Predicting Antibiotic Susceptibility Among Patients With Recurrent Urinary Tract Infection Using a Prior Culture.

PURPOSE: Recurrent cystitis guidelines recommend relying on a local antibiogram or prior urine culture to guide empirical prescribing, yet little data exist to quantify the predictive value of a prior culture. We constructed a urinary antibiogram and evaluated test metrics (sensitivity, specificity, and Bayes' positive and negative predictive values) of a prior gram-negative organism on predicting subsequent resistance or susceptibility among patients with uncomplicated, recurrent cystitis. MATERIALS AND METHODS: We performed a retrospective database study of adults with recurrent, uncomplicated cystitis (cystitis occurring 2 times in 6 months or 3 times in 12 months) from urology or primary care clinics between November 1, 2016, and December 31, 2018. We excluded pregnant females, patients with complicated cystitis, or pyelonephritis. Test metrics were calculated between sequential, paired cultures using standard formulas. RESULTS: We included 597 visits from 232 unique patients wherein 310 (51.2%) visits had a urine culture and 165 had gram-negative uropathogens isolated. Patients with gram-negative uropathogens were mostly females (97%), with a median age of 58.5 years. Our antibiogram found 38.0%, 27.9%, and 5.5% of Escherichia coli isolates had resistance to trimethoprim-sulfamethoxazole, ciprofloxacin, and nitrofurantoin, respectively. Prior cultures (within 2 years) had good predictive value for detecting future susceptibility to first-line agents nitrofurantoin (0.85) and trimethoprim-sulfamethoxazole (0.78) and excellent predictive values (≥0.90) for cefepime, ceftriaxone, cefuroxime, ciprofloxacin, levofloxacin, gentamicin, tobramycin, piperacillin-tazobactam, and imipenem. CONCLUSIONS: Considerable antibiotic resistance was detected among E coli isolates in patients with recurrent, uncomplicated cystitis. Using a prior culture as a guide can enhance the probability of selecting an effective empirical agent.

Pediatric Urologists' Views on the US News & World Report.

PURPOSE: Our goal was to understand the general attitudes of pediatric urologists regarding the US News & World Report rankings for Best Children's Hospitals in Urology. MATERIALS AND METHODS: We performed a cross-sectional survey study distributed via email to active and candidate members of the Societies of Pediatric Urology from October 2022 to December 2022. This anonymous survey was iteratively developed to contain multiple choice questions gathering information on demographics, personal interaction with the rankings system, and about attitudes toward the rankings across various domains. RESULTS: Of the 515 members surveyed, 264 pediatric urologists responded to the survey for a response rate of 51%. There was representation from all sections of the AUA and across all age categories and practice models. Overall, of the respondents, 71% disagreed that the rankings had led to improvements in care and 75% disagreed that programs were reporting their data honestly. Additionally, 71% believed the rankings are inaccurate in reflecting patient outcomes. The majority (86%) of respondents stated they would support organized efforts to withdraw from the rankings. This was significantly different by ranking cohort, with 78% from top 10 programs endorsing withdrawal vs 89% from those programs not in the top 10. CONCLUSIONS: Our survey found that most pediatric urologists would support efforts to withdraw from participating in the rankings and believe that programs are dishonest in reporting their data. The majority also do not believe a survey can adequately distinguish between programs. This highlights a clear need for a critical reevaluation of the rankings.

Reporting of Harms in Randomized Controlled Trials Published in Urology Journals: An Updated Analysis.

