Radical Prostatectomy on YouTube: Education or Disinformation?

Background: YouTube is the second most popular website worldwide. It features numerous videos about radical prostatectomy.The aim of this study was to assess the quality of these videos and screen their benefit for patients and doctors.Methods: All videos on YouTube about radical prostatectomy were analysed using a specially developed software (python 2.7,numpy). According to a predefined selection process most relevant videos were analyzed for quality and reliability using SuitabilityAssessment of Materials (SAM)-Score, Global Quality Score and others.Results: Out of 3520 search results, 179 videos were selected and analysed. Videos were watched a median of 5836 times (interquartilerange (IQR): 11945.5; 18–721546). The median duration was 7.2 minutes (min). 125 of the videos were about roboticprostatectomy. 69 videos each were directly addressed to patients and doctors. Medical content generally was of low quality,while technical quality and total quality were at a high level. Reliability was good.Conclusions: Videos on radical prostatectomy on YouTube allow for patient information. While technical quality and reliabilityare classified as acceptable, medical content was low and warranted preselection. In contrast to Loeb et al. we did notobserve a negative correlation between number of views and scientific quality in different scores. Our findings support the needfor preselection of videos on YouTube as the potential benefit may vary between videos with the significant risk of low medicalquality. (AU)

Radical Prostatectomy on YouTube: Education or Disinformation?

BACKGROUND: YouTube is the second most popular website worldwide. It features numerous videos about radical prostatectomy. The aim of this study was to assess the quality of these videos and screen their benefit for patients and doctors. METHODS: All videos on YouTube about radical prostatectomy were analysed using a specially developed software (python 2.7, numpy). According to a predefined selection process most relevant videos were analyzed for quality and reliability using Suitability Assessment of Materials (SAM)-Score, Global Quality Score and others. RESULTS: Out of 3520 search results, 179 videos were selected and analysed. Videos were watched a median of 5836 times (interquartile range (IQR): 11945.5; 18-721546). The median duration was 7.2 minutes (min). 125 of the videos were about robotic prostatectomy. 69 videos each were directly addressed to patients and doctors. Medical content generally was of low quality, while technical quality and total quality were at a high level. Reliability was good. CONCLUSIONS: Videos on radical prostatectomy on YouTube allow for patient information. While technical quality and reliability are classified as acceptable, medical content was low and warranted preselection. In contrast to Loeb et al. we did not observe a negative correlation between number of views and scientific quality in different scores. Our findings support the need for preselection of videos on YouTube as the potential benefit may vary between videos with the significant risk of low medical quality.

Mapping the landscape of urology: A new media-based cross-sectional analysis of public versus academic interest.

OBJECTIVES: To quantify public and academic interest in the urological field using a novel new media-based methodology. METHODS: We systematically measured public and academic interest in 56 urological keywords and combined in nine subspecialties. Public interest was quantified as video views on YouTube. Academic interest was quantified as article citations using Microsoft Academic Search. The public-to-academic interest ratio was calculated for a comparison of subspecialties as well as for diseases and treatments. RESULTS: For the selected 56 urological keywords, we found 226 617 591 video views on YouTube and 2 146 287 citations in the academic literature. The public-to-academic interest ratio was highest for the subspecialties robotic urology (ratio 6.3) and andrological urology (ratio 4.6). Prostate cancer was the central urological disease combining both a high public (20% of all video views) and academic interest (26% of all citations, ratio 0.8). Further diseases/treatments of high public interest were premature ejaculation (ratio 54.4), testicular cancer (ratio 11.4), erectile dysfunction (ratio 5.5) and kidney transplant (ratio 3.7). Urological treatments had a higher public-to-academic interest ratio (median ratio 0.25) than diseases (median ratio 0.05; P = 0.029). CONCLUSIONS: A quantification of academic and public interest in the urological field is feasible using a novel new media-based methodology. We found several mismatches in public versus academic interest in urological diseases and treatments, which has implications for research strategies, conference planning and patient information projects. Regular re-assessments of the public and academic interest landscape can contribute to detecting and proving trends in the field of urology.

Antibiotic Prophylaxis in Prostate Biopsies: Contemporary Practice Patterns in Germany.

