms due to ureteric stents. Recently, mirabegron has emerged as a potential alternative. So, our study aimed to compare the effect of mirabegron and tamsulosin on ureteric stent-related morbidity. Methods In this randomized controlled study, 80 patients undergoing uncomplicated ureteroscopic lithotripsy with double J stenting for ureteric stones were enrolled. They were divided into two groups: Group A (n=40) received mirabegron (25mg) and Group B (n=40) received tamsulosin (0.4mg). Outcomes were assessed using the Ureteral Stent Symptom Questionnaire (USSQ), International Prostate Symptoms Score (IPSS), and the visual analog pain scale. The t-test and the Chi-square test were utilized to study the efficacy of the interventions across both groups. Results The USSQ urinary symptom score (25.5 vs 33.45; p < 0.001) and body pain score (16.15 vs 26.02; P < 0.001) were significantly lower in the mirabegron group. However, the general health score (17.0 vs 17.28; p = 0.62) and work performance score (7.6 vs 8.0; p = 0.28) did not show a significant difference. The storage symptom score was significantly lower in the mirabegron group (3.98 vs 5.1; p = 0.001). Furthermore, the mirabegron group reported a better quality of life score (2.18 vs 3; p < 0.001). Conclusion Mirabegron has been shown to reduce urinary symptoms associated with ureteric stents and also results in a better quality of life when compared with tamsulosin. However, large-scale, prospective, multicentric studies are further required to holistically evaluate and comprehend the beneficial effects of mirabegron on stent-related morbidity.

Moderately differentiated Sertoli-Leydig cell tumor of ovary with associated mucinous carcinoma and carcinoid-A case report and review of literature.

Sertoli-Leydig Cell Tumors (SLCT) are very rare neoplasms of the ovary (0.2%) and they belong to the group of sex cord-stromal tumors. Of these, 20% of the cases show heterologous elements. We report a case of a 22-year-old woman who presented with complaints of lower abdominal pain and secondary amenorrhea for 10 months. Physical examination revealed right lower abdominal tenderness and fullness. Imaging showed a right ovarian mass. She underwent right salpingo-oophorectomy with bilateral pelvic lymphadenectomy and omentectomy. Microscopic examination revealed a neoplasm with varied histomorphological patterns. The predominant pattern was an atypical proliferative mucinous tumor with foci of microinvasion. The other component was that of moderately differentiated Sertoli-Leydig Cell Tumor. Focal areas resembling carcinoid were also noted. Immunohistochemistry was performed and the Sertoli-Leydig Cells were positive for CD56, calretinin, inhibin, vimentin, and ER. The glandular component was positive for CK20, EMA, CEA, and CDX2. Synaptophysin and chromogranin were positive within nests resembling carcinoid. With the given histomorphological features and immunohistochemistry findings, a diagnosis of moderately differentiated Sertoli-Leydig Cell Tumor of the ovary with associated mucinous carcinoma and carcinoid was rendered. The presence of heterologous elements in SLCTs has been reported to be associated with poor prognosis.