Frequently asked questions on erectile dysfunction: evaluating artificial intelligence answers with expert mentorship

The present study assessed the accuracy of artificiaI intelligence-generated responses to frequently asked questions on erectile dysfunction. A cross-sectional analysis involved 56 erectile dysfunction-related questions searched on Google, categorized into nine sections: causes, diagnosis, treatment options, treatment complications, protective measures, relationship with other illnesses, treatment costs, treatment with herbal agents, and appointments. Responses from ChatGPT 3.5, ChatGPT 4, and BARD were evaluated by two experienced urology experts using the F1 and global quality scores (GQS) for accuracy, relevance, and comprehensibility. ChatGPT 3.5 and ChatGPT 4 achieved higher GQS than BARD in categories such as causes (4.5 ± 0.54, 4.5 ± 0.51, 3.15 ± 1.01, respectively, p < 0.001), treatment options (4.35 ± 0.6, 4.5 ± 0.43, 2.71 ± 1.38, respectively, p < 0.001), protective measures (5.0 ± 0, 5.0 ± 0, 4 ± 0.5, respectively, p = 0.013), relationships with other illnesses (4.58 ± 0.58, 4.83 ± 0.25, 3.58 ± 0.8, respectively, p = 0.006), and treatment with herbal agents (3 ± 0.61, 3.33 ± 0.83, 1.8 ± 1.09, respectively, p = 0.043). F1 scores in categories: causes (1), diagnosis (0.857), treatment options (0.726), and protective measures (1), indicated their alignment with the guidelines. There was no significant difference between ChatGPT 3.5 and ChatGPT 4 regarding answer quality, but both outperformed BARD in the GQS. These results emphasize the need to continually enhance and validate AI-generated medical information, underscoring the importance of artificiaI intelligence systems in delivering reliable information on erectile dysfunction.

Role of serum cathelicidin in diagnosis of patient with prostatitis and prostate carcinoma

Background

This study investigated the diagnostic role of 75 levels measured in serum prostatitis and prostate carcinoma and in the differentiation of these two conditions.

Methods

The study was conducted with 75 patients histopathologically diagnosed with prostate carcinoma or prostatitis and followed up at the Departments of Urology and Medical Oncology and 21 healthy male subjects. Serum cathelicidin levels were investigated using the ELISA method. Statistical analyses were performed using the SPSS for Windows 22.0 package software. Compliance of the variables to normal distribution was examined using visual and analytic methods. In the Kolmogorov–Smirnov test, cases with a p value of greater than 0.05 were accepted as normal distribution.

Results

A total of 75 patients including 45 diagnosed with prostate carcinoma and 30 diagnosed with prostatitis, as well as 21 healthy control subjects were included in the study. Prostate-specific antigen (PSA) was detected as 23 (4–1200) ng/mL in the patients with prostate carcinoma and as 9.85 (3.9–405 ng/mL) in the patients with prostatitis. The cathelicidin levels were diagnostically significant when assessed by ROC analysis in the prostate cancer, prostatitis and control groups (p = 0.005). The cutoff values derived from the ROC curve analysis were 3.5151 ng/mL for distinguishing prostate cancer from prostatitis, 2.2620 ng/mL for prostate cancer versus control group and 1.2340 ng/mL for prostatitis versus control group.

Conclusions

In this study we showed that the serum cathelicidin levels were significantly higher in the patients diagnosed with prostate carcinoma. Measurement of serum cathelicidin levels could be used as a diagnostic marker in prostate carcinoma as well as facilitating differential diagnosis to strengthen the diagnostic suspicion before prostate biopsy and distinguish the diagnosis from prostatitis cases.

Factors affectıng recurrence after trımodal treatment ın ınvasıve bladder cancer

Background

In this study, we aimed to determine which patients will benefit most from TMT treatment, and to evaluate the factors affecting relapse, survival and response to treatment separately.

Methods

For the study, patients who presented to our hospital’s outpatient clinic between 2010 and 2020 and were diagnosed with locally advanced (T2-G3) invasive urothelial bladder cancer and treated with gemcitabine concomitantly with radiotherapy following complete TUR were identified. A total of 112 patients with transitional cell bladder cancer invading the muscle were enrolled in the study including 88 (78.6%) males and 24 (21.4%) females.

