BACKGROUND:Artificial intelligence (AI) is a burgeoning new field that has increased in popularity over the past couple of years, coinciding with the public release of large language model (LLM)-driven chatbots. These chatbots, such as ChatGPT, can be engaged directly in conversation, allowing users to ask them questions or issue other commands. Since LLMs are trained on large amounts of text data, they can also answer questions reliably and factually, an ability that has allowed them to serve as a source for medical inquiries. This study seeks to assess the readability of patient education materials on cardiac catheterization across four of the most common chatbots: ChatGPT, Microsoft Copilot, Google Gemini, and Meta AI. METHODOLOGY:A set of 10 questions regarding cardiac catheterization was developed using website-based patient education materials on the topic. We then asked these questions in consecutive order to four of the most common chatbots: ChatGPT, Microsoft Copilot, Google Gemini, and Meta AI. The Flesch Reading Ease Score (FRES) was used to assess the readability score. Readability grade levels were assessed using six tools: Flesch-Kincaid Grade Level (FKGL), Gunning Fog Index (GFI), Coleman-Liau Index (CLI), Simple Measure of Gobbledygook (SMOG) Index, Automated Readability Index (ARI), and FORCAST Grade Level. RESULTS:The mean FRES across all four chatbots was 40.2, while overall mean grade levels for the four chatbots were 11.2, 13.7, 13.7, 13.3, 11.2, and 11.6 across the FKGL, GFI, CLI, SMOG, ARI, and FORCAST indices, respectively. Mean reading grade levels across the six tools were 14.8 for ChatGPT, 12.3 for Microsoft Copilot, 13.1 for Google Gemini, and 9.6 for Meta AI. Further, FRES values for the four chatbots were 31, 35.8, 36.4, and 57.7, respectively. CONCLUSIONS:This study shows that AI chatbots are capable of providing answers to medical questions regarding cardiac catheterization. However, the responses across the four chatbots had overall mean reading grade levels at the 11th-13th-grade level, depending on the tool used. This means that the materials were at the high school and even college reading level, which far exceeds the recommended sixth-grade level for patient education materials. Further, there is significant variability in the readability levels provided by different chatbots as, across all six grade-level assessments, Meta AI had the lowest scores and ChatGPT generally had the highest.

Mesotheliomas of the tunica vaginalis testis are rare malignant tumors that can present as a scrotal mass or hydrocele. These tumors are typically aggressive with high rates of recurrence and metastasis. Suspected risk factors for malignant mesothelioma include asbestos exposure, chronic inflammation, trauma, and persistent hydrocele. We report the case of a malignant epithelioid mesothelioma of the tunica vaginalis testis that presented as a finding at hydrocelectomy and was ultimately treated with radical inguinal orchiectomy. This patient was on chronic immunosuppression therapy with tacrolimus and mycophenolate mofetil secondary to a kidney transplant but had none of the common risk factors for mesothelioma formation. To our knowledge, this is the first case describing a possible connection between chronic immunosuppression and mesothelioma of the tunica vaginalis. However, future studies are needed to investigate this association and discern whether this could have played a role in our patient or if his mesothelioma formation was coincidental.

