In-hospital cost analysis of aquablation compared with transurethral resection of the prostate in the treatment of benign prostatic enlargement.

PURPOSE: To compare in-hospital treatment costs of aquablation and transurethral resection of the prostate (TURP) in the treatment of benign prostatic enlargement. PATIENTS AND METHODS: Patient data and procedural details were derived from a prospective database. In-hospital costs were calculated using detailed expenditure reports provided by the hospital accounts department. Total costs including those arising from surgical procedures, consumables, personnel and accommodation were analysed for 24 consecutive patients undergoing aquablation and compared with 24 patients undergoing TURP during the same period. Mean total costs and mean costs for individual expense items were compared between treatment groups with t-tests. RESULTS: Mean total costs per patient (± standard deviation) were higher for aquablation at EUR 10,994 ± 2478 than for TURP at EUR 7445 ± 2354. The mean difference of EUR 3549 was statistically significant (p <0.001). Although the mean procedural costs were significantly higher for aquablation (mean difference EUR 3032; p <0.001), costs apart from the procedure were also lower for TURP, but the mean difference of EUR 1627 was not significant (p <0.327). Medical supplies were mainly responsible (mean difference EUR 2057; p <0.001) for the difference in procedural costs. CONCLUSIONS: In-hospital costs are significantly higher for aquablation than for TURP, mainly due to higher costs of medical supplies for the procedure. This difference should be taken into consideration, at least in patients for whom the different side effect profiles of both treatments are irrelevant.

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.

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.

Informative value of histological assessment of tissue acquired during aquablation of the prostate.

PURPOSE: To determine the histological validity of the tissue acquired during aquablation of the prostate. PATIENTS AND METHODS: Prostatic tissue of 12 patients that consecutively underwent aquablation for benign prostatic enlargement was systematically examined. Histological examination was performed by two experienced uropathologists using a digital slide scanner and slide viewer software (Pannoramic 250 and Case Viewer 2.3, 3D Histech, Hungary). The surface areas of the assessable glands were examined and set in relation to the total surface area of the material available for histology and to the patient's total prostate volume. Examinations were performed analogously in ten consecutive patients undergoing transurethral resection of the prostate (TURP) to facilitate interpretation of the results. Data were analyzed using descriptive statistics. RESULTS: A median of 4.06% (range 1.43-7.5%) of the preoperative total prostate volume (median 64.5 ml (range 40-80 ml)) was obtained for histological examination by aquablation. Due to severe mechanical destruction and fragmentation, only a proportion of 0.43% (0.06-1.79%) of this tissue represented histologically assessable glands. Therefore, roughly 0.017% of the total prostatic volume was available for a reliable histological examination. In comparison, 32.5% (6.67-37.5%) of the total prostate volume was removed by TURP and 22.86% (7.45-40.57%) of this tissue represented informative prostatic glands, corresponding to 7.43% of the total prostate volume. CONCLUSION: Histological significance of the tissue obtained by aquablation of the prostate is very limited. Costs and effort of the histological examination must, therefore, be weighed critically against the limited informative value.

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.

Adherence to European Association of Urology and National Comprehensive Cancer Network Guidelines Criteria for Inguinal and Pelvic Lymph Node Dissection in Penile Cancer Patients-A Survey Assessment in German-speaking Countries on Behalf of the European Prospective Penile Cancer Study Group.