Results

Tumor location was significantly associated with tumor recurrence (p = 0.003). Recurrence at follow-up was significantly associated with the number of tumor foci (p = 0.008). Median duration of follow-up and median progression-free survival were 41.50 months and 65 ± 4.21 (95% CI, 56.74-73.25) months, respectively. Progression-free survival was not statistically significantly associated with neutrophil/lymphocyte ratio (NLR), platelet/ lymphocyte ratio (PLR) or BMI (p = 0.32, p = 0.47, p = 0.39, respectively), but muscle invasion during follow-up was significantly associated with progression-free survival (p = 0.009).

Conclusions

Tumor location, the number of tumor foci, history of multiple transurethral resection surgeries and a NLR ≥ 2.56 were significantly associated with recurrence following Trimodal therapy (TMT). A lower rate of recurrence was observed among patients undergoing early TMT after initial diagnosis. None of the patients treated with trimodal therapy experienced severe adverse effects. Therefore, trimodal therapy is a safe, effective and tolerable therapeutic option with a low rate of recurrence in selected eligible patients.

Is Peyronie's an IgG4-related disease?

OBJECTIVE

We believe that IgG4 may have a role in the pathogenesis of Peyronie's disease (PD), and this role could be particularly beneficial for developing new strategies; therefore, we aimed to investigate the role of IgG4 in PD.

METHODS

This study included 3 groups with a total of 139 subjects: (I) PD group (n=61), (II) control group (n=48), and (III) benign prostatic hyperplasia (BPH) group (n=30). IgG4 measurement was performed using the enzyme-linked immunosorbent assay. Plaque size, penile curvature, and the presence of concomitant impotence were evaluated in the PD group. Impotence was assessed based on the International Index of Erectile Function (IIEF).

RESULTS

A significant difference was observed between the PD and control groups and between the PD and BPH groups with regard to IgG4 levels, while no significant difference was found between the BPH and control groups (p=0.0001, p=0.002, and p=0.07, respectively). The IgG4 levels were significantly higher in the PD than in the other groups. The cutoff value determined between the groups was 87.5, 82, and 31.5, respectively. Mean plaque size was 2.0±1.01 cm, and a significant relationship was found between plaque size and IgG4 concentration (p=0.02). Mean penile curvature was 35.6±25.1°, and a significant relationship was found between penile curvature of >60° and IgG4 concentration (p=0.001). Mean IIEF score was 19 (range, 7-25). Moreover, no significant relationship was found between erectile dysfunction and IgG4 concentration. Penile pain was present in 24 (39.3%) patients with PD.

CONCLUSION

The IgG4 levels were significantly increased in patients with PD, which implies that IgG4 may have a role in the pathogenesis of PD. This finding could be particularly beneficial for developing new strategies. Future studies with larger patient series are needed to substantiate our findings.

Course of Urological Problems in Children with Spinal Dysraphism: Long-Term Follow-Up Results

BACKGROUND/AIMS

We aimed to evaluate the course of urinary problems in children with spinal dysraphism.

METHODS

This multicenter study evaluated data on pediatric patients diagnosed with spinal dysraphism between 2010 and 2019. The neurological and urological conditions of the patients were examined retrospectively. This study focused on the course of urological problems. Urodynamic examinations including urodynamic bladder capacity, bladder pressure in maximal capacity, compliance, detrusor hyperactivity, uroflowmetry, and residual urine amount were evaluated. All patients underwent urinary system ultrasonography, urinalysis, hemogram and biochemical tests, and urodynamics at admission and follow-ups.

RESULTS

A total 62 patients (35 males, 27 females) with a mean age of 7.50 ± 4.01 years and age range of 1-16 years were included in the study. Ultrasonographic evaluation revealed normal results in 32 patients and abnormal findings, including moderate-to-severe calyceal dilatation, parenchymal thinning, and residual urine, in 30 patients. At the time of diagnosis, culture-positive urinary tract infection was detected in 22 patients, and leukocyte and/or bacterial positivity was detected in 18 patients. The differences between bladder capacity, bladder pressure at maximal capacity, compliance, and detrusor hyperactivity at first admission and post-treatment were statistically significant (p < 0.05). Vesicoureteral reflux was also detected in 25 patients. Thirty patients underwent oral anticholinergic and antibiotic prophylaxis, while 17 additionally underwent clean intermittent catheterization. Five patients underwent intravesical Botox injection, clean intermittent catheterization, and medical treatment, and 10 patients underwent augmentation cystoplasty.

CONCLUSION

The prevalence of urinary tract problems is high in patients with spinal dysraphism for whom early diagnosis is very important for both urologic and neurosurgical considerations. Early follow-up of urodynamics should be performed, and treatment should be carried out if necessary. Regular follow-up and appropriate treatment have positive effects on the quality of life of these patients and may also prevent the occurrence of severe renal dysfunction.