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy V (MP67)1 May 2024MP67-10 15-YEAR FOLLOW-UP OF ONCOLOGIC AND RENAL FUNCTION OUTCOMES: RADIOFREQUENCY ABLATION OF RENAL TUMORS 3-7 CM USING FIBEROPTIC, NON-CONDUCTING TEMPERATURE MONITORING Robert I. Carey, Genesis G. Dolgetta, Tonya S. King, Benjamin J. Behers, Spencer Kortum, Pedro Briceno, and Karim Ghazli Robert I. CareyRobert I. Carey , Genesis G. DolgettaGenesis G. Dolgetta , Tonya S. KingTonya S. King , Benjamin J. BehersBenjamin J. Behers , Spencer KortumSpencer Kortum , Pedro BricenoPedro Briceno , and Karim GhazliKarim Ghazli View All Author Informationhttps://doi.org/10.1097/01.JU.0001009496.54470.10.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: In this study we describe the 15-year follow up of oncologic and renal function outcomes for a cohort of patients who underwent laparoscopic radiofrequency ablation (LRFA) of solid-enhancing renal masses (SERMs) with real time temperature monitoring of the ablation zone with non-conducting fiberoptic thermistors. METHODS: LRFA was performed with a Covidien Cooltip probe system using multiple probes and multi-pass technique. Direct real-time, fiberoptic temperature monitoring was performed for each case with temperature goals of greater than 60 degrees C achieved at the deep and peripheral margins. RESULTS: Mean tumor size 3.5 cm, median tumor volume 17.2 cm3, and mean RENAL nephrometry score 6.8. Mean GFR was 60.2 pre-surgery, 55.7 at 3 months, and 51.0 at 3 years. Thirty-one patients were female (41.3%), laterality was left 39 (52.0%) and right 36 (48.0%). Pathology showed renal cell carcinoma 70.3% and oncocytoma/AML 29.7%. Three patients required partial nephrectomy for locally recurrent renal cell carcinoma (RCC), while four patients required radical nephrectomy. Only one local recurrence developed metastasis. Overall, there were four instances of metastasis after LRFA leading to disease-specific mortality (DSM) and two without DSM.The 15-year overall survival rate was 0.53, while disease-specific survival (DSS) was 0.94. The risk of overall mortality was 0.26 times lower for ASA 2 vs. 3/4 (p=0.001), 2.1 times greater for every 1 unit increase in log transformed tumor volume (p=0.011) 0.64 times lower for every 20-unit increase (1 SD) in calculated pre GFR (p=0.015), with adjustment for nephrometry score. Nephrometry score was the most significant predictor of salvage therapy (OR 4.0 for every 1-unit increase, p=0.001), and metastasis (OR 2.4 for every 1-unit increase, p=0.009). CONCLUSIONS: This study documents the natural history of LRFA patients with 3-7 cm SERMs followed for 14 years. Although LRFA is feasible with overall excellent preservation of kidney function and 94% DSS, preservation of renal function and RFS decline inversely with tumor size and RENAL nephrometry score. Local tumor bed recurrence, metastasis, and DSM occur over long term follow up with these large tumors despite the independent temperature monitoring. Long term follow-up identified four deaths from metastatic RCC, one of which had pre-existing metastasis but two of which were in T1a patients. Source of Funding: The Burzik Foundation © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e1101 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Robert I. Carey More articles by this author Genesis G. Dolgetta More articles by this author Tonya S. King More articles by this author Benjamin J. Behers More articles by this author Spencer Kortum More articles by this author Pedro Briceno More articles by this author Karim Ghazli More articles by this author Expand All Advertisement PDF downloadLoading ...

Introduction: Current guidelines recommend single anticoagulation (AC) therapy over combined AC plus anti-platelet (AP) therapy in patients with established cardiovascular disease (CVD) and concomitant indication for AC. Data on the in-hospital outcomes of acute myocardial infarction (AMI) in patients on single versus combined therapy is scarce. Methods: The National Inpatient Sample was used to identify adult patients with established CVD on AC and a primary diagnosis of AMI between 2016 and 2020. Data was stratified between patients on single AC and patients on combined AC and AP therapy. In-hospital outcomes were compared after case-control matching for significant comorbidities. Results: A total of 122,975 patients admitted for AMI were included, of which 57,220 (46.5%) were previously on combined therapy. PCI rates were similar in both groups (34.9% vs 34.6%, P=0.247). After matching (15,140 patients in each group), combined therapy was associated with decreased odds of in-hospital mortality, discharge to skilled nursing facilities (SNF), increased odds of mechanical circulatory support (MCS) use, and similar odds of in-hospital cardiovascular and bleeding complications compared to patients on single AC therapy (Figure 1). Conclusion: Combined AC plus AP therapy was associated with decreased in-hospital mortality, increase MCS use, and less SNF discharges compared to patients on single AC therapy admitted for AMI. There was no difference in in-hospital cardiac or bleeding complications.

