Chatbots vs andrologists: Testing 25 clinical cases.

OBJECTIVE: AI-derived language models are booming, and their place in medicine is undefined. The aim of our study is to compare responses to andrology clinical cases, between chatbots and andrologists, to assess the reliability of these technologies. MATERIAL AND METHOD: We analyzed the responses of 32 experts, 18 residents and three chatbots (ChatGPT v3.5, v4 and Bard) to 25 andrology clinical cases. Responses were assessed on a Likert scale ranging from 0 to 2 for each question (0-false response or no response; 1-partially correct response, 2- correct response), on the basis of the latest national or, in the absence of such, international recommendations. We compared the averages obtained for all cases by the different groups. RESULTS: Experts obtained a higher mean score (m=11/12.4 σ=1.4) than ChatGPT v4 (m=10.7/12.4 σ=2.2, p=0.6475), ChatGPT v3.5 (m=9.5/12.4 σ=2.1, p=0.0062) and Bard (m=7.2/12.4 σ=3.3, p<0.0001). Residents obtained a mean score (m=9.4/12.4 σ=1.7) higher than Bard (m=7.2/12.4 σ=3.3, p=0.0053) but lower than ChatGPT v3.5 (m=9.5/12.4 σ=2.1, p=0.8393) and v4 (m=10.7/12.4 σ=2.2, p=0.0183) and experts (m=11.0/12.4 σ=1.4,p=0.0009). ChatGPT v4 performance (m=10.7 σ=2.2) was better than ChatGPT v3.5 (m=9.5, σ=2.1, p=0.0476) and Bard performance (m=7.2 σ=3.3, p<0.0001). CONCLUSION: The use of chatbots in medicine could be relevant. More studies are needed to integrate them into clinical practice.

Artificial Intelligence: Ready To Pass the European Board Examinations in Urology?

The role of artificial intelligence (AI) in the medical domain is increasing on an annual basis. AI allows instant access to the latest scientific data in urological surgery, facilitating a level of theoretical knowledge that previously required several years of practice and training. To evaluate the capability of AI to provide robust data in a specialized domain, we submitted the in-service assessment of the European Board of Urology to three different AI tools: ChatGPT 3.5, ChatGPT 4.0, and Bard. The assessment consists of 100 single-answer questions with four multiple-choice options. We compared the responses of 736 participants to the AI responses. The average score for the 736 participants was 67.20. ChatGPT 3.5 scored 59 points, ranking in 570th place. ChatGPT 4.0 scored 80 points, ranking 80th, just on the border of the top 10%. Google Bard scored 68 points, ranking 340th. Our study demonstrates that AI systems have the capability to participate in a urological examination and achieve satisfactory results. However, a critical perspective must be maintained, as current AI systems are not infallible. Finally, the role of AI in the acquisition of knowledge and the dissemination of information remains to be delineated. Patient summary: We submitted questions from the European Diploma in Urological Surgery to three artificial intelligence (AI) systems. Our findings reveal that AI tools show remarkable performance in assessments of urological surgical knowledge. However, certain limitations were also observed.

Predictive Factors of Early Postoperative Complications After Robot-Assisted Radical Cystectomy for Urothelial Bladder Carcinoma.