PURPOSE: Prostate biopsy (pbx) is the most common outpatient procedure in urology. Complications are urinary tract infections, including hospitalization and sepsis. Recommendations on antibiotic prophylaxis (apx) are scarce, and healthcare data are not available. The study addressed the following endpoints: the duration and spectrum of antimicrobial prophylaxis in transrectal and transperineal pbx in the hospital and the practice setting. METHODS: A questionnaire compiled data about age, gender, board certification, and place of work. Information about the frequency of pbx, duration and type of apx, usage of disinfecting lubricant, and urine or rectal swab cultures was collected. The study refers to German urologists. RESULTS: Overall 478 urologists answered the questionnaire. 15.5% (74) of respondents were residents. 50.8% (243) of urologists work in a practice; the rest in a hospital. Only 4.8% do not perform pbx. Transrectal pbx are performed a median of two times a week. The majority (446, 98%) prescribe an apx, mostly fluoroquinolones (407, 89.5%). In total, 10.1% (46) of the participants use a single-shot-apx. apx has a median duration of 4 days. One-third uses a disinfecting lubricant. Urine and rectal swab cultures are analyzed by 45.5% (207) and 24.4% (111), respectively. CONCLUSION: Most urologists prescribe an extended apx for both transrectal and transperineal pbx. Perineal pbx is still a deviation from everyday practice and not an established alternative to transrectal pbx. Urologists are aware of the increasing fluoroquinolone-resistance and are adapting with rectal swab and urine cultures. Further studies need to evaluate alternatives to 5-day apx and results should be addressed in our guidelines. This is of importance in light of the increasing resistance rates and fluoroquinolone side effects.

Bladder Neck Contracture After Radical Prostatectomy: What Is the Reality of Care?

OBJECTIVES: To evaluate the therapeutic methods and algorithms currently used in the treatment of bladder neck contracture (BNC) after radical prostatectomy (RP). MATERIALS AND METHODS: Heads of 170 urologic departments in Germany, listed at the German Society of Urology (DGU), were invited to participate in an Internet-based customized survey. The questions consisted of an epidemiologic part (kind of hospital, state of practice) and questions inquiring used surgical techniques with their respective incidence and given algorithms for therapy. RESULTS: Of 170 contacted heads of urologic departments in Germany, 84 responded to the questionnaire (return rate 49.41%). The most common treatment modalities are transurethral resection, cold knife incision, hot knife incision, and dilation in descending order. For those institutions using several treatment modalities, 56 (66.67%) follow a therapeutic algorithm, while 28 (33.33%) follow no set order of treatment. However, among the 56 institutions with a set algorithm, 33 different approaches were identified. Of 84 institutions, 29 (34.52%) perform open reanastomosis in case of recurrent BNC, the remaining 55 (65.48%) do not. CONCLUSION: Despite several published guidelines on urethral strictures, numerous self-employed treatment algorithms are used to treat BNC. Although treatment results of these algorithms and the underlying treatment modalities cannot be determined with this work, it highlights the necessity for further studies comparing the different surgeries to allow for a more evidence-based approach.

Aquagenic pruritus in polycythemia vera: characteristics and influence on quality of life in 441 patients.

Aquagenic pruritus (AP) is a symptom typical for polycythemia vera, but very little is known about its exact frequency, characteristics, influence on quality of life, and proper treatment. Therefore, we investigated these aspects in a large cohort of German patients with polycythemia vera using a patient directed questionnaire. Our analysis revealed that 301 of 441 analyzed patients suffered from AP. In 64.8%, AP occurred on average 2.9 years prior to diagnosis of polycythemia vera. Only in 15.4% did this lead to a hematological investigation. AP occurs primarily on the trunk and proximal parts of the extremities. Most patients complain about itching (71.8%), the remainder about tickling, stinging, or burning sensations. Forty-four patients (14.6%) classified the pruritus as "unbearable." Patients with AP reported reduced global health status and higher fatigue, pain, and dyspnea. Only 24% of patients received pruritus specific treatment for pruritus consisting mostly of histamine antagonists, which ameliorated symptoms in about half of the patients. In 5.6% of patients, polycythemia vera directed therapy (phlebotomy/cytoreduction) resolved the symptoms. In summary, AP is a serious symptom in patients with polycythemia vera, which until recently was difficult to treat. The advent of the novel JAK2 inhibitors, however, may open new ways for therapy.

Microbial colonization and ureteral stent-associated storage lower urinary tract symptoms: the forgotten piece of the puzzle?

