Ultrasound-based predictive indicators for treatment outcomes in pediatric vesicoureteral reflux.

PURPOSE: To evaluate the effectiveness of preoperative ultrasound (US) measurements in predicting pediatric vesicoureteral reflux (VUR) treatment outcomes. METHODS: This prospective study enrolled 35 patients (53 renal units) aged 1-16 years who underwent subureteric injection therapy for primary VUR between July 2020 and June 2022. Preoperative ultrasound examinations measured the bladder wall thickness at the ureteral orifice, ureteral submucosal tunnel length, distal ureteral diameter, patient demographics, VUR grade, presenting complaints, bladder-bowel dysfunction, and renal scarring, and the impact of these variables on treatment success was analyzed. RESULTS: Among the patients, 91.4% were female, with a mean age of 6.83 ± 3.84 years. A comparison between the treatment success and failure groups revealed no significant differences in the age, sex, VUR grade, laterality, bilaterality, presenting complaints, bladder-bowel dysfunction, bladder wall thickness, or distal ureteral diameter (p > 0.05). However, renal scarring occurred in 16 (38.1%) patients in the treatment success group and 10 (90.9%) in the treatment failure group (p = 0.002). The treatment failure group had shorter detrusor-to-ureteral orifice distances and smaller detrusor-ureteral orifice distance-to-distal ureteral diameter (D/U) ratios than that of the success group (p = 0.004 and p = 0.006, respectively). Patients with a detrusor-to-ureteral orifice distance < 7.4 mm had an 81.82% likelihood of treatment failure. CONCLUSION: Ultrasound measurements of the detrusor-to-ureteral orifice distance and D/U ratio proved reliable in predicting the success of endoscopic subureteric injection therapy for VUR.

Assessing the educational value of laparoscopic radical nephrectomy videos on YouTube®: A comparative analysis of short versus long videos.

INTRODUCTION: To evaluate the quality of laparoscopic radical nephrectomy videos and determine the extent to which they are informative and educational for healthcare professionals. PATIENTS AND METHODS: We used the YouTube® search engine to search for the term 'laparoscopic radical nephrectomy' with time filters of 4-20 min (Group 1) and >20 min (Group 2) and then sorted the results uploaded chronologically before January 2023. One hundred videos were analysed for each group. The reliability of the videos was assessed using the Journal of American Medical Association (JAMA) Benchmark Criteria and DISCERN questionnaire scores (DISCERN). Educational quality was assessed using the Global Quality Score (GQS) and a 20-item objective scoring system (OSS) for laparoscopic nephrectomy. The popularity of the videos was evaluated using the video power index (VPI). RESULTS: The mean video duration was 8.9 ± 4.3 min in Group 1 and 52.02 ± 31.09 min in Group 2 (P < 0.001). The mean JAMA (2.49 ± 0.61) and OSS scores (60 ± 12.3) were higher in Group 2 than in Group 1, while no significant difference was observed in the mean GQS (2.53 ± 0.7, 2.39 ± 0.88, respectively) between the groups (P < 0.001, P = 0.039, P = 0.131, respectively). CONCLUSION: While the standardisation of surgical videos published on YouTube® and the establishment of auditing mechanisms do not seem plausible, high total OSS, periprocedural OSS, and VPI scores, and high OSS, JAMAS, GQS and DISCERN scores in long videos indicate that such videos offer a greater contribution to education.

Frequently asked questions on erectile dysfunction: evaluating artificial intelligence answers with expert mentorship.

