Urologic Research Research Articles

ChatGPT in Urology: Bridging Knowledge and Practice for Tomorrow's Healthcare, a Comprehensive Review.

Background: Among emerging AI technologies, Chat-Generative Pre-Trained Transformer (ChatGPT) emerges as a notable language model, uniquely developed through artificial intelligence research. Its proven versatility across various domains, from language translation to healthcare data processing, underscores its promise within medical documentation, diagnostics, research, and education. The current comprehensive review aimed to investigate the utility of ChatGPT in urology education and practice and to highlight its potential limitations. Methods: The authors conducted a comprehensive literature review of the use of ChatGPT and its applications in urology education, research, and practice. Through a systematic review of the literature, with a search strategy using databases, such as PubMed and Embase, we analyzed the advantages and limitations of using ChatGPT in urology and evaluated its potential impact. Results: A total of 78 records were eligible for inclusion. The benefits of ChatGPT were frequently cited across various contexts. In educational/academic benefits mentioned in 21 records (87.5%), ChatGPT showed the ability to assist urologists by offering precise information and responding to inquiries derived from patient data analysis, thereby supporting decision making; in 18 records (75%), advantages comprised personalized medicine, predictive capabilities for disease risks and outcomes, streamlining clinical workflows and improved diagnostics. Nevertheless, apprehensions were expressed regarding potential misinformation, underscoring the necessity for human supervision to guarantee patient safety and address ethical concerns. Conclusion: The potential applications of ChatGPT hold the capacity to bring about transformative changes in urology education, research, and practice. AI technology can serve as a useful tool to augment human intelligence; however, it is essential to use it in a responsible and ethical manner.

Causality of genetically determined metabolites on susceptibility to prevalent urological cancers: a two-sample Mendelian randomization study and meta-analysis.

Prevalent urological cancers, including kidney, prostate, bladder, and testicular cancers, contribute significantly to global cancer incidence and mortality. Metabolomics, focusing on small-molecule intermediates, has emerged as a tool to understand cancer etiology. Given the knowledge gap in this field, we employ a two-sample Mendelian randomization (MR) analysis to investigate the causal relationships between genetically determined metabolites (GDMs) and the susceptibility to four common urological cancers. The study employs genome-wide association studies (GWAS) data from European populations, featuring the most extensive case count available for both blood metabolites and four prevalent urological cancers. Preliminary and secondary MR analyses were separately conducted, employing inverse variance weighted (IVW) as the primary method. Multiple statistical analyses, including the MR-Steiger test, Cochran's Q test, leave-one-out analysis, MR-Egger intercept analysis, and MR-PRESSO analysis, were executed to ensure robustness. Additionally, a meta-analysis was carried out to consolidate findings. The weighted median (WM) method was utilized for a relatively lenient correction (PWM < 0.05). After rigorous genetic variation filtering, 645 out of 1,400 metabolites were included in both preliminary and secondary MR analyses. Preliminary MR analysis identified 96 potential causal associations between 94 distinct metabolites and four urological cancers. Secondary analysis based on Finnish outcome data revealed 93 potential causal associations. Cross-database meta-analysis identified 68 blood metabolites associated with four urological cancers. Notably, 31 metabolites remained significant after using WM for correction, with additional 37 suggestive causal relationships. Reverse MR analysis revealed a significant causal association between genetically predicted prostate cancer and elevated 4-hydroxychlorothalonil levels (IVW, combined OR: 1.039, 95% CI 1.014-1.064, p = 0.002; WM, combined OR: 1.052, 95% CI 1.010-1.095, p = 0.014). This comprehensive MR study provides insights into the causal relationships between blood metabolites and urological cancers, revealing potential biomarkers and therapeutic targets, thereby addressing gaps in understanding and laying the foundation for targeted interventions in urological cancer research and treatment.

Artificial Intelligence for Urology Research: The Holy Grail of Data Science or Pandora's Box of Misinformation?

