Caglar Boyaci

Objective: Artificial intelligence (AI) chatbots are increasingly used as accessible sources of medical information. However, concerns remain regarding the quality, reliability, readability, and clinical applicability of AI-generated health content. Intravesical Bacillus Calmette-Guérin (BCG) therapy is a standard adjuvant treatment for intermediate- and high-risk non-muscle invasive bladder cancer (NMIBC) and requires adequate patient understanding of treatment procedures and potential adverse effects. This study aimed to evaluate the quality, reliability, readability, and guideline adherence of information provided by commonly used AI chatbots regarding intravesical BCG therapy. Methods: This cross-sectional methodological study evaluated responses generated by four AI chatbots (ChatGPT, Copilot, Gemini, and Perplexity) to a standardized question regarding intravesical BCG therapy. Responses were independently assessed by five urologists using validated tools including DISCERN, PEMAT-P, WRR, and the Coleman-Liau Index (CLI). Compliance with European Association of Urology (EAU) guidelines was evaluated using a 5-point Likert scale. Results: Responses ranged from 454 to 550 words and required a university-level reading ability (CLI range: 16.02–19.35). DISCERN scores indicated moderate information quality across all chatbots, with Gemini demonstrating the numerically highest median score (51 [47–59]). PEMAT-P actionability scores were generally low (median 40%). Guideline adherence was moderate, with all chatbots receiving a median Likert score of 3. Conclusion: AI chatbots provide moderate-quality information regarding intravesical BCG therapy but require high reading-grade levels and offer limited actionable guidance. AI-generated information may support patient education but should not replace physician counseling.

Background: To determine the duration of delay in healthcare-seeking among women with urinary incontinence (UI), compare the sociodemographic and clinical characteristics of early and delayed consulters, and investigate sociocultural determinants associated with delayed healthcare-seeking behavior. Methods: This cross-sectional study included 154 women presenting with UI to the Urology Outpatient Clinic of Bursa Yuksek Ihtisas Training and Research Hospital between March and June 2026. UI severity was assessed using the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), quality of life using the Incontinence Quality of Life Questionnaire (I-QOL), and sociocultural determinants using the Urinary Incontinence Help-Seeking Scale (UI-HSS), developed by the researchers. Participants were categorized into early consultation (≤1 year) and delayed consultation (>1 year) groups. Factors associated with delayed consultation were evaluated using logistic regression analysis. Results: Overall, 40.3% of participants delayed seeking medical care for more than one year after symptom onset. Women with delayed consultation had lower educational attainment, higher ICIQ-SF scores, and lower I-QOL total scores (all p < 0.001). Scores for illness perception, embarrassment and consultation barriers, normalization beliefs, lack of social support, and fatalism were also significantly higher among delayed consulters (all p < 0.05). Increasing consultation delay was associated with greater symptom severity and poorer quality of life. In multivariable analysis, higher educational level (odds ratio [OR] = 0.57, p = 0.001) and higher I-QOL total score (OR = 0.93, p = 0.005) were associated with lower odds of delayed consultation. Prior use of alternative treatments was also associated with lower odds of delayed consultation (OR = 0.43, p = 0.036). Conclusions: Delayed healthcare-seeking is common among women with UI and cannot be explained solely by symptom severity. Educational level, quality of life, and sociocultural factors were associated with healthcare-seeking behavior. Addressing these factors may facilitate earlier diagnosis and treatment.

Considering that cardiovascular diseases (CVD) and erectile dysfunction (ED) have many common risk factors and pathophysiology, we aimed to determine whether remnant cholesterol (RC) is associated with ED. Patients who were diagnosed with ED and examined with any other andrological complaints between January 2022 and December 2023 in our outpatient clinic were retrospectively reviewed. The erectile function of the participants was evaluated using the International Index of Erectile Function (IIEF-15) form. Fasting blood glucose (FBS), hemoglobin A1c (HbA1c), total cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL), total testosterone, body mass index (BMI) and RC were calculated and recorded. Patients were categorized as having ED (Group 1) and not having ED (Group 2) according to the erectile function score of the IIEF-15 questionnaire. The mean age of the participants included in the study was 46.93±12.29 years. There were 160 (58.6%) patients in Group 1 and 113 (41.4%) patients in Group 2. Age, BMI, FBS and HbA1c levels were significantly higher in Group 1 (p=0.001; p=0.013; p=0.009; p=0.001, respectively). HDL cholesterol level was significantly lower in Group 1 (p=0.008). The mean RC level was 35.7±21.3 mg/dL in Group 1 and 31.8±19.4 mg/dL in Group 2 and was comparable between the two groups (p=0.123). In our study, although the RC level was found to be higher in the ED group, it did not reach a statistically significant level. Further prospective studies with larger sample size are needed.

