Urological Cancers and ChatGPT: Assessing the Quality of Information and Possible Risks for Patients.

INTRODUCTION: OpenAI has created ChatGPT, an artificial intelligence language model that has gained considerable recognition for its capacity to produce text responses resembling human language. Consequently, this study seeks to evaluate the effectiveness of ChatGPT's responses in addressing publicly accessible queries related to prostate, kidney, bladder, and testicular cancers. MATERIAL AND METHODS: A comprehensive compilation of frequently asked questions (FAQs) pertaining to prostate, bladder, kidney, and testicular cancers was gathered from diverse sources. Additionally, the recommendations outlined in the European Association of Urology (EAU) 2023 Guideline Oncology were consulted. The chosen questions for evaluation were presented to the ChatGPT 4.0 premium version. The quality of ChatGPT responses was appraised using the global quality score (GQS). Each ChatGPT response was independently reviewed by a panel of physicians, who assigned a GQS score to assess its overall quality. RESULTS: For prostate cancer, 64.6% of the questions had a GQS score of 5, compared to 62.9 % for bladder, 68.1% for kidney, and 63.9% for testicular cancers, whereas none of the responses had a GQS score of 1. Meanwhile, the category with the lowest proportion of responses, with a GQS score of 5 for each disease, was prognosis and follow-up. The mean GQS score of the answers given to EAU guideline questions was statistically significantly lower than the average score of the answers given to FAQs. CONCLUSION: ChatGPT is a valuable tool for addressing general inquiries regarding urological cancers, boasting commendable accuracy rates. Nonetheless, its performance in responding to questions aligned with the EAU guideline was deemed unsatisfactory.

Evaluating the performance of ChatGPT in answering questions related to urolithiasis.

PURPOSE: ChatGPT is an artificial intelligence (AI) program with natural language processing. We analyzed ChatGPT's knowledge about urolithiasis whether it can be used to inform patients about urolithiasis. METHODS: Frequently asked questions (FAQs) about urolithiasis on the websites of urological associations and hospitals were analyzed. Also, strong recommendation-level information was gathered from the urolithiasis section of the European Association of Urology (EAU) 2022 Guidelines. All questions were asked in order in ChatGPT August 3rd version. All answers were evaluated separately by two specialist urologists and scored between 1 and 4, where 1: completely correct, 2: correct but inadequate, 3: a mix of correct and misleading information, and 4: completely incorrect. RESULTS: Of the FAQs, 94.6% were answered completely correctly. No question was answered completely incorrectly. All questions about general, diagnosis, and ureteral stones were graded as 1. Of the 60 questions prepared according to the EAU guideline recommendations, 50 (83.3%) were evaluated as grade 1, and 8 (13.3%) and 2 (3.3%) as grade 3. All questions related to general, diagnostic, renal calculi, ureteral calculi, and metabolic evaluation received the same answer the second time they were asked. CONCLUSION: Our findings demonstrated that ChatGPT accurately and satisfactorily answered more than 95% of the questions about urolithiasis. We conclude that applying ChatGPT in urology clinics under the supervision of urologists can help patients and their families to have better understanding on urolithiasis diagnosis and treatment.

Evaluating the performance of ChatGPT in answering questions related to pediatric urology.

INTRODUCTION: Artificial intelligence is advancing in various domains, including medicine, and its progress is expected to continue in the future. OBJECTIVE: This research aimed to assess the precision and consistency of ChatGPT's responses to commonly asked inquiries related to pediatric urology. MATERIALS AND METHODS: We examined commonly posed inquiries regarding pediatric urology found on urology association websites, hospitals, and social media platforms. Additionally, we referenced the recommendations tables in the European Urology Association's (EAU) 2022 Guidelines on Pediatric Urology, which contained robust data at the strong recommendation level. All questions were systematically presented to ChatGPT's May 23 Version, and two expert urologists independently assessed and assigned scores ranging from 1 to 4 to each response. RESULTS: A hundred thirty seven questions about pediatric urology were included in the study. The answers to questions resulted in 92.0% completely correct. The completely correct rate in the questions prepared according to the strong recommendations of the EAU guideline was 93.6%. No question was answered completely wrong. The similarity rates of the answers to the repeated questions were between 93.8% and 100%. CONCLUSION: ChatGPT has provided satisfactory responses to inquiries related to pediatric urology. Despite its limitations, it is foreseeable that this continuously evolving platform will occupy a crucial position in the healthcare industry.

