The Efficacy and Safety of Retrograde Intrarenal Surgery in Elderly Patients: A Propensity Score Matching Study by the RIRSearch Group.

INTRODUCTION: To evaluate the efficacy and safety of retrograde intrarenal surgery (RIRS) in elderly patients by comparing them with propensity score-matched age groups. METHODS: Patients who underwent RIRS to treat upper urinary tract stone disease at seven centers were included in the study and were divided into four groups. The age intervals of the patients in Group 1, Group 2, Group 3, and Group 4 were 18-29 years old, 30-49 years old, 50-64 years old, and over 65 years old, respectively. Propensity score matching analysis was used to homogenize the groups in terms of demographic and clinical properties. Operative results, preoperative complications, peroperative complications, postoperative complications, duration of hospitalization time, and stone-free status were compared between groups. RESULTS: A total of 1,017 patients were included in the study. There were 69 (9.9%) patients in Group 1, 324 (46.5%) in Group 2, 217 (31.1%) in Group 3, and 87 (12.5%) in Group 4 after propensity score matching. The operation time and postoperative complication rates were significantly different among groups, whereas the hospitalization time, peroperative complication rates, and stone-free status were similar. The operation time was significantly higher in patients over 65 years old (p=0.001). The postoperative complication rates were significantly higher in Group 1 with Clavien I-II complication predominance (p=0.003). CONCLUSION: The efficacy and safety of RIRS did not change with aging, and RIRS was an effective option for the treatment of upper urinary system stones in elderly patients.

Evaluation of information accuracy and clarity: ChatGPT responses to the most frequently asked questions about premature ejaculation.

Background: Premature ejaculation (PE) is the most prevalent sexual dysfunction in men, and like many diseases and conditions, patients use Internet sources like ChatGPT, which is a popular artificial intelligence-based language model, for queries about this andrological disorder. Aim: The objective of this research was to evaluate the quality, readability, and understanding of texts produced by ChatGPT in response to frequently requested inquiries on PE. Methods: In this study we used Google Trends to identify the most frequently searched phrases related to PE. Subsequently, the discovered keywords were methodically entered into ChatGPT, and the resulting replies were assessed for quality using the Ensuring Quality Information for Patients (EQIP) program. The produced texts were assessed for readability using the Flesch-Kincaid Grade Level (FKGL), Flesch Reading Ease Score (FRES), and DISCERN metrics. Outcomes: This investigation has identified substantial concerns about the quality of texts produced by ChatGPT, highlighting severe problems with reading and understanding. Results: The mean EQIP score for the texts was determined to be 45.93 ± 4.34, while the FRES was 15.8 ± 8.73. Additionally, the FKGL score was computed to be 15.68 ± 1.67 and the DISCERN score was 38.1 ± 3.78. The comparatively low average EQIP and DISCERN scores suggest that improvements are required to increase the quality and dependability of the presented information. In addition, the FKGL scores indicate a significant degree of linguistic intricacy, requiring a level of knowledge comparable to about 14 to 15 years of formal schooling in order to understand. The texts about treatment, which are the most frequently searched items, are more difficult to understand compared to other texts about other categories. Clinical Implications: The results of this research suggest that compared to texts on other topics the PE texts produced by ChatGPT exhibit a higher degree of complexity, which exceeds the recommended reading threshold for effective health communication. Currently, ChatGPT is cannot be considered a substitute for comprehensive medical consultations. Strengths and Limitations: This study is to our knowledge the first reported research investigating the quality and comprehensibility of information generated by ChatGPT in relation to frequently requested queries about PE. The main limitation is that the investigation included only the first 25 popular keywords in English. Conclusion: ChatGPT is incapable of replacing the need for thorough medical consultations.

Bibliometric analysis of most cited Peyronie's disease and its management publications.

