Soc. Int. Urol. J., Volume 6, Issue 2 (April 2025) – 12 articles

Background/Objectives: Late toxicity following radiotherapy is common and compromises patient quality of life. However, the impact of toxicity on patient-reported outcome measures (PROMs) five years after prostate external beam radiotherapy (EBRT) is poorly characterised. We describe PROMs using the Expanded Prostate Cancer Index Composite (EPIC-26) five years post-EBRT compared against radical prostatectomy (RP). Methods: A prospective cohort of patients with localised prostate cancer treated from 2000 to 2020 captured by a state-level cancer registry was analysed. Multivariable mixed-effects linear modelling was performed to compare differences between EPIC-26 domains over time between ERBT and RP patients. The percentage of patients recording a decline in EPIC-26 domains compared with baseline which exceeded the minimal clinically important difference (MCID) was calculated and compared between groups. Additionally, subgroup analysis was performed on patients treated using contemporary techniques. Results: There were 1720 patients (EBRT n = 1441 vs. RP n = 279) with evaluable EPIC-26 PROMS. Patients in the EBRT group had a higher median age (74 vs. 66, p < 0.001) and National comprehensive Cancer Network (NCCN) high-risk disease (61% vs. 24%, p < 0.001). Bowel domain scores were worse after EBRT compared to RP (beta −0.46, 95% CI −1.20–−0.28, p < 0.001), with a greater proportion of patients reporting a change in symptoms that exceeded the MICD at 12 months (22 vs. 11%, p = 0.009). Moderate/big bowel bother scores were significantly higher in the EBRT cohort at baseline and all follow-up periods compared to RP (beta −8.27, 95% CI −10.21–−6.34, p < 0.001). Pad use (i.e., ≥1) per day was significantly lower amongst the EBRT group (beta 16.56, 95% CI 14.35–18.76, p < 0.001). Despite contemporary techniques, EBRT was associated with worse bowel domain scores at 12 (75 vs. 80, p < 0.05) and 60 months (75 vs. 80, p < 0.05) compared to RP; however, EBRT was associated with less pad use at 12 (4% vs. 34%, p < 0.001), 24 (10% vs. 33%, p < 0.001) and 60 months (13% vs. 33%, p = 0.15) than RP. Conclusions: There are significant differences in PROMs after local curative treatment for prostate cancer which persist to five years post-treatment, despite contemporary techniques. Understanding the associated toxicity patterns helps inform shared decision-making during pre-treatment counselling. Full article

Background/Objectives: Bladder cancer, the most common and heterogeneous malignancy of the urinary tract, presents with diverse types and treatment options, making comprehensive patient education essential. As large language models (LLMs) emerge as a promising resource for disseminating medical information, their accuracy and validity compared to traditional methods remain under-explored. This study aims to evaluate the effectiveness of LLMs in educating the public about bladder cancer. Methods: Frequently asked questions regarding bladder cancer were sourced from reputable educational materials and assessed for accuracy, comprehensiveness, readability, and consistency by two independent board-certified urologists, with a third resolving any discrepancies. The study utilized a 3-point Likert scale for accuracy, a 5-point Likert scale for comprehensiveness, and the Flesch–Kincaid (FK) Grade Level and Flesch Reading Ease (FRE) scores to gauge readability. Results: ChatGPT-3.5, ChatGPT-4, and Gemini were evaluated on 12 general questions, 6 questions related to diagnosis, 28 concerning treatment, and 7 focused on prevention. Across all categories, the correct response rate was notably high, with ChatGPT-3.5 and ChatGPT-4 achieving 92.5%, compared to 86.3% for Gemini, with no significant difference in accuracy. However, there was a significant difference in comprehensiveness (p = 0.011) across the models. Overall, a significant difference in performance was observed among the LLMs (p < 0.001), with ChatGPT-4 providing the most college-level responses, though these were the most challenging to read. Conclusions: In conclusion, our study adds value to the applications of Artificial Intelligence (AI) in bladder cancer education, with notable insights into the accuracy, comprehensiveness, and stability of the three LLMs. Full article

Background/Objectives: To evaluate the impact of Minimally Invasive Surgical Therapies (MISTs) on Australian trends for surgeries treating lower urinary tract symptoms (LUTSs) caused by benign prostatic obstruction (BPO). The recent adoption of the prostatic urethral lift (PUL) and water vapour thermal therapy (such as Rezum) into the Medicare Benefits Scheme (MBS) item schedule on the 1 March 2024 has likely had an impact on Australian surgical trends and we aim to describe their impact on the use of other commonly offered BPO-related surgeries. Methods: This study analyses population-adjusted rates of BPO-related surgeries in Australia from January 2004 to September 2024 using publicly available online Medicare Statistics and Census Data. Independent t-tests and significance levels were calculated to compare procedure rates before and after the introduction of PUL and Rezum in March 2024. Results: In total, 301,648 BPO surgical procedures were claimed under MBS in Australia from January 2004 to September 2024, with transurethral resection of the prostate (TURP) being the most common (78%). Procedure rates increased overall with significant shifts in treatment preference: TURP rates have steadily declined in Australia after peaking in 2009 (123.4 per 100,000 adult men), whilst photo-selective vaporisation of the prostate (PVP) and enucleation have risen. Following the introduction of PUL and Rezum on 1 March 2024, enucleation and simple prostatectomy rates increased, while Transurethral needle ablation (TUNA) and urethral and prostatic prosthesis (UPP) decreased. TURP rates were unaffected. Conclusions: Throughout the past two decades, BPO surgical trends in Australia have shifted, with TURP declining as PVP and enucleation have risen. The 2024 MBS listing for PUL and Rezum has boosted their uptake whilst reducing both TUNA and UPP claims. Simple prostatectomy rates remained stable. Full article