Failed insertion of ureteral access sheath during flexible ureterorenoscopy: a randomized controlled trial comparing second session flexible ureterorenoscopy or same session mini percutaneous nephrolithotomy.

PURPOSE: To compare different treatment approaches in patients with failed ureteral access sheath placement during first flexible ureterorenoscopy (f-URS) session. METHODS: Patients with kidney stones measuring 1-2 cm, presented to our urology clinic between September 2020 and September 2021, were included in the study for evaluation. The study was designed prospectively (Clinical-Trials number NCT05911945). Patients were randomized into two groups, in case of a failed ureteral access sheath placement during the first f-URS session. In group 1, JJ stent was placed for dilation and second session of f-URS was planned. In group 2, mini percutaneous nephrolithotomy (mPNL) was performed in the same session. RESULTS: Twenty-four patients were included in each group. Pre-operative demographic data and stone characteristics of the patients in each group were comparable. Operation time, fluoroscopy time, and hospital stay were significantly higher in the mini-PNL group. When SF-36 values were compared, physical function, pain, role limitation, and general health value scores were improved in both groups after treatment. The improvement in physical function and pain parameters was statistically significant in the mPNL group. In patients with failed ureteral access sheath placement, placing a JJ stent for dilation and postponing f-URS for 4-6 weeks provides the advantages of low hospitalization time for each admission, shorter fluoroscopy and operation time. CONCLUSIONS: Performing mPNL in the same session, results in better improvements in SF-36 parameters such as pain and physical function compared to f-URS. The success and complication rates of the two procedures were comparable.

Evaluating the performance of ChatGPT in answering questions related to benign prostate hyperplasia and prostate cancer.

BACKGROUND: The aim of this study was to evaluate the accuracy and reproducibility of ChatGPT's answers to frequently asked questions about benign prostate hyperplasia (BPH) and prostate cancer. METHODS: Frequently asked questions on the websites of urology associations, hospitals, and social media about prostate cancer and BPH were evaluated. Also, strong recommendation-level data were noted in the recommendations tables of the European Urology Association (EAU) 2022 Guidelines on Prostate Cancer and Management of Non-neurogenic Male Lower Urinary Tract Symptoms sections. All questions were asked in order in ChatGPT Mar 23 Version. All answers were evaluated separately by two specialist urologists and scored between 1-4. RESULTS: Forty questions about BPH and 86 questions about prostate cancer were included in the study. The answers to all BPH-related questions resulted in 90.0% completely correct. This rate for questions about prostate cancer was 94.2%. The completely correct rate in the questions prepared according to the strong recommendations of the EAU guideline was 77.8% for BPH and 76.2% for prostate cancer. The similarity rates of the answers to the repeated questions were 90.0% and 93% for questions related to BPH and prostate cancer, respectively. CONCLUSIONS: ChatGPT has given satisfactory answers to questions about BPH and prostate cancer. Although it has limitations, it can be predicted that it will take an important place in the health sector in the future, as it is a constantly evolving platform. ChatGPT was able to provide helpful information about BPH and prostate cancer, although it is not perfect. It is constantly getting better, and may become an important resource in the healthcare field in the future.

Robotic-assisted laparoscopic radical prostatectomy: Initial outcomes of 500 cases.

INTRODUCTION: We aimed to present our experience of robot-assisted laparoscopic radical prostatectomy (RARP). MATERIAL AND METHODS: The study was a retrospective review of 500 patients who underwent RARP between March 2015 and July 2021 in our clinic. A transperitoneal approach was used in all patients. All patients had clinically organ-confined prostate cancer (≤ cT2c). RESULTS: The mean age of the patients was 64.6 ± 5.7 years. The median PSA was 11.4 ng/dL (range 0.3-92.7). The mean operative time was 183.5 min. Positive surgical margin rate was 19.4%. During a mean follow-up of 23.5 months, 96 patients (19.2%) received adjuvant radiotherapy due to the biochemical recurrence and 28 patients (16%) with lymph node positivity received early adjuvant hormone therapy. Considering the continence rates, 69% of the patients were total continence in the 3rd month, while this rate increased to 83 in the 6th month and 91% in the 12th month. CONCLUSION: RARP is a safe and feasible method for experienced centers with patient comfort, surgeon comfort, and successful oncological and functional results.

