Journal of endourology最新文献

{"title":"Flexible Ureteroscopy Versus Minipercutaneous Nephrolithotomy for 2 to 4 cm Renal Stones: A Systematic Review and Meta-Analysis.","authors":"Mohab Alsaid Saad, Aya M Nasr, Tasbih Fawzi Keshk, Rama Farid Qudaih, Alsayed Saad Abdelaziz, Mostafa Said","doi":"10.1177/08927790261475450","DOIUrl":"10.1177/08927790261475450","url":null,"abstract":"<p><strong>Background: </strong>As the global prevalence of urolithiasis rises, selecting the optimal surgical intervention for large renal stones remains critical. Although percutaneous nephrolithotomy (PCNL) is the standard for stones more than 2 cm, the choice between flexible ureteroscopy (FURS) and mini-PCNL (mPCNL) for these burdens is debated. This systematic review and meta-analysis compares the efficacy and safety of FURS versus mPCNL for kidney stones measuring 2 to 4 cm.</p><p><strong>Methods: </strong>Following the Preferred Reporting Items of Systematic Reviews and Meta-Analysis guidelines, a comprehensive search of electronic databases identified randomized controlled trials and observational studies comparing FURS and mPCNL in adults with large renal stones of 2 to 4 cm. Primary outcomes included operative time, length of hospital stay, blood loss, hemoglobin drop, stone-free rate (SFR), and overall complication rates.</p><p><strong>Results: </strong>A total of 20 studies involving 2326 patients were included. The pooled analysis revealed no statistical significance in the overall SFR across groups between FURS and mPCNL (mean difference [MD] = 0.98, 95% confidence interval [CI] [0.95; 1.01], <i>p</i> < 0.1330). Conversely, FURS demonstrated a superior safety profile, with significantly shorter hospital stays (MD = -57.10, 95% CI [-84.10; -30.11], <i>p</i> < 0.0001), reduced hemoglobin drop (MD = -0.75, 95% CI [-1.42; -0.07], <i>p</i> = 0.03), and lower blood transfusion rates (risk difference [RD] -0.02, 95% CI [-0.03; -0.01], <i>p</i> = 0.0013). FURS was associated with a statistically significant decrease in the overall complication incidence rates (risk ratio = 0.52, 95% CI [0.41; 0.65], <i>p</i> < 0.0001).</p><p><strong>Conclusion: </strong>FURS is a highly effective and safer alternative to mPCNL for managing 2 to 4 cm kidney stones. Although FURS and mPCNL offer close efficacy, FURS significantly minimizes surgical morbidity and hospitalization. The integration of advanced suctioning and laser technologies further positions FURS as a competitive primary treatment for large stone burdens.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":"1200-1212"},"PeriodicalIF":3.2,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148712613","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Modified \"Cross-Stitch\" Suturing Technique Is Associated with Shorter Warm Ischemia Time in Robot-Assisted Partial Nephrectomy.","authors":"Yao Lu, Abao Guo, Yafei Ding, Jun Wang, Xianghui Ning, Zhankui Jia","doi":"10.1177/08927790261458682","DOIUrl":"10.1177/08927790261458682","url":null,"abstract":"<p><strong>Objectives: </strong>To compare the efficacy of traditional double-layer suturing techniques <i>vs</i> an improved \"cross-stitch\" suturing technique (CST) in robot-assisted partial nephrectomy (RAPN) for localized renal cell carcinoma.</p><p><strong>Patients and methods: </strong>We retrospectively analyzed clinical data from patients who underwent RAPN at our center between August 2022 and January 2025. A total of 89 patients were ultimately included, including 58 in the double-layer suture group and 31 in the \"cross-stitch\" suturing technique group. To minimize selection bias, 1:1 propensity score matching (PSM) was performed to balance baseline characteristics between groups (matched covariates: age, body mass index, RENAL score, tumor size, tumor location, and growth pattern). In the matched cohort, a double robust estimation strategy was applied. Multivariate regression models were used to adjust for residual confounders, enabling comparison of perioperative indicators, early renal function changes, and postoperative complications between the two groups.</p><p><strong>Results: </strong>After PSM, 52 patients (26 in each group) were analyzed, and the clinical baseline characteristics of both patient groups achieved favorable matching, with significantly reduced differences in the distribution of covariates such as age, BMI, tumor size, radius, exophytic/endophytic, nearness to collecting system, anterior/posterior, location score, tumor location, and growth pattern (standardized mean difference <0.1). Compared with the double-layer suturing group, the \"cross-stitch\" suturing technique group had a significantly shorter operative time (111.1 <i>vs</i> 133.4 minutes, <i>p</i> = 0.002) and warm ischemia time (WIT) (15.4 <i>vs</i> 20.5 minutes, <i>p</i> < 0.001). However, no statistically significant differences were observed between groups in estimated blood loss (<i>p =</i> 0.362), postoperative hospital stay (<i>p =</i> 0.349), positive margin rate (<i>p =</i> 0.932), postoperative complications (<i>p =</i> 0.315), or trifecta achievement rate (<i>p =</i> 0.07).