Urological Applications Research Articles

Use of Platelet Rich Plasma in Urological Conditions

Introduction: Platelet-rich plasma (PRP) has become an increasingly popular therapeutic tool across various medical specialties since its introduction in 1958. Defined as a concentrated solution of platelets and growth factors derived from autologous blood, PRP supports tissue repair and regeneration processes. PRP’s composition includes high concentrations of platelets and growth factors that facilitate angiogenesis, connective tissue remodeling, and cellular repair, making PRP a promising treatment option for complex urological conditions and beyond. Purpose of the study: This review aims to summarize the applications and efficacy of PRP in treating specific urological conditions such as erectile dysfunction, Peyronie's disease, urethral stricture, hypospadias, interstitial cystitis and urinary incontinence. Materials and Methods: To provide a comprehensive summary of current knowledge on this topic, a literature review of English-language articles, with an emphasis on recent publications, was conducted. The review utilized the PubMed database and included 51 studies accessed prior to October 2024. Conclusions: PRP therapy appears to be a promising, safe, and minimally invasive treatment option for several urological conditions. Studies suggest that PRP may benefit erectile function, reduce symptoms in Peyronie's disease, and improve outcomes in conditions related to the urethra and bladder, with minimal reported adverse effects. However, the lack of standardized PRP preparation protocols and large placebo-controlled trials poses a challenge to fully establishing its efficacy. Further research is necessary to confirm PRP’s effectiveness, optimize preparation and administration methods, and develop guidelines for its clinical application in urology.

Exploring Large Language Models and the Metaverse for Urologic Applications: Potential, Challenges, and the Path Forward.

The metaverse, a 3-dimensional digital platform that enables users to interact and engage in realistic virtual activities beyond time and space limitations, has garnered significant investment across industries, particularly in healthcare. In the medical field, the metaverse shows promise as a digital therapeutic platform to enhance interaction between medical professionals and patients. Concurrently, generative artificial intelligence, especially large language models, is being integrated into healthcare for applications in data analysis, image recognition, and natural language processing. In urology, large language models (LLMs) support are increasingly used in urology for tasks such as image diagnosis, data processing, patient education, and treatment assistance in order to provide significant support in clinical settings. By combining LLMs with the immersive capabilities of the metaverse, new possibilities emerge to improve urologic treatment in areas that require consistent treatments, habit formation, and long-term management. This paper reviews current research and applications of LLMs in urology, discusses the challenges associated with their use including data quality, bias, security, and ethical issues, and explores the need for regulatory standards. Furthermore, it highlights the potential of a metaverse-based digital platform to improve urologic care and streamline information exchange to maximize the benefits of this integrated approach in future healthcare applications.

Editorial Comment on "PubMed-Indexed Research Productivity of Urology Applicants and Residents: Does Medical Student Research Productivity Predict Resident Research or Pursuit of an Academic Career?"

Editorial Comment on "PubMed-Indexed Research Productivity of Urology Applicants and Residents: Does Medical Student Research Productivity Predict Resident Research or Pursuit of an Academic Career?"

PubMed-indexed Research Productivity of Urology Applicants and Residents: Does Medical Student Research Productivity Predict Resident Research or Pursuit of an Academic Career?

ObjectivesTo assess the research output of urology residents at top programs and investigate the correlation between medical school research productivity (MRP), research during residency (RRP), and pursuit of academic practice. Further, to characterize trends in MRP before and after the transition to pass/fail scoring of USMLE Step 1. MethodsOur team previously reported on the PubMed-indexed research productivity of applicants matching into top 50 urology programs. Here, we used the same list of residents, recorded their publications during residency, and noted their career paths, including fellowships, academic roles, or private practice. We then highlight the relationship between MRP, RRP, and pursuit of an academic career. We also highlight trends in MRP of applicants matching to top residency programs before and after the transition to pass/fail Step 1 exams. ResultsWe collected data on 727 residents. On multivariate logistic regression, total medical school publications (OR 1.07, 95% CI 0.97, 1.19), total urology publications (OR 1.05, 95% CI 0.92, 1.21), and total first author publications (OR 1.10, 95% CI 0.91, 1.33) were not associated with academic appointment after residency. On the other hand, RRP was correlated with pursuit of academics (1.08, 95% 1.03,1.14). MRP was significantly higher amongst applicants who applied with a pass/fail exam compared to those who did not. ConclusionMRP is not predictive of pursuing an academic career, but RRP is. There is a significant increase in average MRP of those matching to top urology programs after the transition to a pass/fail scoring system for Step 1.