INTRODUCCIÓN: Nuestro objetivo fue presentar nuestra experiencia de prostatectomía radical laparoscópica asistida por robot (RARP). MATERIAL Y MÉTODOS: El estudio fue una revisión retrospectiva de 500 pacientes que se sometieron a una (RARP) entre marzo de 2015 y julio de 2021 en nuestra clínica. En todos los pacientes se utilizó un abordaje transperitoneal. Todos los pacientes tenían cáncer de próstata limitado al órgano clínicamente (≤ cT2c). RESULTADOS: La edad media de los pacientes fue de 64.6 ± 5.7 años. La mediana de PSA fue de 11.4 ng/dL (rango 0.3-92.7). El tiempo operatorio medio fue de 183.5 min. La tasa de márgenes quirúrgicos positivos fue del 19,4%. Durante un seguimiento medio de 23.5 meses, 96 pacientes (19.2%) recibieron radioterapia adyuvante debido a la recurrencia bioquímica y 28 pacientes (16%) con ganglios linfáticos positivos recibieron terapia hormonal adyuvante temprana. Considerando las tasas de continencia, el 69% de los pacientes tenían continencia total en el 3er mes, mientras que esa tasa aumentó a 83 en el 6° mes y 91% en el 12° mes. CONCLUSIÓN: RARP es un método seguro y factible para centros experimentados con comodidad para el paciente, comodidad para el cirujano y resultados oncológicos y funcionales exitosos.

Does nephrolithometry scoring systems predict success and complications in miniPCNL?

OBJECTIVE: Auxiliary nephrolithometric scoring systems (NSSs) have been developed to predict complications and treatment success of conventional percutaneous nephrolithotomy (PCNL). However, to our knowledge, there is no study comparing these NSSs in patients undergoing miniPCNL. This study aimed to compare the NSSs in terms of their ability to predict miniPCNL-related complications and treatment success. METHODS: The data of patients undergoing PCNL between September 2016 and May 2018 were retrospectively reviewed through the electronic medical record system, and 140 patients were included in our study. Stone-free status was evaluated using non-contrast computed tomography between 1 and 3 months after the procedure. PCNL was considered successful if the patient was completely stone free. The postsurgical complications were classified according to the modified Clavien-Dindo classification system. RESULTS: The Clinical Research Office of the Endourological Society (CROES) and STONE NSSs significantly predicted miniPCNL treatment success (p = 0.043, p = 0.018). However, the Guy's NSS did not significantly predict the treatment success (p = 0.415). Guy's, CROES and STONE NSSs were not found to significantly predict postsurgical complications (p = 0.584, p = 0.823, p = 0.189). CONCLUSION: To the best of our knowledge, our study is the first of its kind to investigate the ability of NSSs to predict treatment success and postsurgical complications in patients undergoing miniPCNL. The study found that STONE and CROES NSSs are independent parameters for predicting stone-free status after miniPCNL. In addition, our study found that none of the NSSs were useful in predicting postsurgical complications in patients undergoing miniPCNL.

Modified Autologous Transobturator Tape Surgery - A Prospective Comparison With Transobturator Tape Surgery.

OBJECTIVE: To compare modified autologous transobturator-tape (a-TOT) and transobtrator-tape (TOT) surgeries in terms of effectivity and complications. MATERIALS AND METHODS: Prospectively 117 patients (a-TOT:36,TOT:81) were enrolled in this study. A-TOT was performed with autologous fascia elongated with nonabsorbable sutures and TOT was performed with standard technique. Preoperative data regarding operative time, complications and postoperative visual analog scores (VAS) were noted. Patients were assessed 12 months after surgery. Objective cure was evaluated with cough stress test (CST) and necessity of reoperation due to failure while subjective cure was evaluated with Patient Global Impression of Improvements scale(PGI-I) and the International Consultation on Incontinence Questionnaire-Female Lower Urinary Tract Symptoms(ICIQ-FLUTS) questionnaire. RESULTS: The mean follow-up time was 21.5 ± 1.1 months. Preoperative demographic characteristics were similar. The mean operation time was longer in a-TOT group(P = .001).VAS at postoperative 8. and 24. hours and overall complication rates were similar for the groups. Clavien grade-3 complications occurred only in TOT group (3.7%). Objective cure rates according to CST were 97.3% and 97.6% (P = .998) and the subjective cure rates according to PGI-I were 97.3% and 92.5% (P = .664) for a-TOT and TOT groups, respectively. One patient in TOT group needed reoperation. The a-TOT group gained better improvements in total score and total QoL score of ICIQ-FLUTS (P = .028 and P = .032, respectively) as well as subscore and QoL subscore of filling and voiding sections of ICIQ-FLUTS (P = .043, P = .048,P = .034, and P = .039, respectively). CONCLUSION: The a-TOT technique has similar objective and subjective cure rates and overall complication rates furthermore better results in postoperative voiding dysfunction and de-novo filling phase symptoms when compared to TOT.

