Comparison of traditional outcome measures and self-assessed goal achievement in patients treated surgically for benign prostatic hyperplasia.

PURPOSE: To determine self-assessed goal achievement (SAGA) outcomes in men treated surgically for lower urinary tract symptoms (LUTS) due to benign prostatic obstruction (BPO) and compare them to the traditional outcome measures. METHODS: Single-center analysis of prospective database of men undergoing surgical treatment of LUTS/BPO at a single institution between July 2019 and March 2021. We assessed individual goals, traditional questionnaires, and functional outcomes prior to treatment, and at first follow-up after 6-12 weeks. We compared SAGA outcomes 'overall goal achievement' and 'satisfaction with treatment' to subjective and objective outcomes using Spearman's rank correlations (rho). RESULTS: A total of sixty-eight patients completed the individual goal formulation prior to surgery. Preoperative goals varied between different treatments and individuals. IPSS correlated with 'overall goal achievement' (rho = - 0.78, p < 0.001) and 'satisfaction with treatment' (rho = - 0.59, p < 0.001). Similarly, the IPSS-QoL was correlated with overall goal achievement (rho = - 0.79, p < 0.001) and satisfaction with treatment (rho = - 0.65, p < 0.001). No correlation was seen between SAGA outcomes and functional outcomes Qmax and PVR. CONCLUSIONS: SAGA represents a uniquely patient-specific outcome measure. Our study is, to our knowledge, the first to assess patient-specific goals prior to surgery and examine SAGA outcomes following treatment in men suffering from LUTS/BPO. The correlation of SAGA outcomes with IPSS and IPSS-QoL highlight the importance of this well-established questionnaire. Functional outcomes do not necessarily reflect patient's goals and may rather be considered physician-directed outcomes.

Reduction of stent-associated morbidity by minimizing stent material: a prospective, randomized, single-blind superiority trial assessing a customized 'suture stent'.

OBJECTIVES: To compare a customized 'suture stent' with a standard ureteric stent regarding stent-related symptoms, safety and efficacy. MATERIALS AND METHODS: Patients with urolithiasis located proximal to the iliac vessel crossing, requiring stenting in preparation for secondary ureterorenoscopy (URS) were randomized to standard ureteric stenting or a suture stent. Secondary ureterorenoscopy was performed 2-6 weeks later. The Ureteral Stent Symptoms Questionnaire (USSQ) was completed after 1 week, on the day before URS and 2-6 weeks after stent removal. Stent efficacy and safety were systematically assessed. RESULTS: A total of 88 patients were included in the analysis. The median (range) suture stent length was 10 (5-25) cm vs 26 cm for standard stents. Operation time was longer for insertion of the suture stent (24.0 vs 14.5 min; P < 0.001). Patients with a suture stent had a significantly lower USSQ urinary symptoms score 1 week after stent insertion, adjusted for baseline symptoms by subtracting scores from the final visit without indwelling stent (mean 7.1 vs 13.7, difference -6.6, 95% confidence interval [CI] -3.4 to -9.8; P < 0.001). Prior to secondary URS (after 2-6 weeks), baseline-adjusted urinary symptoms (mean 4.7 vs 12.2, difference -7.5, 95% CI -4.5 to -10.4; P < 0.001) and pain subscores (11.5 vs 17.6, difference -6.1, 95% CI -0.7 to -11.6; P = 0.004) were significantly lower in the suture stent group. All other USSQ subscores showed no significant differences. Adverse events occurred in 15 patients and were similarly frequent in the two groups. No significant differences were found between the groups regarding ureteric access during secondary URS. CONCLUSION: Replacement of the distal part of ureteric stents by a suture can reduce stent-associated symptoms without restrictions regarding secondary stone removal or safety.

The German linguistic validation of the Wisconsin Stone Quality of Life questionnaire (WisQoL).