</p><p><strong>Conclusion: </strong>The modified CST was associated with shorter WIT and operative time and may be particularly suitable for localized renal tumors of moderate complexity. However, no significant differences were observed in postoperative renal function or trifecta after matching, and these findings should be interpreted with caution and require further validation.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":"1271-1277"},"PeriodicalIF":3.2,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148217883","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radiofrequency Ablation for Recurrent Renal Tumors After Partial Nephrectomy: A Retrospective Cohort Study of Technical Considerations and Oncologic Outcomes.","authors":"Jiyu Yang, Xiang Wang, Zhihua Li, Zibo Zhang, Man Zhang, Zhaohui Sun, Kaifeng Yao, Derun Li, Xuesong Li, Kai Zhang","doi":"10.1177/08927790261473185","DOIUrl":"10.1177/08927790261473185","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the technical feasibility, safety profile, and oncologic outcomes of radiofrequency ablation (RFA) in managing locally recurrent renal tumors following partial nephrectomy (PN).</p><p><strong>Design: </strong>A retrospective cohort study.</p><p><strong>Methods: </strong>A retrospective cohort of 46 patients with post-PN tumor recurrence treated with RFA (April 2017-August 2024) was analyzed, with a median of 58 years and 87.0% male. Baseline characteristics, perioperative data, and follow-up outcomes were collected. Surgical strategies and therapeutic efficacy, including tumor recurrence and incomplete ablation, were evaluated.</p><p><strong>Results: </strong>Among 46 patients (39 with single tumors and 7 with multiple tumors), postoperative pathological evaluation following PN confirmed malignancy in 46 cases, predominantly clear cell carcinomas (91.3%). The median interval between PN and RFA was 42.7 months (interquartile range [IQR]: 15.4-73.3). The median tumor size was 2.1 cm (IQR: 1.6-2.4). The median RENAL nephrometry score for recurrent tumors was 6 (IQR: 5-7). The median procedure time was 19.0 minutes (IQR: 16.0-22.6), with a median postoperative hospital stay of 1 day (IQR: 1-1). With a median follow-up of 29.3 months (IQR: 15.5-64.5), the incidences of severe complications, tumor recurrence, and incomplete ablation were 2.2%, 17.4%, and 10.9%, respectively. Limitations include modest cohort size, retrospective design, and predominant ultrasound guidance potentially affecting targeting accuracy.</p><p><strong>Conclusion: </strong>RFA demonstrates safety and efficacy as a nephron-sparing therapeutic option for recurrent renal tumors post-PN. However, the observed risks of incomplete ablation and recurrence underscore the necessity of enhanced postoperative surveillance for those patients.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":"1286-1295"},"PeriodicalIF":3.2,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148701572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preserving the Endoscopic Promise of HoLEP: A Standardized Technique for Safe and Efficient Morcellation Across Prostate Sizes.","authors":"Nabila Reem Khondakar, Jenny Guo, Amir Patel, Jack Peterson, Jodhel Destina, Alyssa McDonald, Allaa Fadl-Alla, Perry Xu, Amy E Krambeck","doi":"10.1177/08927790261472603","DOIUrl":"10.1177/08927790261472603","url":null,"abstract":"<p><strong>Introduction: </strong>Holmium laser enucleation of the prostate (HoLEP) is an effective minimally invasive treatment for benign prostatic hyperplasia across a wide range of prostate sizes. However, concerns regarding morcellation efficiency and the need for open cystotomy in very large glands remain barriers to adoption. We evaluated morcellation characteristics across prostate sizes and identified predictors of prolonged morcellation time at a high-volume center.</p><p><strong>Methods: </strong>We performed a retrospective analysis of an institutional HoLEP registry from January 2021 to April 2026. Patients with preoperative prostate volume and documented morcellation time were included. Morcellation time and efficiency were analyzed by prostate size category. Multivariable linear regression was used to identify factors associated with prolonged morcellation.