ChatGPT: Is This Patient Education Tool for Urological Malignancies Readable for the General Population?

Background: With widespread adoption of technological advancements in everyday life, patients are now increasingly able and willing to obtain information about their health conditions, treatment options, and indeed expected outcomes via the convenience of any device than can access the worldwide web. This introduces another aspect of patient care in the provision of healthcare for the modern doctor. ChatGPT is the first of an increasing number of self learning programs that have been released recently which may revolutionize and impact healthcare delivery. Methods: The aim of this study is to obtain an objective measure of the readability of information provided on ChatGPT when compared with current validated patient information sheets provided by government health institutions in Western Australia. The same structured questions were input into the program for three major urological malignancies (urothelial, renal, and prostate), with the response generated evaluated with a validated readability scoring system - Flesch-Kincaid reading ease score. The same scoring system was then applied to current patient information sheets in circulation from Cancer Council Australia and UpToDate. Results: Findings in this study looking at ease of readability of information provided on ChatGPT as compared to other government bodies and healthcare institutions confirm that they are non-inferior and may be a useful tool or adjunct to the traditional clinic based consultations. Ease of use of the information generated from ChatGPT was increased further when the question was modified to target an audience of 16 years of age, the average level of education attained by an Australian. Discussion: Future research can be done to look into incorporating the use of similar technologies to increase efficiency in the healthcare system and reduce healthcare costs.

Radiological Density, Atomic Numbers, and Stone Fragmentation of Bego Stones Used for Research in Endourology: Comparison to Real Urinary Stones.

Objective: The aim of the study was to characterize artificial stones used for research in endourology in terms of radiological properties and hardness, based on stone fragmentation, and to compare them with real stones. Materials and Methods: We built artificial stones using BegoStone Plus™ powder (BEGO, Lincoln, RI), with powder (g)-water (mL) ratios ranging from 15:03 to 15:12. The CT Gemstone Spectral Imaging Software® (GE Medical Systems, LLC, Waukesha, WI) was used to evaluate the radiological density in HU and spectral properties. Stone fragmentation was assessed in an in vitro experimental setting. These properties of artificial stones were compared with real urinary calculi. Results: Regarding radiological density in terms of HUs, 15:03 artificial calculi showed similar results when compared with real stones comprising calcium oxalate and calcium phosphate. The 15:03 and 15:04 artificial stones showed similar spectral property results to calcium pyrophosphate stones. The 15:11 artificial stones showed similar stone fragmentation results to real stones comprising uric acid, and 15:03 artificial calculi showed similar results to apatite and cystine stones. Conclusions: Artificial stones are useful for research in endourology. Stones with a powder (g)-water (mL) ratio of 15:03 proved to mimic real hard stones in terms of HUs, atomic number, and stone fragmentation in our study and could be used as artificial hard stones, and 15:11 stones showed similar stone fragmentation to uric acid stones. Our study might suggest that standard Bego stones are useful to investigate different areas in endourology, but not radiological properties because radiological homogeneity is not ensured unless more sophisticated mixing methods are used.

Computed Tomography-Guided Prostate Sampling and Fiducial Marker Insertion in Patients With Absent Rectums.

OBJECTIVES: We aimed to present our experience and the outcomes of a novel technique, computed tomography (CT)-guided prostate biopsy and fiducial marker insertion in patients with absent rectums. METHODS: Patients who underwent CT-guided prostate biopsy at a single institution from November 2010 to November 2022 were retrospectively reviewed. Patients were included if they had a clinical suspicion of prostate cancer and had absent rectums from previous surgical resection. Contrast-enhanced CT scan was used to perform transgluteal prostate biopsy. Patient demographics, multiparametric magnetic resonance imaging, and biopsy details were recorded. RESULTS: Thirteen biopsy procedures and 1 CT-guided fiducial marker insertion were performed on 12 unique patients. The reasons for the absence of rectums included surgical resection for rectal cancer (n = 10) and surgical resection for inflammatory bowel disease (n = 2). Clinically significant cancer was found in 7 of 13 biopsy results (52.8%), clinically insignificant cancer in 3 of 13 (23.1%), and benign cancer in 3 of 13 (23.1%). No complications were recorded. CONCLUSIONS: Our data support CT-guided prostate biopsy as an accurate and effective technique for investigating prostate cancer that requires tissue sampling in patients with absent rectums.

The Utility of Renal Mass Biopsy in Large Renal Masses.