Introduction: Peyronie's disease (PD) is a common urologic illness, motivating numerous scientific investigations and publications. Scientific publications have more authors each year. A bibliometric review of the PD literature might help urologists and sexual medicine professionals comprehend publication tendencies in this subject. The current study was aimed at presenting a bibliometric analysis of PD, which is one of the important and trending subjects of andrology. Methods: On January 5, 2023, Web of Science scanned documents with the terms Peyronie's disease" "Peyronie's disease treatment", "Peyronie's disease management", "Peyronie's disease surgery" and "Peyronie's disease injection" from 1975 through 2023. Titles, years, authors, citations, citation indices, journal names, authors' countries of origin, article categories, and funding sources were recorded. Results: "Clinical Efficacy, Safety and Tolerability of Collagenase Clostridium Histolyticum for the Treatment of Peyronie Disease in 2 Large Double-Blind, Randomized, Placebo Controlled Phase 3 Studies" has the most citations and citation index. Most of the T100 articles were published in 2020, primarily in the Journal of Urology. These articles mainly focused on treatment, especially surgeries. All of these articles were in English, and the vast majority of them were by authors from the US who were most frequently collaborated with by other authors. Conclusion: This research analyzed the top 100 PD studies. This research focused on pathophysiology, innovative surgical procedures, and new approaches of PD. It also recommended bigger databases and more financing for research.

Use of the Systemic Immune-Inflammation Index to Predict Treatment Efficacy in Patients with Bladder Pain Syndrome.

OBJECTIVE: To determine the relationship between bladder pain syndrome (BPS) and systemic inflammatory index (SII) and to examine the impact of treatment protocols on it. STUDY DESIGN: Observational Study. Place and Duration of the Study: Department of Urology, Tekirdag Namik Kemal University, Tekirdag, Turkiye, from January 2017 to December 2022. METHODOLOGY: A retrospective analysis was conducted on 30 BPS patients who underwent medical therapy. Upon diagnosis, the patients completed the king's health questionnaire (KHQ), beck depression questionnaire (BDQ), beck anxiety questionnaire (BAQ), and short form (SF-36) quality of life form. Peripheral blood SII was measured. After six months of regular therapy, the SII was recalculated when the patients completed the same forms again. The SII was compared between instances when patients reported more complaints, higher form scores, and instances when they reported fewer and lower scores. RESULTS: The patients had a mean age of 46.1 ± 13.6 years, with four males and 26 females. The mean follow-up duration was 76.3 ± 24.5 months. Five patients of KHQ subcategories showed statistically significant decreases following therapy (52 to 39.17, 66.66 to 54.16, 54.40 to 41.07, 75.55 to 58.14, and 60.55 to 40.47). All patients of SF-36 components increased (p = 779, p = 0.393, p = 0.007, p = 0.004, p = 0.008, p = 0.041, p = 0.010, and p = 0.767, respectively). BDQ and BAQ decreased after therapy (11.55 to 11.41 and 11.86 to 11.24, respectively). Lymphocyte count, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and SII decreased significantly (p = 0.001, 0.019, 0.002 and 0.039, respectively). CONCLUSION: SII, lymphocyte count, NLR, and PLR decreased after treatment, similar to BDQ and BAQ. SII is a simple and feasible method for evaluating the treatment efficacy of BPS. KEY WORDS: Bladder pain syndrome, Lymphocyte, Neutrophil, Systemic immune inflammation index, Platelet.

Responses of Five Different Artificial Intelligence Chatbots to the Top Searched Queries About Erectile Dysfunction: A Comparative Analysis.