Serious Games as a Therapeutic Tool in Pediatric Urology: A Review of Current Applications and Future Directions.

This paper examines the use of serious games that integrate engaging gameplay with educational and therapeutic benefits with a particular focus on their application in urology. The study reviews both domestic and international cases to evaluate the current practices and implications of these digital therapies. While serious games have been widely utilized in the treatment of pediatric cancer and psychiatric disorders-areas that require long-term care and management-their application in urology, in particular pediatric urology, has been limited. Although digital therapies like serious games are still emerging in the field of urology, they hold promise as effective supplements to traditional treatments while offering new options for managing a range of urological conditions. Pediatric conditions such as bedwetting, urinary incontinence, and dysuria, which often benefit from long-term training and habit formation, are particularly well-suited to this approach. By helping pediatric patients better understand and manage their symptoms, serious games can play a supportive role in the treatment process and have shown positive medical outcomes. This paper reviews the definitions and therapeutic effects of serious games, analyzes their current use in the medical field, and argues for their increased application in treating pediatric urinary conditions.

Clinical insights into nanomedicine and biosafety: advanced therapeutic approaches for common urological cancers.

Urological cancers including those of the prostate, bladder, and kidney, are prevalent and often lethal malignancies besides other less common ones like testicular and penile cancers. Current treatments have major limitations like side effects, recurrence, resistance, high costs, and poor quality of life. Nanotechnology offers promising solutions through enhanced diagnostic accuracy, targeted drug delivery, controlled release, and multimodal imaging. This review reflects clinical challenges and nanomedical advances across major urological cancers. In prostate cancer, nanoparticles improve delineation and radiosensitization in radiation therapy, enable fluorescent guidance in surgery, and enhance chemotherapy penetration in metastatic disease. Nanoparticles also overcome bladder permeability barriers to increase the residence time of intravesical therapy and chemotherapy agents. In renal cancer, nanocarriers potentiate tyrosine kinase inhibitors and immunotherapy while gene vectors and zinc oxide nanoparticles demonstrate antiproliferative effects. Across modalities, urological applications of nanomedicine include polymeric, liposomal, and metal nanoparticles for targeted therapy, prodrug delivery, photodynamic therapy, and thermal ablation. Biosafety assessments reveal favorable profiles but clinical translation remains limited, necessitating further trials. In conclusion, nanotechnology holds significant potential for earlier detection, precise intervention, and tailored treatment of urological malignancies, warranting expanded research to transform patient outcomes.

Digital health applications in urology

Digital health applications (DiGA) were included in the German healthcare system in 2020. They are available for prescription and reimbursed by public and private insurance companies. For the specialty of urology, there are currently two DiGA available: for the treatment of erectile dysfunction and benign prostatic hyperplasia/overactive bladder (BPH/OAB). The legal basis, clinical results and practical implementation are presented. Evaluation of websites and publications to show the regulatory requirements, mode of action, results of clinical trials and prescribing practice with DiGA. Since 2020, 63DiGA have been listed in the register of the Federal Office for Drugs and Medical Devices (BfArM), 35 of them definitively. Two urological DiGA aim to treat erectile dysfunction and BPH/OAB. Randomized, controlled studies have shown asignificant and clinically relevant patient benefit for both DiGA. Further urological DiGA are in clinical development. DiGAs offer multimodal therapy combinations that have not yet been used in clinical practice and show amultidimensional benefit for the patient.

The Role of 3D-Printed Phantoms and Devices for Organ-specified Appliances in Urology.