</p><p><strong>Results: </strong>A total of 2114 patients met inclusion criteria. The median prostate volume was 102 cc (IQR 65-150). The median morcellation time across all cases was 6 minutes and increased progressively with prostate size: <100 cc, 3 minutes; 100-199 cc, 10 minutes; 200-299 cc, 19.5 minutes; 300-399 cc, 29 minutes; and ≥400 cc, 39 minutes (<i>p</i> < 0.001). Prostate size, age, prior benign prostatic hyperplasia surgery, and trilobar anatomy were associated with longer morcellation time. Intraoperative complication rates were low (2.8%) and not significantly associated with prostate size (<i>p</i> = 0.292). Only one patient required open cystotomy for adenoma retrieval following attempted morcellation of a 547 cc prostate.</p><p><strong>Conclusions: </strong>Morcellation time increases with prostate size but remains efficient even in very large glands. Using a standardized technique, prostates up to 400 cc can be morcellated endoscopically with extremely low conversion rates.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":"1222-1228"},"PeriodicalIF":3.2,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148664057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Modified Clavien-Dindo Framework and a Heatmap Analysis to Identify Predictors of Complications After Endoscopic Enucleation of the Prostate.","authors":"Gurpremjit Singh, Hasim Bakbak, Ahmad Abdelaziz, Nikita D Sharma, Jonathan E Katz, Robert Marcovich, Hemendra N Shah","doi":"10.1177/08927790261473192","DOIUrl":"10.1177/08927790261473192","url":null,"abstract":"<p><strong>Background: </strong>Holmium laser enucleation of prostate (HoLEP) is a size-independent procedure for benign prostatic obstruction. However, the predictors of various complications are poorly defined in the literature.</p><p><strong>Objective: </strong>We propose a standardized framework for reporting postenucleation complications using a modified Clavien-Dindo (CD) classification. We aim to identify predictors of postoperative complications following HoLEP within this unified framework, integrating both patient- and procedure-related variables.</p><p><strong>Methodology: </strong>We retrospectively analyzed a prospectively collected database of patients undergoing HoLEP. Complications were stratified according to a modified CD classification framework developed for HoLEP. Predictors were analyzed using multinomial regression, and a heatmap was generated to identify correlations among predictors.</p><p><strong>Results: </strong>A total of 855 patients were included in the study. The median prostate volume was 102 cc. Minor complications were seen in 513 patients (60%), most frequently transient incontinence (37.4%). Major complications occurred in 46 patients (5.4%), primarily bladder neck stenosis (2%) and urethral stricture (2%). Multivariate analysis showed that advancing age (odds ratio [OR] 1.03; <i>p</i> = 0.008), recurrent urinary retention (OR 1.60; <i>p</i> = 0.003), elevated body mass index (BMI) (OR 1.04; <i>p</i> = 0.017), Anticoagulation use (OR 1.44; <i>p</i> = 0.029) and longer operative duration (OR 1.004; <i>p</i> = 0.002) were independent predictors of minor complications. Major complications were associated with smaller prostates (OR 0.93, <i>p</i> = 0.016). Spearman's correlation showed that postoperative incontinence was correlated with advanced age (<i>r</i> = 0.090, <i>p</i> < 0.01), high BMI (<i>r</i> = 0.082, <i>p</i> < 0.05), and longer surgical duration (<i>r</i> = 0.119, <i>p</i> < 0.01). Prostate volume was negatively correlated with postoperative inability to void (<i>r</i> = -0.107, <i>p</i> < 0.01), bladder neck stenosis (<i>r</i> = -0.107, <i>p</i> < 0.01), and urethral stricture (<i>r</i> = -0.102, <i>p</i> < 0.01). Gross hematuria was correlated with anticoagulation use (<i>r</i> = 0.101, <i>p</i> < 0.01) and BMI (<i>r</i> = 0.114, <i>p</i> < 0.01), although neither factor predicted major complications.</p><p><strong>Conclusion: </strong>We proposed a standardized framework for reporting complications following endoscopic enucleation of the prostate. Our study also identified predictors of post-HoLEP major and minor complications.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":"1213-1221"},"PeriodicalIF":3.2,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148664039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effect of Vitamin C Supplements on Urinary Stone Risk: A Systematic Review and Meta-Analysis.","authors":"Ala'a Farkouh, Evan Seibly, Matthew I Buell, Daniel Jhang, Akin S Amasyali, Zhamshid Okhunov, D Duane Baldwin","doi":"10.1177/08927790261471733","DOIUrl":"10.1177/08927790261471733","url":null,"abstract":"<p><strong>Introduction and objective: </strong>With the increased intake of vitamin C supplements during the COVID pandemic, physicians have reported an increase in stone incidence and complexity. The purpose of this systematic review and meta-analysis was to study the effect of vitamin C supplements on urine parameters associated with stone formation.