Comparison of Two Different Anesthesia Methods in Patients Undergoing Percutaneous Nephrolithotomy

PURPOSE

The study aims to compare the effectiveness, safety and costs of two different anesthesia methods in percutaneous nephrolithotomy (PCNL) operations.

MATERIAL AND METHOD

In our study, data was retrospectively examined of 1657 patients who underwent PCNL due to renal calculi between 2009 and 2017. Patients were separated into two groups according to the type of anesthesia; as those who underwent PCNL by general anesthesia (GA) (n = 572) and those under spinal anesthe-sia(SA) (n = 1085). Standard PCNL technique was used in both groups. Gender, age, operation duration, period of hospitalization, stone-free ratio, post-operative narcotic analgesic need and complications were compared between these two groups.

RESULTS

A total of 1657 patients consisting of 1064 (64.2%) male patients and 593 (35.8%) female patients were included in the study. The average age of the all patients was 33.2 ± 12.4 (range 16-74) years. The two groups were similar in terms of mean age, gender, stone size, stone location and body mass index. Mean operation time was sig-nificantly shorter in the SA group than in the GA group (81.8 ± 33.9 minute vs. 118.2 ± -42.9 minute respectively, P < .001). Mean period of hospitalization was remarkable shorter in the SA group than in the GA group (30.0 ± 9.9 hours vs. 38.4 ± 11.2 hours respectively, P < .001). Post-operative narcotic analgesic need rate was significantly higher in the GA group than in the SA group (33.4% vs. 10.9%, respectively, P < .001). Anesthesia cost was found significantly lower in the SA group than in the GA group (USD 21.3±2.8 vs. USD 83.6 ± 9.5, respectively, P < .001). Significant difference was not observed between both groups in terms of stone-free ratio, amount of bleed-ing, fluoroscopy time, pre-operative and post-operative complications.

CONCLUSION

Compared to those performed with GA, PCNL performed with SA is a safe, effective and low-cost method.

Role of native Thiol, total Thiol and dynamic Disulphide in diagnosis of patient with prostate cancer and prostatitis

BACKGROUND

Our study investigates whether Native Thiol, Total Thiol and disulphide levels measured in serum of patients with prostate cancer and prostatitis and of healthy subjects, have any role in differential diagnosis.

MATERIALS AND METHODS

Patients followed up for histopathologically verified diagnosis of prostate cancer and prostatitis in 2016-2017 at the Medicalpark Gaziantep Hospital Urology Clinic were included in the study. Native Thiol (NT), Total Thiol (TT), Dynamic Disulphide (DD) levels in serum were measured by a novel automated method.

RESULTS

NT, TT, DD, NT / TT ratios, DD / TT ratio and DD / NT ratio were measured as 118.4 ± 36.8μmoL / L, 150.3 ± 45.3μmoL / L, 15.9 ± 7μmoL / L, 78.8 ± 7μmoL / L, 10.5 ± 3.5μmoL / L, 13.8 ± 5.8μmoL / L respectively in patients with prostate cancer; as 116.4 ± 40.5μmoL / L, 147.5 ± 50.1μmoL / L, 15.5 ± 8.7μmoL / L, 79.7 ± 9μmoL / L, 10.1 ± 4.5μmoL / L, 13.5 ± 7.2μmoL / L in patients with prostatitis and as 144.1 ± 21.2μmoL / L, 191 ± 32.3μmoL / L, 23.4 ± 10.1μmoL / L, 76.1 ± 98.3μmoL / L, 11.9 ± 4.1μmoL / L, 16.4 ± 6.9μmoL / L in healthy subjects. Significant difference was detected between groups of NT, TT and DD levels (p = 0.008, p = 0.001, p = 0.002). No significant difference was detected in terms of the NT / TT, DD / TT and DD / NT rates (p = 0.222, p = 0.222, p = 0.222).

CONCLUSIONS

Serum NT, TT, DD levels in patients with prostatitis and prostate cancer were found significantly lower compared to the control group. This indicates that just as inflammation, prostate cancer also increases oxidative stress on tissues.

Aggressive course in a patient with mucin-producing urothelial-type adenocarcinoma of the prostate: A case report and review of the literature

Prostate cancer is one of the frequently seen types of cancers in men. The most frequent histological type of prostate cancer is the acinar adenocarcinoma. Mucin-producing urothelial-type adenocarcinoma of the prostate is a very rare subtype. The mucin-producing urothelial-type adenocarcinoma of the prostate has microscopic similarities with colon and bladder adenocarcinoma. It has a more aggressive clinical course and does not respond to androgen deprivation therapy. A 77-year-old male patient diagnosed with mucinous prostate cancer was presented in the current case report.