PURPOSE: Harms are often overlooked, but important, outcomes of randomized controlled trial reporting. Our goal was to determine if harms reporting has improved in high-impact urology journals. MATERIALS AND METHODS: Randomized controlled trials published in The Journal of Urology®, Urology, European Urology, and BJU International in 2012 and 2020 were analyzed. Each randomized controlled trial was evaluated by 2 authors in a masked-duplicate fashion to evaluate for adherence to harms reporting guidelines recommended by the Consolidated Standards of Reporting Trials (CONSORT) group. RESULTS: One hundred and thirty-two published studies met inclusion criteria. Between 2012 and 2020, there was a statistically significant increase in the median number of harms criteria reported between 2012 and 2020 (5.3 vs 7.2; P = .01). Methods criteria demonstrating the greatest improvements included item #3 "which harms were assessed," item #4a "when harm information was collected," and item #4b "methods to attribute harm to intervention." Results sections with the most improvement in reporting include item #6 "reasons for patient withdrawal," item #8a "effect size for harms," and item #8b "stratified serious + minor harms." CONCLUSIONS: Reporting of adverse events in randomized trials published in several top urology journals has demonstrated marked improvement. Studies published in 2020 reported approximately 70% of CONSORT-Harms criteria-an increase of nearly 40% since 2004. While these improvements mark significant change, deficits remain present and should be addressed to provide clinicians with the most complete perspective possible.

Urology HEIRS: A Feasibility and Acceptability Study for Video-Based Research on Physician-Family Communication in Pediatric Urology Visits.

PURPOSE: Patient- and family-centered communication is essential to healthcare equity. However, less is known about how urologists implement evidence-based communication and dynamics involved in caring for diverse pediatric patients and caregivers. We sought to evaluate the feasibility and acceptability using video-based research to characterize physician-family communication in pediatric urology. MATERIALS AND METHODS: We assembled a multidisciplinary team to conduct a multi-phase learning health systems project to establish the Urology HEIRS (Health Experiences and Interactions in Real-time Studies) corpus for research and interventions. This paper reports the first phase, evaluating feasibility and acceptability based on consent rate, patient diversity, and qualitative identification of verbal and paraverbal features of physician-family communication. We used applied conversation analysis methodology to identify salient practices across eight pediatric urologists. RESULTS: We recruited 111 families at two clinic sites, of these 82 families (N = 85 patients, ages 0-20) participated in the study with a consent rate of 73.9%. The racial/ethnic composition of the sample was 45.9% non-Hispanic White, 30.6% any race of Hispanic origin, 16.5% non-Hispanic Black/African American, 4.7% any ethnicity of Asian/Asian American, 2.3% some other race/ethnicity, and 24.7% of families used interpreters. We identified 11 verbal and paraverbal communication practices that impacted physician-family dynamics, including unique challenges with technology-mediated interpreters. CONCLUSIONS: Video-based research is feasible and acceptable with diverse families in pediatric urology settings. The Urology HEIRS corpus will enable future systematic studies of physician-family communication in pediatric urology and provides an empirical basis for specialty-specific training in patient- and family-centered communication.

Adults With Spina Bifida Fare Worse Than Young Adults: A Systemic Vulnerability in Urinary Tract Infection-Related Hospital Care.

PURPOSE: We aim to estimate the odds of UTI-related hospital care in spina bifida (SB) patients aged 18 to 25 years as compared with patients with SB in adolescence (11-17 years) or adulthood (26-35 years). We hypothesize that patients with SB in the typical transitional age, 18 to 25 years, will have higher odds of UTI-related hospital care as compared to adolescent SB patients or adult SB patients. MATERIALS AND METHODS: Using Cerner Real-World Data, we performed a retrospective cohort analysis comparing SB patients to age- and gender-matched controls. SB cases between 2015 and 2021 were identified and compared in 3 cohorts: 11 to 17 years (adolescents), 18 to 25 years (young adults [YA]), and 26 to 35 years (adults). Logistic regression analysis was used to characterize the odds of health care utilization. RESULTS: Of the 5497 patients with SB and 77,466 controls identified, 1839 SB patients (34%) and 3275 controls (4.2%) had at least 1 UTI encounter. UTI-related encounters as a proportion of all encounters significantly increased with age in SB patients (adolescents 8%, YA 12%, adult 15%; P < .0001). Adjusting for race, sex, insurance, and comorbidities, the odds of a UTI-related encounter in YA with SB were significantly higher than for adolescents with SB (adolescent odds ratio = 0.65, 95% CI: 0.57-0.75, P < .001). YA had lower odds of a UTI-related encounter as compared with adults with SB (adult odds ratio = 1.31, 95% CI: 1.16-1.49, P < .001). CONCLUSIONS: YA with SB have higher odds of UTI-related hospital care than adolescents, but lower odds of UTI-related hospital care when compared with adults.

