Matteo Romagnoli

Background/Objectives: Recently, the European Association of Urology (EAU) guidelines presented the EAU guidelines bot to assist urologists in the reading of the guidelines; however, to date, no external validation is available. The aim of our study is to assess the accuracy, completeness, and clarity of the guidelines bot in reading renal transplantation guidelines and clinical cases. Methods: A total of 103 questions derived from the recommendations included in the EAU guidelines on renal transplantation, together with 10 distinct clinical scenarios, were created. Each question and clinical case was submitted to the EAU guidelines bot, and the corresponding responses were independently evaluated by two expert urologists in terms of accuracy, completeness, and clarity. Each domain was scored using a 5-point Likert scale. In cases of disagreement between the two reviewers, a third urologist was consulted. Accuracy, completeness, and clarity were analyzed for the clinical cases and per chapter and grade of recommendation for the questions. Results: Overall, 103 questions were generated. Regarding accuracy, 101/103 responses (98%) were classified as accurate, corresponding to scores of 4–5, whereas 2/103 responses (2%) showed fair accuracy, corresponding to a score of 3. No responses were considered inaccurate, defined as a score of 1–2. In terms of completeness, 101/103 responses (98%) were judged to be complete, with scores of 4–5, while 2/103 responses (2%) were rated as fairly complete, with a score of 3. No responses were classified as incomplete. With regard to clarity, 102/103 responses (99%) were considered clear, corresponding to scores of 4–5, whereas 1/103 response (1%) was rated as fairly clear, with a score of 3. No responses were deemed unclear. No significant differences were observed when comparing responses related to strong versus weak recommendations. For the clinical scenarios, 8/10 responses (80%) were rated as accurate, with scores of 4–5, while 2/10 responses (20%) showed fair accuracy, with a score of 3. Regarding completeness, all 10 responses (100%) were classified as fairly complete, corresponding to a score of 3. Finally, in terms of clarity, 8/10 responses (80%) were judged to be clear, with scores of 4–5, whereas 2/10 responses (20%) were rated as fairly clear, with a score of 3. Conclusions: The EAU guidelines bot represents an accurate tool for renal transplantation. Besides some occasional inaccuracies the bot is an excellent tool for urologists, especially to clarify doubt about the EAU guidelines. At the same time, it can give good support when facing a clinical case.

Objective: Accurate interpretation and reporting of urodynamic studies are essential for diagnosis and management of lower urinary tract dysfunction, yet remain time‐consuming and operator‐dependent. To develop and validate the Urodynamic Report Writer App (URapp), a GPT‐4o‐based virtual assistant that supports interpretation of clinician‐supplied urodynamic data and draft report generation. Methods: Multiphase development and validation study. URapp was modeled using scientific literature and international urodynamic guidelines. Training used urodynamic examinations from multiple referral centers, with supervised fine‐tuning by two expert urodynamicists. Validation was performed by functional urology specialists using a Likert scale (0–5) assessing clinical relevance, interpretative accuracy, diagnostic usefulness, clarity of urodynamic concept explanations, practical recommendations, and adherence to evidence‐based standards. In the final phase, URapp generated reports for a consecutive sample of 100 urodynamic studies, independently evaluated by two expert urologists. Results: Development required approximately 6 months. Validation scores were high across domains: interpretative accuracy (4.5 ± 0.2), explanation of urodynamic concepts (5.0 ± 0), adherence to evidence‐based standards (4.8 ± 0.3), clarity and practicality of recommendations (4.2 ± 0.3), clinical relevance (3.8 ± 0.3), and diagnostic usefulness (3.5 ± 0.5). All 100 consecutive cases (median age 61 yr) received overall scores ≥4. Limitations include retrospective design, limited sample size, and absence of prospective clinical outcome assessment. Conclusions: URapp may support standardized, guideline‐adherent urodynamic reporting in clinical practice. Prospective multicenter studies are required before routine clinical implementation.