Urology is one of the fields that are always at the frontline of bringing scientific advancements into clinical practice, including 3D printing (3DP). This study aims to discuss and presents the current role of 3D-printed phantoms and devices for organ-specified applications in urology. The discussion started with a literature search regarding the two mentioned topics within PubMed, Embase, Scopus, and EBSCOhost databases. 3D-printed urological organ phantoms are reported for providing residents new insight regarding anatomical characteristics of organs, either normal or diseased, in a tangible manner. Furthermore, 3D-printed organ phantoms also helped urologists to prepare a pre-surgical planning strategy with detailed anatomical models of the diseased organs. In some centers, 3DP technology also contributed to developing specified devices for disease management. To date, urologists have been benefitted by 3D-printed phantoms and devices in the education and disease management of organs of in the genitourinary system, including kidney, bladder, prostate, ureter, urethra, penis, and adrenal. It is safe to say that 3DP technology can bring remarkable changes to daily urological practices.

The Impact of the COVID-19 Pandemic on the Cost of the Urology Application Process

ObjectiveTo review the self-reported costs of urology residency applications from 2019 to 2023 and examine the impact of Society of Academic Urologists (SAU) policy changes made during the COVID-19 pandemic on these costs. MethodsData from the Texas Seeking Transparency in Applications to Residency (STAR) survey was used to evaluate costs incurred by fourth-year urology residency applicants from U.S. medical schools. Outcomes included median total cost (mTC), interview costs, application fees, and other associated costs, alongside the number of interviews offered and match outcomes. Cost comparisons among surgical specialties were made. Simple linear regression was used to identify cost drivers and cost-outcome correlations. ResultsBetween 2019 and 2023, 522 urology residency applicants responded to the survey. The adoption of virtual interviews and discontinuation of in-person away rotations in the 2020-21 cycle led to a 79% reduction in mTC and a 92% reduction in interview costs. Key cost drivers were the number of away rotations and number of applications submitted. Each incremental away rotation is associated increased cost of $1,490. In the 2020-21 cycle, urology applicants spent on average $2,000 more than their general surgery counterparts. Urology shared the position of most expensive surgical specialty with thoracic surgery and ophthalmology in the 2021-22 match cycle. ConclusionPandemic-related policy changes significantly reduced the costs of urology residency applications, helping to reduce socio-economic barriers. The critical role of away rotations in securing match success, along with their associated costs, highlights equity concerns for students from institutions without home urology programs.

Robotic urologic applications of the hinotori™ Surgical Robot System

ObjectiveTo assess the safety and effectiveness of urological tumor surgeries using the hinotori™ Surgical Robot System (hinotori) in a real-world clinical setting. MethodsAll surgeries including procedures of robot-assisted radical prostatectomy (RARP), robot-assisted partial nephrectomy (RAPN), robot-assisted radical nephrectomy (RARN), robot-assisted nephroureterectomy (RANU), robot-assisted adrenalectomy (RAA), and robot-assisted radical cystectomy with intracorporeal urinary diversion (RARC+ICUD) for urological tumors with hinotori and da Vinci surgical system (da Vinci) from January 2022 through September 2023 were enrolled. We evaluated the safety and effectiveness of surgery using hinotori compared using da Vinci. ResultsRobotic surgeries using hinotori were performed in a total of 91 cases, comprising 42 cases of RARP, 18 cases of RAPN, six cases of RARN, 10 cases of RANU, 13 cases of RAA, and two cases of RARC+ICUD. No major intraoperative complications were observed in any cases using hinotori. No major postoperative complications occurred in any of the cases. No case experienced unrecoverable equipment error during surgery. Meanwhile, robotic surgeries using da Vinci were performed in a total of 277 cases that included 126 cases of RARP, 94 cases of RAPN, 12 cases of RARN, 10 cases of RANU, 20 cases of RAA and 15 cases of RARC+ICUD. Major intraoperative complications occurred two cases. Major postoperative complications occurred in seven cases. Seven cases required transfusion. One case underwent conversion to open surgery. During the study period, no case experienced an unrecoverable equipment error. Surgical outcomes for cases with hinotori were comparable to those with da Vinci. ConclusionsThis study demonstrated that hinotori is a safe and feasible tool for robotic surgeries in the field of urology.