Introduction: Artificial intelligence tools such as the large language models (LLMs) Bard and ChatGPT have generated significant research interest. Utilization of these LLMs to study the epidemiology of a target population could benefit urologists. We investigated whether Bard and ChatGPT can perform a large-scale calculation of the incidence and prevalence of kidney stone disease. Materials and Methods: We obtained reference values from two published studies, which used the National Health and Nutrition Examination Survey (NHANES) database to calculate the prevalence and incidence of kidney stone disease. We then tested the capability of Bard and ChatGPT to perform similar calculations using two different methods. First, we instructed the LLMs to access the data sets and independently perform the calculation. Second, we instructed the interfaces to generate a customized computer code, which could perform the calculation on downloaded data sets. Results: While ChatGPT denied the ability to access and perform calculations on the NHANES database, Bard intermittently claimed the ability to do so. Bard provided either accurate results or inaccurate and inconsistent results. For example, Bard's "calculations" for the incidence of kidney stones from 2015 to 2018 were 2.1% (95% CI 1.5-2.7), 1.75% (95% CI 1.6-1.9), and 0.8% (95% CI 0.7-0.9), while the published number was 2.1% (95% CI 1.5-2.7). Bard provided discrete mathematical details of its calculations, however, when prompted further, admitted to having obtained the numbers from online sources, including our chosen reference articles, rather than from a de novo calculation. Both LLMs were able to produce a code (Python) to use on the downloaded NHANES data sets, however, these would not readily execute. Conclusions: ChatGPT and Bard are currently incapable of performing epidemiologic calculations and lack transparency and accountability. Caution should be used, particularly with Bard, as claims of its capabilities were convincingly misleading, and results were inconsistent.

Plant-Based Diets and Disease Progression in Men With Prostate Cancer.

Plant-based diets are associated with many health and environmental benefits, including primary prevention of fatal prostate cancer, but less is known about postdiagnostic plant-based diet patterns in individuals with prostate cancer. To examine whether postdiagnostic plant-based dietary patterns are associated with risk of prostate cancer progression and prostate cancer-specific mortality. This longitudinal observational cohort study included men with biopsy-proven nonmetastatic prostate cancer (stage ≤T3a) from the diet and lifestyle substudy within the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) enrolled at 43 urology practices across the US from 1999 to 2018. Participants completed a comprehensive diet and lifestyle questionnaire (including a validated food frequency questionnaire [FFQ]) between 2004 and 2016. Data were analyzed from August 2022 to April 2023. Overall plant-based diet index (PDI) and healthful plant-based diet index (hPDI) scores were calculated from the FFQ. The primary outcome was prostate cancer progression (recurrence, secondary treatment, bone metastases, or prostate cancer-specific mortality). The secondary outcome was prostate cancer-specific mortality. Among 2062 participants (median [IQR] age, 65.0 [59.0-70.0] years), 61 (3%) identified as African American, 3 (<1%) identified as American Indian or Alaska Native, 9 (<1%) identified as Asian or Pacific Islander, 15 (1%) identified as Latino, and 1959 (95%) identified as White. Median (IQR) time from prostate cancer diagnosis to FFQ was 31.3 (15.9-62.0) months after diagnosis. During a median (IQR) follow-up of 6.5 (1.3-12.8) years after the FFQ, 190 progression events and 61 prostate cancer-specific mortality events were observed. Men scoring in the highest vs lowest quintile of PDI had a 47% lower risk of progression (HR, 0.53; 95% CI, 0.37-0.74; P for trend = .003). The hPDI was not associated with risk of progression overall. However, among 680 individuals with Gleason grade 7 or higher at diagnosis, the highest hPDI quintile was associated with a 55% lower risk of progression compared with the lowest hPDI quintile (HR 0.45; 95% CI, 0.25-0.81; P for trend = .01); no association was observed in individuals with Gleason grade less than 7. In this cohort study of 2062 men with prostate cancer, higher intake of plant foods after prostate cancer diagnosis was associated with lower risk of cancer progression. These findings suggest nutritional assessment and counseling may be recommended to patients with prostate cancer to help establish healthy dietary practices and support well-being and overall health.