The aim of the study is to evaluate and compare the quality and readability of responses generated by five different artificial intelligence (AI) chatbots-ChatGPT, Bard, Bing, Ernie, and Copilot-to the top searched queries of erectile dysfunction (ED). Google Trends was used to identify ED-related relevant phrases. Each AI chatbot received a specific sequence of 25 frequently searched terms as input. Responses were evaluated using DISCERN, Ensuring Quality Information for Patients (EQIP), and Flesch-Kincaid Grade Level (FKGL) and Reading Ease (FKRE) metrics. The top three most frequently searched phrases were "erectile dysfunction cause", "how to erectile dysfunction," and "erectile dysfunction treatment." Zimbabwe, Zambia, and Ghana exhibited the highest level of interest in ED. None of the AI chatbots achieved the necessary degree of readability. However, Bard exhibited significantly higher FKRE and FKGL ratings (p = 0.001), and Copilot achieved better EQIP and DISCERN ratings than the other chatbots (p = 0.001). Bard exhibited the simplest linguistic framework and posed the least challenge in terms of readability and comprehension, and Copilot's text quality on ED was superior to the other chatbots. As new chatbots are introduced, their understandability and text quality increase, providing better guidance to patients.

The Predictive Factors for the Longer Survival of the Reusable Flexible Ureterorenoscopy.

PURPOSE: The flexible ureterorenoscopy (FURS) is expensive and fragile equipment which easily break down during the surgery. f-URS have yet some problems with their durability that affect survival. One of the most important ways to increase the survival of a device is to improve its use in the right indications. We aimed to investigate whether the durability of the f-URS will be affected due to the volume and location of the stone and some anatomical features of the including infundibulopelvic angle (IPA), and location anomalies. MATERIALS AND METHODS: The collected data from 705 patients' data including their age, sex, stone location, and stone volume, S-ReSC score, Hounsfield unit (HU) as stone density, IPA, BMI, and the usage time of f-URS using 10f-URS were included to study. Exp(B) values and confidence intervals (95% CIs) of parameters were calculated with COX regression and Roc curve analysis was also used to determine the cut-off value. RESULTS: Renal malformation, DJstent use, previous ESL application, and UAS use did not affect contrary to expectations stone volume, HU, IPA, and S-ReSC score were among the factors statistically significant affecting the durability of the device. It was observed, Exp(B) values of the affecting factors to be 0.984, 0.268, 0.894, and 0.607, respectively. We found the most appropriate cutoff value for IPA as 41.25 degrees. CONCLUSION: The mean stone volume broken by each of the subsequent f-URS may increase, while the mean operative time may decrease as time progresses. This result shows us the importance of mastery of the device, such as the deflection maneuver, and the correct use distance of the laser, which improves with the increase in user experience, and makes us interpret that the operation time is shortened with this self-confidence. Factors including stone volume, HU, IPA, S-ReSC score affect the durability of the f-URS device and the as well as manufacturing features.

Retrograde Intrarenal Surgery Learning Curves of Urology Residents Supervised by an Experienced Endourologist: An RIRSearch Study.

INTRODUCTION: Although retrograde intrarenal surgery (RIRS) is being performed with increasing frequency, there are only a limited number of studies about the learning curve (LC). This study aimed to analyze the LC of RIRS for five surgeons who underwent the same training. MATERIALS AND METHODS: The data of the 410 patients who underwent RIRS between April 2017 and 2022 in a single institution, which were performed consecutively by five surgeons, were analyzed. All 50 cases performed by each surgeon were included and numbered consecutively and separately, according to the date of the operation. The combined stone-free rate (SFR) was calculated for each surgeon's cases in the same row, and the LCs were created using moving average and cumulative sum (CUSUM) analyses. Separate multivariable analyses identified each period's (LC vs. beyond) characteristics. RESULTS: The LCs from the combined SFRs reached a plateau after approximately 50 cases for both the CUSUM and the moving average. The effect of stone burden on SFR was more evident in the first 50 cases compared to subsequent cases in the multivariable analyses (p = 0.001 and p = 0.047, respectively). Case order and stone density were independent factors in the first 50 cases (OR: 1.02 [95% CI 1.00-1.04], p = 0.04 and OR: 0.99 [95% CI 0.99-1.00], p = 0.04) but not significant in subsequent cases (OR: 0.97 [95% CI 0.94-1.00], p = 0.1 and OR: 1.00 [95% CI 0.99-1.00], p = 0.7, respectively). Compared to single locations except the lower calyx, the unfavorable effect of the multiple-stone localization on SFR grew in strength after the 50th case (OR: 0.42 [95% CI 0.23-0.78], p = 0.01 and OR: 0.20 [95% CI 0.09-0.46], p < 0.001, respectively). CONCLUSIONS: This is the first study reporting on the RIRS LCs of urology residents. While stone burden, density, and multiple-stone localization were the factors determining SFR in the learning period, after completing the LC, the effect of stone burden weakened and multiple-stone localization became stronger.

