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INTRODUCTION: Ureteroscopy has become increasingly chosen as a treatment of choice for patients with kidney stone disease and laser as the energy source for stone lithotripsy is a key part of this. Our aim was to analyse a national database to evaluate the burden of adverse events related to laser fibers and laser machines. METHODS: Search was performed of the Manufacturer User and Facility Device Experience (MAUDE) database in the United States for all events related to holmium laser fibers and holmium laser machines during ureteroscopy between 2012-2021. Information collected included the following: problem, timing, prolonged anaesthesia, early termination of procedure, injury and retained parts. RESULTS: 699 holmium laser fiber events were reported and these had been manufactured by 13 different companies. The commonest problems were breakage outside the patient while in use (26.3%) and breakage of the laser fiber tip (21.2%). Manufacturers concluded root cause to be device failure in 8.9%. 29% of issues occurred before the laser had been activated. 5.2% of cases had to be cancelled as a result of an event. Significantly more injuries were sustained intra-operatively by operating staff compared to patients (6% vs. 0.2%, p < 0.001). All these injuries were superficial burns to the skin with the hand being the most affected body part (88.1%). Zero ocular injuries were reported. Only eight events were related to laser machines and all involved sudden hardware failure but no patient injury. CONCLUSIONS: Laser fibers are fragile. Most adverse events are due to operator error. Direct patient injury from laser fiber is scarce but operating staff should be aware of the risk of sustaining minor burns. Laser machines rarely incur problems and, in this study, did not result in any safety issues beyond need to abort the procedure due to lack of spare equipment.

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Background and objective: Generative artificial intelligence models are among the most promising and widely used tools used in health care. This review investigates GPT-4 answers to decision-making questions regarding the diagnosis and treatment of urolithiasis across several clinical settings and their correspondence to the current European Association of Urology (EAU) guidelines. Methods: In March 2024, the GPT-4 model was asked 11 questions, containing a brief description of a patient with urolithiasis. All questions were grouped according to urolithiasis care step: diagnosis, urgent care, scheduled intervention, and metaphylaxis. When responses were received, compliance with the current EAU guidelines was assessed by experienced urologists. Key findings and limitations: Although all responses were provided with information that corresponded to EAU guidelines, six of the 11 answers were associated with missed guideline-provided parts, and incorrect data were given in eight of the 11 answers. GPT-4 is relatively safe in the initial diagnostic flow of patients suspected of having stones within the urinary tract and during treatment planning; however, its understanding of all the nuances of metaphylaxis leaves much to be desired and is far from the dogma given in the EAU guidelines. Moreover, GPT-4 knowledge of strategy and algorithm is not always aligned with the EAU guidelines. Conclusions and clinical implications: Despite the fact that from the perspective of patients with urolithiasis, GPT-4 is capable of answering their questions well, the specificity of questions from urologists is labor intensive for its current version, and necessitates the ability to interpret it correctly and further attempts to improve it. While some aspects of diagnostics are more accurate, these struggle with surgical planning and algorithms in line with the EAU guidelines. Patient summary: The generative artificial intelligence (AI) model GPT-4 is capable of answering urology-related questions, but lacks detailed responses. Although some aspects of the diagnostics are accurate, knowledge of surgical planning is not in line with the European Association of Urology guidelines. Future improvements should focus on efforts to enhance the accuracy, reliability, and clinical relevance of AI tools in urology.