A short history of the British Urology Researchers in Surgical Training (BURST): The power of collaborative research

The British Urology Researchers in Surgical Training (BURST) is a UK-based, trainee-led urology research collaborative. Since inception in 2014, BURST has led projects in several urological subspecialties with the aim of improving urological practice for patient benefit. Key innovations we have used include an emphasis on social media communications and developing innovative technology solutions to improve collaboration. In this review article, we summarise our recent studies and highlight important strategies for performing collaborative research. Level of evidence: Not applicable.

Effects of Prostatic Inflammation on Clinical Outcomes in Patients with Benign Prostate Hyperplasia

Background: Benign prostate hyperplasia (BPH), a non-cancerous enlargement of the prostate gland, prevalently impacts the aging male population, often disrupting the quality of life with its accompanying urinary symptoms. The intersection between BPH and prostatic inflammation has emerged as a focal point in urological research, with inflammation speculated to exacerbate BPH progression and symptoms. Understanding this relationship is pivotal in refining therapeutic approaches and improving patient outcomes. Objective: This study aimed to elucidate the effects of prostatic inflammation on the clinical outcomes of patients with BPH, focusing on symptom progression, treatment efficacy, and long-term complications. Methods: This Study Conducted at Gajju Khan Medical College Swabi, KPK, Pakistan, in the duration from January, 2023 to June, 2023. This prospective cohort study involved 126 men with BPH, categorized into two groups based on the presence (n=63) or absence (n=63) of prostatic inflammation. Data were collected over three years, with assessments including demographic information, clinical histories, and prostate examinations. Primary outcomes measured were the progression of BPH symptoms, urinary function, and prostate size. Secondary outcomes included quality of life, acute urinary retention, the need for surgical intervention, medication efficacy, and long-term complications. Statistical analyses employed included Chi-square tests, t-tests, and ANOVA, with SPSS software. Results: The group with prostatic inflammation showed significantly more severe symptom progression (p &lt; 0.01), impaired urinary function (p &lt; 0.01), and increased prostate size (p &lt; 0.01) compared to the non-inflamed group. Secondary outcomes also favored the non-inflamed group with better quality of life scores (75.2 ± 5.2 vs. 78.8 ± 4.8, p &lt; 0.01), lower rates of acute urinary retention (20.3% vs. 15.5%, p &lt; 0.01). Conclusion: Prostatic inflammation significantly worsens the clinical outcomes of BPH, affecting symptom progression, treatment response, and the likelihood of long-term complications. These findings suggest the need for integrated therapeutic strategies that address both BPH and prostatic inflammation to optimize patient care.

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

Purpose: Urology is one of the most competitive specialties for residency matches in the United States. Data reported by the American Urological Association from match cycles spanning 2014 to 2021 reveal a median of 0.34% (0%-3%) of unfilled spots, a median of 1.48 (1.28-1.87) applicants per position, and a median of 75% (63%-87%) match rate. Recent research has shown that program directors value applicants' research highly. We sought to assess the research productivity of matched urology residency applicants, identify trends in research volume over time, and investigate the potential correlation between research output and program ranking. Materials and Methods: Doximity Urology program ranking list from the 2017 to 2021 match cycles was sorted by reputation, extracted, and populated using each program's official website resident roster, including name, medical school, postgraduate year, and additional degrees. Rosters were crossed-checked against social media posts from the official accounts. Each identified urology resident was queried in PubMed. Journal ranking was determined through Scimagojr; top-quartile journals were classified as Q1. Results: In total 131 of 145 programs were identified, and 1605 matched applicants spanning the 2017 to 2021 match cycles. The mean and median total publications were 2.44 and 1, respectively, and 2.17 and 1 when excluding case reports. 64.2% of applicants had at least one publication, and 42.2% had at least one urological publication. Applicants matching into higher-ranked programs had more research and urological research. Multivariable regression analysis revealed that Q1 research (β 2.38) and urology research (β 2.33) significantly affected rank. Match cycle analysis revealed an increase in total and urology-focused research, whereas regression analysis demonstrated significant increases in total publications (β 0.019) per cycle. Conclusion: Overall research, urology-focused research, first authorship, and publication in higher-ranked journals play an essential role in the urology match.