Multi-Institutional Outcomes of Dorsal Onlay Buccal Mucosal Graft Urethroplasty in Patients With Postprostatectomy, Postradiation Anastomotic Stenosis.

PURPOSE: The treatment of urethral stenosis after a combination of prostatectomy and radiation therapy for prostate cancer is understudied. We evaluate the clinical and patient-related outcomes after dorsal onlay buccal mucosal graft urethroplasty (D-BMGU) in men who underwent prostatectomy and radiation therapy. MATERIALS AND METHODS: A multi-institutional, retrospective review of men with vesicourethral anastomotic stenosis or bulbomembranous urethral stricture disease after radical prostatectomy and radiation therapy from 8 institutions between 2013 to 2021 was performed. The primary outcomes were stenosis recurrence and development of de novo stress urinary incontinence. Secondary outcomes were surgical complications, changes in voiding, and patient-reported satisfaction. RESULTS: Forty-five men were treated with D-BMGU for stenosis following prostatectomy and radiation. There was a total of 7 recurrences. Median follow-up in patients without recurrence was 21 months (IQR 12-24). There were no incidents of de novo incontinence, 28 patients were incontinent pre- and postoperatively, and of the 6 patients managed with suprapubic catheter preoperatively, 4 were continent after repair. Following repair, men had significant improvement in postvoid residual, uroflow, International Prostate Symptom Score, and International Prostate Symptom Score quality-of-life domain. Overall satisfaction was +2 or better in 86.6% of men on the Global Response Assessment. CONCLUSIONS: D-BMGU is a safe, feasible, and effective technique in patients with urethral stenosis after a combination of prostatectomy and radiation therapy. Although our findings suggest this technique may result in lower rates of de novo urinary incontinence compared to conventional urethral transection and excision techniques, head-to-head comparisons are needed.

Outcomes of a universal germline screening program in a community urology practice.

The role of germline genetic testing in urologic oncology has expanded in recent years. However, implementation of genetic testing in community practices remains a challenge, often due to limited access to qualified genetics trained providers. In this study, we report outcomes of a universal germline screening program in a community urology practice. Between November 2021 and September 2022, all patients referred for urology clinic visits at Frederick Health (Frederick, MD, USA) were provided an online genetics screening questionnaire prior to the visit. Responses were compared against National Comprehensive Cancer Network (NCCN) criteria for germline testing. Those who met criteria were provided educational materials at the end of the questionnaire, and then counseled by a trained urologic oncologist (HC) in the clinic or referred to a genetic counselor prior to testing. Testing was performed with a 36-gene pan-cancer panel (CancerNext) or a 14-gene targeted prostate cancer panel (ProstateNext), with or without additional RNA analysis (RNAinsight) (Ambry Genetics, CA, USA). Demographic and clinical parameters, as well as genetic testing results, were retrospectively collected under IRB approval. In the study period, 765 patients were seen over 1370 clinic visits. Of these, 505 patients (66.0%) completed the screening questionnaire. The majority were completed via email (54.5%) with the remainder (45.5%) via text message. Of the patients who completed screening, 125/505 (24.7%) met NCCN criteria for germline testing. 58/125 patients (46.4%) who met criteria underwent germline testing, of whom 5/58 (8.6%) had distinct pathogenic mutations identified. These included actionable mutations in BRCA1, BRCA2, and CHEK2, as well as an additional pathogenic mutation in NBN. Variants of unknown significance were identified in 8/58 patients (13.8%) in 11 total genes. Challenges to implementation of this program included meeting institutional requirements for genetic testing consent, facilitating specimen collection in clinic, and integration of results into the electronic health record. Genetic risk assessment for high-risk individuals is feasible as part of a universal screening program in a community urology practice. Approximately 8% of tested patients were found to have pathogenic germline mutations, which is consistent with contemporary tertiary referral cohorts.

Adult genitourinary sarcoma: analysis using hospital-based cancer registry data in Japan.

