Soc. Int. Urol. J., Volume 5, Issue 3 (June 2024) – 14 articles

In this study, AEEP (anatomical enucleation of the prostate) with a thulium laser was performed in 115 men at a single institution between January 2019 and March 2022 for surgical treatment of lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) [...] Full article

Objectives: To understand the clinical characteristics, risk factors, diagnosis, treatment, and outcomes of urinary tract obstruction caused by fungal balls. Materials and Methods: A comprehensive search was conducted across PubMed, Embase, and Medline following the PRISMA guidelines, including case reports and case series. Study quality and risk of bias were assessed using the Oxford Centre for Evidence-Based Medicine (CEBM) document. The systematic review process was aimed at gathering and synthesising all available research evidence on the topic. Results: We included 54 articles reporting on 57 patients, primarily males (61.4%) with a median age of 56 years. The most common presenting symptoms were flank pain (71.9%) and fevers (59.6%). All diagnoses were made on the presence of yeast in urine or intra-operative tissue cultures and the presence of obstruction on imaging. The most common pathogen isolated were those of the Candida species (61.5%) followed by Aspergillus (33.3%). Multimodal management was the mainstay approach with the use of systemic and local antifungal therapy in combination with surgical drainage of the obstruction. The mortality rate was around 12.3%. Conclusions: Management of renal or ureteral obstruction caused by fungal balls requires a multimodal and multidisciplinary approach, comprising systemic antifungal therapy, drainage procedures, and in some instances, surgical intervention. The growing prevalence of antifungal resistance and the high mortality potential of fungal uropathy necessitates ongoing research into the optimal diagnostic and treatment modalities for this condition. Full article

Objectives: ChatGPT is a large language model that is able to generate human-like text. The aim of this study was to evaluate ChatGPT as a potential supplement to urological clinical practice by exploring its capacity, efficacy and accuracy when delivering information on frequently asked questions from patients with bladder cancer. Methods: We proposed 10 hypothetical questions to ChatGPT to simulate a doctor–patient consultation for patients recently diagnosed with bladder cancer. The responses were then assessed using two predefined scales of accuracy and completeness by Specialist Urologists. Results: ChatGPT provided coherent answers that were concise and easily comprehensible. Overall, mean accuracy scores for the 10 questions ranged from 3.7 to 6.0, with a median of 5.0. Mean completeness scores ranged from 1.3 to 2.3, with a median of 1.8. ChatGPT was also cognizant of its own limitations and recommended all patients should adhere closely to medical advice dispensed by their healthcare provider. Conclusions: This study provides further insight into the role of ChatGPT as an adjunct consultation tool for answering frequently asked questions from patients with bladder cancer diagnosis. Whilst it was able to provide information in a concise and coherent manner, there were concerns regarding the completeness of information conveyed. Further development and research into this rapidly evolving tool are required to ascertain the potential impacts of AI models such as ChatGPT in urology and the broader healthcare landscape. Full article

Objectives: Perioperative blood transfusion (PBT) has been associated with worse survival after radical cystectomy (RC) in patients with muscle-invasive bladder cancer (MIBC). Here, we evaluated the association between PBT and survival after RC that was preceded by neoadjuvant chemotherapy (NAC). Methods: A retrospective analysis was performed on 949 patients with cT2-4aN0M0 bladder cancer who received NAC prior to RC between 2000 and 2013 at 19 centers. Kaplan–Meier estimates of overall survival (OS) were made. Presumed risk factors for OS were analyzed using Cox regression analysis. PBT was defined by the administration of any packed red blood cells during surgery or during the post-operative hospital stay. Results: A transfusion was given to 608 patients (64%). Transfused patients were more likely to have adverse clinical and pathologic parameters, including clinical stage and performance status. Transfused patients had worse OS (p = 0.01). On multivariable Cox regression, PBT was found to be independently associated with worse OS (HR 1.53 (95% CI 1.13–2.08), p = 0.007). Conclusions: PBT is common after NAC and RC, which may be linked, in part, to the anemia induced by NAC. PBT was associated with several adverse risk factors that correlate with poor outcomes after NAC and RC, and it was an independent predictor of adverse OS on multivariable analysis. Further study should determine if measures to avoid blood loss can reduce the need for PBT and thereby improve patient outcomes. Full article

Controversy surrounds population-based screening for prostate cancer, which has typically relied on PSA level for risk stratification. This commentary examines the recent prospective trial examining the use of biphasic prostate MRI scans as a screening tool for prostate cancer. Using a reliable test, such as MRI prostate, at an earlier point along the diagnostic pathway, the authors provide a novel solution to a difficult problem. Further research is warranted to assess how biphasic MRI might be feasible at a population level. Full article

Objective: To assess the quality and readability of online information on holmium laser enucleation of the prostate in managing benign prostate hyperplasia using the most-used search engine worldwide, Google. Methods: Google search terms “Holmium laser surgery” and “enlarged prostate” were used to generate 150 search results. Two independent authors (i) excluded any paywall, scientific literature, or advertisement and (ii) conducted an independent assessment on information quality, which was based on DISCERN, QUEST, and JAMA criteria, and readability, which was based on the FKG, GFI, SMOG, and FRE scores on qualified webpages. A third author was involved if there were any discrepancies between the assessments. Results: 107 qualified webpages were included in the data analysis. The median DISCERN score was 42 out of 80 (IQR 35–49). The median JAMA score was 0 out of 4 (IQR 0–1). The median QUEST score was 9 out of 28 (IQR 9–12). Using the non-parametric ANOVA and post hoc Games–Howell test, significant differences were identified between rankings of webpages. Sponsorship had no influence on the quality of webpages. The overall readability level required a minimum reading level of grade 11. Linear regression analysis showed that a higher ranked webpage is a positive predictor for all three quality assessment tools. Conclusions: The overall quality of online information on HoLEP is poor. We identify that the top-ranked google searches have a higher DISCERN score and are a positive predictor for DISCERN/QUEST/JAMA. Quality online information can benefit patients but should be used in conjunction with professional medical consultation. Full article