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BACKGROUND: The ASCAPE project aims to improve the health-related quality of life of cancer patients using artificial intelligence (AI)-driven solutions. The current study employs a comprehensive dataset to evaluate sleep and urinary incontinence, thus enabling the development of personalized interventions. METHODS: This study focuses on prostate cancer patients eligible for curative treatment with surgery. Forty-two participants were enrolled following their diagnosis and were followed up at baseline and 3, 6, 9, and 12 months after surgical treatment. The data collection process involved a combination of standardized questionnaires and wearable devices, providing a holistic view of patients' QoL and health outcomes. The dataset is systematically organized and stored in a centralized database, with advanced statistical and AI techniques being employed to reveal correlations, patterns, and predictive markers that can ultimately lead to implementing personalized intervention strategies, ultimately enhancing patient QoL outcomes. RESULTS: The correlation analysis between sleep quality and urinary symptoms post-surgery revealed a moderate positive correlation between baseline insomnia and baseline urinary symptoms (r = 0.407, p = 0.011), a positive correlation between baseline insomnia and urinary symptoms at 3 months (r = 0.321, p = 0.049), and significant correlations between insomnia at 12 months and urinary symptoms at 3 months (r = 0.396, p = 0.014) and at 6 months (r = 0.384, p = 0.017). Furthermore, modeling the relationship between baseline insomnia and baseline urinary symptoms showed that baseline insomnia is significantly associated with baseline urinary symptoms (coef = 0.222, p = 0.036). CONCLUSIONS: The investigation of sleep quality and urinary incontinence via data analysis through the ASCAPE project suggests that better sleep quality could improve urinary disorders.

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Aging is a fundamental biological process characterized by a progressive decline in physiological functions and an increased susceptibility to diseases. Understanding aging at the molecular level is crucial for developing interventions that could delay or reverse its effects. This review explores the integration of machine learning (ML) with multi-omics technologies-including genomics, transcriptomics, epigenomics, proteomics, and metabolomics-in studying the molecular hallmarks of aging to develop personalized medicine interventions. These hallmarks include genomic instability, telomere attrition, epigenetic alterations, loss of proteostasis, disabled macroautophagy, deregulated nutrient sensing, mitochondrial dysfunction, cellular senescence, stem cell exhaustion, altered intercellular communication, chronic inflammation, and dysbiosis. Using ML to analyze big and complex datasets helps uncover detailed molecular interactions and pathways that play a role in aging. The advances of ML can facilitate the discovery of biomarkers and therapeutic targets, offering insights into personalized anti-aging strategies. With these developments, the future points toward a better understanding of the aging process, aiming ultimately to promote healthy aging and extend life expectancy.

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BACKGROUND: This study aims to provide a comprehensive overview of the current literature on the utilisation of ChatGPT in the fields of clinical medicine, urology, and academic medicine, while also addressing the associated ethical challenges and potential risks. METHODS: This narrative review conducted an extensive search of the PubMed and MEDLINE databases, covering the period from January 2022 to January 2024. The search phrases employed were "urologic surgery" in conjunction with "artificial intelligence", "machine learning", "neural network", "ChatGPT", "urology", and "medicine". The initial studies were chosen from the screened research to examine the possible interaction between those entities. Research utilising animal models was excluded. RESULTS: ChatGPT has demonstrated its usefulness in clinical settings by producing precise clinical correspondence, discharge summaries, and medical records, thereby assisting in these laborious tasks, especially with the latest iterations of ChatGPT. Furthermore, patients can access essential medical information by inquiring with ChatGPT. Nevertheless, there are multiple concerns regarding the correctness of the system, including allegations of falsified data and references. These issues emphasise the importance of having a doctor oversee the final result to guarantee patient safety. ChatGPT shows potential in academic medicine for generating drafts and organising datasets. However, the presence of guidelines and plagiarism-detection technologies is necessary to mitigate the risks of plagiarism and the use of faked data when using it for academic purposes. CONCLUSIONS: ChatGPT should be utilised as a supplementary tool by urologists and academicians. However, it is now advisable to have human oversight to guarantee patient safety, uphold academic integrity, and maintain transparency.