BACKGROUND: Urologists' adherence to European Association of Urology and National Comprehensive Cancer Network guideline recommendations to perform inguinal (ILND) and pelvic (PLND) lymph node dissection in penile cancer (PC) patients is not known. OBJECTIVE: To assess a German-speaking European cohort of urologists based on their criteria to perform ILND and PLND in PC patients. DESIGN, SETTING, AND PARTICIPANTS: A 14-item survey addressing general issues of PC treatment was developed and sent to 45 clinical centers in Germany (n = 34), Austria (n = 8), Switzerland (n = 2), and Italy (n = 1). INTERVENTION: Two of the 14 questions assessed the criteria to perform ILND and ipsilateral PLND. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Correct responses for ILND and PLND criteria were assessed. Based on a multivariate logistic-regression-model, criteria independently predicting guideline adherence were identified. RESULTS AND LIMITATIONS: In total, 557 urologists participated in the survey, of whom 43.5%, 19.3%, and 37.2% were residents in training, certified, and in leading positions, respectively. ILND and PLND criteria were correctly identified by 35.2% and 23.9%, respectively. Of the participants, 23.3% used external sources for survey completion. The use of auxiliary tools (odds ratio [OR] 1.57; p[bootstrapped] = 0.028) and participants outside of Germany (OR 0.56; p[bootstrapped] = 0.006) were predictors of ILND guideline adherence. The number of PC patients treated yearly (p = 0.012; OR 1.06) and the use of auxiliary tools (p < 0.001; OR 5.88) were predictors of PLND adherence. Department size, healthcare status, professional status, and responsibility for PC surgery did not predict endpoints. Limitations include sample size and results in comparison with retrospective studies. CONCLUSIONS: Our results demonstrate overall suboptimal knowledge of the correct indications to perform ILND and PLND in PC patients among the surveyed urologists. We propose that governments and healthcare providers should be encouraged to centralize PC management. PATIENT SUMMARY: The management of inguinal and pelvic lymph nodes is crucial for the survival of penile cancer patients. Disease rarity mandates referral to clinical practice guidelines for appropriate treatment selection.

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.

Readability Assessment of Commonly Used German Urological Questionnaires.

PURPOSE: We intended to assess the readability of the German versions of commonly used urological questionnaires and identify questions that are potentially demanding for patients. MATERIALS AND METHODS: The Guidelines of the European Association of Urology were analyzed for recommended questionnaires. Readability of the German versions of these questionnaires including their respective single-items was analyzed using established readability assessment tools. RESULTS: A total of 13 questionnaires were analyzed. The calculated readability scores ranged between the 4.3th and 10.3th grade level. Easiest readability as calculated by median grade levels was found for the short and long forms of the International Consultation on Incontinence Questionnaires-Female and -Male Lower Urinary Tract Symptoms and the SF-Qualiveen (all median grade level 5.0). The short form of the International Index of Erectile Function showed the hardest readability (median grade level 10.0). Readability of the single-items varied widely between the assessed questionnaires with up to 80% (the International Index of Erectile Function) of their single-items being written above recommended grade levels. CONCLUSIONS: The majority of commonly used German urological questionnaires comply with recommended readability levels. Some questionnaires as well as single-items of most of the questionnaires clearly exceed recommended readability levels. This should be considered for interpretation of their results and when revising questionnaires.

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.

Readability assessment of commonly used urological questionnaires.

Purpose: This study was performed to assess readability of the most commonly used questionnaires in urology including a separate analysis of their single-items to identify questions that might be especially demanding for patients. Materials and Methods: The guidelines of the European Association of Urology were screened for recommended questionnaires. Readability was analyzed for complete questionnaires as well as their single-items separately using well established readability assessment tools, including Flesch-Kincaid grade level (FKGL), Simple Measure of Gobbledygook grade level (SMOG), Coleman-Liau Index (CLI), Gunning-Fog Index, and the Flesch Reading Ease formula. Results: A total of 13 questionnaires were included to the analysis. Calculation of grade levels (FKGL, SMOG, CLI, FGI) showed readability scores of 2.7th to 16.7th grade. Easiest readability as calculated by median grade levels was found for the short form of the International Consultation on Incontinence Questionnaires-Female Lower Urinary Tract Symptoms short form (FLUTS-SF) while the short form of the International Index of Erectile Function (IIEF-5) showed the hardest readability. Based on the FKGL between 0% (FLUTS-SF) and 80% (IIEF-5) of the single-items were written above the recommended grade levels. Conclusions: The questionnaires that are used most frequently in urology mainly show a satisfactory overall readability. Inadequate readability levels were not only found for individual questionnaires but also for single-items of the majority of assessed questionnaires. This requires consideration for the interpretation of results and when developing novel health-related surveys.

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.

Readability assessment of online patient education materials provided by the European Association of Urology.