The impact of genomic biomarkers on a clinical risk prediction model for upgrading/upstaging among men with favorable-risk prostate cancer.

The challenge of distinguishing indolent from aggressive prostate cancer (PCa) complicates decision-making for men considering active surveillance (AS). Genomic classifiers (GCs) may improve risk stratification by predicting end points such as upgrading or upstaging (UG/US). The aim of this study was to assess the impact of GCs on UG/US risk prediction in a clinicopathologic model. Participants had favorable-risk PCa (cT1-2, prostate-specific antigen [PSA] ≤15ng/mL, and Gleason grade group 1 [GG1]/low-volume GG2). A prediction model was developed for 864 men at the University of California, San Francisco, with standard clinical variables (cohort 1), and the model was validated for 2267 participants from the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) registry (cohort 2). Logistic regression was used to compute the area under the receiver operating characteristic curve (AUC) to develop a prediction model for UG/US at prostatectomy. A GC (Oncotype Dx Genomic Prostate Score [GPS] or Prolaris) was then assessed to improve risk prediction. The prediction model included biopsy GG1 versus GG2 (odds ratio [OR], 5.83; 95% confidence interval [CI], 3.73-9.10); PSA (OR, 1.10; 95% CI, 1.01-1.20; per 1ng/mL), percent positive cores (OR, 1.01; 95% CI, 1.01-1.02; per 1%), prostate volume (OR, 0.98; 95% CI, 0.97-0.99; per mL), and age (OR, 1.05; 95% CI, 1.02-1.07; per year), with AUC 0.70 (cohort 1) and AUC 0.69 (cohort 2). GPS was associated with UG/US (OR, 1.03; 95% CI, 1.01-1.06; p<.01) and AUC 0.72, which indicates a comparable performance to the prediction model. GCs did not substantially improve a clinical prediction model for UG/US, a short-term and imperfect surrogate for clinically relevant disease outcomes.

Effects of first year COVID-19 pandemic on urology practice in three major Arab Countries: Sub-Analysis of a survey by Arab association of urology research group.

The World Health Organization (WHO) declared the coronavirus disease-19 (COVID-19) pandemic on March 11, 2020. The health care system faced tremendous challenges in providing ethical and high-quality care. The impact of COVID-19 on urological practices varied widely worldwide, including in Arab countries. This study aimed to compare the influence of the COVID-19 pandemic on urology practice in Egypt, the KSA, and the UAE during the first year of the pandemic. This sub-analysis assessed the demographics and COVID-19's effects on urological practice in terms of adjustments to hospital policy, including outpatient consultations, the management of elective and urgent surgical cases, and the continuation of education across the three countries. The availability of personal protective equipment (PPE) and urologists' emotional, physical, and verbal intimidation during COVID-19 were also compared. Regarding the impact on hospital policy, consultations replaced by telemedicine were significantly higher in the KSA (36.15%), followed by the UAE (33.3%), then Egypt (10.4%) (P = 0.008). Elective cases requiring ICU admission were 65.1% in Egypt, 45.2% in the KSA, and 58.2% in the UAE and were performed only in high-risk patients. PPE was freely available in 20.8% of the Egyptian hospitals compared to 83.3% in the KSA and 81.8% in the UAE. Online courses were significantly higher in Egypt (70.8%), followed by the UAE (53%) and the KSA (41.7%) (P = 0.02). Emotional intimidation was higher than verbal intimidation, representing 80%, 75.9%, and 76% in the UAE, KSA, and Egypt, respectively. This sub-analysis outlined significant hospital policy changes across the three Arab countries. Exposure to emotional, verbal, and physical intimidation was observed. The development of teleconsultations and online platforms for educational purposes was observed.