You have accessJournal of UrologyProstate Cancer: Detection & Screening III (MP31)1 May 2024MP31-11 COMPARISON OF COMPUTER-ASSISTED MRI FUSION GUIDED PROSTATE BIOPSIES WITH COGNITIVE-ASSISTED MRI FUSION BIOPSIES Tonya S. King, Genesis G. Dolgetta, Benjamin J. Behers, Spencer Kortum, Joshua Davis, Christopher W. Guske, Tyler Vidal, and Robert I. Carey Tonya S. KingTonya S. King , Genesis G. DolgettaGenesis G. Dolgetta , Benjamin J. BehersBenjamin J. Behers , Spencer KortumSpencer Kortum , Joshua DavisJoshua Davis , Christopher W. GuskeChristopher W. Guske , Tyler VidalTyler Vidal , and Robert I. CareyRobert I. Carey View All Author Informationhttps://doi.org/10.1097/01.JU.0001008936.35187.0b.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Multiparametric magnetic resonance imaging (MRI) of the prostate is being developed at many levels to improve diagnostic accuracy of prostate biopsies in men who have elevated PSA levels. As MRI fusion technology is adopted into a community, it is not known how well prostate biopsies guided by computer-assisted MRI (CA-MRI) fusion compare with cognitive-assisted MRI (Cog-MRI) pre-existing as standard of care (SOC) in that community. METHODS: This IRB approved retrospective database compares 1074 CA-MRI fusion biopsies of the prostate with 128 Cog-MRI fusion guided biopsies of the prostate. All biopsies were performed over a common period of five years in a consistent manner transrectally using the same fusion technology and systematic biopsies were obtained at the same setting. All CA- MRI fusion biopsies were performed with the Artemis (Innomedicus) MRI Fusion device in an operating room under propofol anesthesia by a community of 12 urologists. All Cog-MRI fusion biopsies were performed with a B&K 3000 Ultrasound under local lidocaine anesthesia only by a single urologist. Data was collected and analyzed with SAS statistical software. RESULTS: Cog-MRI biopsy positivity rates for PI-RADS 3 (4/7, 57.1%), PI-RADS 4 (43/52,82.7%), PI-RADS 5 (38/42, 90.5%, and PI-RADS 3-5 (85/101, 84.2%) are superior in every category compared to CA-MRI positivity rates for PI-RADS 3 (50/89, 56.1%), PI-RADS 4 (403/538, 74.9%), PI-RADS 5 (262/298, 88.2%), and PI-RADS 3-5 (715/925, 77.3%). There is no significant difference between mean BMI of the Cog-MRI (27.8) and CA-MRI (27.4) groups (p=0.31) or the PSA (10.1 and 9.1, respectively, p=0.55). There was no significant difference in the detection of Gleason 6 cancer in any of the groups but there was a lower percentage of Gleason 6 in the Cog-MRI PI-RADS 5 group (5.3%) than in the CA-MRI PI-RADS 5 group (13.2%). Baseline transrectal ultrasound guided biopsies (n=428) done without prior MRI during this period demonstrated 59.1% positivity. CONCLUSIONS: Despite the significantly higher cost of performing CA-MRI biopsies in this study, prostate biopsy positivity is superior for Cog-MRI fusion biopsies for PI-RADS classifications 3, 4, 5, and combined 3-5 compared to CA-MRI fusion biopsies. Fewer Gleason 6 cancers were found in PI-RADS 5 lesions in Cog-MRI biopsies than CA-MRI biopsies. Both CA-MRI and Cog-MRI fusion biopsied outperformed standard TRUS biopsies done without prior MRI imaging. The 84.2% positivity rate in this study for all PI-RADS 3-5 Cog-MRI fusion biopsies should be a reasonable benchmark for CA-MRI fusion technology to achieve. Source of Funding: The Burzik Foundation © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e508 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Tonya S. King More articles by this author Genesis G. Dolgetta More articles by this author Benjamin J. Behers More articles by this author Spencer Kortum More articles by this author Joshua Davis More articles by this author Christopher W. Guske More articles by this author Tyler Vidal More articles by this author Robert I. Carey More articles by this author Expand All Advertisement PDF downloadLoading ...