Background/Objectives: Erectile dysfunction (ED) significantly impacts the well-being and quality of life of millions of men. Understanding geographic patterns and associated factors influencing ED search trends can offer valuable insights for healthcare improvement and advocacy. This study investigated the correlation between Google search trends for ED and various factors across the US. Methods: Google search trends for “erectile dysfunction” were collected over a 6-year period between March 2018 and August 2024. The Google search trends provided data for individual states on a scale from 1 to 100. Search volumes were analyzed alongside the urologist-to-population ratio, percentage of the population aged 65 and older, median household income, and percentage of state residents with a bachelor’s degree or higher. Pearson correlation coefficients were used to examine the relationships between ED search volumes and these factors. Results: Higher ED search volumes were associated with a higher percentage of older adults (r = 0.4332, p = 0.001676). A negative correlation was found between ED search volume and higher education (r = −0.482, p = 0.000394). No significant correlation was found between median household income and ED search volume (r = −0.201, p = 0.164) or a greater urologist density (r = 0.0612, p = 0.6729). Conclusions: This study highlights how healthcare access and demographics influence ED search trends. States with older, less educated populations showed higher interest, while wealthier areas with more urologists had no significant correlation. These findings can guide targeted interventions to improve sexual care in underserved regions. Full article

Background/Objectives: Gender disparity is prevalent in urology and other surgical specialties, with under-representation of females in both academic and professional settings, including in the Arabian Gulf region. To investigate female participation in Arabian Gulf urological conferences over the past three years, focusing on abstract presenters, faculty, speakers, and moderators. Methods: Data were collected from three major conferences: the 34th Saudi Urological Conference (SUA), the Urological Asian Association and Emirates Urological Conference (UAA-EUSC), and the 11th Emirates Urological Conference and 18th Pan Arab Continence Society Conference (EUSC-PACSC). The gender of the presenters and faculty was identified using genderize.io, faculty images, and Google searches. Statistical analyses, including chi-square and Fisher’s exact tests, were conducted to assess gender disparities. Results: Out of 536 abstracts, 13.25% were presented by females, with significant variation across conferences (p = 0.018). Female representation was lowest in the basic sciences category (3.13%) and highest in the other category (35.29%) (p = 0.01). Abstract to publication rates did not differ significantly between genders. Male dominance was noted among faculty members (94.21% male), speakers (96.44% male), and moderators (98.98% male), with no significant gender distribution differences across roles (p = 0.1762). Conclusions: This study highlights significant gender disparities at Arabian Gulf urological conferences, particularly in leadership roles and research presentations. Recommendations include promoting female leadership, supporting mentorship programs, and ensuring gender diversity in conference management and speaker line-ups to foster a more inclusive environment. Full article

Background/Objectives: Penile fractures are a rare urological emergency, defined as the traumatic rupture of the tunica albuginea. They are classically diagnosed on clinical grounds, requiring urgent operative repair, most commonly by penile degloving. Magnetic resonance imaging (MRI) has emerged as a promising tool in the management of penile fractures. Often recommended in the setting of equivocal clinical diagnoses, MRI can help diagnose, as well as localise, the site of injury. Furthermore, it also holds potential in differentiating penile fractures from mimicking conditions, thereby possibly preventing unnecessary surgical procedures. This study is aimed at evaluating the diagnostic accuracy of MRI for penile fractures. Furthermore, it seeks to explore MRI’s effectiveness in guiding the surgical approach through precise localisation of the injury site. Methods: The PubMed, Embase, and Cochrane databases were searched from January 1995 to December 2022. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed, and a total of 246 cases from 32 studies were identified. Results: Pooled results for MRI use in penile fracture diagnosis resulted in a positive predictive value of 97.8%, a negative predictive value of 87.0%, a sensitivity of 98.6%, and a specificity of 80%. MRI can accurately guide localised incisions, due to its ability to accurately identify the exact site of injury, with no additional reported complications or conversions to degloving. Considerable heterogeneity was observed within MRI parameters and protocols used in the studies identified. Conclusions: This review suggests that MRI is an accurate imaging modality for penile fractures and should be considered as a first-line investigation for equivocal cases. Its application may refine clinical management by avoiding unnecessary surgeries in cases mimicking penile fractures and improve pre-operative planning through precise injury localisation. This study is limited by heterogeneity in MRI protocols and the small sample sizes and retrospective nature of many included studies. The future standardisation of MRI protocols could enhance its utility and reliability in the clinical setting. Additionally, further research is needed to evaluate the long-term outcomes following the repair of small fractures detected on MRI and following MRI-guided localised incisions during surgical repair. Level of Evidence: 2. Full article