Objectives: The role of needle core renal biopsy in large renal masses, defined as lesions larger than 4 cm, is debatable, as larger renal masses are associated with malignant histology. We aim to review the safety and impact of renal biopsy on the management of large renal masses. Methods: A retrospective, single-center review of all renal biopsies performed between January 2011 and December 2020 at Royal Perth Hospital was conducted. Indications for biopsy, complications and final management plans were correlated to assess the value of biopsies in large renal masses. Results: In total, 126 biopsies were performed. Indeterminate imaging findings and comorbidities were the main indications for biopsies. We identified 116 (92.1%) diagnostic biopsies and 10 (8.0%) non-diagnostic biopsies due to insufficient samples or inflammatory tissue. Of the diagnostic biopsies, 99 (78.6%) were malignant and 17 (13.5%) were benign. Unnecessary extirpative surgery was avoided in 17 patients. Histology included renal cell carcinoma (96%) and other malignancies such as urothelial carcinoma (3%) and non-Hodgkin's lymphoma (1%). Benign biopsies identified histology including angiomyolipoma (35.3%) and oncocytoma (52.5%). The median follow-up time was 68 months (range 19-132 months). Conclusion: Renal biopsies in large renal masses may aid in preventing unnecessary surgery, especially in situations where imaging findings are equivocal or in patients with many comorbidities.

An update on management of renal colic.

BACKGROUND: Renal tract pain is a common presentation in the primary care setting that can masquerade as other abdominopelvic conditions, and vice versa. A stepwise approach to a patient with renal tract pain can aid immensely in formulating an accurate diagnosis and providing optimal care. OBJECTIVE: The aim of this article is to present current evidence-based recommendations for renal tract pain to assist in its diagnosis, assessment and management. DISCUSSION: Renal tract pain is mediated by a surge in prostaglandin release, leading to arterial vasodilatation, increased vascular permeability, and subsequently ureteric oedema and spasms. Referred and migratory pain are hallmarks of this condition and are unique to renal colic because of the progressive passage of the stone along the ureter. Diagnosis requires a stepwise approach with history-taking, assessment, blood tests and imaging. Successful management of renal tract pain necessitates a combination of analgesia and medical expulsive therapy, failing which surgical intervention is required.

Review of acute symptomatic urolithiasis in Auckland.

AIM: To evaluate the incidence of acute symptomatic urolithiasis in the Auckland region. Associated epidemiological factors and stone characteristics were also studied and compared to previous research conducted in order to analyse trends. METHOD: All patients that presented acutely with symptomatic urolithiasis to the Auckland District Health Board (AHDB) between July 2014 and June 2015 were studied. Clinical data was obtained from medical records and population data was based on estimates provided by the Ministry of Health. Two-tailed tests and the Pearson Chi-Square tests were used for analysis. RESULTS: Overall, 1,125 patients (1,328 events) presented with an incidence of 85 per 100,000 per year, which was lower than that reported in 2006. The highest incidence was found among the Middle Eastern ethnic subgroup (0.130 %), followed by Maori (0.102%), Asian (0.087%), European (0.084%) and Pacific (0.041%) ethnicity. Males were more likely to be affected than females. Urolithiasis was most common in the fifth decade of life (25%). Forty-seven percent of the study population presented with multiple stones and 64% had recurrent urolithiasis or were 'high risk' stone formers. Distal ureteric stones <5mm were the most common (27%). Urine cultures were positive in 16% of cases. Seven hundred and thirty-nine (57%) were managed with medical management and ureteroscopy was most commonly performed for those who needed surgical intervention. CONCLUSIONS: The overall incidence of urolithiasis has decreased compared to previous research conducted in Auckland. This deviation could be attributed to the large influx of Asian immigrants observed in this period of time. A caucasian male, between 40-49 years, with a calculus <5mm in the distal ureter with a history of a previous urolithiasis has the highest chance to present with renal colic.

Intravesical bacillus Calmette-Guérin instillation in non-muscle-invasive bladder cancer: A review.

Intravesical bacillus Calmette-Guérin has been the standard of care for high-risk non-muscle-invasive bladder cancer for 40 years. It remains one of the most successful immunotherapies ever used. Bacillus Calmette-Guérin shows superior efficacy to alternative intravesical treatments, and has an established role in reducing both recurrence and progression in non-muscle-invasive bladder cancer. It remains relatively safe, and has acceptable tolerability of both local and systemic side-effects. The present review provides insights into the role of bacillus Calmette-Guérin compared with alternative treatments both in primary and refractory settings.

Venous thromboembolism prophylaxis in urology: A review.

Venous thromboembolism is potentially a lethal problem, and is associated with chronic morbidity. Venous thromboembolism is frequently diagnosed after urological surgery, yet the role of perioperative venous thromboembolism prophylaxis is not clearly defined. Any current recommendations are largely based on evidence derived from other surgical specialties. Even within different guidelines, there remains significant variation, suggesting a consensus is required. The present review aims to define the problem of venous thromboembolism within the urological population, and identifies patients at risk. It evaluates the role of various types of mechanical and pharmacological prophylaxis, along with its timing and duration of administration in common urological operations. The current guidelines are summarized and compared in order to give the reader a better perspective of this vital condition.