Efficacy of mirabegron in medical expulsive therapy

To show the efficacy of mirabegron for medical expulsive treatment, in patients had intramural located distal ureteral stone. A 80 patients had intramural ureteral stone were assessed retrospectively between April 2017 and January 2018. Mirabegron 50 mg/day + diclofenac 100 mg/day (group 1, n = 40), and only diclofenac 100 mg/day (group 2, n = 40) were administered to patients, consecutively. Age, gender, stone size, laterality, and severity of hydronephrosis were recorded. Spontaneous stone expulsion rates (SER), stone expulsion time, and the number of daily colic episodes were evaluated. In the group 1, one (2.5%) patient was excluded due to nasopharyngitis, and one (2.5%) patient was excluded due to 5 mmHg systolic blood pressure increase. In addition, four (10%) patients in group 1, and six (15%) patients in group 2, who did not attend follow-up examinations, were excluded from the study. There was not any statistically significant difference between the two groups in terms of age, gender, stone location, severity of hydronephrosis, stone size (p = 0.736, p = 0.310, p = 0.467, p = 0.801, p = 0.761, consecutively). Spontaneous expulsion ratios were calculated as 73.52% in group 1, and 47.05% in group 2 (p = 0.026). However, there was not any statistically significant difference in terms of stone expulsion time (p = 0.979). SER for patients had ≤ 6 mm stones was higher in group 1 (87.5 vs 52.49%, p = 0.031). In addition, group 2 patients had more pain episodes (1.02 ± 0.52 vs. 1.29 ± 0.57, p = 0.049). In the current study, mirabegron has been shown to be an efficient, safe and a new treatment modality, with lower side effect profile for the intramural located distal ureteral stones.

Lack of Any Role of Systemic Inflammatory Responses in Predicting Muscle Invasion by Bladder Cancer

BACKGROUND

The purpose of this study is to evaluate if there is a relation between platelet:lymphocyte ratio (PLR) and neutrophil lymphocyte ratio (NLR) values and tumour histology and spread in bladder cancer cases.

MATERIALS AND METHODS

Bladder cancer patients undergoing TUR-M operation, with histopathologically verified diagnosis, followed-up and treated at the Private Medical Park Gaziantep Hospital between 2010 and 2015, were included in the study. NLR and PLR values were calculated using complete blood count data obtained at the first presentation.

RESULTS

A total of 99 patients were included in the study, 7 (7.1%) women and 92 men (92.9%). When NLR was used as the indicator of systemic inflammatory response (SIR), it was determined that 52 (52.5%) of the patients were SIR negative and 47 (47.5%) SIR positive. No significant relation could be detected between NLR and tumour grade and muscle invasion (p=0.948, p=0.480). When PLR was used as SIR indicator, it was determined that 71 (71.7%) of the patients were found as negative and 28 (28.3%) as positive. No significant relation could be detected between PLR and tumour grade and muscle invasion (p=0.651, p=0.494).

CONCLUSIONS

In our study we did not detected a relation between tumour histological behavior and PLR and NLR in bladder cancer. However, NLR and PLR are easily calculated, accessible, inexpensive and simple-to-use laboratory data from whole blood counts.

Comparative Evaluation of Efficacy of Use of Tamsulosin and/or Tolterodine for Medical Treatment of Distal Ureteral Stones

OBJECTIVES

To evaluate the activity of the therapeutic agents (tamsulosin and/or tolterodine) used to accelerate the expulsion of stones and to reduce the probable complications during observation of the medical treatment of distal ureteral stones to allow spontaneous passage.

METHODS

A total of 120 patients with distal ureteral stones were included in the study. Patients with stones less than 10 mm and allowing urinary flow were included in the study. The patients were studied in four randomly divided groups. Group 1 patients received tamsulosin 0.4 mg/day, group 2 patients received tamsulosin 0.4 mg/day plus tolterodine 2 mg (twice a day), group 3 patients received tolterodine 2 mg (twice a day), and group 4 patients did not receive any medical treatment (control group).

RESULTS

Differences among the four groups in patient age and stone dimension were not statistically significant (P >0.05). The stone expulsion rates were greater (P <0.05) in groups 1 and 2 than in groups 3 and 4. A significant variation (P <0.05) regarding the time to stone expulsion was observed in groups 1 and 2.

CONCLUSIONS

In our study, the use of tamsulosin for the expulsion of distal ureteral stones was effective; however, the use of tolterodine provided no additional advantages.