Panagiotis Nikolinakos

Background: Pelviureteric junction obstruction (PUJO) is a leading cause of hydronephrosis in children, and pyeloplasty remains the most frequently performed robot-assisted procedure in this population. This systematic review and meta-analysis aimed to compare outcomes and complication rates across open pyeloplasty (OP), laparoscopic pyeloplasty (LP), and robot-assisted laparoscopic pyeloplasty (RALP). Methods: The PRISMA guidelines were followed. No external funding was received. MEDLINE, PubMed, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched up to February 2026. Studies including ≥10 patients aged Results: Thirty-eight studies (n=3,159) met the inclusion criteria; 13 were meta-analysed. LP demonstrated longer operative time than OP [mean difference (MD), 21.58 min, 95% confidence interval (CI): 4.28–38.88] (P=0.01). Operative time was comparable between RALP and LP (MD, −1.92 min, 95% CI: −45.75 to 41.72) (P=0.93). LP was associated with shorter hospital stay than OP (MD, −2.33 days, 95% CI: −4.61 to −0.05) (P=0.04). RALP showed reduced length of stay (LOS) compared to LP (MD, −0.89, 95% CI: −1.35 to −0.36) (P=0.0007). Success rates were comparable between OP and LP and between OP and RALP; RALP demonstrated higher success rates when compared to LP [odds ratio (OR) 2.78, 95% CI: 1.09–7.11] (P=0.03). Minor and major complication rates were comparable across all approaches. Certainty of evidence ranged from low to very low across outcomes. Conclusions: All approaches achieve high success with comparable complication profiles. Minimally invasive techniques, particularly RALP, are associated with shorter hospital stay. Higher-quality prospective data are needed.

Background: Recent advances in AI, particularly large language models, have generated growing interest in their application to medical education and examination preparation. However, the accuracy, reasoning quality, and adherence to clinical guidelines of these tools in postgraduate urology assessments remain unclear. Objective: This study aimed to evaluate the performance of 3 AI tools, ChatGPT (GPT-4.0), Claude (version 4.5), and AMBOSS, on European Board of Urology (EBU)–style multiple-choice questions, with a particular focus on accuracy, insight, concordance, and adherence to European Association of Urology (EAU) guidelines. Methods: A total of 200 single-best-answer questions from the EBU In-Service Assessment workbook (2021-2022) were input into each AI model. Models were prompted to select an answer and provide an explanation. Two urologists with post–Fellowship of the Royal College of Surgeons (FRCS) training independently assessed the outputs. Accuracy was defined as correct answer selection. Concordance was defined as the logical alignment between the answer and its explanation. Insight was evaluated across 3 domains—nonobvious deduction, discriminative reasoning, and clinical validity—and was graded as low, moderate, or high. Results: ChatGPT demonstrated the highest accuracy (171/200, 85.5%), compared to Claude and AMBOSS (both 159/200, 79.5%; P=.14). Concordance was also significantly higher for ChatGPT (190/200, 95%) than for Claude (176/200, 88%) and AMBOSS (152/200, 76%; P<.001). Nonobvious deduction was predominantly low to moderate across all models, reflecting the recall-based nature of many questions. ChatGPT and Claude showed stronger discriminative reasoning, while AMBOSS demonstrated limited exclusion of alternative options. Clinical validity was high overall, with ChatGPT showing the greatest consistency with EAU guidelines. There was substantial agreement between the 2 reviewers (weighted κ coefficient >0.61). Conclusions: AI tools can achieve high accuracy on EBU-style assessments; however, differences in reasoning quality and guideline adherence are evident. ChatGPT demonstrated superior performance across all evaluated domains, supporting its role as a potential adjunct in postgraduate urology education.