Purpose Since some urological diseases are age-dependent, these patients are admitted to urology wards for treatment more frequently as an inevitable result of aging. In this study, the urological hospitalization reasons and outcomes patients in octogenarian and nonagenarian age groups were evaluated in comparison with younger adult patients. Methods After examining a total of 5615 urology ward admissions of individuals aged 18–99 years, we included 443 (7.7%) patients aged 80–89 years in the octogenarian group and 32 (0.6%) patients in the nonagenarian group. Ten percent of the remaining 5150 adults were randomly selected to form the control group. Results The mean ages of the control, octogenarian, and nonagenarian groups were 55.4 ± 16, 83.3 ± 2.6, and 91.9 ± 1.8 years, respectively. The most frequent reasons for the hospitalization were a history of or active bladder tumors in the octogenarian and nonagenarian groups [117 (38.5%) and 3 (21.4%), respectively]. The incidences of any complication in the control, octogenarian, and nonagenarian groups were 61 (12.2%), 63 (15.7%), and 12 (42.9%), respectively. Mortality was seen in five (1%) patients in the control group, 11 (2.5%) in the octogenarians, and five (15.6%) in the nonagenarians. The complication and mortality rates of the nonagenarian group were statistically significantly higher than the remaining two groups (p < 0.001). Conclusion Due to additional problems that increase with aging, the urology hospitalizations of octogenarian and nonagenarian patients result in more complications. Mortality rates also increase with age. It is aimed to contribute to the literature by revealing the needs and outcomes of octogenarian and nonagenarian patients in the urology clinic.

Kilic M, et al. Investig Clin Urol. 2023 Jul;64(4):404-411. https://doi.org/10.4111/icu.20230013

Objective: To investigate whether bladder wall thickness (BWT) is associated with The International Prostatic Symptom Score (IPSS) and uroflowmetry parameters in male patients with lower urinary tract symptoms (LUTS). Material and Methods: Prostate volume, prostate specific antigen (PSA), post-void residual (PVR) urine volume, IPSS, maximum and average urinary flow rates ( Qmax, Qave), BWT and intravesical prostatic protrusion (IPP) grades of male patients who applied to the urology outpatient clinic with LUTS between June 2021 and January 2022 were recorded. .Patients were divided into 2 groups in terms of BWT (Group: 1 BWT < 5 mm; Group 2: BWT ≥ 5 mm). We compared IPSS, PVR, PSA, Qmax, Qave, prostat volume and IPP grades between two groups. Results: A total of 110 patients were included in the study (Group 1: n= 65, Group 2: n=45). Median(IQR) age, and median BWT values of the patients were 56.5(15) years, and 4.25(3.60) mm, respectively. PSA, prostate volume, total urine volume, Qmax, Qave, IPSS and IPP values were found to be statistically different, while age and PVR were similar between two groups. In addition, a strong correlation was found between BWT and IPSS- Qave, and a very strong correlation between BWT and Qmax. Conclusion: BWT is a simple sonographic measurement that can be used to estimate IPSS and uroflowmetry parameters in urology practice. Keywords: bladder wall thickness, lower urinary tract symptoms, ultrasonography

Primitive neuroectodermal tumors (PNET) are most common in the central nervous system. Peripheral placements are extremely rare. PNET is from the Ewing sarcoma family. Ewing's sarcoma is evaluated in two groups: bone and non-bone origin. Renal PNET is extremely rare. Peripheral PNETs of renal origin are usually seen in young adults, progress with an aggressive clinical picture and have a poor prognosis. in the follow-up imaging of a 62-year-old female patient after gastrectomy due to stomach cancer (adenocarcinoma), a renal mass was detected incidentally in the left kidney. The patient had no identified complaints. In the middle segment of the left kidney, computed tomography (CT) examination untracked 42.5x44.6 mm nodular mass lesion which holds hipodens contrast material was noticed. The patient underwent laparoscopic left radical nephrectomy. On pathological examination, a diagnosis of PNET/Ewing sarcoma was made. Immunohistochemically, membranous/cytoplasmic and nuclear staining with FLI1 and CD99 were observed in the tumor sections. However, staining with LCA was not seen. The patient was scheduled chemotherapy by oncology. At the end of the fourth course of chemotherapy, no recurrence was found in the radiological controls of the patient.