BACKGROUND: Genitourinary sarcomas are rare in adults and few large-scale studies on adult genitourinary sarcoma are reported. We aimed to elucidate the clinical characteristics, survival outcomes, and prognostic factors for overall survival of adult genitourinary sarcoma in Japan. METHODS: A hospital-based cancer registry data in Japan was used to identify and enroll patients diagnosed with genitourinary sarcoma in 2013. The datasets were registered from 121 institutions. RESULTS: A total of 116 men and 39 women were included, with a median age of 66 years. The most common primary site was the kidney in 47 patients, followed by the paratestis in 36 patients. The most common histological type was liposarcoma in 54 patients, followed by leiomyosarcoma in 25 patients. The 5-year overall survival rates were 57.6%. On univariate analysis, male gender, paratestis as primary organ, and histological subtype of liposarcoma were predictive of favorable survival while primary kidney, bladder, or prostate gland location were predictive of unfavorable survival. On multivariate analysis, primary paratestis was an independent predictor of favorable survival while primary kidney, bladder, or prostate gland were independent predictors of unfavorable survival. CONCLUSIONS: This is the first report showing the clinical characteristics and survival outcomes of adult genitourinary sarcoma in Japan using a real-world large cohort database.

The Getting It right First Time (GIRFT) programme in urology; rationale and methodology.

The Getting It Right First Time (GIRFT) programme is a quality improvement initiative covering the National Health Service in England. The programme aims to standardise clinical practices and improve patient and system level outcomes by utilising data-driven insights and clinically-led recommendations. There are GIRFT workstreams for every medical and surgical specialty, including urology. Defining features of the GIRFT methodology are that it is clinically led by experienced clinicians, data-driven, and specialty specific. Each specialty workstream conducts deep-dive visits to every hospital, analysing performance data and engaging with clinicians and management to identify and share improvement priorities. For urology, GIRFT has completed deep-dive visits and published reports outlining priority areas for development. Reports include recommendations pertaining to streamlining care pathways, reducing the acuity of care environments, enhancing emergency services, optimising utilisation of outpatient services, and workforce training and utilisation. The GIRFT academy provides guides for implementing best practices specific to priority areas of care. These include important disease pathways, and GIRFT-advocated innovations such as urology investigation units and urology area networks. GIRFT offers clinical transformation, cost reduction, equity in access to care, and leaner models of care that are often more environmentally sustainable. Evaluation efforts of the programme have focussed on assessing the adoption of GIRFT recommendations, understanding barriers to change, and modelling the climate impact of advocated practices.

Litigation claims in Urology in the UK National Health Service: an analysis of the trends, costs and causes over a 16-year period.

OBJECTIVE: To analyse the litigation trends and the reasons for claims within the specialty of Urology, within the UK National Health Service (NHS), over a 16-year period. MATERIALS AND METHODS: Data were requested from NHS Resolution under the Freedom of Information Act 2000. This included the total number of claims in Urology, the number of these that were successful (settled or closed), and the costs in damages paid out per financial year between 2006 and 2022. A breakdown of the successful claims by their primary cause was also collected. These were coded into the categories: 'non-operative', 'intraoperative', 'postoperative', and 'other'. RESULTS: A total of 4124 litigation claims were made between 2006 and 2022 and 60.9% (2511/4124) of these claims were successful. In all, £145 million (British pounds) was paid out in damages. The number of successful claims increased 2.9-fold from the start to end of this 16-year period, and the costs in damages paid out increased 10-fold. Regarding primary causes for the successful claims, failure or delay in treatment (20.9%, 525/2511), failure or delay in diagnosis (14.5%, 364/2511), and intraoperative problems (9.1%, 229/2511) accounted for the highest proportion. Overall, non-operative causes for successful claims accounted for 73.3% (1840/2511), intraoperative for 20.1% (504/2511), and postoperative for 3.9% (98/2511). CONCLUSIONS: The number of successful urological litigation claims, and their associated costs is rising. The majority are due to non-operative causes, which may be partially explained by NHS waiting lists alongside the effects of the coronavirus disease 2019 (COVID-19) pandemic.

Complications of immuno-oncology care: what urologist should know.