PURPOSE: To assess the readability of the web-based patient education material provided by the European Association of Urology. MATERIALS AND METHODS: English patient education materials (PEM) as available in May 2017 were obtained from the EAU website. Each topic was analyzed separately using six well-established readability assessment tools, including Flesch-Kincaid Grade Level (FKGL), SMOG Grade Level (SMOG), Coleman-Liau Index (CLI), Gunning Fog Index (GFI), Flesch Reading Ease Formula (FRE) and Fry Readability Graph (FRG). RESULTS: A total of 17 main topics were identified of which separate basic and in-depth information is provided for 14 topics. Calculation of grade levels (FKGL, SMOG, CLI, GFI) showed readability scores of 7th-13th grade for basic information, 8th-15th grade for in-depth information and 7th-15th grade for single PEM. Median FRE score was 54 points (range 45-65) for basic information and 56 points (41-64) for in-depth information. The FRG as a graphical assessment revealed only 13 valid results with an approximate 8th-17th grade level. CONCLUSION: The EAU provides carefully worked out PEM for 17 urological topics. Although improved readability compared to similar analyses was found, a simplification of certain chapters might be helpful to facilitate better patient understanding.

Economic Aspects of Morbidity Caused by Ureteral Stents.

OBJECTIVE: To assess the economic burden of temporary ureteral stenting. METHODS: The German version of the ureteral stent symptom questionnaire was completed by 74 patients with unilateral inserted indwelling stents. Cost accounting was performed considering the costs of ureteral stents, drugs, consultation of healthcare professionals, hospitalization, stent extraction and work incapacity due to stent-related problems. RESULTS: Total costs arising from stent-related problems amounted to US dollars (USD) 133,355, median USD 455 (113-11,948) for the entire stent indwelling time, and USD 15 (4-398) per patient per day. Costs (USD total/median (range)) arose mainly from work incapacity (104,154/0 (0-11, 498)), followed by healthcare professional consultation (9,177/0 (0-612)), drug costs (8,736/111 (0-427)), stent material (8,390/113), stent removal (2,235/0 (0-1,769)) and outpatient hospital care (663/0 (0-663)). Most patients also showed a reduced capacity for work due to symptoms associated with indwelling stents. CONCLUSION: The economic burden of morbidity associated with indwelling ureteral stents is considerably high and should be taken into account when performing ureteral stenting, especially in cases where it is not strictly indicated and when stent removal is scheduled.

Information needs of early-stage prostate cancer patients: within- and between-group agreement of patients and health professionals.

PURPOSE: The aims of this study were to analyze agreement on information needs within a group of early-state prostate cancer patients and to compare information preferences of patients with the view of health-care professionals about patients' needs. METHODS: Sample consists of patients (n = 128) and six subgroups of health-care professionals (urologists, n = 32; nurses, n = 95; radiotherapy technologists (RTTs), n = 36; medical oncologists, n = 19; radiation oncologists, n = 12; general practitioners (GPs), n = 10). Information needs have been assessed with 92 questions concerning prostate cancer and its treatment. Respondents judged the importance of addressing each question. Within- and between-group agreements of patients and health-care professional groups were estimated with raw agreement indices as well as chance-corrected Kappa and Gwet's AC1 measures. Finally, group-specific core items rated with high importance as well as high agreement were defined. RESULTS: Patients rated on average (median) half, i.e., 51 out 92 items as essential (interquartile range (IQR) = 36-66), 26 items as desired (IQR = 14-38), and 10 items as avoidable (IQR = 2-22). Within-group agreement on the presented information topics is modest for any participating group (AC1(patients)= 0.319; AC1(professionals) = 0.295-0.398). Agreement between patients and professionals is low too (AC1 = 0.282-0.329). Defining group-specific core sets of information topics results in 51 items being part of at least one core set. Concordance of the item core sets of patients and professionals is moderate with κ = 0.38-0.66, sensitivity of professionals' core sets for patients' preferences varies between 56 and 74%. CONCLUSIONS: Results emphasize the need for dialogue between doctor/professional and patient in identifying the information needed by individual patients and support the importance of shared decision making.