INTRODUCTION: This study aimed to evaluate the association of bladder diameter ratio (BDR), filling-phase detrusor pressure (Pdet), vesicoureteral reflux (VUR), age at initiation of clean intermittent catheterization (CIC), and estimated glomerular filtration rate (eGFR) with renal scarring in children with neurogenic bladder secondary to spinal dysraphism. METHODS: A retrospective review was conducted, including 133 patients followed between October 2023 and January 2025. Urodynamic studies and voiding cystourethrography (VCUG) were performed within a short interval of dimercaptosuccinic acid (DMSA) scintigraphy. BDR was measured on standardized anteroposterior VCUG images as the mean of two independent measurements. Correlation analyses, receiver operating characteristic (ROC) curves, and multivariable logistic regression were performed. Internal validation was conducted using bootstrap resampling, and model calibration and decision curve analysis were also assessed. RESULTS: Renal scarring was identified in 55.6% of patients. Children with scarring had significantly higher BDR values (1.51 +/- 0.27 vs. 1.27 +/- 0.27, p<0.001). BDR demonstrated the strongest discrimination (area under the curve [AUC] 0.74, 95% confidence interval [CI] 0.64-0.83) and remained the variable most strongly associated with renal scarring in multi-variable analysis (adjusted odds ratio [OR] 1.027, p=0.002). Although Pdet >32 cmH2O and high-grade VUR were associated with scarring, their effects were attenuated after adjustment. eGFR was lower in scarred patients (117.3 vs. 130.4 mL/min/1.73 m2, p=0.003), although its early discriminatory performance was limited. CONCLUSIONS: BDR showed the strongest association with renal scarring among the evaluated morphologic and urodynamic parameters. Pdet and VUR provided supportive but overlapping risk information, whereas eGFR reflected later functional decline. Because the BDR and Pdet thresholds in this study were derived from the present dataset, they should be interpreted as exploratory and require external validation before being used clinically. Given its availability from routine VCUG imaging, BDR may assist in identifying higher-risk patients pending confirmation in independent cohorts.
INTRODUCTION: Patients rely on online searches for patient education materials (PEMs). PEMs are recommended to be written at or below a sixth-grade reading level but are regularly written at a college reading level. Using prompt engineering, we assess the information, misinformation, and readability of ChatGPT responses to urologic oncology questions. METHODS: Forty-five questions relating to prostate, bladder, and kidney cancer were presented to ChatGPT (version 4o, OpenAI). Quality of health information was assessed using DISCERN (1 [low] to 5 [high]). Understandability and actionability were assessed using PEMAT-P (0 [low] to 100% [high]). Misinformation was scored from 1 [no misinformation] to 5 [high misinformation]. Grade and reading level were calculated using the Flesch-Kincaid scale [5 (easy) to 16 (difficult), and 100-90 (5th grade level) to 10-0 (professional level), respectively]. Prompt engineering was then applied to responses and evaluated. RESULTS: ChatGPT answers are highly accurate but at too advanced a reading level and lacked explanations of benefits, risks, visual aids, actionability, and citations. Using prompt engineering, DISCERN (3.42-4.47, p<0.0001), PEMAT-P understandability (88.4-95.5%, p<0.0001), actionability (25.6-84.2%, p<0.0001), grade reading level (10.5-5.3, p<0.0001), and reading level (42 [college level] to 71.7 [7th grade], p<0.0001), all significantly improved. Misinformation did not change significantly. CONCLUSIONS: Using prompt engineering, ChatGPT provides highly accurate and understandable PEMs at a patient-appropriate reading level and provides concrete resources for patient action. Urologists should understand prompt engineering and be involved in the development of artificial chatbots to optimize results.