The Effect of Ventilation Mode in Anesthesia on Renal Mobility During Retrograde Intrarenal Surgery. Single-Blind Randomized Study.

PURPOSE: Renal mobility can present challenges for surgeons during stone fragmentation. The respiratory setup of the mechanical ventilator during RIRS might affect renal mobility. The aim of this study was to evaluate the effect of high ventilation (HV) and standard ventilation (SV) modes on renal mobility during RIRS. MATERIALS AND METHODS: Patients who underwent RIRS at a single center between November 2020 and November 2021 were retrospectively included in the study. Renal mobility was measured under fluoroscopic view in HVandSV modes during retrograde pyelography. The surgeon, who was absolutely blind about mechanical ventilation modes, was asked to assess the renal movement grade. After the ventilation mode was changed, the surgeon reassessed renal mobility. The data and the surgeon's assessment were recorded and compared to each other. RESULTS: A total of 86 patients with a mean age of 48.6 ± 15.7 years were included in the study. There was a significant difference between the SV and HV modes in terms of renal mobility in fluoroscopic view (17.1±6.1 mm and 13.6 ± 5.2mm, respectively; p=0.007). According to the surgeon's assessments, the grade of renal mobility was found to be significantly higher in the SV group 2.8 ±1.1 compared to the HV group 2.2 ± 0.8 (p=0.001). Renal movement increased significantly under fluoroscopic vision as the renal grading of the surgeon increased(p=0.013). This data demonstrated that the surgeon's assessment of renal mobility was significantly correlated with fluoroscopic kidney movement. CONCLUSION: Kidney movement was decreased significantly in HV mode during RIRS according to both fluoroscopic findings and surgeon assessment. Most surgeries of mobile kidneys were performed in HV mode, due to the surgeon's preference.

The effect of the pandemic period on Bladder Pain Syndrome patients under amitriptyline treatment.

INTRODUCTION: COVID-19 is a disease that may cause anxiety, depression, and stress. Bladder pain syndrome (BPS) is a disease in which stress and psychological factors might negatively affect its course. In this study, we aimed to examine the possible clinical aggregation of the pandemic period on BPS patients. MATERIALS AND METHODS: A total of 35 BPS patients diagnosed between 2010 and 2018 were included. All patients were using medical treatment, and the follow-up period was at least 6 months. According to our clinical follow-up protocol, the BPS patients were given the King's Health Questionnaire (KHQ), Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), Overactive Bladder Form V8 (OAB-V8), and Visual Analog Score (VAS) in every visit. In the sixth month of the pandemic, the clinical course of the patients was questioned by telephone or video interview, and their treatment continuities were questioned. Information was received about the delays in their follow-up and the difficulties in accessing healthcare opportunities. The same questionnaires were filled out and compared with pre-pandemic scores. RESULTS: The mean age of the patients included in the study was 50.2 ± 13.32 (min:20, max:74), 11 were males and 24 were females. The mean follow-up periods were 71.8 ± 35.6 months. All questionnaire scores showed an increase compared to the pre-pandemic period. A statistically significant increase was detected during the pandemic in all sub-units of the KHQ. The VAS and OAB-V8 scores of 16 patients who requested hospital admission were significantly higher than before the pandemic. However, there was no statistically significant difference in the increase in VAS and OAB-V8 scores of the 19 patients who refused to come to the hospital. CONCLUSION: BPS patients have been negatively affected by the emotional effects of the COVID-19 pandemic. Due to the fear, stress, anxiety, and depression, the symptoms of BPS patients exacerbated, and the patients could not receive the necessary support due to a lack of regular follow-ups.