OBJECTIVES: To provide a practical review of immune-related adverse events (irAEs) that may be encountered in uro-oncology patients. PATIENTS AND METHODS: We conducted a literature review of studies reporting irAEs including articles published through September 2023 for uro-oncology patients and the potential relevancy for the practicing urologist. RESULTS: Immunotherapy has revolutionised cancer treatment, extending its impact to urological malignancies including for patients with urothelial, kidney, and prostate cancers. Immuno-oncology (IO) compounds have achieved measurable and durable responses in these cancers. Urologists, choosing to administer or co-manage IO patient care, should be prepared to understand, evaluate, and treat irAEs. This review discusses the spectrum of irAEs that can be encountered. Ongoing trials are exploring the use of immunotherapy at earlier stages of uro-oncological diseases, thus underscoring the evolving landscape of urological cancer treatment. Paradoxically, some data suggests that the occurrence of irAEs is associated with improved oncological outcomes. CONCLUSIONS: Immune-related AEs, while manageable, may be life-threatening and require lifelong therapy. A thorough understanding of AEs and toxicity of a novel drug class is imperative.

Lessons from a population-based bladder cancer registry: exploring why survival is not improving.

OBJECTIVE: To explore the causes of the decrease in bladder cancer survival that has occurred over the past four decades. METHODS: We extracted data from the South Australian Cancer Registry. Data from the period 1 January 1977 to 31 December 2020 were extracted to explore changes in incidence and survival among a total of 8356 patients diagnosed with ≥pT1 disease. Invasive bladder cancer was defined as ≥pT1 in this study. RESULTS: Invasive bladder cancer age-standardized incidence decreased from 7.20 cases per 100 000 people in 1977 to 5.85 cases per 100 000 in 2020. The mean age at diagnosis increased from 68 years to 76 years. The crude incidence for patients aged 80 years and over increased by 3.3% per year (95% confidence interval [CI] 2.1 to 4.6). Overall survival decreased over the study period (hazard ratio [HR] 1.22 [95% CI 1.09 to 1.35]), however, survival increased after adjusting for age at diagnosis (HR 0.80 [95% CI 0.76 to 0.94]). Despite a decrease in non-bladder cancer-specific deaths in older people, there was no change in the bladder cancer-specific death rate in older people (HR 0.94 [95% CI 0.70 to 1.26]). Male sex was associated with higher survival (HR 0.87 [95% CI 0.83 to 0.92]), whereas socioeconomic advantage was not. CONCLUSIONS: Invasive bladder cancer survival has decreased over the past 40 years, with the age structure of the population being a significant contributing factor. PATIENT SUMMARY: We looked at why bladder cancer survival is decreasing using a large cancer registry with information from 1977 to 2020. We found that people are now more likely to be diagnosed at an older age. Older people often live for a shorter time with bladder cancer compared to younger people. Bladder cancer survival has decreased because there are more older people with the disease than previously.

'Spin' in urology non-randomised studies comparing therapeutic interventions: a temporal analysis.

OBJECTIVE: To determine the prevalence of 'spin' (i.e., reporting practices that distort the interpretation of results by positively reflecting negative findings or downplaying potential harms) strategies and level of spin in urological observational studies and whether the use of spin has changed over time. MATERIALS AND METHODS: MEDLINE and Embase were searched to identify observational studies comparing therapeutic interventions in the top five urology journals and major urological subspecialty journals, published between 2000 and 2001, 2010 and 2011, and 2020 and 2021. RESULTS: A total of 235 studies were included. Spin was identified in 81% of studies, with a median of two strategies per study. The most commonly used strategies were inadequate implication for clinical practice (30%), causal language or causal claim (29%), and use of linguistic spin (29%). Moderate to high levels of spin were found in 55% of conclusions. From 2000 to 2020, the average number of strategies used has significantly decreased each decade (H = 27.459, P < 0.001), and the median level of spin in conclusions was significantly lower in studies published in the 2020s and 2010s than in the 2000s (H = 11.649, P = 0.003). CONCLUSIONS: Our results suggest that 81% of urological observational studies comparing therapeutic interventions contained spin. Over the past two decades, the use of spin has significantly declined, but this remains an area for improvement, with 70% of included studies published in the 2020s employing spin. Medical writing should scrupulously avoid words or phrases that are not supported by data in the manuscript.