Background/Objectives: Prostatic lymphoma is a rare malignant tumour that frequently causes urinary tract obstruction. It is uncommon for patients to present with systemic features or B-symptoms. As a result, it is often diagnosed incidentally during surgical lower urinary tract symptoms (LUTS) treatment. This systematic review aims to identify any common clinical features of prostatic lymphoma diagnosed incidentally during surgical LUTS treatment and summarise disease treatment and outcomes. Methods: The study protocol was registered with Prospective Register of Systematic Reviews (PROSPERO). A search was performed across the following electronic databases: MEDLINE, Embase, Web of Science, and Cochrane Database of Systematic Reviews. Full texts of eligible studies were analysed and data were extracted. The review was performed in accordance with PRISMA guidelines. Results: A total of 24 case reports compromising 25 cases were included. The median (IQR) age was 67 (61–73) years. All patients reported LUTS as their primary complaint, and the median duration of LUTS prior to diagnosis was 17 (4–44) months. Serum prostate-specific antigen (PSA) was normal in 10 cases and prostatomegaly present on imaging in 16 cases. A total of 10 different subtypes of lymphoma were reported. Extra-prostatic involvement was reported in eight patients. Chemotherapy, with or without adjuvant radiotherapy, was the mainstay of lymphoma treatment. The majority of articles reported positive outcomes, with complete remission in 17 cases. Conclusions: Prostatic lymphoma is a difficult clinical diagnosis due to its similar presentation to benign prostatic hyperplasia (BPH). Although rare, prostatic lymphoma may need to be considered as a diagnosis in patients with an atypical presentation of BPH. Prognosis is often favourable after prompt referral to haematology or oncology. Full article

Background/Objectives: YouTube is an open-access video streaming platform with minimal regulation which has led to a vast library of unregulated medical videos. This study assesses the quality of information, understandability and actionability of videos on YouTube pertaining to sacral neuromodulation (SNM). Methods: The first 50 videos on YouTube after searching “sacral neuromodulation for bladder dysfunction” were reviewed. Thirty-eight of these videos met the inclusion criteria. These videos were reviewed by two Urology Registrars and the videos were scored using two standardised tools. The DISCERN tool assesses quality of information and the Patient Education Materials Assessment Tool for Audiovisual Material (PEMAT-A/V) tool assesses user understandability and accessibility. Results: Forty-two percent of videos were deemed to be poor or very poor, with 58% being fair, good or excellent according to the DISCERN standardised tool. For PEMAT-A/V the average score for understandability was 74% (43–100%) and actionability was 38% (0–100%). We found statistical significance comparing the duration of videos to the DISCERN groups (p = 0.02). We also found significance comparing the understandability of videos using the PEMAT-A/V score to the DISCERN groups (p ≤ 0.05). Conclusions: Forty-two percent of videos on SNM are of poor or very poor quality. The actionability score for consumers to seek out further information is also low at 38%. This raises concerns about the quality of information that is widely available on YouTube and how consumers will use this information when making decisions about their health. Full article

Background/Objectives: To understand the clinical characteristics, risk factors, diagnosis, treatment, and outcomes of xanthogranulomatous prostatitis. Methods: A comprehensive search was conducted across PubMed, Embase, and Medline following Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, including case reports and case series. Study quality and risk of bias were assessed using the Oxford Centre for Evidence-Based Medicine (CEBM) document. The systematic review process aimed to gather and synthesize all available research evidence on the topic. Results: We included 24 articles reporting on 33 patients, with a median age of 64 years. The most common presenting symptoms were lower urinary tract symptoms (81.8%), and only one patient was asymptomatic. The mean prostate-specific antigen (PSA) level upon presentation was 6.5 ng/mL. Notably, 51.5% of patients were suspected of harbouring clinically significant prostate carcinoma, and only one patient had concurrent prostate adenocarcinoma. All diagnoses were based on changes associated with xanthogranulomatous prostatitis demonstrated upon histopathological examination. A variety of pathogens were isolated, including Escherichia coli, Pseudomonas aeruginosa, Proteus species, and Enterobacter species. Transurethral resection of the prostate (60.6%) was the mainstay approach to management. In total, 27.3% of patients were successfully managed with non-surgical therapy. Conclusions: The majority of patients were suspected of prostate carcinoma prior to the histopathological diagnosis of xanthogranulomatous prostatitis. One patient underwent unnecessary radical prostatectomy as a result. The management of xanthogranulomatous prostatitis includes transurethral resection of the prostate and conservative management with the use of antibiotics. This outlines the importance of following well-established protocols upon suspicion of prostate carcinoma in order to avoid unnecessary radical prostatectomy. Full article