The present study assessed the accuracy of artificiaI intelligence-generated responses to frequently asked questions on erectile dysfunction. A cross-sectional analysis involved 56 erectile dysfunction-related questions searched on Google, categorized into nine sections: causes, diagnosis, treatment options, treatment complications, protective measures, relationship with other illnesses, treatment costs, treatment with herbal agents, and appointments. Responses from ChatGPT 3.5, ChatGPT 4, and BARD were evaluated by two experienced urology experts using the F1 and global quality scores (GQS) for accuracy, relevance, and comprehensibility. ChatGPT 3.5 and ChatGPT 4 achieved higher GQS than BARD in categories such as causes (4.5 ± 0.54, 4.5 ± 0.51, 3.15 ± 1.01, respectively, p < 0.001), treatment options (4.35 ± 0.6, 4.5 ± 0.43, 2.71 ± 1.38, respectively, p < 0.001), protective measures (5.0 ± 0, 5.0 ± 0, 4 ± 0.5, respectively, p = 0.013), relationships with other illnesses (4.58 ± 0.58, 4.83 ± 0.25, 3.58 ± 0.8, respectively, p = 0.006), and treatment with herbal agents (3 ± 0.61, 3.33 ± 0.83, 1.8 ± 1.09, respectively, p = 0.043). F1 scores in categories: causes (1), diagnosis (0.857), treatment options (0.726), and protective measures (1), indicated their alignment with the guidelines. There was no significant difference between ChatGPT 3.5 and ChatGPT 4 regarding answer quality, but both outperformed BARD in the GQS. These results emphasize the need to continually enhance and validate AI-generated medical information, underscoring the importance of artificiaI intelligence systems in delivering reliable information on erectile dysfunction.

Comparison of the micro-percutaneous neprhrolithotomy results between adult and pediatric cases: Is it safe and effective for pediatric cases?

OBJECTIVE: To compare the safety and effectivity of micro percutaneous nephrolithotomy (MicroPNL) in adults and children. MATERIAL AND METHODS: Twenty children and twenty adult patients underwent MicroPNL were evaluated prospective consecutively,between June 2016 and December 2017,who were not suitable for retrograde intrarenal surgery (RIRS).Demographic data,stone free rates,length of hospitalization,duration of the operation,fluoroscopy time,transfusion rates,requirement of double J (D-J) catheter implantation and complications were examined. RESULTS: Seventeen patients with complete data in each group were evaluated within the scope of the study. Mean age was 40.76±14.96 (18-67) years in adults and 5.38±3.84 (10 months-14 years) years in children.There were no differences found between two groups for the mean operation time, fluoroscopy time,and length of hospitalization.Total success rate was noted 94.11% in each group (p=1).While no complications were seen in adults, three complications developed in the pediatric group (p=0.07). One patient in children group had steinstrasse.In addition,intraperitoneal fluid extravasation occurred in one pediatric patient during the operation.After paracentesis,postoperative period was observed uneventful.Also,one pediatric patient had high fever due to urinary tract infection.While there was no need for perioperative D-J catheter implantation in adults,D-J catheter was implanted in 6 (35.29%) pediatric patients, due to fragmented stone burden (p= 0.007) (Table 1). CONCLUSION: According to our results, micaroPNL is safe and effective treatment option in symptomatic renal stones smaller than 2 cm, especially in adults. Unfortunately,it needs more attention due to the risk of complications in pediatric population.

Results of minimally invasive procedures for ESWL refractory renal stones smaller than 2 cm: A single center experience. / Resultados de los procedimientos mínimamente invasivos en litiasis renales menores de 2 cm refractarias a litotricia extracorporea. Experiencia individual en un centro.

OBJECTIVES: To evaluate the efficacyand reliability of endourological procedures in patientswith renal stones up to 2 cm that were found to be resistantto extracorporeal shock wave lithotripsy (ESWL). METHODS: 611 patients who had undergone ESWLdue to renal stones up to 2 cm at the ESWL unit of ourclinic, were retrospectively evaluated. Standard percutaneousnephrolithotomy (PNL), micro-PNL, retrogradeintrarenal surgery (RIRS) was performed on the patientswho had stones resistant to ESWL. Demographic data,stone free rate, duration of hospital stay, duration of operation,the duration of scopy, the rates of transfusion andthe complications were recorded. RESULTS: The mean age of 611 patients included tothe current study was 40.76±15.45 years, the meansize of stones was calculated as 205.47±90.5 mm2.While the renal stones were removed in 468 patients(76.59%) after ESWL, endourological procedures wereperformed in 142 patients (23.24%) who had ESWLresistant stones. Standard PNL was performed in 73patients (51.4%), RIRS was performed in 51 patients(35.91%), micro-PNL was performed in 18 patients(12.68%). The success rates after the surgical procedureswere 93.15%, 90.16% and 88.88%, respectively.No major complication was observed in patient groupswho had undergone RIRS and microPNL. CONCLUSION: The surgical approaches, which areselected according to the size and localization of stones,could provide a success rate of 98.03% in ESWLresistant stones and these procedures could be reliablyperformed with considerably lower complication rates.