Gender disparities among publications within international sexual medicine urology journals and the impact of blinding in the review process.

BACKGROUND: While female urologists are known to publish at less frequency than their male peers, The Journal of Sexual Medicine was reported to have among the highest growth in female authorship from 2002 to 2020 in urology journals. AIM: We sought to assess the frequency of female authorship in sexual medicine journals worldwide and the factors that affect this, including the blinded/unblinded review process. METHODS: Eleven sexual medicine journals were assessed for geographic location, peer review method, and SCImago Journal Rank citation index (a metric of citation frequency and prestige). Journals were grouped into top, middle, and bottom quartiles based on metric score. Web of Science was used to access the publications' first, second, last, and corresponding authors from the past 5 years. An internet search or Gender-API.com was used to determine the gender identities of authors. Univariate and multivariable logistic regression models were performed. OUTCOMES: Outcomes included the likelihood of female authorship (first, second, last, and corresponding) based on journal location and ranking, the clustering of female authors, the journal's peer review process, and the frequency of female editorial board members. RESULTS: Overall, 8938 publications were identified. Women represented 30.7%, 31.3%, 21.3%, and 18.7% of the first, second, last, and corresponding authors, respectively; gender was unable to be assessed for 2.6%, 17.2%, 7.3%, and 2.7%. On univariate analysis, journals from North America, in the top quartile, and with a double-blind review process were more likely to have female authors (P < .001). On multivariate analysis, articles were more likely to have a female first author if they had a double-blind peer review process (odds ratio [OR], 1.20; 95% CI, 1.02-1.40), a female second author (OR, 2.54; 95% CI, 2.26-2.85), or a female corresponding author (OR, 7.80; 95% CI, 6.69-9.10). CLINICAL IMPLICATIONS: Gender-concordant mentoring and universal double-blind manuscript review processes may minimize the impact of gender bias and increase female authorship rates, in turn producing more diverse research. STRENGTHS AND LIMITATIONS: This is the first study assessing female authorship in sexual medicine journals. Limitations include not assessing every author listed on articles and being unable to determine gender identities for some authors. CONCLUSION: Female authorship rates are higher than reported rates of practicing female urologists but still lower than their male peers. Female authors were more likely to be published in journals with double-blind peer review processes and when publishing with additional female authors.

The efficacy of artificial intelligence in urology: a detailed analysis of kidney stone-related queries.

PURPOSE: The study aimed to assess the efficacy of OpenAI's advanced AI model, ChatGPT, in diagnosing urological conditions, focusing on kidney stones. MATERIALS AND METHODS: A set of 90 structured questions, compliant with EAU Guidelines 2023, was curated by seasoned urologists for this investigation. We evaluated ChatGPT's performance based on the accuracy and completeness of its responses to two types of questions [binary (true/false) and descriptive (multiple-choice)], stratified into difficulty levels: easy, moderate, and complex. Furthermore, we analyzed the model's learning and adaptability capacity by reassessing the initially incorrect responses after a 2 week interval. RESULTS: The model demonstrated commendable accuracy, correctly answering 80% of binary questions (n:45) and 93.3% of descriptive questions (n:45). The model's performance showed no significant variation across different question difficulty levels, with p-values of 0.548 for accuracy and 0.417 for completeness, respectively. Upon reassessment of initially 12 incorrect responses (9 binary to 3 descriptive) after two weeks, ChatGPT's accuracy showed substantial improvement. The mean accuracy score significantly increased from 1.58 ± 0.51 to 2.83 ± 0.93 (p = 0.004), underlining the model's ability to learn and adapt over time. CONCLUSION: These findings highlight the potential of ChatGPT in urological diagnostics, but also underscore areas requiring enhancement, especially in the completeness of responses to complex queries. The study endorses AI's incorporation into healthcare, while advocating for prudence and professional supervision in its application.

Machine learning enables automated screening for systematic reviews and meta-analysis in urology.