PURPOSE: WisQoL (Wisconsin Stone Quality of Life questionnaire) is a disease specific, health related quality of life measure designed for patients who form kidney stones. The goal of this study was to develop and validate a German version of WisQoL. METHODS: The German version of the WisQoL was developed following a standardized multistep process. Patients were recruited prior to stone treatment, and completed the questionnaire as well as the SF-36v2 (36-Item Short Form Health Survey). This was repeated 1, 3, and 6 months after stone surgery. Scores of the 28 questionnaire items were summarized into sum scores for four domains and a total score. The psychometric properties of the questionnaire were statistically analyzed. RESULTS: The German WisQoL demonstrated excellent internal consistency (Cronbach's α > 0.90 for all domains at all visits). All inter-domain associations were positive. The test-retest reliability for patients with unchanged self-reported health state was considered satisfactory (Spearman's rho for total score 0.70 [95% CI 0.55 to - 0.80]). The German WisQoL demonstrated good convergent validity with the validated SF-36v2 (correlation between corresponding items 0.44 to 0.64). All domain scores showed significant sensitivity to change induced by stone treatment (p ≤ 0.05). Total WisQoL scores generally improved during the first 3 months following stone treatment, and remained stable thereafter. CONCLUSION: The German WisQoL proved to be a reliable and robust instrument to evaluate health related quality of life measures of kidney stone patients in the clinical setting. It is expected to be of use for further research in patients with kidney stones.

Systematic assessment of information about surgical urinary stone treatment on YouTube.

PURPOSE: To systematically assess the quality of videos on the surgical treatment of urinary stones available on YouTube using validated instruments. METHODS: A systematic search for videos on YouTube addressing treatment options of urinary stones was performed in October 2019. Assessed parameters included basic data (e.g. number of views), the grade of misinformation reporting of conflicts of interest. Quality of content was analyzed using the validated DISCERN questionnaire. Data were analyzed using descriptive statistics. RESULTS: A total of 100 videos with a median of 26,234 views (1020-1,720,521) were included in the analysis. Of these, only 26 videos were rated to contain no misinformation and only nine disclosed potential conflicts of interest. Overall, the median quality of the videos was low (2 out of 5 points for DISCERN question 16). Videos uploaded by healthcare professionals and medical societies/organizations offered significantly higher levels of quality. In particular, the videos provided by the EAU achieved the highest rating with a median score of 3.0. CONCLUSIONS: The majority of videos concerning the surgical treatment of urinary stones have a low quality of content, are potentially subject to commercial bias and do not report on conflicts of interest. Videos provided by medical societies, such as the EAU, provide a higher level of quality. This highlights the importance of active recommendation of evidence-based patient education materials.

Qualitative Assessment of Medical Information on YouTube: A Multilingual Comparison of Common Urological Conditions.

INTRODUCTION: Patients nowadays often search video-sharing platforms for online patient education materials. Since previous assessments of urological videos were limited to English, we systematically assessed the quality of videos on treatment of benign prostatic hyperplasia (BPH), prostate cancer (PCa), and urinary stone disease (USD) in 4 different languages on YouTube using validated instruments. METHODS: The search for videos on YouTube addressing treatment options of BPH, PCa, and USD was performed in October 2020 in -English, French, German, and Italian. Assessed parameters included basic data (e.g., number of views), grade of misinformation, and reporting of conflicts of interest. Quality of content was analyzed using the validated DISCERN questionnaire. Data were analyzed using descriptive statistics. RESULTS: A total of 240 videos (60 videos in each language) were analyzed. Videos on USD in English had the highest number of views (median views 271,878 [65,313-2,513,007]). The median overall quality of videos assessed showed a moderate quality (2.5-3.4 points out of 5 points for DISCERN item 16). Median total DISCERN score of all videos divided by language showed very similar results: English (39.75 points), French (38 points), German (39.5 points), and Italian (39 points). Comparing the different diseases, videos about BPH showed the highest median scores, especially in German language (median score 43.25 points). CONCLUSIONS: Videos concerning the treatment of BPH, PCa, and USD have a low to moderate quality of content, with no differences seen between the languages assessed. These findings further support the notion of improved patient information materials on video platforms such as YouTube.

Information on surgical treatment of benign prostatic hyperplasia on YouTube is highly biased and misleading.