INTRODUCTION:Prepubertal males undergoing cancer treatment or hematopoietic stem cell transplant (HSCT) are at risk of infertility but currently have no fertility preservation (FP) options. Immature testicular tissue cryopreservation (TTC) has been used for successful pregnancies/live births in animal models. Human TTC for experimental biobanking is currently being planned at select Canadian sites, with potential for expansion. Canadian patients/caregivers from metropolitan centers have previously demonstrated interest. To build an equitable national strategy, it is prudent to capture attitudes from caregivers from non-metropolitan sites. The aims of this study conducted in Saskatchewan were to describe the attitudes of caregivers of prepubertal male cancer/HSCT patients toward TTC and to measure caregiver willingness thresholds to consent to testicular biopsy for TTC. METHODS:A questionnaire with demographic information, rank-order list regarding perceived barriers to TTC, and open-ended question was administered to caregivers of prepubertal cancer/HSCT patients at our tertiary pediatric hospital. An additional theoretical threshold setting exercise was conducted. RESULTS:Fifty-two caregivers participated (response rate 85.2%; 73.5% female; age 37 years; 78% White; 18% Indigenous; all five income quintiles represented). Caregiver attitudes were child-focused (risk/benefit of procedure) rather than caregiver-focused (travel, cost.) On average, caregivers endorsed willingness to accept TTC in the setting of: minimum 26% chance of infertility from treatment; maximum 29% chance of biopsy complications; minimum 18% chance of future FP use; maximum $616 annual storage cost; and maximum 7.4 hours driving time. CONCLUSIONS:Caregivers across Saskatchewan demonstrated interest in TTC. These results can inform efforts to expand TTC options and equitable access for prepubertal cancer/HSCT patients.
INTRODUCTION: The accurate diagnosis of prostate cancer remains a clinical challenge, with both multiparametric magnetic resonance imaging (mpMRI) and 18F-prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA PET/CT) emerging as important imaging modalities. This meta-analysis aimed to compare the diagnostic performance of 18F-PSMA PET/CT vs. MRI for detecting prostate cancer. METHODS: A comprehensive systematic review and meta-analysis was conducted following PRISMA guidelines. Multiple databases were searched through February 2025. Studies comparing 18F-PSMA PET/CT with MRI for prostate cancer diagnosis using histopathology as the reference standard were included. Random-effects models were used to pool sensitivity data, with heterogeneity assessed using I2 statistics. RESULTS: Six studies comprising 310 patients were included. The pooled sensitivity for MRI was 0.81 (95% confidence interval [CI] 0.08-0.99) with substantial heterogeneity (I2=93.8%). For 18F-PSMA PET/CT, the overall sensitivity was 0.50 (95% CI 0.12-0.87) with high heterogeneity (I2=96.0%). Subgroup analysis showed 18F-PSMA PET had a pooled sensitivity of 0.50 (95% CI 0.12-0.87), while MRI demonstrated 0.81 (95% CI 0.42-0.96). No significant publication bias was detected. CONCLUSIONS: Both imaging modalities showed variable diagnostic performance across studies. The combination of PSMA PET/CT and MRI may provide complementary information for optimal prostate cancer detection, although substantial heterogeneity suggests the need for standardized protocols and larger prospective trials.
INTRODUCTION: We aimed to evaluate the prognostic significance of positive surgical margins (PSM) and associated clinicopathologic factors on long-term oncologic outcomes following robot-assisted radical prostatectomy (RARP). METHODS: We analyzed a prospectively maintained registry of patients undergoing RARP between 2003 and 2022, stratified by surgical margin status (positive vs. negative [NSM]). Primary outcomes were overall survival (OS) and biochemical recurrence-free survival (BCRFS). Multivariable Cox regression adjusted for age, prostate-specific antigen (PSA), Gleason grade group (GGG), pathologic stage, nodal status, and adjuvant therapy. A prognostic nomogram for OS was developed in the PSM cohort. RESULTS: Among 3969 patients, 459 (11.4%) had PSM, which was more common in the presence of adverse pathologic features. On unadjusted analysis, PSM was associated with worse OS (hazard ratio [HR] 1.39, 95% confidence interval [CI] 1.02-1.90, p=0.036) and BCRFS (HR 2.20, 95% CI 1.62-2.97, p<0.001). After adjustment, PSM was not independently associated with OS (adjusted [a]HR 1.16, p=0.377) or BCRFS (aHR 0.86, p=0.343). In the PSM cohort, >= pT3a disease, node-positive status, and advanced pathologic stage were strong predictors of mortality (HRs 3.91, 3.86, and 3.62, respectively), while adjuvant radiation therapy was associated with improved survival (HR 0.46, p=0.025). The PSM-specific nomogram demonstrated time-dependent area under the curve (AUC) of 0.737 (3 years), 0.713 (5 years), 0.774 (10 years), and 0.932 (20 years). CONCLUSIONS: PSMs are associated with worse unadjusted outcomes, largely driven by their association with high-risk pathologic features, but are not independently prognostic after accounting for tumor biology and disease stage. A PSM-specific nomogram may support individualized postoperative risk stratification and shared decision-making, pending external validation.