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy IV (MP56)1 May 2024MP56-07 PROPENSITY SCORE ADJUSTED COMPARISON AND 15-YEAR FOLLOW-UP OF ONCOLOGIC AND RENAL FUNCTION OUTCOMES: RADIOFREQUENCY ABLATION VERSUS PARTIAL NEPHRECTOMY Robert I. Carey, Genesis G. Dolgetta, Tonya S. King, Spencer Kortum, Benjamin J. Behers, Pedro Briceno, and Karim Ghazli Robert I. CareyRobert I. Carey , Genesis G. DolgettaGenesis G. Dolgetta , Tonya S. KingTonya S. King , Spencer KortumSpencer Kortum , Benjamin J. BehersBenjamin J. Behers , Pedro BricenoPedro Briceno , and Karim GhazliKarim Ghazli View All Author Informationhttps://doi.org/10.1097/01.JU.0001008940.44711.d4.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: We describe the 15-year follow-up of oncologic and renal function outcomes for a cohort of patients who underwent either laparoscopic radiofrequency ablation (LRFA) or partial nephrectomy (PN) for solid-enhancing renal masses between 3-7 cm. This study is unique due to the large tumor size, follow-up length, and use of RENAL nephrometry scoring for all tumors. METHODS: LRFA was performed with a Covidien Cooltip probe system using multiple probes and multi-pass technique. Direct real-time, fiberoptic temperature monitoring was performed for each case with temperature goals of greater than 60 degrees C achieved at the deep and peripheral margins. PN was performed with standard arterial and venous clamping and sliding clip renorrhaphy closure. Renal function was assessed at 3 months and annually thereafter. Oncologic and renal function outcomes for both cohorts were compared using a propensity-score based analysis with adjustment for age, baseline renal function, tumor volume, RENAL score, and histologic stage. RESULTS: Patients undergoing LRFA (n=50) were older (median age 73 vs. 68 years, p<0.001), with similar BMI (median 26.6 vs. 28.5) and gender (66% vs. 70% male, p=0.71) compared to PN (n=117). For LRFA and PN, median tumor volume was 14.9 vs. 36.1 (p<0.001), median pre-surgery GFR was 61.4 vs. 50.9 (p=0.002), and median RENAL score was 6.5 vs. 9.0 (p<0.001). LRFA had more T1a patients (72% vs. 36.8%, p<0.001). With propensity score adjustment, patients undergoing PN had 95% lower odds of metastasis (p=0.002), and 85% lower odds of radical nephrectomy (p=0.031), compared to LRFA. PN had lower rates of both overall mortality (HR=0.44, 95%CI 0.14-1.39, p=0.16) and disease-specific mortality (HR=0.14, 95%CI 0.01-1.89, p=0.14), however neither were statistically significant. Disease-specific survival was 91% for LRFA. 3/50 (6%) of patients undergoing LRFA required salvage PN. Propensity adjusted mean % change in GFR at one year was significantly greater for PN vs. LRFA (24% vs. -14%, p<0.001). CONCLUSIONS: PN patients showed better renal function preservation and required fewer salvage surgeries than LRFA. At one-year, renal function declines 14% for LRFA, while improving 24% for PN, with adjustment for propensity score. Local tumor bed recurrence and metastasis occur more frequently with LRFA over 15-year follow-up with these tumors despite the independent temperature monitoring. Source of Funding: The Burzik Foundation © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e928 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Robert I. Carey More articles by this author Genesis G. Dolgetta More articles by this author Tonya S. King More articles by this author Spencer Kortum More articles by this author Benjamin J. Behers More articles by this author Pedro Briceno More articles by this author Karim Ghazli More articles by this author Expand All Advertisement PDF downloadLoading ...

Background/Objectives: Studies have shown that consistent reductions of 2 mm Hg in systolic blood pressure (SBP) for the general normotensive population can result in significant decreases in mortality from heart disease and stroke. The purpose of this meta-analysis was to determine the optimal dose and duration of treatment for magnesium and potassium supplementation, having previously discovered that both reduce SBP by −2.79 and −2.10 mm Hg, respectively. Methods: Placebo-controlled, randomized clinical trials examining the effects of magnesium and potassium supplementation on SBP were identified. Pairwise meta-analyses with subgroups for dosage and treatment duration were run. Results: Magnesium at dosages of ≤360 mg/day and durations greater than 3 months reduced SBP by −3.03 and −4.31 mm Hg, respectively. Potassium at dosages of ≤60 mmol/day and durations greater than 1 month reduced SBP by −2.34 and −2.80 mm Hg, respectively. Conclusions: Both supplements demonstrated greater reductions in SBP for the general population at lower dosages and longer treatment durations. Future studies are needed to validate these findings and provide tailored recommendations. These studies could investigate varying dosages over long-term follow-up to provide robust data on optimal dosages and treatment durations, as our findings were limited due to reliance on previously published trials.