Purpose: To identify protective and risk factors of early postoperative complications after robot-assisted radical cystectomy (RARC) for urothelial bladder carcinoma. Methods: Data of all robot-assisted cystectomies performed in six French centers between February 2010 and December 2019 were retrospectively reviewed. All RARCs for bladder cancer (muscle-invasive and high-risk or Bacillus Calmette-Guerin-resistant nonmuscle-invasive bladder cancer) were included. Perioperative outcomes and early postoperative complications (in the first 30 days) were collected. Multivariable analysis was performed to identify factors associated with early postoperative complications. Results: Two hundred seventy patients were included. The overall incidence of early postoperative complications after RARC was 52.2% (27% of major complications). Most frequent complications were infectious complications (24.4%) and paralytic ileus (15.6%). Anticoagulant therapy (odds ratio [OR] = 2.909, 95% confidence interval [CI]: 1.003-8.432) and ureteroenteric anastomosis-type Wallace II (OR = 4.4, 95% CI: 1.435-13.489) were associated with a higher rate of overall complications. Complete intracorporeal diversion was a protective factor (OR = 0.399, 95% CI: 0.222-0.718). Tobacco consumption, anticoagulant therapy, and ureteroenteric anastomosis-type Wallace II were associated with a higher rate of minor complications (OR = 2.01, 95% CI: 1.079-3.744; OR = 2.495, 95% CI: 1.022-6.089; OR = 3.836, 95% CI: 1.384-10.63, respectively). Opioid-free analgesia (OFA) was associated with a lower rate of infectious complications (OR = 0.148, 95% CI: 0.034-0.644). Conclusion: Early postoperative complication rate after RARC for urothelial bladder carcinoma is high. Encouraging complete intracorporeal diversion and promoting OFA seem to reduce postoperative complications in the first 30 days. Prospective studies are needed to provide a high level of evidence.

Preliminary assessment of patient and physician satisfaction with the use of teleconsultation in urology during the COVID-19 pandemic.

PURPOSE: Lockdown during the COVID-19 pandemic compelled urologists to change access to healthcare, especially for oncology patients. Teleconsultation is a safe way to receive medical advice without a risk of infection, and was implemented urgently in our academic centres. Our purpose was to evaluate patient and physician satisfaction with teleconsultation set up during the COVID-19 pandemic. METHODS: From March 16th 2020, all face-to-face consultations were cancelled in France, except for emergencies. Teleconsultation was started immediately by five senior urologists in two academic hospitals. All patients received an email survey including the validated Teleconsultation Satisfaction Questionnaire (TSQ) and demographic questions. Data were collected prospectively. Physicians also responded to the TSQ. Patient satisfaction was measured objectively with the validated 14-item TSQ. Each item was scored on a 5-point Likert scale. Factors associated with positive satisfaction with teleconsultation were assessed by multivariable logistic regression. RESULTS: Overall, 105 patients replied to the survey (91.3%). Median age was 66 years (IQR: 55‒71) and 95 were men (90.5%). Median overall TSQ score was 67 (IQR: 60‒69); teleconsultation was judged to be a good experience by 88 patients (83.8%) and four physicians (80%). Patients who met their surgeon for the first time were more likely to have a good experience (OR = 1.2 [95% CI 1.1‒1.5], p = 0.03). CONCLUSION: Introduced rapidly during the COVID-19 lockdown, urology teleconsultation attained a high level of satisfaction among both patients and physicians. A major change in telemedicine use is foreseen in the post COVID-19 era.

Functional outcomes obtained with intracorporeal neobladder after robotic radical cystectomy for cancer: a narrative review.

Robot-assisted radical cystectomy with intracorporeal urinary diversion is one of the most challenging procedures in urological surgery. Over the past 15 years, this procedure has gained in popularity and the number of procedures performed has increased significantly. While ileal conduit remains the most common diversion, orthotopic neobladders are also formed in a few expert centres that have developed their technique for totally intracorporeal neobladder. The objective of this review is to summarise the techniques currently used to perform totally intracorporeal neobladder with a special focus on their functional outcomes, such as continence or sexual function. The techniques described are the Karolinska-modified Studer neobladder, the USC-modified Studer neobladder, the pyramid pouch, the Y-pouch, and the vesica Ileale Padovana, some trying to totally reproduce the steps of open surgery and others trying to simplify them. Functional outcomes vary depending on the technique performed. Standardisation in assessing outcomes is lacking, as well as objective outcome measurements with questionnaires or urodynamic assessments. Current evidence shows acceptable functional outcomes after totally intracorporeal neobladder construction, but larger prospective randomised series with longer follow-up, better defined outcomes, and more objective measurements are needed in the future.