Thesis research in urology: what is good and what is bad?

Insufficient attention of clinicians to scientific research is one of the major concerns of medical education. To date, urological science is developing so rapidly that it is difficult for physicians to stay within the limits of modern technology. Urological science and clinical management should closely cooperate and share experience. In this regard, it seems useful to understand the problems of thesis research in urology. Of course, to understand not all the problems, but only a part of them, presented on the website of the High Certification Committee. Ten-year analysis (2013 – 2022) allows us to see trends and weaknesses, to form assumptions about the causes of processes and to see adjusting directions of unfavourable influencing factors on scientific research in urology.

Outcomes of initial 100 cases of laparoscopic nephrectomy at tertiary care center (PKLI).

Laparoscopic nephrectomy has been adopted by many centers in the last few decades. However, there are a few inherent challenges while adopting laparoscopic nephrectomy in a new unit. These include a significant learning curve required to adopt this modality. This study aimed to share the initial experience of adopting laparoscopic nephrectomy at our center. In total, 101 patients were analyzed in the study. These patients underwent laparoscopic radical or simple nephrectomy (for renal mass and noncancer renal cases respectively) at Department of Urology, Pakistan Kidney and Liver Institute and Research Centre, Lahore from April 2018 till January 2021. Data were entered in the statistical analysis software file. Analysis was attained by utilizing SPSS version 20. Implementation of Mean along with standard deviation values was utilized in the case of the continuous variables. While frequency/percentages represented categorical factors. The mean age of patients was 42.81±15.49 years and their overall BMI was 26.41±5.30 kg/m2. Out of these, 57 (56.43%) were males and 44(43.56%) were female. Eighteen percent of patients had a previous surgical history on the ipsilateral side. Total operative time was 163.98±58.02 minutes while mean hospital stay reached 3.2±0.87 days. The tumor-free margin was attained in all cases of radical nephrectomy. Based on Clavien-Dindo classification, Grade-1 (n=3; 2.97%), Grade-2 (n=6; 5.94%), Grade-3A (n=1; 0.99%), and Grade-3B (n=1; 0.99%) complications were observed. In a newly developed urology center, laparoscopic nephrectomy can be a daunting task. Good teamwork among the surgical team members and careful selection of cases can result in satisfactory procedural outcomes.

Stem Cells In Urology: A Promising Development For The Treatment Of Urological Disorders.

Madam, It was fascinating to read the latest research published in the Journal of Pakistan Medical Association (JPMA) on the utilisation of stem cells in urology. The study had some amazing findings, and I believe it has the power to revolutionise the treatment of urological disorders.1 Recent advances in stem cell research have opened new possibilities for treating various urological conditions. For example, findings have shown that stem cells can be used to promote tissue regeneration and repair in patients with urinary incontinence or erectile dysfunction.2 Additionally, stem cells can regenerate damaged renal tissue, offering the latest treatment options for patients with kidney disease.4 Apromising area of research includes use of mesenchymal stem cells (MSCs) to treat urological conditions. MSCs are multipotent cells that can specify into various cell types, including muscles, bones, and cartilage. They have been shown to up level the symptoms and improve quality of life in patients with urinary incontinence,They may also be very effective in treating a variety of urological conditions.2 One more area of research entails the use of induced pluripotent stem cells (iPSCs) in urology. iPSCs are reprogrammed from adult cells, like skin cells, into an embryonic-like state. They are differentiated into various cell types, making them a potentially important tool for regenerative medicine. Research has shown that iPSCs can be used to produce functional urothelial cells, which line the urinary tract and play a major role in bladder function.5 Overall, stem cell research in urology is a developing area that shows promise. It offers new treatment varieties for patients with urological conditions and has the potential to improve their quality of life. I strongly believe that this research will be of great interest to clinicians and researchers in this urology field, and I look forward to seeing further more developments in this exciting area of medicine. It is also important to note that further research is strongly needed to fully explore the potential of stem cells in urology. This includes examining the long-term safety standards and efficacy of stem cell therapy, as well as identifying the optimal stem cell sources and delivery methods for variety of urological conditions. I strongly believe that ongoing research will continue to shed light on these important questions.