Large language models in science

Large language models (LLMs) are gaining popularity due to their ability to communicate in ahuman-like manner. Their potential for science, including urology, is increasingly recognized. However, unresolved concerns regarding transparency, accountability, and the accuracy of LLM results still exist. This review examines the ethical, technical, and practical challenges as well as the potential applications of LLMs in urology and science. Aselective literature review was conducted to analyze current findings and developments in the field of LLMs. The review considered studies on technical aspects, ethical considerations, and practical applications in research and practice. LLMs, such as GPT from OpenAI and Gemini from Google, show great potential for processing and analyzing text data. Applications in urology include creating patient information and supporting administrative tasks. However, for purely clinical and scientific questions, the methods do not yet seem mature. Currently, concerns about ethical issues and the accuracy of results persist. LLMs have the potential to support research and practice through efficient data processing and information provision. Despite their advantages, ethical concerns and technical challenges must be addressed to ensure responsible and trustworthy use. Increased implementation could reduce the workload of urologists and improve communication with patients.

Exploring the Feasibility of GPT-4 as a Data Extraction Tool for Renal Surgery Operative Notes.

GPT-4 is a large language model with potential for multiple applications in urology. Our study sought to evaluate GPT-4's performance in data extraction from renal surgery operative notes. GPT-4 was queried to extract information on laterality, surgery, approach, estimated blood loss, and ischemia time from deidentified operative notes. Match rates were determined by the number of "matched" data points between GPT-4 and human-curated extraction. Accuracy rates were calculated after manually reviewing "not matched" data points. Cohen's kappa and the intraclass coefficient were used to evaluate interrater agreement/reliability. Our cohort consisted of 1498 renal surgeries from 2003 to 2023. Match rates were high for laterality (94.4%), surgery (92.5%), and approach (89.4%), but lower for estimated blood loss (77.1%) and ischemia time (25.6%). GPT-4 was more accurate for estimated blood loss (90.3% vs 85.5% human curated) and similarly accurate for laterality (95.2% vs 95.3% human curated). Human-curated accuracy rates were higher for surgery (99.3% vs 93% GPT-4), approach (97.9% vs 90.8% GPT-4), and ischemia time (95.6% vs 30.7% GPT-4). Cohen's kappa was 0.96 for laterality, 0.83 for approach, and 0.71 for surgery. The intraclass coefficient was 0.62 for estimated blood loss and 0.09 for ischemia time. Match and accuracy rates were higher for categorical variables. GPT-4 data extraction was particularly error prone for variables with heterogenous documentation styles. The role of a standard operative template to aid data extraction will be explored in the future. GPT-4 can be utilized as a helpful and efficient data extraction tool with manual feedback.

Current Potential for Outpatient Care in Urology: What the IGES Report Means if Applied to Real Data

The hospital reform initiated through an expert opinion of the German research institute IGES places great emphasis on the aspect of outpatient care. In this context, the current IGES guidelines extend further than has previously been the case. There are only very isolated instances where this theoretical potential has been translated into practical application in urology. This study aims to reflect the theoretical potential calculated using real data from urology with a view to practical application. Using the algorithm of the "Hospital Structure Navigator" of DKTIG (Deutsche Krankenhaus TrustCenter und Informationsverarbeitung GmbH), focused on the extension of the AOP (Ambulatory Operations and Procedures) catalogue, section-21 data of the year 2022 from the Clinic for Urology at the University Hospital Schleswig-Holstein was analysed. The inclusion and exclusion criteria provided by IGES were applied, along with a limitation of the length of stay to two days and a minimum case number of 30 cases per year. Since this resulted in a very low potential for target DRGs (Diagnosis-Related Groups), the criteria were further modified. With this approach, a plausibility check for the outpatient treatment capability of identified cases was conducted. After applying the inclusion and exclusion criteria, only one applicable DRG (L18B) emerged, but with the expanded criteria, eight DRGs were identified. From the case flat rates determined, three appropriate OPS codes were identified:1.) Ureterorenoscopic removal of stones from the kidney with lithotripsy (5-550.31)2.) Transurethral resection of a bladder tumour, not fluorescence-supported (5-573.40)3.) Bougienage of a ureter, transurethral (5-560.2) CONCLUSION: With the current set of criteria defined by IGES for urology, no significant outpatient potential can be achieved. However, the expansion of criteria has uncovered areas that could be well implemented with a broader set of criteria and are currently seen more systematically in the realm of measures replacing inpatient procedures or hybrid DRGs. In addition to the need to clarify the fundamental outpatient feasibility of the methods on an individual case basis, there are limitations here, especially for multimorbid populations. Therefore, in expanding the catalogue, the legislator must take into account the higher risk and monitoring effort required for these patients.