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OBJECTIVES: To evaluate the effects of inserting a Foley catheter after ureteroscopy (URS) and JJ stent placement on pain scores, voiding patterns, biochemical parameters and postoperative complications. PATIENTS AND METHODS: A randomised clinical trial (1:1) with adult patients following unilateral URS + JJ stent placement was planned. In Group A, no Foley catheter was placed, in Group B, a Foley catheter was placed following URS + JJ stent placement. The primary objective was to evaluate effect of placing a Foley catheter on International Prostate Symptom Score (IPSS), Ureteric Stent Symptom Questionnaire (USSQ) score and postoperative biochemical parameters. The secondary objective was to evaluate postoperative complications. RESULTS: A total of 112 patients were included (56/group). A ureteric access sheath was used in each patient. Patients had similar demographic and surgical parameters. The pre- and postoperative biochemical analyses including white blood cell count, C-reactive protein, procalcitonin and creatinine levels were similar between the two groups. The IPSS were similar between the two groups. All the subdomains of the USSQ were similar between two groups except Total Body Pain score, which was lower in Group B. The visual analogue scale scores were similar. Complications were all Clavien-Dindo Grade I and II, and the complication rate was 5.4% and 8.9% in Group A and B, respectively. CONCLUSION: Placing a Foley catheter following URS + JJ stent placement did not show significant effects on postoperative biochemical parameters and voiding symptoms. However, a Foley catheter lowered the Total Body Pain score on the USSQ without having significant effects on VAS scores. The practice of placing a Foley catheter following URS and JJ stent placement should be based on surgeon's preference keeping in mind the potential positive effect on pain scores.

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In an era increasingly focused on integrating Artificial Intelligence (AI) into healthcare, the utility and user satisfaction of AI applications like ChatGPT have become pivotal research areas. This study, conducted in Greece, engaged 193 doctors from various medical departments who interacted with ChatGPT 4.0 through a custom web application. The participants, representing a diverse range of medical specialties, received responses from the specific chatbot tailored to their specific departmental inquiries. Their satisfaction was gauged using a validated form featuring a 1-to-5 rating scale. The results highlighted a possible correlation between the doctors' medical departments and their satisfaction levels with ChatGPT 4.0. Significantly, doctors from certain departments (like General Surgery and Cardiology) reported lower satisfaction scores, ranging from 2.73 to 2.80 out of 5, in contrast to their colleagues from departments like Biopathology and Orthopedics, who scored between 4.00 and 4.46 out of 5. This variation in satisfaction levels underscores the diverse needs within different medical specialties and illuminates both the potential of ChatGPT and the areas needing improvement, especially in delivering department-specific medical information. Despite its limitations, ChatGPT version 4.0 is emerging as a valuable tool in the medical community, indicating potential future advancements and more extensive integration into healthcare practices. The study's findings are crucial in understanding the distinct preferences and requirements of healthcare professionals across various medical departments, thereby guiding the future development of AI tools in healthcare.

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Social media (SoMe) is now a core part of modern-day life with increased use among both patients and urologists. The interplay of SoMe between these two parties is complex. From a patient perspective, SoMe platforms can serve as educational tools as well as communication portals to support networks and patient communities. However, studies report the educational value of content online is often poor and may contain misinformation. For urologists, SoMe can lead to research collaborations, networking and educational content but areas of concern include the potential negative impact SoMe can have on mental health and sharing of patient images without appropriate consent. This review serves to provide an overview of the interaction between SoMe and urology practice and provide practical guidance to navigating it.

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BACKGROUND AND OBJECTIVE: The aim of this review was to define patients who are at high risk of recurrence of urolithiasis, to delineate diagnostic and therapeutic algorithms for each type of stone, and to clarify general guidelines and recommendations for prevention of recurrence. METHODS: A professional research librarian carried out literature searches for all sections of the urolithiasis guidelines, covering the timeframe between 1976 and June 2023. KEY FINDINGS AND LIMITATIONS: For every patient with urolithiasis, an attempt should be made to analyse the stone. Patients should be given general instructions on how to prevent recurrence, including adequate fluid and calcium intake, and low consumption of sodium and protein. Identifying and correcting the causative factors is a cornerstone in preventing the recurrence of urolithiasis. Diagnostic and therapeutic algorithms by stone composition are available. Every patient should undergo baseline metabolic screening, while patients with calcium stones, who are at high risk of relapse and complications, should undergo extensive metabolic screening with two 24-h urine collections and should receive targeted therapy. Patients with uric acid, infection, or cystine stones are at high risk of relapse. All patients at high risk of recurrence should be closely monitored, especially those not complying with therapy in the long term. CONCLUSIONS AND CLINICAL IMPLICATIONS: Metabolic stone evaluation and patient follow-up are highly recommended to prevent urolithiasis recurrence.