OBJETIVO: Evaluar la eficacia y fiabilidad de los procedimientos endourológicos en pacientes con litiasis renal de hasta 2 cm resistentes a litotricia extracorporea por ondas de choque (LEOC).MÉTODOS: 611 pacientes que habían recibido LEOC por litiasis renales de hasta 2 cm en la unidad de litotricia de nuestra clínica fueron evaluados retrospectivamente. En los pacientes con cálculos resistentes a LEOC se realizaron nefrolitotomía percútanea estándar,micro-NLP y cirugía intrarenal retrograda (CIRR). Se registraron los datos demográficos, las tasas de pacientes libres de litiasis, duración de la estancia hospitalaria,duración de la operación, duración de la escopia, tasas de transfusiones y las complicaciones. RESULTADOS: La edad media de los pacientes incluidos en el estudio (n=611) fue 40,76±15,45 años, el tamaño medio de la litiasis 205,47±90,5 mm2. La LEOC resolvió la litiasis en 468 pacientes (76,59%) pero en 142 pacientes con litiasis resistentes a LEOC(23,24%) se realizaron intervenciones endourológicas.Se realizó NLP estándar en 73 pacientes (51,4%), CIRR en 51 (35,91%), y micro NLP en 18 (12,68%). Las tasas de éxito después de los procedimientos quirúrgicos fueron del 93,15%, 90,16% y 88,88%, respectivamente. No se observaron complicaciones mayoresen los grupos de pacientes sometidos a CIRR y micro NLP.CONCLUSIÓN: Los abordajes quirúrgicos, que son seleccionadosen función del tamaño y localización de las litiasis, pueden ofrecer una tasa de éxitos del 98,03% en litiasis resistentes a LEOC y estos procedimientos pueden ser realizados de forma fiable con una tasa de complicaciones considerablemente menor.

Efficacy of medical expulsive treatment with doxazosin in pediatric patients.

OBJECTIVE: To evaluate the possible efficacy of an α1 blocker (doxazosin) therapy on the management and disease course in pediatric patients with distal ureteral stones. MATERIALS AND METHODS: A total of 45 patients (24 boys and 21 girls) with a single lower ureteral stone were included in the study program. Their age range was 3-15 years (mean 6.65 ± 3.78). The children were randomized into 2 main groups: group 1 (n = 21), who received only ibuprofen 20 mg/kg/d divided into 2 equal doses for pain control during follow-up; and group 2 (n = 24), who received, in addition to ibuprofen, 0.03 mg/kg/d doxazosin once daily, before bed. RESULTS: The stone expulsion rate was 28.5% (6 of 21) in group 1 and 70.8% (17 of 24) in group 2 (P = .001). The number of daily colic attacks and stone expulsion time clearly demonstrated the advantage of doxazosin, with a statistically significant diminished number of pain attacks (P = .04) and shorter stone expulsion period (P = .001). Stones <5 mm were expulsed at greater rates than stones 5-10 mm in group 2 (P = .046). Also children aged <6 years passed the stones with significantly greater rates than children aged ≥7 years (P = .008). CONCLUSION: The use of α-adrenergic blocker agents could have certain advantages in attempts to render children stone free within a shorter period, which would inevitably diminish the number of colic attacks and the need for analgesic usage.

Reliability of percutaneous nephrolithotomy in pediatric patients: comparison of complications with those in adults.