OBJECTIVES: To assess the quality of videos on the surgical treatment of lower urinary tract symptoms associated with benign prostatic hyperplasia (LUTS/BPH) available on YouTube, given that such video-sharing platforms are frequently used as sources of patient information and the therapeutic landscape of LUTS/BPH has evolved substantially during recent years. MATERIALS AND METHODS: A systematic search for videos on YouTube addressing treatment options for LUTS/BPH was performed in May 2019. Measures assessed included basic data (e.g. number of views), grade of misinformation and reporting of conflicts of interest. The quality of content was analysed using the validated DISCERN questionnaire. Data were analysed using descriptive statistics. RESULTS: A total of 159 videos with a median (range) of 8570 (648-2 384 391) views were included in the analysis. Only 21 videos (13.2%) were rated as containing no misinformation, 26 (16.4%) were free of commercial bias, and two (1.3%) disclosed potential conflicts of interest. According to DISCERN, the median overall quality of the videos was low (2 out of 5 points for question 16). Only four of the 15 assessed categories (bipolar and holmium laser enucleation of the prostate, transurethral resection of the prostate and patient-based search terms) were scored as having moderate median overall quality (3 points). CONCLUSION: Most videos on the surgical treatment of LUTS/BPH on YouTube had a low quality of content, provided misinformation, were subject to commercial bias and did not report on conflicts of interest. These findings emphasize the importance of thorough doctor-patient communication and active recommendation of unbiased patient education materials.

In-hospital cost analysis of prostatic artery embolization compared with transurethral resection of the prostate: post hoc analysis of a randomized controlled trial.

OBJECTIVES: To perform a post hoc analysis of in-hospital costs incurred in a randomized controlled trial comparing prostatic artery embolization (PAE) and transurethral resection of the prostate (TURP). PATIENTS AND METHODS: In-hospital costs arising from PAE and TURP were calculated using detailed expenditure reports provided by the hospital accounts department. Total costs, including those arising from surgical and interventional procedures, consumables, personnel and accommodation, were analysed for all of the study participants and compared between PAE and TURP using descriptive analysis and two-sided t-tests, adjusted for unequal variance within groups (Welch t-test). RESULTS: The mean total costs per patient (±sd) were higher for TURP, at €9137 ± 3301, than for PAE, at €8185 ± 1630. The mean difference of €952 was not statistically significant (P = 0.07). While the mean procedural costs were significantly higher for PAE (mean difference €623 [P = 0.009]), costs apart from the procedure were significantly lower for PAE, with a mean difference of €1627 (P < 0.001). Procedural costs of €1433 ± 552 for TURP were mainly incurred by anaesthesia, whereas €2590 ± 628 for medical supplies were the main cost factor for PAE. CONCLUSIONS: Since in-hospital costs are similar but PAE and TURP have different efficacy and safety profiles, the patient's clinical condition and expectations - rather than finances - should be taken into account when deciding between PAE and TURP.

Influence of biofilms on morbidity associated with short-term indwelling ureteral stents: a prospective observational study.

PURPOSE: To evaluate the influence of biofilms on morbidity associated with short-term ureteral stenting using contemporary methods of biofilm examination and validated assessment of symptoms. METHODS: Patients undergoing temporary ureteral stenting for secondary ureterorenoscopy due to urinary calculi were prospectively included. The German Ureteral Stent Symptoms Questionnaire (USSQ) was used to assess stent-associated morbidity. Biofilms were removed from stents using 'pinhole extraction', a novel, validated, abrasion-based technique. Extracted biofilms were analyzed for total mass, bacterial load and mineral components. Correlation between total biofilm mass and USSQ total score was the primary outcome variable analyzed using Spearman correlation. Secondary outcomes included correlations between various biofilm characteristics and symptoms. RESULTS: 94 patients were included in the analysis. Extracted biofilm mass had a median of 37.0 mg (0-310.2 mg) per stent. No correlation between total biofilm mass and USSQ total score was found (Spearman r = 0.012; p = 0.911). Correlations between biofilm characteristics and morbidity were generally weak and not significant. Significant correlations could be found between biofilm mass and hematuria (r = 0.280; p = 0.007), and between the number of bacteria (qPCR) and the USSQ subscore for pain (r = 0.243; p = 0.019) and the intake of analgesics (r = 0.259; p = 0.012). CONCLUSION: Based on elaborated biofilm examination methods and validated self-reported outcome measures, our findings indicate that biofilms might aggravate some lower urinary tract symptoms but are not the main trigger for stent-associated morbidity in short-term ureteral stenting.