Background/Objectives: Recently the European Association of Urology (EAU) guidelines presented the EAU Guidelines bot to assist urologists in the reading of the guidelines; however, there is a lack of up-to-date external validation. The aim of our study is to assess the accuracy, completeness, and clarity of the guidelines bot in urethral strictures. Methods: A total of 117 questions based on the EAU urethral strictures guidelines recommendations were developed. Each question was input to the EAU guidelines bot and the response was assessed by two expert urologists to assess the accuracy, completeness, and clarity. Moreover, 10 simple clinical cases were input. A 5-point Likert scale was used as a score and, in case of discrepancies, a third urologist was queried. Accuracy, completeness and clarity were assessed per chapter and per grade of recommendation. All questions and answers were recorded in an Excel file. Results: Overall 117 questions were developed. In terms of accuracy, 111/117 (95%) were defined as accurate (scores 4–5), 4/117 (3%) presented a fair accuracy (score 3), and 2/117 (2%) were deemed not accurate. In terms of completeness, 93/117 (80%) were defined as complete (scores 4–5), 22/117 (19%) presented a fair completeness (score 3), and 2/117 (2%) were deemed not complete. Finally, in terms of clarity, 104/117 (89%) were defined as clear (scores 4–5), 13/117 (11%) presented a fair clarity (score 3), and 0/109 (0%) were deemed not clear. When comparing strong and weak recommendations, no differences were recorded. Overall the answers to simple clinical cases were in line with the guidelines with good accuracy, completeness and clarity scores. Conclusions: The EAU guidelines bot represents an accurate tool for urethral stenosis guidelines. Some fine-tuning is needed to improve readability and clarity.

Background: The aim of this study was to evaluate treatment satisfaction and decision regret in patients undergoing minimally invasive surgical therapies (MISTs) for lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH). Materials and Methods: We analyzed prospectively collected data from consecutive patients undergoing MISTs across five Italian primary care urology centers. All patients underwent a comprehensive clinical assessment, including detailed medical history and physical examination. Preoperative, perioperative, and postoperative variables were recorded. Decision regret was assessed using validated questionnaires, with significant regret defined as a score >25%. Results: A total of 155 patients were included, with a median age of 64 years (IQR 58–66) and a median IPSS of 23 (IQR 18–26). Among them, 90 patients (51%) underwent Aquablation, 21 (12%) received a temporary implantable nitinol device (iTIND), 26 (15%) underwent water vapor thermal therapy (WVTT), and 37 (21%) were treated with prostatic urethral lift (PUL). The overall median decision regret score was 0 (IQR 0–15), with 23 patients (15%) reporting significant regret (>25%). Higher regret rates were observed in patients treated with PUL and WVTT compared to those undergoing iTIND and Aquablation. None of the evaluated variables—including age, BMI, prostate volume, preoperative Qmax, or preoperative IPSS—were significantly associated with treatment regret. However, although not reaching statistical significance, a prostate volume >60 cc was associated with higher regret in patients undergoing WVTT (OR = 3.33) and PUL (OR = 4.2). Conclusions: Among patients undergoing MISTs, treatment regret is not negligible and appears higher when patient selection is suboptimal. Larger studies are warranted to better identify predictors of decision regret and optimize patient selection for these procedures.

Background and Objectives: The impact of lifestyle on lower urinary tract symptoms has been deeply evaluated in recent years; however, studies in the young population are missing. The aim of this study is to evaluate the impact of alcohol intake, tobacco and cannabinoid smoking, physical activity, and dietary regime on urinary symptoms and sexual function in young adults under 30 years of age. Methods: A prospectively enrolled population of healthy young adults of both sexes under 30 years of age was selected. Young people with comorbidities were excluded. All participants were assessed by completing an anonymous questionnaire which included questions on medical history, lifestyle, smoking and alcohol intake, urinary symptoms, and sexual function only in male subjects. The questionnaire was postponed in case there was an acute pathology. Results: Overall, 802 young adults were prospectively enrolled, of whom 44% were male and 56% female, with a median age of 26 (23/28) years. In our population, 580/818 (70.9%) subjects presented an IPSS ≥ 3. In the analysis of the association between urinary symptoms and smoking, smokers presented urinary symptoms more frequently than nonsmokers (76% vs. 61%; p < 0.05). No association between urinary symptoms and alcohol intake, cannabinoid smoking, physical activity, and dietary regimen was recorded. On multivariable analysis, smokers had an almost doubled risk of urinary symptoms compared to nonsmokers (OR: 1.78; p = 0.001). Conclusions: In conclusion, we demonstrated how even in the young population there can be a correlation between LUTSs and different lifestyles.