Long-term Prostate Cancer–specific Mortality After Prostatectomy, Brachytherapy, External Beam Radiation Therapy, Hormonal Therapy, or Monitoring for Localized Prostate Cancer

BackgroundThe optimal treatment of localized prostate cancer (PCa) remains controversial. ObjectiveTo compare long-term survival among men who underwent radical prostatectomy (RP), brachytherapy (BT), external beam radiation therapy (EBRT), primary androgen deprivation therapy (PADT), or monitoring (active surveillance [AS]/watchful waiting [WW]) for PCa. Design, setting, and participantsThis is a cohort study with long-term follow-up from the multicenter, prospective, largely community-based Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) registry. Men with biopsy-proven, clinical T1–3aN0M0, localized PCa were consecutively accrued within 6 mo of diagnosis and had clinical risk data and at least 12 mo of follow-up after diagnosis available. Outcome measurements and statistical analysisPCa risk was assessed, and multivariable analyses were performed to compare PCa-specific mortality (PCSM) and all-cause mortality by primary treatment, with extensive adjustment for age and case mix using the Cancer of the Prostate Risk Assessment (CAPRA) score and a well-validated nomogram. Results and limitationsAmong 11 864 men, 6227 (53%) underwent RP, 1645 (14%) received BT, 1462 (12%) received EBRT, 1510 (13%) received PADT, and 1020 (9%) were managed with AS/WW. At a median of 9.4 yr (interquartile range 5.8–13.7) after treatment, 764 men had died from PCa. After adjusting for CAPRA score, the hazard ratios for PCSM with RP as the reference were 1.57 (95% confidence interval [CI] 1.24–1.98; p < 0.001) for BT, 1.55 (95% CI 1.26–1.91; p < 0.001) for EBRT, 2.36 (95% CI 1.94–2.87; p < 0.001) for PADT, and 1.76 (95% CI 1.30–2.40; p < 0.001) for AS/WW. In models for long-term outcomes, PCSM differences were negligible for low-risk disease and increased progressively with risk. Limitations include the evolution of diagnostic and therapeutic strategies for PCa over time. In this nonrandomized study, the possibility of residual confounding remains salient. ConclusionsIn a large, prospective cohort of men with localized PCa, after adjustment for age and comorbidity, PCSM was lower after local therapy for those with higher-risk disease, and in particular after RP. Confirmation of these results via long-term follow-up of ongoing trials is awaited. Patient summaryWe evaluated different treatment options for localized prostate cancer in a large group of patients who were treated mostly in nonacademic medical centers. Results from nonrandomized trials should be interpret with caution, but even after careful risk adjustment, survival rates for men with higher-risk cancer appeared to be highest for patients whose first treatment was surgery rather than radiotherapy, hormones, or monitoring.

Implementation of a shared research database to increase medical student awareness and involvement in urology research A pilot study.

We aimed to assess the effect of a shared institutional research database on medical students' scholarly work, perceived research competency, and self-reported satisfaction. An institutional inventory database was created on Google Sheets with a listing of available mentors and a description of their ongoing research projects. The inventory database was shared with interested students and faculty. Students who agreed to participate were surveyed pre- and post-inventory. Survey questions assessed student demographics, prior research experience, and their perception of research competency and satisfaction. The number of presentations, publications, and articles pre- and post-inventory were also abstracted. Survey responses were compared using the Mann-Whitney U test. A total of 20 students were surveyed pre-inventory and at a median followup of six months (5-7) post-inventory. There was a significant increase in scholarly presentations and publications post-inventory (p<0.05 for all). Furthermore, post-inventory, students reported feeling more confident in establishing an academic career, finding good mentors, managing their relationship with their mentor, managing professional challenges, and effectively showcasing themselves professionally and describing their research (p<0.05 for all). More than 65% of students agreed or strongly agreed that the database was easy to use, accessible, transparent, and would like a similar database created for other specialty departments. After performing mentorship-guided research through an institutional research database, medical students felt more confident in their ability to perform research and produced more scholarly work. Therefore, we recommend a research database be created across all institutional departments to foster interest in conducting research.