PURPOSE: To investigate and implement semiautomated screening for meta-analyses (MA) in urology under consideration of class imbalance. METHODS: Machine learning algorithms were trained on data from three MA with detailed information of the screening process. Different methods to account for class imbalance (Sampling (up- and downsampling, weighting and cost-sensitive learning), thresholding) were implemented in different machine learning (ML) algorithms (Random Forest, Logistic Regression with Elastic Net Regularization, Support Vector Machines). Models were optimized for sensitivity. Besides metrics such as specificity, receiver operating curves, total missed studies, and work saved over sampling were calculated. RESULTS: During training, models trained after downsampling achieved the best results consistently among all algorithms. Computing time ranged between 251 and 5834 s. However, when evaluated on the final test data set, the weighting approach performed best. In addition, thresholding helped to improve results as compared to the standard of 0.5. However, due to heterogeneity of results no clear recommendation can be made for a universal sample size. Misses of relevant studies were 0 for the optimized models except for one review. CONCLUSION: It will be necessary to design a holistic methodology that implements the presented methods in a practical manner, but also takes into account other algorithms and the most sophisticated methods for text preprocessing. In addition, the different methods of a cost-sensitive learning approach can be the subject of further investigations.

Performance of ChatGPT on the Taiwan urology board examination: insights into current strengths and shortcomings.

PURPOSE: To compare ChatGPT-4 and ChatGPT-3.5's performance on Taiwan urology board examination (TUBE), focusing on answer accuracy, explanation consistency, and uncertainty management tactics to minimize score penalties from incorrect responses across 12 urology domains. METHODS: 450 multiple-choice questions from TUBE(2020-2022) were presented to two models. Three urologists assessed correctness and consistency of each response. Accuracy quantifies correct answers; consistency assesses logic and coherence in explanations out of total responses, alongside a penalty reduction experiment with prompt variations. Univariate logistic regression was applied for subgroup comparison. RESULTS: ChatGPT-4 showed strengths in urology, achieved an overall accuracy of 57.8%, with annual accuracies of 64.7% (2020), 58.0% (2021), and 50.7% (2022), significantly surpassing ChatGPT-3.5 (33.8%, OR = 2.68, 95% CI [2.05-3.52]). It could have passed the TUBE written exams if solely based on accuracy but failed in the final score due to penalties. ChatGPT-4 displayed a declining accuracy trend over time. Variability in accuracy across 12 urological domains was noted, with more frequently updated knowledge domains showing lower accuracy (53.2% vs. 62.2%, OR = 0.69, p = 0.05). A high consistency rate of 91.6% in explanations across all domains indicates reliable delivery of coherent and logical information. The simple prompt outperformed strategy-based prompts in accuracy (60% vs. 40%, p = 0.016), highlighting ChatGPT's limitations in its inability to accurately self-assess uncertainty and a tendency towards overconfidence, which may hinder medical decision-making. CONCLUSIONS: ChatGPT-4's high accuracy and consistent explanations in urology board examination demonstrate its potential in medical information processing. However, its limitations in self-assessment and overconfidence necessitate caution in its application, especially for inexperienced users. These insights call for ongoing advancements of urology-specific AI tools.

Development and outcomes of surgical and urological kidney transplantation programs in Germany: a total population analysis from 2006 to 2021.

PURPOSE: Kidney transplantation (KT) is the most frequently performed organ transplantation. In Germany, KT is performed in urology and surgery departments with unknown consequences of this parallel structure. The aim of the study was to compare the development and outcome of KT in urology and surgery departments. METHODS: On an institutional level, we analyzed the annual caseload from 2006 to 2021 with the reimbursement. INFO tool based on hospitals' quality reports (Reimbursement Institute, Hürth, Germany). For outcome comparison we extracted raw data from the transplantation centers' quality reports (Deutsche Stiftung Organtransplantation, DSO). RESULTS: A total of 23,599 cases (17,781 deceased donor and 5,818 living donor KTs) were included. The total number of KTs decreased from 1851 in 2006 to 1701 in 2021 (- 8%; p = 0.12). The total number of urological KTs decreased from 592 cases in 2006 to 395 cases in 2021 (- 33.3%; p = 0.01). Further analysis revealed no significant differences between intra- and postoperative complications and graft quality at one year for deceased donor KTs (DDKT) although differences in immediate renal function and graft quality at discharge could be observed. There were no significant differences in immediate renal function and graft quality at discharge for living donor KTs (LDKT) between the specialties. CONCLUSION: KTs performed in urology departments declined between 2006 and 2021. Nevertheless, intra- and postoperative complications as well as long-term function did not differ between surgical and urological KT programs. Hence, an interdisciplinary approach, especially considering the upcoming challenges in KT as, e.g., robot-assisted surgery seems reasonable.