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy IV (PD61)1 May 2024PD61-10 HEALTHCARE FAILURE MODE AND EFFECT ANALYSIS EVALUATING da Vinci Xi TRANSPERITONEAL PROSTATECTOMY WITH da Vinci SINGLE PORT PROSTATECTOMY Tonya S. King, Genesis G. Dolgetta, Christopher W. Guske, Benjamin J. Behers, Spencer Kortum, Maximilian S. Carey, Karim Ghazli, and Robert I. Carey Tonya S. KingTonya S. King , Genesis G. DolgettaGenesis G. Dolgetta , Christopher W. GuskeChristopher W. Guske , Benjamin J. BehersBenjamin J. Behers , Spencer KortumSpencer Kortum , Maximilian S. CareyMaximilian S. Carey , Karim GhazliKarim Ghazli , and Robert I. CareyRobert I. Carey View All Author Informationhttps://doi.org/10.1097/01.JU.0001009352.31737.3d.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Although some institutions have reported equivalent outcomes for da Vinci single port prostatectomy (SPP) and da Vinci Xi transperitoneal prostatectomy (XiTPP), healthcare failure mode and effect analysis (HFMEA) studies evaluating the implementation of SPP into a community with a pre-existing high quality XiTPP program is lacking. METHODS: Data was collected from an IRB-approved prospectively maintained database of robotic prostatectomy (RALRP) in a single institution. From December 15, 2022, to June 1, 2023, 148 consecutive patients underwent XiTPP with surgeons, each with more than 15 years of experience with XiTPP. In the same time period, 22 patients underwent SPP with a different surgeon also with more than 15 years of experience. Operative and peri-operative data were collected and analyzed with -----SAS statistical software. RESULTS: Median age was 70 for SPP and 72 for XiTPP. Median surgery time was 242.5 min (167-655 min to max) for SPP and 105 min (61–169 min to max) for XiTPP, p<0.001. SPP patients were more likely to have a positive margin >3mm than XiTPP (38.1% vs. 8.5%, respectively, p=0.001). Transfusion rate was 2/21 (9.5%) for SPP and 1/148 (0.68%) for XiTPP, p=0.044. Risk of having a hospital length of stay of more than two nights was 16.7% for SPP and 0% for XiTPP, p=0.001. Median estimated blood loss was 300 cc (50-1700 cc) for SPP and <50 cc for XiTPP, p<0.001. The median prostate weight was larger for XiTPP (52 g) than SPP (45.5 g), although not statistically significant, p=0.06, and there was higher percentage of EPE and SVI in the XiTPP patients, although not statistically significant. There was no significant difference in preoperative hemoglobin or Gleason Grade Group, but XiTPP patients were higher stage (T2 58% and >T3 42%) than SPP (T2 73% and >T3 0%), p<0.001. The presence of the surgical margin greater than 3 mm is significantly higher for SPP (38.1%) than XiTPP (8.5%). CONCLUSIONS: In an institution with a long-standing history of high quality XiTPP robotic surgery for prostate cancer, HFMEA analysis of the introduction of SPP failed to demonstrate an upward slope of improvement over a 6-month period. The step-by-step quality metric curves did not converge. With high levels of statistical significance (p<0.001), XiTPP demonstrated a stable plateau of higher quality HFMEA parameters of operative time, EBL, positive margins >3 mm, transfusion rates and use of post-operative computed tomography imaging. Source of Funding: Burzik Foundation © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e1283 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Tonya S. King More articles by this author Genesis G. Dolgetta More articles by this author Christopher W. Guske More articles by this author Benjamin J. Behers More articles by this author Spencer Kortum More articles by this author Maximilian S. Carey More articles by this author Karim Ghazli More articles by this author Robert I. Carey More articles by this author Expand All Advertisement PDF downloadLoading ...

Cystic teratomas are a common ovarian neoplasm that are rarely found in other locations of the body, namely the sacrococcygeal region and anterior mediastinum. Localization to the urinary bladder is exceedingly rare, with only a few cases documented in the literature. Cystic teratomas are usually asymptomatic and found incidentally, but localization to the bladder can present as irritative lower urinary tract symptoms and/or mimic urinary tract calculi. We report the rare case of a mature cystic teratoma of the urinary bladder, presenting as foul-smelling urine with recurrent urinary tract infections and microhematuria, that was originally misdiagnosed as a bladder calculus.

brand of mesh were not associated with SBO. Only ELOS was found to be associated with SBO on multivariate analysis. Mean age was 66.1 years and mean BMI 28.2. Robotic console time between 59 and 123 min. All 8 reoperations for SBO had previous abdominal procedures, and 6 were coded as ELOS. There were no reoperations for SBO in patients with no previous abdominal surgery. CONCLUSIONS: RASCP is a safe and durable surgery for repair of POP. Risk of reoperation for SBO is associated with concomitant ELOS. In ELOS patients the risk of SBO is 7.5% and in patients without ELOS the risk is 0.5%. Although many patients presenting for RASCP have had previous abdominal operations, not all such patients require ELOS. For patients with histories of numerous prior bowel or abdominal surgeries who are at increased risk for ELOS at time of RASCP, careful patient selection is recommended and appropriate preoperative counseling suggested.