BACKGROUND Recent advances in artificial intelligence (AI), particularly large language models, have generated growing interest in their application to medical education and examination preparation. However, the accuracy, reasoning quality, and adherence to clinical guidelines of these tools in postgraduate urology assessments remain unclear. OBJECTIVE To evaluate the performance of three AI tools ChatGPT (GPT-4.0), Claude-4.5, and AMBOSS on European Board of Urology (EBU)-style multiple-choice questions, with particular focus on accuracy, insight, concordance, and adherence to European Association of Urology (EAU) guidelines. METHODS A total of 200 single-best-answer questions from the EBU In-Service Assessment workbook (2021–2022) were input into each AI model. Models were prompted to select an answer and provide an explanation. Two post-FRCS urologists independently assessed outputs. Accuracy was defined as correct answer selection. Insight was evaluated across three domains: non-obvious deduction, discriminative reasoning, and clinical validity, graded as low, moderate, or high. Concordance was defined as logical alignment between the answer and its explanation. RESULTS ChatGPT demonstrated the highest accuracy (85.5%), compared to Claude and AMBOSS (both 79.5%). Concordance was also highest for ChatGPT (95%), followed by Claude (88%) and AMBOSS (76%). Non-obvious deduction was predominantly low-to-moderate across all models, reflecting the recall-based nature of many questions. ChatGPT and Claude showed stronger discriminative reasoning, while AMBOSS demonstrated limited exclusion of alternative options. Clinical validity was high overall, with ChatGPT showing the greatest consistency with EAU guidelines. CONCLUSIONS AI tools can achieve high accuracy on EBU-style assessments; however, differences in reasoning quality and guideline adherence are evident. ChatGPT demonstrated superior performance across all evaluated domains, supporting its role as a potential adjunct in postgraduate urology education.

Neonatal ventriculitis is a complication of meningitis and is associated with high morbidity and mortality. Despite clinical importance, evidence regarding intraventricular antibiotic therapy has not been systematically collated. Our aim was to evaluate the existing literature on intraventricular antibiotic administration for neonatal ventriculitis, focusing on indications, antibiotic type, dosage, administration intervals, adverse effects, and patient outcomes. A systematic search of Ovid MEDLINE, PubMed, EMBASE, CENTRAL, and Scopus was conducted up to October 2025. Conference abstracts, letters, reviews, expert opinions, and studies including patients older than 28 days were excluded. Risk of bias was assessed using the Joanna Briggs Institute (JBI) appraisal tools for case reports and case series. The review was prospectively registered on PROSPERO (CRD420251018399). The inclusion criteria were met by 19 studies involving 43 neonates. Ventriculitis followed persistent or inadequately treated meningitis in 21 cases (48.8%). Most neonates (97.7%) received concurrent systemic antibiotics, mostly intravenously. Dosing regimens and administration intervals varied considerably, except for vancomycin, which was consistently administered at 10 mg daily. Overall survival was 79.1%. Clinical and laboratory improvement was reported in 30.2% of cases, while hydrocephalus occurred in 37.2%. Estimated in-hospital mortality was 9.3%, with hydrocephalus the leading cause of death. Intraventricular antibiotic therapy for neonatal ventriculitis has been described in small case series and case reports and may be associated with clinical and laboratory improvement. However, the low level of evidence precludes conclusions of effectiveness. Prospective studies are required to define its role alongside systemic therapy.

Objective: To provide a national evaluation of contemporary litigation trends within Paediatric Urology within National Health Service (NHS) England by examining long-term trends, the financial burden and the underlying causes of successful claims over the last 19 years. Materials and methods: Litigation data were obtained from NHS Resolution through a Freedom of Information (FOI) Act 2000 request, from 2006/2007 to 2024/2025. For all paediatric urology cases (patients < 18 years), information was collected on the total number of claims, the number of which were successful, and the associated costs of damages and legal fees. Successful claims were reviewed according to the recorded primary cause and the primary injury sustained. Results: In total, 216 litigation claims were submitted in Paediatric Urology during the study period, of which 134 (62%) were successful. Damages paid amounted to £5.32 million. The number of claims rose 3.6-fold over the 19-year-period. Damages increased 2.2-fold, from £195,750 in 2010/2011 to £441,410 in 2024/2025. The leading causes of successful claims were failure or delay in diagnosis (29.1%, 39/134), failure or delay in treatment (24.6%, 33/134), and inappropriate treatment (4.4%, 6/134). Operative factors accounted for 9.7% (13/134), while non-operative causes represented 66.41% (89/134). The most common primary injuries were removal of a testicle (36.5%, 49/134), additional or unnecessary procedures (17.1%, 23/134), unnecessary pain (8.9%, 12/134), and renal damage or failure (6.2%, 9/134). Conclusion: Both total and successful Paediatric Urology claims have progressively risen steadily across NHS England. Most stem from non-operative issues potentially influenced by extended waiting times. Improving clinician education, promoting learning from avoidable incidents, and ongoing monitoring are essential to mitigate risks, improve patient outcomes, and reduce medicolegal costs.