Indocyanine green (ICG) fluorescence technology in pediatric robotic surgery

This study aimed to report our experience in indocyanine green (ICG) fluorescence-guided surgery (FGS) in pediatric robotics. The data of 55 patients (35 boys and 20 girls), who underwent robotic surgery using ICG fluorescence in three institutions over the last 7 years, were retrospectively reviewed. The following robotic procedures were included: pyeloplasty (n = 21), complex Lich–Gregoir ureteral reimplantation (n = 8), varicocelectomy (n = 7), adnexal pathology resection (n = 8), partial nephrectomy (n = 4), nephrectomy (n = 4), renal cyst removal (n = 2), and excision of prostatic utricle (n = 1). The ICG was injected intravenously in all indications except for varicocele where intratesticular injection was done, and prostatic utricle or paraureteral diverticulum where trans-catheter injection was done. The ICG dosage was 0.2–0.3 mg/mL/kg. All the procedures were performed using da Vinci Xi platform. Firefly® allowed to switch form bright light to ICG-NIRF view and vice versa. All the procedures were accomplished in robotics without conversions to laparoscopy or open surgery. No episodes of allergy or anaphylaxis to ICG were recorded. An excellent ICG-NIRF view of target organs was obtained in all procedures. Based on our experience, we believe that application of ICG FGS in pediatric robotics enhances the identification of critical anatomical elements and pathological structures, thereby positively impacting both oncological and functional outcomes. This technique is safe, feasible, and versatile. We advocate the consideration of ICG as the standard of care in certain procedures such as partial nephrectomy, varicocele repair, tumor resection, and ovarian torsion. Nonetheless, further investigations are warranted to explore its potential broader applications in pediatric urology.

Online Interest in Urology Residency: A Comprehensive Analysis of Current Internet Temporal and Geographic Patterns

Urology is one of the most competitive specialties in medicine, creating a challenge for prospective students looking to secure a residency position. Our study aims to assess online interest in urology residency by querying online interaction with search terms and criteria for urology residency programs. Utilizing Google Trends analysis from 2011 to 2024, this study examined urology-related search volume indexes, as well as temporal and geographical patterns. Furthermore, the number of residency positions from the American Urological Association database for the 2022 match process was evaluated. Our analysis of temporal trends revealed increased interest in urologist salaries from 2011 to 2019, followed by a decline from 2019 to 2023. Interest in urology-related interviews, applications, research, and letters increased in 2019, marked by the start of the COVID-19 pandemic. California, New York, and Texas had the lowest interest-to-position (IP) ratio, while Maryland, New Jersey, and Virginia had the highest IP ratio. Our analysis reveals an evolving interest in salaries, residency programs, and USMLE Step 1 changes in areas connected with urology. We report key geographical areas with high urology residency interest and low numbers of programs, implying a need for expanded residencies in underserved yet high-interest areas. Awareness and continued interest monitoring after the COVID-19 pandemic is critical for understanding interest in urology applicants.

Sacral Neuromodulation: Device Improvement and Current Applications in Urology.