Exploring the Ethical, Legal, and Social Implications of ChatGPT in Urology.

ChatGPT is programmed to generate responses based on pattern recognition. With this vast popularity and exponential growth, the question arises of moral issues, security and legitimacy. In this review article, we aim to analyze the ethical and legal implications of using ChatGPT in Urology and explore potential solutions addressing these concerns. There are many potential applications of ChatGPT in urology, and the extent to which it might improve healthcare may cause a profound shift in the way we deliver our services to patients and the overall healthcare system. This encompasses diagnosis and treatment planning, clinical workflow, patient education, augmenting consultations, and urological research. The ethical and legal considerations include patient autonomy and informed consent, privacy and confidentiality, bias and fairness, human oversight and accountability, trust and transparency, liability and malpractice, intellectual property rights, and regulatory framework. The application of ChatGPT in urology has shown great potential to improve patient care and assist urologists in various aspects of clinical practice, research, and education. Complying with data security and privacy regulations, and ensuring human oversight and accountability are some potential solutions to these legal and ethical concerns. Overall, the benefits and risks of using ChatGPT in urology must be weighed carefully, and a cautious approach must be taken to ensure that its use aligns with human values and advances patient care ethically and responsibly.

Association Between Common Urologic Medications and Onset of Alzheimer’s Disease and Related Dementias in Men With Prostate Cancer Managed by Different Primary Treatment Modalities

To understand the relationship between common urologic medications phosphodiesterase-5 inhibitors (PDE5i) and anticholinergics (AC) and risk of dementia onset in men who underwent different primary treatments for prostate cancer. Patients (>50years) with prostate cancer (1998-2022) without Alzheimer's disease or related dementias were selected from Cancer of the Prostatic Strategic Urologic Research Endeavor Registry. Minimum medication use was 3months. Fine-Gray regression was performed to determine the association between medication exposure and dementia onset ≥12months after primary treatment in men matched on age, race, comorbid conditions, smoking, and type of clinical site, with competing risk of death. Among 5937 men (53% PDE5i; 14% AC), PDE5i users were younger (63 vs 70, P<.01) with less CAD, CVA, DM (all P<.01); AC users were older (68 vs 66, P<.01) with higher incidence of comorbidities (P<.01). Median months of use was 24.3 (IQR 12.1, 48.7) for PDE5i and 12.2 (IQR 6.1, 24.3) for AC users. Cumulative incidence of Alzheimer's disease or related dementias was 6.5% at 15years. PDE5i (P=.07) and AC (P=.06) were not associated with dementia regardless of primary treatment modality. In this retrospective cohort study, PDE5i and AC use do not appear independently associated with risk of dementia. Notably, our cohort was generally healthy and younger which may limit our ability to detect significance. We recommend prospective investigation into association between PDE5i and dementia and advise continued judicious stewardship of AC in older patient populations.

Bridging the Gap Between Urological Research and Patient Understanding: The Role of Large Language Models in Automated Generation of Layperson's Summaries.