</p><p><strong>Methods: </strong>A comprehensive review was performed to retrieve relevant articles published from 1965 until February 2023. Studies were included if they were interventional studies investigating the effect of vitamin C supplements on 24-hour urinary parameters (oxalate, citrate, and calcium) in both stone formers (SFs) and nonstone formers (NSFs), compared with either baseline values or a placebo group. Meta-analyses were performed to calculate the mean difference (MD) measuring the effect of vitamin C supplements on these parameters.</p><p><strong>Results: </strong>The initial database search yielded 808 titles and after rigorous screening, nine studies were included. Pooled analysis revealed a significant increase in urinary oxalate after vitamin C supplementation compared with baseline (MD = 9.72 mg/24 h; <i>p</i> < 0.001). When compared with placebo, vitamin C also significantly increases urinary oxalate excretion (MD = 6.45 mg/24 h; <i>p</i> < 0.001). Subgroup analyses of both comparisons showed that vitamin C increases urinary oxalate in both SFs and NSFs (<i>p</i> < 0.05 for all). Analyses of studies reporting on 24-hour urinary citrate or calcium revealed no significant effect of vitamin C on either parameter.</p><p><strong>Conclusions: </strong>Vitamin C supplements significantly increase urinary oxalate excretion in both SFs and NSFs. This may contribute to stone formation and may worsen stone presentation among those who consume these supplements.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":"1242-1253"},"PeriodicalIF":3.2,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148630715","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of the Use of Shear Wave Ultrasound Elastography for Prediction of Extracorporeal Shock Wave Lithotripsy Outcomes and Renal Calculi Chemical Compositions: A Prospective Study.","authors":"Ahmed Zoeir, Abdallah Shehata, Basma Eldeeb, Mohamed Abo El-Enen","doi":"10.1177/08927790261472606","DOIUrl":"10.1177/08927790261472606","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the use of shear wave ultrasound elastography (SWUE) in prediction of outcomes of shock wave lithotripsy (SWL) for medium-sized renal stones and to correlate HU and SWUE values with the chemical stone compositions.</p><p><strong>Materials and methods: </strong>A total of 110 patients with medium-sized renal stones were scheduled for SWL and included. The patients were assessed by non-contrast CT and SWUE. The patients were categorized into two groups: Group A, SWL success, included 80 patients; and Group B, SWL failure, included 30 patients. Baseline data, stone characteristics, and kilopascal (kPa) values were assessed and compared in both groups.</p><p><strong>Results: </strong>The mean age of studied patients was 42.44 ± 11.45 and 43.50 ± 13.20 years in Groups A and B, respectively (<i>p</i> = 0.679). The mean body mass index of Group A was 25.41 ± 2.93 and Group B was 26.28 ± 2.74 (<i>p</i> = 0.161). The median (interquartile range [IQR]) of HU of stones was 858.5 (778.0-967.0) in Group A versus 1075.0 (1010.0-1150.0) in Group B (<i>p</i> < 0.001). The median (IQR) of kPa values of renal stones was 10.05 (8.20-13.0) in Group A versus 18.20 (15.60-19.20) in Group B (<i>p</i> < 0.001). The median (IQR) of skin-to-stone distance was 85.50 (80.0-92.0) in Group A versus 96.0 (89.0-105.0) in Group B (<i>p</i> < 0.001).</p><p><strong>Conclusions: </strong>SWUE could be used as a non-invasive and safe alternative method to detect the hardness of stones and predict the outcomes of SWL and the chemical stone compositions.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":"1278-1285"},"PeriodicalIF":3.2,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148673686","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Repeated Transurethral Interventions Increase Elastin Degradation and Stricture Severity.","authors":"Merlin Mamachan, Michael Witthaus, Jill Buckley, Mahadevan Rajasekaran","doi":"10.1177/08927790261472647","DOIUrl":"10.1177/08927790261472647","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the role of elastin in the progression of recurrent urethral strictures induced by repeated transurethral endoscopic interventions, using a preclinical animal model with translational relevance.