Predictability and Inducibility of Detachment of Prostatic Central Gland Tissue after Prostatic Artery Embolization: Post Hoc Analysis of a Randomized Controlled Trial.

PURPOSE: To assess the frequency and potential predictors of prostatic central gland tissue detachment (CGD), an enucleation-like reaction that sporadically occurred in a randomized controlled trial assessing efficacy and safety of prostatic artery embolization (PAE). MATERIALS AND METHODS: Trial data were analyzed to identify patients with CGD after PAE. Clinical parameters, MR imaging findings, technical details of PAE, and periinterventional data were compared between patients with and without CGD to identify parameters for prediction, induction, or early detection of CGD after PAE. RESULTS: CGD occurred after PAE in 3 of 48 patients (6.3%); these cases had good functional outcomes, but CGD was associated with increased risk of ejaculatory dysfunction and occurrence of complications. Frequency of preoperative transurethral bladder catheterization (100% vs 13.3%; P = .005), central gland index (mean ± standard deviation, 0.86 ± 0.02 vs 0.69 ± 0.14; P < .001), amount of particles applied (1.93 mL ± 0.12 vs 0.96 mL ± 0.36; P < .001), maximum early postoperative pain score (7.33 ± 2.08 vs 1.89 ± 2.40; P = .009), and blood C-reactive protein (CRP) levels after 48 hours (69.0 vs 18.58 mg/dL; P = .045) and 1 week (113.50 vs 5.16 mg/dL; P = .004) were significantly higher in cases of CGD. CONCLUSIONS: CGD is a rare reaction that might be triggered by prostatic zonal anatomy, embolization technique, and mechanical or inflammatory processes. It should be considered in patients with severe postoperative pain and high CRP levels who experience voiding dysfunction after PAE to avoid complications. Investigation of larger cohorts might further elucidate this tissue response.

Detection of microbial colonization of the urinary tract of patients prior to secondary ureterorenoscopy is highly variable between different types of assessment: results of a prospective observational study.

This study compares the findings of different detection methods for microorganisms in patients with ureteral stents undergoing secondary ureterorenoscopy including the use of a novel validated examination pipeline for biofilms on ureteral stents. Of the included 94 patients, 21.3% showed bacteriuria in preoperative urine cultures. Intraoperative urine culture showed bacteriuria in four (4.3%) of the patients. Stent biofilm cultures were positive in 12.9% and qPCR detected bacterial DNA in 18.1%. The findings of the different examinations were poorly correlated with each other. Detection of microorganisms in the urinary tract of patients with indwelling ureteral stents is highly dependent on timing (i.e. pre- vs intraoperative) and method of assessment. Preoperative routine urine cultures are not predictive for intraoperative urine- and stent culture. These results cast doubt on the clinical relevance of enterococcal species, staphylococci, and streptococci if identified preoperatively prior to stent removal. The timing of oral preoperative antibiotic prophylaxis might need to be reconsidered.

Spoilt for Choice: A Survey of Current Practices of Surgical Urinary Stone Treatment and Adherence to Evidence-Based Guidelines among Swiss Urologists.

INTRODUCTION: Urologists have to master a variety of techniques to be able to offer the most appropriate surgical stone treatment for each individual patient. Therefore, we performed a survey among board-certified Swiss urologists to assess the availability of the different surgical methods, the current practices of surgical treatment of urolithiasis and the adherence to evidence-based guideline recommendations in Switzerland. METHODS: A 14-question survey assessed the working environment, equipment, perioperative settings and decision trees for specific stone scenarios. Data was analyzed using descriptive statistics and chi-square tests to determine differences between frequencies of answers. RESULTS: Hundred and five members of Swiss Urology (38%) completed the survey. All treatment modalities are available for the majority of respondents. Ureterorenoscopy was found to have the highest availability (100%) and was the preferred choice in the majority of stone scenarios. A high adherence to the guidelines was found for the treatment of ureteral stones <10 mm (100% proximal and distal), and >10 mm (69% proximal, 94% distal). All respondents answered in accordance with the guidelines regarding the treatment of middle and upper pole stones <10 mm, 10-20 mm and lower pole stones 10-20 mm. Guideline adherence was 99% for lower pole stones <10 mm, 78% for lower pole stones >20 mm, and 63% for middle/upper pole stones >20 mm. CONCLUSION: This survey provides a detailed insight into current stone treatment practices in Switzerland. The full spectrum of urinary stone treatment options is available for the majority of Swiss urologists. The choice of treatment shows a high accordance with evidence-based guidelines and a preference for retrograde endoscopic surgery in the majority of stone scenarios.