PURPOSE: Ureteral stents are frequently associated with side effects. Most patients suffer from storage lower urinary tract symptoms (LUTS). Storage LUTS are commonly attributed to the irritation of the trigone, smooth muscle spasm or a combination of factors. The relationship between microbial ureteral stent colonization (MUSC) and de novo or worsening storage LUTS has not been investigated yet. METHODS: Five hundred ninety-one polyurethane ureteral stents from 275 male and 153 female patients were prospectively evaluated. The removed stents were sonicated to dislodge adherent microorganisms. Urine flow cytometry was performed to detect pyuria. A standardized urinary symptom questionnaire was given to all patients. RESULTS: Thirty-five per cent of male and 28% of female cases showed de novo or worsened storage LUTS. MUSC was more common in patients with storage LUTS compared to patients without storage LUTS (men: 26 vs. 13%, respectively, P < 0.05; women: 63 vs. 48%, respectively, P = 0.13). Pyuria was significantly more common in patients with storage LUTS compared to patients without storage LUTS (men: 55 vs. 40%, respectively, P < 0.05; women: 70 vs. 45%, respectively, P < 0.05). No significant correlation was observed between the detected genera of microorganisms and storage LUTS. CONCLUSIONS: Our data show a significant association between MUSC- and stent-related de novo experienced or worsened storage LUTS in men. The incidence of MUSC is most common in both female and male patients with storage LUTS and accompanying pyuria. In these patients, a combination of antibiotics and anti-inflammatory drugs may be regarded as treatment option.

Radiation exposure during endourologic procedures using over-the-table fluoroscopy sources.

BACKGROUND AND PURPOSE: Fluoroscopy is used daily by endourologic surgeons worldwide without knowledge of received radiation doses. We wanted to assess the radiation exposure of endourologic surgeons by frequently performed endourologic interventions with an over-the-table x-ray system. PATIENTS AND METHODS: In this prospective single-center study, 235 endourologic interventions in 188 patients from April to September 2010 were included. Sixty-seven ureteral stent placements (USP), 51 ureteral stent changes (USC), 67 percutaneous stent changes (PSC), 11 percutaneous nephrolithotomies (PCNL), and 39 ureterorenoscopies (URS) were performed by 12 surgeons. The surgeon`s radiation exposure was measured with one thermoluminescent dosimeter (TLD) at the forehead and one at the ring finger. TLDs were analyzed at a central institute. The radiation dose detected at the forehead was counted as representative for the lens of the eye and the thyroid. RESULTS: Mean patient age was 60.6 (± 18.8) years. Analysis of the TLD showed the following average values at the forehead for each intervention: USP and USC 0.04 mSv; PSC 0.03 mSv; PCNL 0.18 mSv; URS 0.1 mSv. Average finger values are: USP 0.13 mSv; USC 0.21 mSv; PSC 0.20 mSv; PCNL 4.36 mSv; URS 0.15 mSv. CONCLUSIONS: This report evaluates surgeons' radiation exposure by everyday endourologic interventions of different complexity. Most can be performed with an over-the-table x-ray system without exceeding statutory limits. Especially for PCNL, surgeons should consider possible protective action.

Congenital and acquired polycythemias.

INTRODUCTION: Polycythemias are characterized by an increased concentration of red blood cells. Because blood cell counts are a routine investigation, these disorders present to non-hematologic physicians. Polycythemia vera (PV), an acquired stem cell disease, is the most important variant. METHODS: Selective literature review and the authors' own clinical experiences. RESULTS AND DISCUSSION: Erythropoietin, which is produced in the kidneys, and its receptor system in the bone marrow, are of critical importance in polycythemia. Congenital polycythemias are caused by mutations of the Erythropoietin-receptor gene, hemoglobin variants, 2,3-bisphosphoglycerate mutase deficiency or by disturbances of renal oxygen sensing. Acquired polycythemias can occur secondary to hypoxia at high altitudes, or primarily through acquired mutations in the EPO-receptor signaling system (JAK2 mutations). Alternatively they may be caused by pulmonary or renal disease. An artificial erythrocytosis is induced by athletes through doping. Differential diagnosis comprises erythropoietin determination, JAK2 mutation analysis and if necessary hemoglobin electrophoresis. Only PV requires immediate treatment, because of a high thromboembolic risk. Epidemiological studies on polycythemias in German speaking countries are urgently needed.