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Prostate cancer is the second most common cancer among men, with many treatment modalities available for patients, such as radical prostatectomy, external beam radiotherapy, brachytherapy, high-intensity focused ultrasound, cryotherapy, electroporation and other whole-gland or focal ablative novel techniques. Unfortunately, up to 60% of men with prostate cancer experience recurrence at 5 to 10 years. Salvage radical prostatectomy can be offered as an option in the setting of recurrence after a primary non-surgical treatment. However, the complexity of salvage radical prostatectomy is considered to be greater than that of primary surgery, making it the least popular treatment of choice. With the wide use of robotic platforms in urologic oncologic surgery, salvage radical prostatectomy has attracted attention again because, compared to past data, modern series involving salvage Robot-Assisted Radical Prostatectomy have shown promising results. In this narrative literature review, we comprehensively examined data on salvage radical prostatectomy. We investigated the correlation between the different types of primary prostate cancer therapy and the following salvage radical prostatectomy. Furthermore, we explored the concept of a robotic approach and its beneficial effect in salvage surgery. Lastly, we emphasized several promising avenues for future research in this field.

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Introduction: Kidney stones in pregnant is not a common emergency, but it is one that is extremely challenging to manage. There exists no previous survey, which maps the different practice patterns adopted. Our aim was to deliver a survey to evaluate the current status of practice patterns across different parts of the world regarding the management of stone disease in pregnancy. Methods: Through an iterative process, 19-item survey was devised. This contained the following five sections: (1) Demographics, (2) General items, (3) Diagnosis and Imaging, (4) Initial management, (5) Surgery. It was disseminated via social media and email chains. Results: A total of 355 responses were collected, and the majority (66.2%) reported no established hospital protocol for stones in pregnancy. Ultrasound was the most popular first line imaging choice (89.9%) but 8% would choose non-contrast CT. The latter was also chosen as second line choicer in 34.6% as opposed to magnetic resonance imaging. A large proportion (42.5%) had requested CT in pregnancy previously. With equivocal ultra sound results, only 19.4% would proceed to ureteroscopy (URS) but 40.9% would opt for CT. Twenty-four-48 hours were the most popular (37.6%) time period to observe before surgical intervention. Ureteral stent and nephrostomy were regarded as equally effective, and 6 weeks was most popular frequency for an exchange. Most do not use fetal heart rate monitoring intraoperatively. A total of 3.94% had previously performed percutaneous nephrolithotomy during pregnancy. Conclusion: Practice patterns vary widely for suspected kidney stones in pregnancy and use of CT appears increasingly popular. This includes when faced with equivocal ultrasound results and instead of proceeding to ureteroscopy. Most hospitals lack an established management protocol for this scenario.

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Social media is increasingly used as a platform for patients to explore health care information. Our objective was to study the content on TikTok® in order to gain insight into the perspectives shared by the public on vasectomy. A search was performed using the hashtag ´#vasectomy´ on 12.20.2023 and the top 100 video posts from persons self-identifying as patients were included. Using an adaptation of a previously published system, a framework was created for organising and categorising the data related to vasectomy. Domains covered included reason for vasectomy, complications, vasectomy as a controversial topic in society and reference to the 2022 Dobbs v. Jackson ruling. Most content originated from the United States (85.0%) and the median number of views per video was 261 200 (interquartile range (IQR) 8416-1 800 000). In 12.0% of posts, the individual clearly stated that they were under 30 years of age. Two of the commonest topics to be addressed in the videos were recovery (41.0%) and pain (40.0%). 30.0% discussed the reason for undergoing vasectomy. Reasons included women's rights (12%), safety over tubal ligation (5.0%) and desire to be childless (4.0%). 9.0% referred to the Dobbs v. Jackson ruling. Complications were discussed in 19.0% including vasectomy failure (12.0%). 23.0% contained factually incorrect medical information. 31.0% of videos included the user voicing that vasectomy was considered to be a controversial subject. More than half of the videos (61.0%) were positive regarding the vasectomy process. Our findings reveal that vasectomy receives very high engagement on social media. This study confirms that patients do use it to share their experiences, both positive and negative. Misconceptions regarding this contraception method are common among the public and the urological community should work to address this.