This study assessed ChatGPT's ability to generate readable, accurate, and clear layperson summaries of urological studies, and compared the performance of ChatGPT-generated summaries with original abstracts and author-written patient summaries to determine its effectiveness as a potential solution for creating accessible medical literature for the public. Articles from the top 5 ranked urology journals were selected. A ChatGPT prompt was developed following guidelines to maximize readability, accuracy, and clarity, minimizing variability. Readability scores and grade-level indicators were calculated for the ChatGPT summaries, original abstracts, and patient summaries. Two MD physicians independently rated the accuracy and clarity of the ChatGPT-generated layperson summaries. Statistical analyses were conducted to compare readability scores. Cohen's κ coefficient was used to assess interrater reliability for correctness and clarity evaluations. A total of 256 journal articles were included. The ChatGPT-generated summaries were created with an average time of 17.5 (SD 15.0) seconds. The readability scores of the ChatGPT-generated summaries were significantly better than the original abstracts, with Global Readability Score 54.8 (12.3) vs 29.8 (18.5), Flesch Kincade Reading Ease 54.8 (12.3) vs 29.8 (18.5), Flesch Kincaid Grade Level 10.4 (2.2) vs 13.5 (4.0), Gunning Fog Score 12.9 (2.6) vs 16.6 (4.1), Smog Index 9.1 (2.0) vs 12.0 (3.0), Coleman Liau Index 12.9 (2.1) vs 14.9 (3.7), and Automated Readability Index 11.1 (2.5) vs 12.0 (5.7; P < .0001 for all except Automated Readability Index, which was P = .037). The correctness rate of ChatGPT outputs was >85% across all categories assessed, with interrater agreement (Cohen's κ) between 2 independent physician reviewers ranging from 0.76-0.95. ChatGPT can create accurate summaries of scientific abstracts for patients, with well-crafted prompts enhancing user-friendliness. Although the summaries are satisfactory, expert verification is necessary for improved accuracy.

Experimental Animal Models for Preclinical Investigation of the Bladder Cancer

Abstract: The current treatments for bladder cancer are unable to substantially avoid the disease's growth and recurrence, which is a serious public health problem. Researchers have explored a variety of approaches in an effort to effectively replicate the pathophysiology of human tumors using experimental tumor models. The investigation of the available models is a necessary tool in order to choose the most appropriate scheme which serves the translation of potential treatments from a primary experimental bench to the clinical settings. The most suitable murine models of bladder cancer should have excellent reproductivity, intravesical predictability, and accessibility in order to facilitate the mechanistic, chemopreventive, and therapeutic research that can be expanded into clinical trials. This article provides a complete evaluation of both in vitro and in vivo bladder cancer models, comparing their advantages and limitations in urological research.

Guidelines for Reporting Observational Research in Urology: The Importance of Clear Reference to Causality.

Guidelines for Reporting Observational Research in Urology: The Importance of Clear Reference to Causality.

Long-term complications and health-related quality of life outcomes after radical prostatectomy with or without subsequent radiation treatment for prostate cancer

BackgroundTo report objective long-term complications and health related quality of life (HRQOL) outcomes after radical prostatectomy (RP) with and without radiation therapy (RT) for prostate cancer (CaP). MethodsWe analyzed patients diagnosed with CaP who underwent RP from the UCSF Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) registry between 1995 and 2020. Cox proportional hazards were used to assess risk of postoperative complications which included cystitis, gastrointestinal (GI) toxicity, incontinence requiring a surgical procedure, ureteral injury and urinary stricture. Repeated measures mixed models were used to assess the effects of radiation and complications on patient-reported urinary, bowel, and sexual function after surgery. ResultsOf 6,258 men who underwent RP, cumulative incidence of EBRT was 9.1% at 5 years after surgery. Patients who received postoperative radiation were at increased risk for onset of cystitis (HR 5.60, 95% CI 3.40–9.22, P < 0.01). Receipt of RT was not associated with other complications. In repeated measures analysis, postoperative RT was associated with worsening general health scores, adjusting for complications of incontinence, urinary stricture, GI toxicity or ureteral injury, independent of whether patients had those complications. ConclusionsRT after RP was associated with an increase in the risk of cystitis and worse general health in the long term. Other complications and HRQOL outcomes did not demonstrate differences by whether patients had RT or not. While post-operative RT is the only curative option for CaP after RP, patients and providers should be aware of the increased risks when making treatment decisions.