Modified autologous transobturator tape surgery - evaluation of short term results.

OBJECTIVES: The aim of this study is to evaluate the short-term outcomes of our modified autologous transobturator tape (aTOT) technique with rectus abdominis muscle fascial graft for the treatment of female stress urinary incontinence (SUI). MATERIAL AND METHODS: The data of 22 patients who underwent modified aTOT were recorded. Perioperative data regarding operative time, complications and postoperative visual analogue scores were noted. Patients were assessed 18 months after surgery. The primary endpoints of this study were the improvements in the International Consultation on Incontinence Questionnaire-Female Lower Urinary Tract Symptoms (ICIQ-FLUTS) subscores, one-hour pad test and cough stress test rates as an objective cure as well as the improvements in the PGI-I and ICIQ-FLUTS quality of life scores as a subjective cure. RESULTS: Mean age and the mean follow-up period were 51.7 ± 9.8 years and 20.1 ± 0.9 months, respectively. Urethral hypermobility and a positive cough stress test were detected in all the patients. Mean operative time was 43.8 ± 8.1 min. and the overall complication rate was 9%. Mean VAS scores at postoperative 24 hours were 2.6 ± 1.2. At the postoperative eighteenth month, no patient had a positive cough test and mean PGI-I score was 2 while two patients had moderate urinary incontinence according to the pad test. Pad test results, ICIQ subscores of voiding QoL, incontinence, incontinence QoL, total score and total QoL score at baseline and eighteen months after surgery were 76.9 ± 19.9, 9.6 ± 4.1, 15.5 ± 4.0, 39.5 ± 7.9, 27.9 ± 6.6, 68.4 ± 13.8 and 7.1 ± 2, 10.1 ± 2.4, 6.6 ± 2.1, 13.4 ± 4.5, 20.4 ± 4.8, 39.7 ± 9.2 respectively (p = 0.001, p = 0.004, p = 0.001, p = 0.001, p = 0.001, and p = 0.001, respectively) CONCLUSIONS: Modified aTOT is an effective and safe method with low morbidity for SUI treatment in short term.

Autologous transobturator midurethral sling.

OBJECTIVE: The aim of this study is to describe a novel transobturator midurethral sling surgery technique by using rectus abdominis fascia. MATERIAL AND METHODS: A 54-year-old woman complaining of urinary leakage during effort was diagnosed as pure stress urinary incontinence after detailed questioning, pelvic examination, uroflowmetry and measurement of residual urine volume. She was anxious about complications related to synthetic meshes. However, she was not interested in relatively morbid surgeries such as colposuspension and pubovaginal sling. Autologous transobturator midurethral sling was discussed with the patient. The patient approved the surgery and the surgery was planned. A 5 cm rectus fascia was harvested via suprapubic incision and non-absorbable stay sutures were placed on its' both edges. Anterior vaginal incision together with paravaginal dissection was performed, as in classical transobturator sling surgery. Groin puncture and blind dissection of adipose tissue was performed. C-shaped trocars were inserted, and advanced through groin punctures and brought up to midurethral incision by finger guidance. Stay sutures were transported via C-shaped trocars to the groin puncture in both sides. Graft was positioned on the midurethral part without any tension and stay sutures were tied to create a tissue bridge on obturator membrane. Incisions were closed and vaginal tampon was placed. Patient was discharged at the first postoperative day. RESULTS: At postoperative third and sixth months, patient was totally dry and did not have any voiding complaints. Small abdominal and vaginal incisions were clean, as well. CONCLUSION: Autologous transobturator midurethral sling surgery is a safe, effective and feasible surgical option for stress urinary incontinence in the era which mesh-related concerns are rising. Studies with larger volume and long-term follow up periods are needed.

Prediction of recurrence in non-muscle invasive bladder cancer patients. Do patient characteristics matter?