Reliability and accuracy of varicocoele videos in YouTube.

OBJECTIVE: To evaluate the scientific impact of videos about varicocoele on YouTube. METHODS: A cross-sectional study was conducted at Turkey in September 2020, and comprised YouTube videos related to varicocoele. The videos were divided into 2 groups according to their reliability and accuracy using the European Association of Urology Sexual and Reproductive Guidelines 2020. A 5-point modified reliability (DISCERN) tool, Global Quality Score, and Journal of the American Medical Association scores of each video were calculated. The user's engagements by total views, video-related comments, and "likes" and "dislikes" to the videos were compared. Data was analysed using SPSS 23. Results: Of the 151 videos assessed, 73(48.34%) were included; 36(49.3%) reliable and 37(50.7%) unreliable. All scores were significantly higher for reliable videos (p<0.05). The mean number of views was 108448±90567 for reliable and 392626±895897 for unreliable videos (p=0.044). The rates of "likes" and "dislikes" were similar between the groups, whereas the comment rate was significantly higher for reliable videos (p<0.05). Most of the videos 40(54.8%) were uploaded by medical advertisements or for-profit companies, while those uploaded by universities or professional organisations were 19(26%). CONCLUSIONS: Nearly half of the varicocoele-related videos on YouTube were unreliable, and the reliability of videos was not directly related to their popularity.

A Rare Case in Urology: Inflammatory Myofibroblastic Tumour.

Inflammatory myofibroblastic tumour (IMT) is a soft tissue malignancy with a mixture of myofibroblastic spindle cells with hyalinised stroma and inflammatory infiltrates. We report a case of a 35-year male patient with a 100×90 mm mass located at the posterior wall of the urinary bladder just adjacent to the prostate and rectum. The mass caused grade 3 hydronephrosis in the left kidney and grade 1 hydronephrosis in the right kidney. The patient was operated and the mass lesion was excised completely. Because the left ureter was adherent to the mass, it was excised at the most distal part and uretero-neo-cystostomy was performed as the bladder and the prostate were preserved. Morphology and immunohistochemistry were consistent with IMT. With surgical excision of the tumour, no recurrence or metastases were seen up to 3 years postoperatively. Key Words: Inflammatory myofibroblastic tumour, Bladder, Urinary system, Hydronephrosis.

Erectile dysfunction iceberg in an urology outpatient clinic: How can we encourage our patients to be more forthcoming?

The study's aim was to document the rates of declared and hidden erectile dysfunction (ED) at urology outpatient clinic while attempting to develop a method to encourage patients to talk about ED. A total of 506 patients, all of whom underwent the same procedure by the same clinician with a standard algorithm, were prospectively evaluated. The patients who declared ED as their primary or secondary symptom were grouped as 'very early treatment seekers' (VETS) and 'early treatment seekers' (ETS) respectively. The patients who hid their ED until directly questioned and the patients whose ED was diagnosed with an IIEF-5 questionnaire were grouped as 'late treatment seekers' (LTS) and 'very late treatment seekers' (VLTS) respectively. The total number of ED was 291 (57.5%), comprised of 54 (18.6%) patients in the VETS, 48 (16.5%) in the ETS, 143 (49.1%) in the LTS and 46 (15.8%) in the VLTS groups. The rate of severe ED was significantly higher in the VETS group, whereas the rate of mild ED was significantly higher in the VLTS group (p < .001). Most of the patients would not seek help for their ED until the clinician directly or indirectly questioned them. Simple manipulations uncovered the hidden ED patients.