Sacral neuromodulation (SNM) offers a therapeutic approach to urological patients suffering from idiopathic overactive bladder (OAB) syndrome, with or without incontinence and non-obstructive urinary retention (NOR), who are not responding to or are not compliant with conservative or medical therapies. The exact mechanism of action of SNM is not fully understood but modulation of the spinal cord reflexes and brain networks by peripheral afferents is regarded as the main pathway. Over the years, surgical techniques improved, leading to the development of the modern two-stage implantation technique. The quadripolar lead is positioned percutaneously under fluoroscopy guidance through the third sacral foramen following the trajectory of S3. The procedure can be performed under local or general anesthesia with the patient in prone position. Current applications of sacral neuromodulation in urology are increasing thanks to the recent improvements of the devices that make this a valuable option not only in conditions such as overactive bladder and non-obstructing urinary retention but also neurogenic lower urinary tract dysfunction.

Fostering Diversity in Urology: Addressing Ethnic Disparities in Applicant and Resident Recruitment.

In this retrospective database review, the objective was to investigate the ethnic composition of urology applicants and residents in recent years and assess whether any advancements have been made in enhancing the recruitment of candidates from historically underrepresented groups in medicine. A retrospective database review was conducted on self-reported data on the ethnicity of urology applicants from academic year 2016 to 2017 (AY2016) to AY2021 and urology residents from AY2011 to AY2021. Applicant data were collected from the Association of American Medical Colleges, and resident data were collected from the Accreditation Council for Graduate Medical Education. The ethnic proportions of applicants and residents within cohorts were analyzed using χ2 tests, and differences between cohorts were analyzed using Z tests. There was a statistically significant decrease in the proportion of White applicants from 61.4% to 50.5% from AY2016 to AY2021 and a statistically significant increase in the proportion of applicants of multiple race/ethnicity from 4.7% to 12.0% from AY2016 to AY2021. There were disproportionately more Hispanic/Latino residents than applicants and disproportionately fewer residents of multiple race/ethnicity than applicants in the 2 cycles analyzed. There were disproportionately fewer Black residents than applicants only in the comparison of AY2016 to AY2020 applicants to AY2020 residents. There continues to be a lack of ethnic representation among applicants and residents in urology from underrepresented groups in medicine, despite some measurable improvement over the years. This deficit highlights the important need for new and ongoing efforts to diversify the field.

Analyzing the Current State and Visibility of Diversity, Equity, and Inclusion Initiatives at Urology Residency Programs

ObjectiveTo analyze AUA urology residency program websites to determine visibility of DEI initiatives. There is growing interest in diversity, equity, and inclusion (DEI) initiatives by urology applicants, and in recent years, urology programs have invested in efforts to promote DEI. MethodsAll ACGME-accredited urology residency program with a website were assessed. Military programs were excluded. A DEI Score Card was developed using published pillars of DEI, including five domains: departmental inclusion, pipeline growth, departmental education, community engagement, and faculty demographics. Program Doximity rank, address, and surrounding demographics were collected to determine predictors of investing in DEI. Results141 urology residency websites were included for analysis. Only 40.7% of programs referenced DEI on their webpage, and 21.4% offered funded mentorship opportunities. Department education and community engagement were the least popular initiatives. The Western, Northeastern, and North Central sections had the highest DEI total score with wide variation across domains. Mention of DEI was not associated with program’s county-level social vulnerability or percent minority but was associated with being a top 50 program (OR=4.0; 95% CI 1.8, 8.9; p=0.0007). DiscussionLess than half of academic urology programs' websites referenced DEI initiatives. Using a DEI score card, our study shows that investment in diversity, equity, and inclusion varies widely by AUA section, and greater investment is positively correlated with program rank. Our DEI score card serves as a tool that programs can use to assess their current DEI investment, identify areas for improvement, and ensure existing initiatives are visible to applicants.

Editorial Comment: Trends in PubMed-Indexed Research in Matched Urology Applicants: A Cross-Sectional Analysis of the 2017-2021 Match Cycles

Editorial Comment: Trends in PubMed-Indexed Research in Matched Urology Applicants: A Cross-Sectional Analysis of the 2017-2021 Match Cycles

Editorial Comment: Trends in PubMed-Indexed Research in Matched Urology Applicants: A Cross-Sectional Analysis of the 2017-2021 Match Cycles

Editorial Comment: Trends in PubMed-Indexed Research in Matched Urology Applicants: A Cross-Sectional Analysis of the 2017-2021 Match Cycles