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Background: Photodynamic diagnosis (PDD) during transurethral resection of bladder tumor (TURBT) is guideline recommended, as it improves bladder cancer detection rates. However, the extent to which PDD is implemented in everyday clinical practice has not been thoroughly assessed. We aimed to evaluate the current trends and major perioperative outcomes of TURBT with PDD. Methods: The present study evaluated the GeRmAn Nationwide inpatient Data (GRAND) from 2010 (the year when PDD started to be coded separately in Germany) to 2021, which were made available from the Research Data Center of the German Bureau of Statistics. We undertook numerous patient-level and multivariable logistic regression analyses. Results: Overall, 972,208 TURBTs [228,207 (23%) with PDD and 744,001 (77%) with white light] were performed. Patients offered PDD during TURBT were younger (p < 0.001), presented fewer comorbidities (p < 0.001) and were discharged earlier from hospital (p < 0.001). PDD was associated with additional costs of about EUR 500 compared to white-light TURBT (p < 0.001). The yearly TURBT cases remained relatively stable from 2010 to 2021, whereas utilization of PDD underwent a 2-fold increase. After adjusting for major risk factors in the multivariate regression analysis, PDD was related to lower rates of transfusion (1.4% vs. 5.6%, OR: 0.29, 95% CI: 0.28 to 0.31, p < 0.001), intensive care unit admission (0.7% vs. 1.4%, OR: 0.56, 95% CI: 0.53 to 0.59, p < 0.001) and 30-day in-hospital mortality (0.1% vs. 0.7%, OR: 0.24, 95% CI: 0.22 to 0.27, p < 0.001) compared to white-light TURBT. On the contrary, PDD was related to clinically insignificant higher rates of bladder perforation (0.6% versus 0.5%, OR: 1.3, 95% CI: 1.2 to 1.4, p < 0.001), and reoperation (2.6% versus 2.3%, OR: 1.2, 95% CI: 1.1 to 1.2, p < 0.001). Conclusions: The utilization of PDD with TURBT is steadily increasing. Nevertheless, the road toward the establishment of PDD as the standard of care for TURBT is still long, despite of the advantages of PDD.

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OBJECTIVE: To conduct a systematic review (SR) of literature to assess the existing evidence concerning the success and complications of endourological ex vivo stone surgeries. METHODS: Eligible studies for inclusion focused on investigating the success and/or complications related to endourological ex vivo surgeries in donors with nephrolithiasis. A SR was undertaken in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The search included databases of Web of Science, PubMed, and Scopus and only article in English were included. Studies published between 2002 and 2023 included in this SR. RESULTS: After screening 1726 abstracts, this SR included 16 studies with a total of 209 patients. The mean stone size was 5.6 mm and majority of kidneys contained single stones, located in the lower calyx. After ex vivo endourological stone surgeries, the average stone-free rate was found to be 95.4%. The mean duration of ex vivo surgery was 17.3 minutes. Regarding intraoperative complications, two patients (1%) experienced mucosal injuries during pneumatic lithotripsy. As for postoperative complications, two patients (1%) experienced vascular complications. In terms of urological complications, hematuria was observed in 24 patients (11.5%), while one patient (0.5%) experienced clot formation in renal pelvis. Seven patients (3.3%) had urinary tract infections, and three patients (1.4%) developed urolithiasis during the follow-up. Additionally, one patient (0.5%) experienced complete occlusion of ureteroneocystostomy and required revision. CONCLUSION: Given the advancements in current technology and techniques, endourological ex vivo stone surgeries are increasingly recognized as an effective and safe option for donors with nephrolithiasis. TRIAL REGISTRATION: This systematic review was registered under the protocol registration number CRD42024538384/PROSPERO.