The role of urology and radiology in prostate biopsy: current trends and future perspectives.

PURPOSE: Prostate biopsy is central to the accurate histological diagnosis of prostate cancer. In current practice, the biopsy procedure can be performed using a transrectal or transperineal route with different technologies available for targeting of lesions within the prostate. Historically, the biopsy procedure was performed solely by urologists, but with the advent of image-guided techniques, the involvement of radiologists in prostate biopsy has become more common. Herein, we discuss the pros, cons and future considerations regarding their ongoing role. METHODS: A narrative review regarding the current evidence was completed. PubMed and Cochrane central register of controlled trials were search until January 2024. All study types were of consideration if published after 2000 and an English language translation was available. RESULTS: There are no published studies that directly compare outcomes of prostate biopsy when performed by a urologist or radiologist. In all published studies regarding the learning curve for prostate biopsy, the procedure was performed by urologists. These studies suggest that the learning curve for prostate biopsy is between 10 and 50 cases to reach proficiency in terms of prostate cancer detection and complications. It is recognised that many urologists are poorly able to accurately interpret multi parametric (mp)-MRI of the prostate. Collaboration between the specialities is of importance with urology offering the advantage of being involved in prior and future care of the patient while radiology has the advantage of being able to expertly interpret preprocedure MRI. CONCLUSION: There is no evidence to suggest that prostate biopsy should be solely performed by a specific specialty. The most important factor remains knowledge of the relevant anatomy and sufficient volume of cases to develop and maintain skills.

How does artificial intelligence master urological board examinations? A comparative analysis of different Large Language Models' accuracy and reliability in the 2022 In-Service Assessment of the European Board of Urology.

PURPOSE: This study is a comparative analysis of three Large Language Models (LLMs) evaluating their rate of correct answers (RoCA) and the reliability of generated answers on a set of urological knowledge-based questions spanning different levels of complexity. METHODS: ChatGPT-3.5, ChatGPT-4, and Bing AI underwent two testing rounds, with a 48-h gap in between, using the 100 multiple-choice questions from the 2022 European Board of Urology (EBU) In-Service Assessment (ISA). For conflicting responses, an additional consensus round was conducted to establish conclusive answers. RoCA was compared across various question complexities. Ten weeks after the consensus round, a subsequent testing round was conducted to assess potential knowledge gain and improvement in RoCA, respectively. RESULTS: Over three testing rounds, ChatGPT-3.5 achieved RoCa scores of 58%, 62%, and 59%. In contrast, ChatGPT-4 achieved RoCA scores of 63%, 77%, and 77%, while Bing AI yielded scores of 81%, 73%, and 77%, respectively. Agreement rates between rounds 1 and 2 were 84% (κ = 0.67, p < 0.001) for ChatGPT-3.5, 74% (κ = 0.40, p < 0.001) for ChatGPT-4, and 76% (κ = 0.33, p < 0.001) for BING AI. In the consensus round, ChatGPT-4 and Bing AI significantly outperformed ChatGPT-3.5 (77% and 77% vs. 59%, both p = 0.010). All LLMs demonstrated decreasing RoCA scores with increasing question complexity (p < 0.001). In the fourth round, no significant improvement in RoCA was observed across all three LLMs. CONCLUSIONS: The performance of the tested LLMs in addressing urological specialist inquiries warrants further refinement. Moreover, the deficiency in response reliability contributes to existing challenges related to their current utility for educational purposes.