You have accessJournal of UrologyThis Month in Adult Urology1 Apr 2023This Month in Adult Urology D. Robert Siemens D. Robert SiemensD. Robert Siemens More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003192AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail A Closer Look at Complex Renal Cystic Lesions Given the high prevalence of complex renal cystic lesions, as well as the anxiety and costs associated with management, comprehensive examinations of their natural history and treatment outcomes are always a welcome addition. In this issue of The Journal, 2 groups clarify issues around their classification and risks of malignancy. First, Couture et al (page 694) in a single-institution series from Canada identified and reviewed Bosniak IIF renal cysts and evaluated the impact of the most recent 2019 classification on the diagnosis of such lesions.1 In their cohort, the newest classification would have led to a 76% decrease in a Bosniak IIF diagnosis, with no increase in any higher complexity diagnoses, translating to a significant reduction of overdiagnosis. Secondly, Lee et al (page 686) from Philadelphia, Pennsylvania, add to considerations of trying to distinguish indolent cystic renal masses compared to those more biologically aggressive tumors.2 In their single-center study, they explored associations of the radiographic characteristics and high-grade pathology. One of their interesting observations was a disconnect between “cystic” designation on imaging and any such cystic description on pathology reports for those who went on to have surgery. The authors conclude that although 23% of their resected cystic renal lesions demonstrated high-grade disease, judicious use of active surveillance and delayed intervention of most radiographic cystic renal masses is still warranted. Cannabidiol Oil for Pain Control After Ureteroscopy Despite good evidence that stents are not overly beneficial after uncomplicated ureteroscopy, they remain commonly used and a significant cause of grief after management of stone disease. Several large population-level studies have even suggested ureteroscopy is associated with persistent opioid use in those patients who were previously opioid naïve. Alternative strategies for analgesia of stent discomfort would be a welcome addition. Cannabidiol (CBD) oil is a non-opioid analgesic frequently used for chronic pain conditions, though little is known about its role after ureteroscopy. Narang et al (page 726) from Phoenix, Arizona, report a randomized, blinded, placebo-controlled trial to determine the safety and efficacy of a Food and Drug Administration–approved CBD oil as part of a multimodal approach including rescue opioids.3 This well-performed trial demonstrated that the CBD oil was safe but ineffective in any of the end points studied and, importantly, did not mitigate opioid usage. Although only 90 patients were randomized, the use of CBD oil, at least in this dose and formulation, does not appear to have much benefit for patients with the aggravating but short-term discomfort from stents. Variation in Monitoring Patients for Lower-risk Prostate Cancer As active surveillance for lower-risk prostate cancer has evolved from strict protocols in tertiary care institutions to a guideline preference with broad uptake in routine practice, the compliance of recommended monitoring has not been well described. Leapman et al (page 710) present a retrospective cohort multicenter study of Medicare beneficiaries diagnosed between 2004 and 2016 and initially managed with observation for at least 12 months.4 In those patients followed without treatment for at least 5 years, only 48% had any additional prostate biopsies and 31% had ≥1 prostate MRI. Accepting that patient preference and clinical factors including age and risk are central to the decisions around intensity of monitoring, some of the other observations from the authors point to ongoing sociodemographic disparities in the delivery of guideline-concordant care. These findings are likely comparable in today’s practice and in many other jurisdictions. Ongoing efforts to finesse our recommendations around intensifying or de-escalating follow-up, and then strengthen guideline adherence, remain imperative to ensure the optimal care of all patients diagnosed with low- and intermediate-risk prostate cancer. Home-based Peroneal Nerve Neuromodulation vs Solifenacin The intolerance, and therefore adherence, of medical therapy remains a hindrance to satisfying management of overactive bladder symptoms. The promise of noninvasive neuromodulation/stimulation, though, has been constrained by issues including access, length of the treatment, and the burden of travel for therapy. Krhut et al (page 734) in a multinational study report a randomized trial in women with symptoms of overactive bladder who were treatment naïve, comparing peroneal nerve neuromodulation in a home-based setting to standard treatment using solifenacin.5 Although the primary end point was safety, the secondary assessments of efficacy over the study period suggest quite comparable results with reduced treatment-related adverse events with neuromodulation. Issues with maintenance of results from neuromodulation strategies cannot be answered by this study, but the authors conclude that home-based peroneal nerve stimulation had a considerably better initial risk-benefit profile. Bonus Material: Artificial Intelligence in Scientific Publishing It is likely that the technological advances imbued by artificial intelligence (AI) are primed to restructure medicine, enhancing the experiences of patients and clinicians alike. Tools incorporating AI have already impacted our personal lives and virtually every sector of business. It is no surprise that these developments are leading to a rapid transformation of how we conduct our academic endeavors, including scientific publishing. The role of AI in publishing has long promised some efficiencies and increased accuracy in the creation, assessment, and editing of academic work. However, the realization of any benefits (including plagiarism checks, copyediting, identification of peer reviewers, comprehensive literature searches, content classification, etc) may have been just upended by recent advances in the technology. Readers should turn their attention to the letter to the editor by González-Padilla (page 682) from Spain.6 The cheeky piece highlights the challenges presented to the publishing industry, and potentially our academic veracity, by ChatGPT created by OpenAI. ChatGPT is, so far, a freely accessible chatbot that creates realistic-sounding text in response to prompts and is good enough to deceive reviewers. Although highly lamented by many, it is likely that this technology is poised to become an integral collaborator for authors, contributing background, conceptual designs, and first drafts. The time is ripe for a holistic and nuanced discussion of the role of AI in medical publishing. REFERENCES 1. . Evolution of Bosniak IIF renal cysts and impact of the 2019 Bosniak classification. J Urol. 2023; 209(4):694-700. Link, Google Scholar 2. . Pathological and clinical outcomes in a large surveillance and intervention cohort of radiographically cystic renal masses. J Urol. 2023; 209(4):686-693. Link, Google Scholar 3. . Effect of cannabidiol oil on post-ureteroscopy pain for urinary calculi: a randomized, double-blind, placebo-controlled trial. J Urol. 2023; 209(4):726-733. Link, Google Scholar 4. . Use of monitoring tests among patients with localized prostate cancer managed with observation. J Urol. 2023; 209(4):710-718. Link, Google Scholar 5. . Prospective, randomized, multicenter trial of peroneal electrical transcutaneous neuromodulation vs solifenacin in treatment-naïve patients with overactive bladder. J Urol. 2023; 209(4):734-741. Link, Google Scholar 6. . Concerns about the potential risks of artificial intelligence in manuscript writing. Letter. J Urol. 2023; 209(4):682-683. Link, Google Scholar © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue 4April 2023Page: 653-654 Peer Review Report Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information D. Robert Siemens More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...