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The increase in practices related to enhancing penile size can be attributed to the belief that an improved genital appearance contributes to a man's virility, coupled with an altered self-perception of his body. It is crucial to tailor interventions to meet the genuine needs of patients by thoroughly assessing their history, psychological state, and potential surgical benefits, all while considering the associated risks of complications. This systematic review aims to summarize the available evidence on outcomes, complications, and quality of life after penile augmentation surgery, examining both minimally invasive and more radical techniques. A search of the PubMed and Scopus databases, focusing on English-language papers published in the last 15 years, was performed in December 2023. Papers discussing surgery in animal models and case reports were excluded from the present study unless further evaluated in a follow-up case series. The primary outcomes were changes in penile dimensions, specifically in terms of length and girth, as well as the incidence of surgical complications and the impact on quality of life. A total of 1670 articles were retrieved from the search and 46 were included for analysis. Procedures for penile length perceived enhancements include lipoplasty, skin reconstruction plasty, V-Y and Z plasty, flap reconstruction, scrotoplasty, ventral phalloplasty, and suspensory ligament release; techniques for increasing corporal penile length include penile disassembly, total phalloplasty, and sliding elongation. Finally, penile girth enhancement may be performed using soft tissue fillers, grafting procedures, biodegradable scaffolds, and Penuma®. In conclusion, while penile augmentation surgeries offer potential solutions for individuals concerned about genital size, the risks and complexities need to be accounted for.

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With the rapid increase in computer processing capacity over the past two decades, machine learning techniques have been applied in many sectors of daily life. Machine learning in therapeutic settings is also gaining popularity. We analysed current studies on machine learning in robotic urologic surgery. We searched PubMed/Medline and Google Scholar up to December 2023. Search terms included "urologic surgery", "artificial intelligence", "machine learning", "neural network", "automation", and "robotic surgery". Automatic preoperative imaging, intraoperative anatomy matching, and bleeding prediction has been a major focus. Early artificial intelligence (AI) therapeutic outcomes are promising. Robot-assisted surgery provides precise telemetry data and a cutting-edge viewing console to analyse and improve AI integration in surgery. Machine learning enhances surgical skill feedback, procedure effectiveness, surgical guidance, and postoperative prediction. Tension-sensors on robotic arms and augmented reality can improve surgery. This provides real-time organ motion monitoring, improving precision and accuracy. As datasets develop and electronic health records are used more and more, these technologies will become more effective and useful. AI in robotic surgery is intended to improve surgical training and experience. Both seek precision to improve surgical care. AI in ''master-slave'' robotic surgery offers the detailed, step-by-step examination of autonomous robotic treatments.

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Current management of non-metastatic muscle invasive bladder cancer (MIBC) includes radical cystectomy and cisplatin-based neoadjuvant chemotherapy (NAC), offers a 5-year survival rate of approximately 50% and is associated with significant toxicities. A growing body of evidence supports the role of liquid biopsies including circulating tumour DNA (ctDNA) as a prognostic and predictive marker that could stratify patients according to individualised risk of progression/recurrence. Detectable ctDNA levels prior to radical cystectomy have been shown to be correlated with higher risk of recurrence and worse overall prognosis after cystectomy. In addition, ctDNA status after NAC/neoadjuvant immunotherapy is predictive of the pathological response to these treatments, with persistently detectable ctDNA being associated with residual bladder tumour at cystectomy. Finally, detectable ctDNA levels post-cystectomy have been associated with disease relapse and worse disease-free (DFS) and overall survival (OS) and might identify a population with survival benefit from adjuvant immunotherapy.