CT-calculometry (CT-CM): advanced NCCT post-processing to investigate urinary calculi.

PURPOSE: This study aimed at evaluating the potential of CT-calculometry (CT-CM) as a novel method to determine mineralisation, composition, homogeneity and volume of urinary calculi based on preoperative non-contrast-enhanced computed tomography (NCCT) scans. MATERIALS AND METHODS: CT-CM was performed in preoperative NCCTs of 25 patients treated for upper tract urinary calculi by ureterorenoscopy or percutaneous nephrolithotomy. Absolute mineralisation values were achieved by use of quantitative CT-osteoabsorptiometry and compared to Fourier infrared spectroscopy as a reference for stone composition. Homogeneity was assessed by advanced software-based NCCT post-processing and visualised by using a maximum intensity projection algorithm. Volumetric measurement was performed by software-based three-dimensional reconstruction. RESULTS: CT-CM was feasible in all of the 25 NCCTs. Absolute mineralisation values calculated by quantitative CT-OAM might be used to identify the most frequent stone types. High levels of inhomogeneity could be detected even in pure component stones. Volumetric measurement could be performed with minimal effort. CONCLUSIONS: CT-CM is based on advanced NCCT post-processing software and represents a novel and promising approach to determine mineralisation, composition, homogeneity and volume of urinary calculi based on preoperative NCCT. CT-CM could provide valuable information to predict outcome of different stone treatment methods.

Surgical management of urolithiasis - a systematic analysis of available guidelines.

BACKGROUND: Several societies around the world issue guidelines incorporating the latest evidence. However, even the most commonly cited guidelines of the European Association of Urology (EAU) and the American Urological Association (AUA) leave the clinician with several treatment options and differ on specific points. We aimed to identify discrepancies and areas of consensus between guidelines to give novel insights into areas where low consensus between the guideline panels exists, and therefore where more evidence might increase consensus. METHODS: The webpages of the 61 members of the Societé Internationale d'Urologie were analysed to identify all listed or linked guidelines. Decision trees for the surgical management of urolithiasis were derived, and a comparative analysis was performed to determine consensus and discrepancies. RESULTS: Five national and one international guideline (EAU) on surgical stone treatment were available for analysis. While 7 national urological societies refer to the AUA guidelines and 11 to the EAU guidelines, 43 neither publish their own guidelines nor refer to others. Comparative analysis revealed a high degree of consensus for most renal and ureteral stone scenarios. Nevertheless, we also identified a variety of discrepancies between the different guidelines, the largest being the approach to the treatment of proximal ureteral calculi and larger renal calculi. CONCLUSIONS: Six guidelines with recommendations for the surgical treatment of urolithiasis to support urologists in decision-making were available for inclusion in our analysis. While there is a high grade of consensus for most stone scenarios, we also detected some discrepancies between different guidelines. These are, however, controversial situations where adequate evidence to assist with decision-making has yet to be elicited by further research.

Readability Assessment of Patient Education Material Published by German-Speaking Associations of Urology.

OBJECTIVE: To assess the readability and comprehensibility of web-based German-language patient education material (PEM) issued by urological associations. MATERIALS AND METHODS: German PEM available in June 2017 was obtained from the European Association of Urology (EAU), German (DGU), Swiss (SGU) and Austrian (ÖGU) Association of Urology websites. Each educational text was analyzed separately using 4 well-established readability assessment tools: the Amstad Test (AT), G-SMOG (SMOG), Wiener Sachtextformel (WS) and the Lesbarkeitsindex (LIX). RESULTS: The EAU has issued PEM on 8 topics, the DGU 22 and the SGU 5. The ÖGU refers to the PEMs published by the DGU. Calculation of grade levels (SMOG, WS, LIX) showed readability scores of the 7th-14th grades. The easiest readability was found for materials on Nocturia and Urinary Incontinence issued by the EAU. Kidney Cancer and Infertility, issued by the DGU had the hardest readability. The EAU achieved the best median AT score, followed by the SGU, and the DGU. CONCLUSION: Remarkable differences between readability were found for the PEMs issued by EAU, DGU and SGU. Materials published by the EAU were the easiest to read. Improving the readability of certain PEMs is of crucial importance to meet patient needs and act in the interests of a growing, self-informing German-speaking patient community.

