Patrick Betschart

Purpose: This study evaluated the quality of ChatGPT‐generated medical history summaries compared to human‐created documentation in a paediatric orthopaedic practice setting. Methods: A prospective, randomised, blinded comparative study was conducted involving 20 consecutive paediatric patients (mean age 14.2 ± 2.3 years; 11 males, 9 females) presenting with knee problems. Audio recordings of medical consultations were transcribed and processed by ChatGPT‐4o (OpenAI) using standardised prompts. Three independent orthopaedic specialists evaluated both human‐generated and AI‐generated summaries using eight quality criteria: temporal consistency, spatial consistency, accident description, symptom accuracy, symptom specificity, previous interventions, writing style and overall impression. Each criterion was scored on a 6‐point Likert scale. Results: Human‐created summaries received significantly higher overall ratings (5.2 ± 0.8) compared to ChatGPT‐generated summaries (4.5 ± 0.8, p < 0.001, Cohen's d = 0.80). After Bonferroni correction for multiple comparisons, statistically significant differences favouring human documentation were confirmed in four of eight criteria: temporal consistency ( p < 0.001), spatial consistency ( p < 0.001), accident description ( p < 0.001) and overall impression ( p < 0.001). No significant differences were observed for writing style and documentation of previous interventions. Inter‐rater reliability was moderate (ICC = 0.64). ChatGPT demonstrated frequent temporal inconsistencies (14 of 60 evaluations, 23%) and omission of relevant accident details (21 of 60 evaluations, 35%). Conclusion: While AI‐generated summaries showed acceptable stylistic quality, human documentation significantly outperformed ChatGPT in critical clinical dimensions, including temporal consistency and accuracy of complex orthopaedic presentations. Current large language models are not ready to replace human medical documentation in paediatric orthopaedic practice without careful oversight. The findings support the implementation of hybrid workflows where AI assists but does not replace human clinical judgement. Level of Evidence: Level I.

A 66-years old male patient presents with lower urinary tract symptoms, mostly due to obstructive symptoms, and an enlarged prostate with 80 cm³, with a broad-based median lobe, suggestive of benign prostatic obstruction (BPO). Trans-urethral resection of the prostate (TURP) was proposed. However, the patient desired to preserve ejaculatory function and was afraid of a potential negative impact on erectile function. Thus, the patient inquired about minimally invasive therapies (MITs) as alternatives to TURP. In this review, currently available MITs for BPO are described including prostatic artery embolization, water vapor thermal therapy (Rezum®), prostatic urethral lift, iTIND® (temporary implantable device) and aquablation (Aquabeam®). Focus is given on the description of the technique, level of evidence and advantages over conventional surgical options.

As multiple different treatment options are available for prostate cancer (PCa) and YouTube is commonly used as a source for medical information, we performed a systematic and comparative assessment of available videos guiding patients on their choice for the optimal treatment. An independent search for surgical therapy or radiotherapy of PCa on YouTube was performed and the 40 most viewed videos of both groups were analyzed. The validated DISCERN questionnaire and PEMAT were utilized to evaluate their quality and misinformation. The median overall quality of the videos was found to be low for surgery videos, while radiotherapy videos results reached a moderate quality. The median PEMAT understandability score was 60% (range 0–100%) for radiotherapy and 75% (range 40–100) for surgery videos. The radiotherapy videos contained less misinformation and were judged to be of higher quality. Summarized, the majority of the provided videos offer insufficient quality of content and are potentially subject to commercial bias without reports on possible conflict of interest. Thus, most of available videos on YouTube informing PCa patients about possible treatment methods are not suited for a balanced patient education or as a basis for the patient’s decision.

The Central European Journal of Urology is an open access quarterly-issued journal, which provides a forum for the presentation of original clinical, experimental and other research studies...

Objectives: To compare a customized 'suture stent' with a standard ureteric stent regarding stent‐related symptoms, safety and efficacy. Materials and Methods: Patients with urolithiasis located proximal to the iliac vessel crossing, requiring stenting in preparation for secondary ureterorenoscopy (URS) were randomized to standard ureteric stenting or a suture stent. Secondary ureterorenoscopy was performed 2–6 weeks later. The Ureteral Stent Symptoms Questionnaire (USSQ) was completed after 1 week, on the day before URS and 2–6 weeks after stent removal. Stent efficacy and safety were systematically assessed. Results: A total of 88 patients were included in the analysis. The median (range) suture stent length was 10 (5–25) cm vs 26 cm for standard stents. Operation time was longer for insertion of the suture stent (24.0 vs 14.5 min; P < 0.001). Patients with a suture stent had a significantly lower USSQ urinary symptoms score 1 week after stent insertion, adjusted for baseline symptoms by subtracting scores from the final visit without indwelling stent (mean 7.1 vs 13.7, difference −6.6, 95% confidence interval [CI] −3.4 to −9.8; P < 0.001). Prior to secondary URS (after 2–6 weeks), baseline‐adjusted urinary symptoms (mean 4.7 vs 12.2, difference −7.5, 95% CI −4.5 to −10.4; P < 0.001) and pain subscores (11.5 vs 17.6, difference −6.1, 95% CI −0.7 to −11.6; P = 0.004) were significantly lower in the suture stent group. All other USSQ subscores showed no significant differences. Adverse events occurred in 15 patients and were similarly frequent in the two groups. No significant differences were found between the groups regarding ureteric access during secondary URS. Conclusion: Replacement of the distal part of ureteric stents by a suture can reduce stent‐associated symptoms without restrictions regarding secondary stone removal or safety.