PURPOSE: To evaluate patients, diagnosed with non-muscle invasive bladder cancer, according to patient specific parameters including hemoglobin level, estimated glomerular filtration rate (eGFR), body mass index (BMI) and cigarette smoking and to identify if any of these parameters matters in terms of recurrence prediction. METHODS: 231 patients who have undergone transurethral resection of the bladder (TURB) between January 2015 and January 2018 and diagnosed with non-muscle invasive bladder cancer (NMIBC) were included. Patient demographic characteristics including age, sex, BMI and cigarette smoking were assessed. Hemoglobin, creatinine and eGFR values were recorded. Follow-up was performed according to the European Association of Urology (EAU) guidelines' recommendations. Recurrence and progression during follow-up were recorded. RESULTS: 231 patients were included in the study. Median patient BMI, Hb levels, and eGFR values were 26.51 kg/m2 (IQR 5.48), 14,2 g/dL (IQR 2.50), and 83.25 ml/min/1.73m2 (IQR 27.83), respectively. Among all patients, 105 (45%) were ex-smokers and 78 (33%) were current smokers, 41 had anemia (17.7%), 37 (16%) patients were obese; 104 (45%) had mildly impaired renal function and 34 (14.7%) had impaired renal function. During follow-up, 67 (29%) patients had disease recurrence and 21 (9.1%) had disease progression (9.1%). Univariate and multivariate analyses revealed significant relationship between recurrence and obesity, impaired renal function and cigarette smoking. CONCLUSIONS: Recurrence is a commonly encountered unfortunate consequence of NMIBC, and obesity, renal failure, history of smoking and anemia seem to increase the rate of recurrence among bladder cancer patients.

Factors affecting infectious complications following flexible ureterorenoscopy.

In the present study, we aimed to clarify predictive factors that may cause postoperative infectious complications after flexible ureterorenoscopy (f-URS). In a 4-year prospective study, charts of patients who underwent f-URS between January 2014 and January 2018 for renal stone(s) in a tertiary academic center were reviewed. A standardized f-URS procedure was performed for all patients. Post-operative infectious complications including fever, sepsis and septic shock were categorized into same group. Patients with and without infectious complications were compared in the terms of preoperative, operative and post operative characteristics. In total, 463 patients who did not face infectious complications and 31 patients who faced infectious complications were enrolled into the study. The mean age was significantly lower in patients who did face infectious complications (34.8 vs 44.7 years old, p < 0.001). On the other hand, presence of renal abnormality was significantly more common in patients with infectious complications (12.3% vs 35.5%, p < 0.001). The mean operation time was 65.3 min in patients with infectious complications and significantly longer when compared with patients who did not face infectious complication (47.8 min, p < 0.001). Stone-free rate was significantly higher in patients without infectious complications (85.3% vs 77.5, p = 0.009). Multivariate regression analysis revealed that longer operation time ≥ 60 min, presence of renal abnormality and age ≤ 40 years were predictive factors for infectious complications following f-URS. The present study has demonstrated that operation time ≥ 60 min, presence of renal abnormality and patients with ≤ 40 years were significantly associated with infectious complications following f-URS.

Comparison of Flexible Ureterorenoscopy and Mini Percutaneous Nephrolithotomy in the Management of Multiple Renal Calculi in 10-30 mm Size.

PURPOSE: To evaluate the efficacy and safety of flexible ureterorenoscopy (f-URS) and mini percutaneous nephrolithotomy (mini-perc) in the management of 10-30 millimeter multiple renal stones. MATERIALS AND METHODS: The charts of patients who underwent f-URS or mini-perc for multiple kidney stones between January 2011 and July 2015 were retrospectively analyzed. Patients with multiple 10-30-mm-sized renal stones were enrolled in the study. A total of 374 patients underwent mini-perc and 85 patients met the study inclusion criteria. In the same period, f-URS was performed in 562 patients, and 163 had 10-30-mm multiple renal stones. We selected 85 patients to serve as the control group from this cohort using propensity score matching with respect to the patient's age, ASA score, number, size, and location of stones to avoid potential bias between groups. RESULTS: The mean operation time and fluoroscopy screening time (FST) was significantly longer in the mini-perc group (P = .001 and P = .001, respectively). The mean hospitalization time was 76.9±38.7 hours in the mini-perc group and 25.0±27.7 hours in the f-URS group (P = .001). Post-operative complications, according to the Clavien classification system, were significantly more frequent in the mini-perc group (P = .003). The stone-free rate was 87% in the f-URS group and 83.5% in the mini-perc group (P = .66). CONCLUSION: Our study demonstrated that f-URS and mini-perc were effective treatment options for multiple renal stones 10-30 mm in size. However, f-URS was associated with a significantly lower complication rate, shorter operation time, shorter FST, and shorter hospitalization time.