Prevention and treatment of symptoms associated with indwelling ureteral stents: A systematic review.

Temporary drainage of the upper urinary tract by internal ureteral stents is a routine procedure in endourology. However, it is associated with a clear side-effect profile. Our aim was to evaluate prevention and treatment options of stent-related symptoms. We carried out a systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines using MEDLINE and SCOPUS, and identified 107 appropriate records. A high number of these studies showed clear methodological limitations. Available data clearly support the use of α1 -blockers in patients suffering from stent-related symptoms. It seems that antimuscarinic monotherapy or combination with α1 -blockers might also play an important role, whereas the use of classical analgesics in the treatment of stent-related symptoms has not been assessed systematically within clinical trials so far. Improvements in stent design and material seem to have the potential to reduce stent-related symptoms. However, so far there is no type of stent with outstanding characteristics and clear evidence suggesting fundamental advantages compared with a standard double pigtail stent. Although stent diameter does not seem to influence patients' comfort, it seems to be beneficial to choose a proper stent-length. Coated and drug-eluting stents, as well as intravesical drug application, seem to be promising concepts to prevent stent-related symptoms, but still have to be considered as experimental approaches. Furthermore, thorough patient education has the potential to reduce the morbidity associated with ureteral stenting. Further research in the field seems to be mandatory.

Minimally Invasive Therapies for Benign Prostatic Obstruction: A Review of Currently Available Techniques Including Prostatic Artery Embolization, Water Vapor Thermal Therapy, Prostatic Urethral Lift, Temporary Implantable Nitinol Device and Aquablation.

A 66-years old male patient presents with lower urinary tract symptoms, mostly due to obstructive symptoms, and an enlarged prostate with 80 cm3, with a broad-based median lobe, suggestive of benign prostatic obstruction (BPO). Trans-urethral resection of the prostate (TURP) was proposed. However, the patient desired to preserve ejaculatory function and was afraid of a potential negative impact on erectile function. Thus, the patient inquired about minimally invasive therapies (MITs) as alternatives to TURP. In this review, currently available MITs for BPO are described including prostatic artery embolization, water vapor thermal therapy (Rezum®), prostatic urethral lift, iTIND® (temporary implantable device) and aquablation (Aquabeam®). Focus is given on the description of the technique, level of evidence and advantages over conventional surgical options.

Stay cool! Special underwear for cyclic cooling significantly decreases scrotal skin temperature.

INTRODUCTION: Male reproductive health is rapidly declining during the past decades and it is well known that scrotal temperature is linked to male infertility. MATERIAL AND METHODS: We performed a prospective data evaluation within a counterfactual analysis study design. Scrotal cooling was performed using Snowballs™ underwear, scrotal temperature was monitored using a wireless temperature sensor (SensorPush, Brooklyn, NY, 11215). RESULTS: Overall, scrotal skin temperatures were monitored for 1008 hours. Median scrotal skin temperature was 34.6°C (IQR 33.1 to 35.3) and 35.3°C (IQR 34.4 to 35.9) in the experimental (SnowWedge™) period and control period, respectively, which was significantly different (P <0.001). CONCLUSIONS: Cyclic scrotal skin cooling using specialized underwear is feasible and efficacious without impairing the activities of daily living and reduces median scrotal skin temperature significantly by 0.7°C. Given the proven association of scrotal skin temperature and semen quality, cyclic scrotal skin cooling by a device such as Snowballs™ underwear may eventually increase semen quality and fertility.

Radiotherapy or Surgery? Comparative, Qualitative Assessment of Online Patient Education Materials on Prostate Cancer.