PURPOSE: To assess the reliability of percutaneous nephrolithotomy (PNL) in pediatric patients by comparing complications between pediatric patients and adults by use of the modified Clavien grading system. MATERIALS AND METHODS: The data of 74 pediatric (0 to 16 years) and 535 adult (17 years and older) patients who underwent PNL owing to kidney stone disease between January 2005 and December 2011 were analyzed retrospectively. The complications in the pediatric and adult patients were classified in five grades according to the modified Clavien system. RESULTS: The most frequent cause of grade I complications was fever requiring antipyretics, which was seen in 4 pediatric patients (5.4%) and 30 adult patients (5.6%). Grade II complications (blood transfusions, <12 hours urinary leakage) were observed in 11 pediatric patients (14.8%) and 80 adult patients (14.9%). Grade III complications were also seen in 6 pediatric patients (8.1%) (grade IIIb; D-J catheter implantation under general anesthesia) and 78 adult patients (14.5%) (grade IIIa; D-J catheter implantation and angio-embolization under local anesthesia). There was no statistically significant difference between the two groups in terms of grade I, II, or III complications (p>0.05). Colonic injury occured in one patient (1.3%) in the pediatric group (grade IVa). In the adult group, one patient (0.2%) died as the result of myocardial infarction (grade V). CONCLUSIONS: Thanks to technological developments and minimalization of the equipment used, when indicated, pediatric patients can be safely treated with PNL with low complication rates similar to those in adult patients.

Results of minimally invasive procedures for eswl refractory renal stones smaller than 2 cm: a single center experience / Resultados de los procedimientos mínimamente invasivos en litiasis renales menores de 2 cm refractarias a litotricia extracorporea. Experiencia individual en un centro

Objectives: To evaluate the efficacy and reliability of endourological procedures in patients with renal stones up to 2 cm that were found to be resistant to extracorporeal shock wave lithotripsy (ESWL). Methods: 611 patients who had undergone ESWL due to renal stones up to 2 cm at the ESWL unit of our clinic, were retrospectively evaluated. Standard percutaneous nephrolithotomy (PNL), micro-PNL, retrograde intrarenal surgery (RIRS) was performed on the patients who had stones resistant to ESWL. Demographic data, stone free rate, duration of hospital stay, duration of operation, the duration of scopy, the rates of transfusion and the complications were recorded. Results: The mean age of 611 patients included to the current study was 40.76±15.45 years, the mean size of stones was calculated as 205.47±90.5 mm2. While the renal stones were removed in 468 patients (76.59%) after ESWL, endourological procedures were performed in 142 patients (23.24%) who had ESWL resistant stones. Standard PNL was performed in 73 patients (51.4%), RIRS was performed in 51 patients (35.91%), micro-PNL was performed in 18 patients (12.68%). The success rates after the surgical procedures were 93.15%, 90.16% and 88.88%, respectively. No major complication was observed in patient groups who had undergone RIRS and microPNL. Conclusion: The surgical approaches, which are selected according to the size and localization of stones, could provide a success rate of 98.03% in ESWL resistant stones and these procedures could be reliably performed with considerably lower complication rates

Objetivo: Evaluar la eficacia y fiabilidad de los procedimientos endourológicos en pacientes con litiasis renal de hasta 2 cm resistentes a litotricia extracorporea por ondas de choque (LEOC). Métodos: 611 pacientes que habían recibido LEOC por litiasis renales de hasta 2 cm en la unidad de litotricia de nuestra clínica fueron evaluados retrospectivamente. En los pacientes con cálculos resistentes a LEOC se realizaron nefrolitotomía percútanea estándar, micro-NLP y cirugía intrarenal retrograda (CIRR). Se registraron los datos demográficos, las tasas de pacientes libres de litiasis, duración de la estancia hospitalaria,duración de la operación, duración de la escopia, tasas de transfusiones y las complicaciones. Resultados: La edad media de los pacientes incluidos en el estudio (n=611) fue 40,76±15,45 años, el tamaño medio de la litiasis 205,47±90,5 mm2. La LEOC resolvió la litiasis en 468 pacientes (76,59%) pero en 142 pacientes con litiasis resistentes a LEOC (23,24%) se realizaron intervenciones endourológicas. Se realizó NLP estándar en 73 pacientes (51,4%), CIRR en 51 (35,91%), y micro NLP en 18 (12,68%). Las tasas de éxito después de los procedimientos quirúrgicos fueron del 93,15%, 90,16% y 88,88%, respectivamente. No se observaron complicaciones mayores en los grupos de pacientes sometidos a CIRR y micro NLP. Conclusión: Los abordajes quirúrgicos, que son seleccionados en función del tamaño y localización de las litiasis, pueden ofrecer una tasa de éxitos del 98,03% en litiasis resistentes a LEOC y estos procedimientos pueden ser realizados de forma fiable con una tasa de complicaciones considerablemente menor