TikTok has become a hub for easily accessible medical information. However, the quality and completeness of this information for testicular cancer has not been examined. Our study aims to assess the quality and completeness of testicular cancer information on TikTok. A search was performed on TikTok using the search terms “Testicular Cancer” and “Testicle Cancer”. Inclusion criteria encompassed videos about testicular cancer in English. We excluded non-English videos, irrelevant videos, and videos without audio. We evaluated these videos using the DISCERN instrument and a completeness assessment. A total of 361 videos were considered for screening and 116 videos were included. Of these, 57 were created by healthcare professionals (HCPs). The median video length was 40 s (5–277 s), with >25 million cumulative views and a median of 446,400 views per video. The average DISCERN score was 29.0 ± 5.7, with HCPs providing higher-quality videos than non-HCPs (30.8 vs. 5.5, p < 0.05). HCPs also had more reliable videos (21.2 vs. 18.1, p < 0.05). Overall quality levels were mostly poor or very poor (97.4%), with none being good or excellent. Most HCP videos were poor (63.2%), whilst many non-HCP videos were very poor (61.0%). The most viewed video had 2,800,000 views but scored a 31 on the DISCERN tool and one on the completeness assessment. The highest DISCERN score had 11,700 views. HCP videos better defined the disease and were more complete (p < 0.05). Most videos discussed self-assessment but were lacking in definitions, risk factors, symptoms, evaluation, management, and outcomes. Most of TikTok’s testicular cancer information lacks quality and completeness, whilst higher-quality videos have limited reach. Full article

Background: Prostate cancer is a malignant neoplasm of the male genitourinary system with the highest incidence worldwide. Susceptibility genes related to aggressiveness and prognosis, such as BRCA1/2, ATM, PTEN, have been identified. Currently, reports related to germline mutations in patients with prostate cancer in Latin American populations are very limited or absent. In the Mexican population, reports are also limited, especially in the context of metastatic prostate cancer. Determining the prevalence of these mutations is relevant to predict the potential aggressiveness of tumors and allow the use of targeted therapies, such as PARPi inhibitors. Objective: Determine the prevalence of germline mutations in patients with metastatic prostate cancer and establish their clinical characteristics at diagnosis. Material and Methods: Sixty-nine patients with metastatic PCa underwent testing and genetic analysis using the Comprehensive Multi-Cancer Hereditary Cancer Panel. The prevalence of germline mutations was assessed, and the cohort was divided into two groups for the evaluation and analysis of clinical characteristics between the mutated and non-mutated populations. Results: We identified mutations in 15 out of 69 patients (21.73%), while 54 patients (78.26%) had no mutations. Pathogenic mutations were observed in 15.9% of patients, Variants of Uncertain Significance (VUS) in 34.78%, and 5.79% had both. The most frequent mutations included ATM (11.54%), BRCA1 (11.54%), BRCA2 (7.69%), FANCA (7.69%), and FANCM (7.69%). No statistically significant differences were found in PSA levels, age at diagnosis, and resistance to castration between the two groups. Conclusions: Our study unveiled a mutation rate of 21.73%, marked by a significant prevalence of ATM, FANCA, FANCM, and Variants of Uncertain Significance (VUS). This pattern deviates from findings in other series, underscoring the necessity for improved access to clinical genetic testing in our population. Full article

An 82-year-old male experienced severe bleeding during transurethral resection of the prostate (TURP) due to an undetected prostatic arteriovenous malformation (AVM). Initial management with a catheter was followed by successful transarterial embolisation. This case highlights the effectiveness of endovascular angioembolisation for unexpected prostatic AVMs. Full article

Objectives: Benign prostatic hyperplasia is one of the most common urological diseases. Among these patients, the presence of detrusor underactivity or acontractility represents a challenging condition since no medical treatment is available. Our objective is to evaluate early term outcomes following transurethral anatomical enucleation of the prostate with Tm:YAG support. Methods: In a retrospective analysis of 115 patients who underwent this procedure between January 2019 and March 2022 due to lower urinary tract symptoms, 8 patients with urodynamic evidence of detrusor underactivity secondary to a non-neurogenic aetiology were identified. Detrusor underactivity was defined as a bladder contractility index of <100. Results: Median age, prostate volume and bladder contractility index were 73.2 years, 78.5 cm³ and 63.9, respectively. Median International Prostate Symptom Score/quality of life, Q_max and post-void residual volume were 15/3.5 points, 4.4 mL/s and 189 mL, respectively. Postoperatively, immediate catheter-removal success rate was 87.5% (7/8), at 2 months all patients were catheter-free and remained so at 1-year follow-up. Significant improvements for quality of life, Q_max and post-void residual volume were detected. Median postoperative International Prostate Symptom Score/Quality of life, Q_max and post-void residual volume were 7/2, 21.6 mL/s and 0 mL, respectively. Conclusions: This surgical approach offers high catheter-free rates, significantly improves functional voiding parameters and increases patient satisfaction in patients with benign prostatic hyperplasia and concomitant detrusor underactivity. Therefore, it can be regarded as an effective approach for such patients. Full article