As multiple different treatment options are available for prostate cancer (PCa) and YouTube is commonly used as a source for medical information, we performed a systematic and comparative assessment of available videos guiding patients on their choice for the optimal treatment. An independent search for surgical therapy or radiotherapy of PCa on YouTube was performed and the 40 most viewed videos of both groups were analyzed. The validated DISCERN questionnaire and PEMAT were utilized to evaluate their quality and misinformation. The median overall quality of the videos was found to be low for surgery videos, while radiotherapy videos results reached a moderate quality. The median PEMAT understandability score was 60% (range 0-100%) for radiotherapy and 75% (range 40-100) for surgery videos. The radiotherapy videos contained less misinformation and were judged to be of higher quality. Summarized, the majority of the provided videos offer insufficient quality of content and are potentially subject to commercial bias without reports on possible conflict of interest. Thus, most of available videos on YouTube informing PCa patients about possible treatment methods are not suited for a balanced patient education or as a basis for the patient's decision.

Aquablation versus holmium laser enucleation of the prostate in the treatment of benign prostatic hyperplasia in medium-to-large-sized prostates (ATHLETE): protocol of a prospective randomised trial.

INTRODUCTION: A novel method for the surgical treatment of benign prostatic hyperplasia (BPH) called Aquablation has become commercially available. Previous studies have been able to show similar functional results when compared with transurethral resection of the prostate and a high efficacy has been demonstrated when this approach is applied to patients with a prostate size of 80-150 cm3.Holmium laser enucleation of the prostate (HoLEP) is a well-established procedure in the surgical treatment of BPH in prostate glands larger than 30 mL and a first-line therapy in glands over 80 mL. To date, no data are available whether Aquablation is non-inferior compared with HoLEP in the treatment of patients with medium-to-large-sized prostates regarding safety and efficacy. METHODS AND ANALYSIS: This is a prospective, randomised, open-label, non-inferiority clinical trial conducted at a Swiss centre of tertiary care. The primary outcome is assessment of non-inferiority of Aquablation compared with HoLEP in reducing lower urinary tract symptoms due to benign prostatic obstruction measured by the International Prostate Symptom Score (IPSS). Randomisation will be performed using secuTrial, stratifying on age (<70 years, 70+ years) and prostate volume (<100 mL, 100+ mL). Both interventions are performed in an inpatient setting and regular follow-up controls starting 8 weeks after intervention and continuing up to 5 years will be performed. The primary outcome (change in IPSS from baseline to 6 months) will be tested for non-inferiority with a one-sided t-test. Secondary outcomes, such as efficacy parameters, several patient-reported outcome measures, and periprocedural and safety parameters will be described by calculating means or relative frequencies for each treatment group and testing differences with two-sided standard superiority tests. ETHICS AND DISSEMINATION: The study was approved by the local ethics committee (EKOS 2020-02353). Results of the primary endpoint and each of the secondary endpoints will be published in an international peer-reviewed journal. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov Registry (NCT04560907).

Radiation Exposure During Prostatic Artery Embolisation: A Systematic Review and Calculation of Associated Risks.

Although evidence supporting the efficacy and safety of prostatic artery embolisation (PAE) is increasing, potential associated risks of ionising radiation in this context remain largely unknown. We systematically reviewed reports on radiation exposure (RE) during PAE in the literature and estimated the risk RE poses using a Monte Carlo dose calculation algorithm. Of 842 studies screened, 22 were included. The overall mean dose area product (DAP) was 181.6 Gy∙cm2 (95% confidence interval 125.7-262.4). The risk model for the effects of RE in a 66-yr-old patient exposed to DAP of 200 Gy∙cm2 showed that the probability of cancer death from the intervention was 0.117%. The highest specific lifetime risk was expected for leukaemia (0.061%). Wide DAP variation between individual studies (medians ranging from 33.2 to 863.4 Gy∙cm2) indicate large potential to reduce RE during PAE at some study centres. RE must be included in patient counselling on PAE, especially for younger patients. PATIENT SUMMARY: We systematically assessed radiation exposure during prostatic artery embolisation (PAE) in the literature and simulated the associated risks in a computer model. PAE exposes patients to very low but not negligible risks, which are most relevant for younger men. This should be discussed with patients before PAE.