Purpose: To assess migration of urinary stones with ureteral stents in place. Materials and Methods: We performed a retrospective analysis of stone characteristics and locations in patients treated with secondary retrograde intrarenal surgery for symptomatic urinary stones at our institution. We analyzed 393 patients with a median age of 53 years and a median stone size of 7 mm. Stone location was assessed at ureteral stent insertion and four weeks later prior to stent removal and retrograde intrarenal surgery (RIRS). Results: Migration of urinary stones was seen in 33.1% of the patients with an indwelling ureteral stent. Stones with caudal migration were smaller for any given initial position. 7.1% of the stones were located at one of the three sites of narrowing at initial presentation, this percentage increased to 18.8% at the time of stone extraction. Stone composition did not affect stone migration. Conclusion: Radiographic imaging prior to retrograde intrarenal surgery is recommended due to the migration of urinary stones with indwelling ureteral stents. The most appropriate surgical approach can be devised depending on stone localization.

Purpose WisQoL (Wisconsin Stone Quality of Life questionnaire) is a disease specific, health related quality of life measure designed for patients who form kidney stones. The goal of this study was to develop and validate a German version of WisQoL. Methods The German version of the WisQoL was developed following a standardized multistep process. Patients were recruited prior to stone treatment, and completed the questionnaire as well as the SF-36v2 (36-Item Short Form Health Survey). This was repeated 1, 3, and 6 months after stone surgery. Scores of the 28 questionnaire items were summarized into sum scores for four domains and a total score. The psychometric properties of the questionnaire were statistically analyzed. Results The German WisQoL demonstrated excellent internal consistency (Cronbach’s α > 0.90 for all domains at all visits). All inter-domain associations were positive. The test–retest reliability for patients with unchanged self-reported health state was considered satisfactory (Spearman’s rho for total score 0.70 [95% CI 0.55 to − 0.80]). The German WisQoL demonstrated good convergent validity with the validated SF-36v2 (correlation between corresponding items 0.44 to 0.64). All domain scores showed significant sensitivity to change induced by stone treatment (p ≤ 0.05). Total WisQoL scores generally improved during the first 3 months following stone treatment, and remained stable thereafter. Conclusion The German WisQoL proved to be a reliable and robust instrument to evaluate health related quality of life measures of kidney stone patients in the clinical setting. It is expected to be of use for further research in patients with kidney stones.

Purpose To systematically assess the quality of videos on the surgical treatment of urinary stones available on YouTube using validated instruments. Methods A systematic search for videos on YouTube addressing treatment options of urinary stones was performed in October 2019. Assessed parameters included basic data (e.g. number of views), the grade of misinformation reporting of conflicts of interest. Quality of content was analyzed using the validated DISCERN questionnaire. Data were analyzed using descriptive statistics. Results A total of 100 videos with a median of 26,234 views (1020–1,720,521) were included in the analysis. Of these, only 26 videos were rated to contain no misinformation and only nine disclosed potential conflicts of interest. Overall, the median quality of the videos was low (2 out of 5 points for DISCERN question 16). Videos uploaded by healthcare professionals and medical societies/organizations offered significantly higher levels of quality. In particular, the videos provided by the EAU achieved the highest rating with a median score of 3.0. Conclusions The majority of videos concerning the surgical treatment of urinary stones have a low quality of content, are potentially subject to commercial bias and do not report on conflicts of interest. Videos provided by medical societies, such as the EAU, provide a higher level of quality. This highlights the importance of active recommendation of evidence-based patient education materials.

We report the case of a 74-year-old patient in whom a ductal prostate cancer was incidentally endoscopically diagnosed in the course of ureteral stenting due to a left distal ureteral stone. The initial PSA was 0.8μg/l and the digital rectal examination was not suspicious. A radical prostatectomy was performed, and the ensuing follow-up was unremarkable with no signs of recurrence. Fourteen years later, the patient presented with an obstructive pyelonephritis due to a left-sided ureteral stone requiring ureteral stenting. An exophytic tumor was seen in the lining of vesicourethral anastomosis and surgically excised after the pyelonephritis subsided. The histopathological and immunohistochemical analysis revealed a ductal cancer of the prostate consistent with a late local recurrence. Serum PSA was below the limit of detection. Re-staging performed by an MRI of the pelvis, thoracoabdominal CT scan, and gallium-68 PSMA-PET did not reveal any other signs of disease. The ensuing follow-up is planned with regular flexible cystoscopy and computed thoracoabdominopelvic CT scans.