</p><p><strong>Methods: </strong>Urethral strictures were induced in middle-aged male New Zealand White rabbits (<i>n</i> = 6) via endoscopic electrocoagulation (50 W, 600 Hz, 10 seconds) at two sites located 4 cm and 5 cm from the urethral meatus. A subset of animals (<i>n</i> = 3) subsequently underwent repeated urethral dilation (UD) using Foley balloon inflation for 10 minutes. Ultrasound-guided imaging was performed at the preinjury and postinjury time points to assess urethral diameter. Urethral tissues collected 45 days postinjury were processed for Verhoeff's Van Gieson (VVG) staining and elastin fragmentation quantification. Human urethral stricture tissues obtained during urethroplasty were also analyzed using VVG staining and immunostaining for collagen I and elastin.</p><p><strong>Results: </strong>A retrograde urethrogram performed on day 14 post-injury revealed urethral stricture formation at the injury site, with further narrowing observed by day 45. In the electrocoagulation-only group, the urethral cross-sectional area decreased to approximately 5-10 mm² at the injury site (∼30%-50%), whereas in the electrocoagulation plus UD group, a further reduction, reaching approximately 3-8 mm² (∼60%-75%) relative to baseline, was observed. VVG-stained histological sections from the electrocoagulation-only group showed elastic fiber fragmentation, degradation, and irregular distribution, whereas the electrocoagulation plus UD group exhibited more severe elastic fiber fragmentation and a nonuniform distribution. The quantification of elastin fragmentation and elastin% showed higher mean values in the electrocoagulation plus UD group than in the electrocoagulation-only group, although the differences were not statistically significant. VVG staining of human urethral stricture tissues demonstrated extensive degradation of the elastic fiber network, and immunostaining revealed colocalized expression of collagen I and elastin.</p><p><strong>Conclusion: </strong>This study suggests that elastin degradation is associated with urethral fibrogenesis in recurrent stricture formation following repeated transurethral interventions.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":"1229-1234"},"PeriodicalIF":3.2,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148793955","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"<i>Erratum to:</i> \"A Modified \"Cross-Stitch\" Suturing Technique Is Associated with Shorter Warm Ischemia Time in Robot-Assisted Partial Nephrectomy\" by Lu et al. <i>Journal of Endourology 2026;</i> doi: 10.1177/08927790261458682.","authors":"","doi":"10.1177/08927790261467490","DOIUrl":"10.1177/08927790261467490","url":null,"abstract":"","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":"1318"},"PeriodicalIF":3.2,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148396617","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Physician-Supervised ChatGPT-Assisted Versus Physician-Led Informed Consent for Reducing Preoperative Anxiety: A Randomized Controlled Trial.","authors":"Yavuz Mert Aydın, Tevfik Erdem Özarslan, Merve Sena Baytar, Necmettin Aydın Mungan","doi":"10.1177/08927790261473184","DOIUrl":"10.1177/08927790261473184","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate whether ChatGPT-assisted informed consent (IC) is noninferior to conventional physician-led IC in reducing preoperative anxiety (PA) among patients undergoing a urologic procedure.</p><p><strong>Materials and methods: </strong>In this prospective, open-label randomized controlled trial, 180 adult patients scheduled for retrograde intrarenal surgery/ureteroscopy or holmium laser enucleation of the prostate were randomized 1:1 to either artificial intelligence (AI)-assisted or physician-led IC. The primary outcome was postintervention anxiety changes, measured using the State-Trait Anxiety Inventory (STAI-1). Secondary outcomes included IC duration and postoperative quality of recovery (QoR), assessed using the QoR-15. Analysis of covariance was performed to adjust for baseline anxiety differences. Noninferiority was defined as an upper 95% confidence interval (CI) margin of +5 STAI points.</p><p><strong>Results: </strong>After applying the exclusion criteria, a total of 161 patients were included (AI-assisted: <i>n</i> = 83; control: <i>n</i> = 78). Baseline anxiety scores were higher in the AI-assisted group (<i>p</i> < 0.01). STAI-1 scores decreased significantly in both groups following the IC process (<i>p</i> < 0.01), with no significant between-group difference in ΔSTAI-1 (<i>p</i> = 0.533). After adjustment for baseline STAI-1 and STAI-2 scores, postintervention anxiety did not differ between groups (mean difference, 0.26; 95% CI: -1.45 to 1.97), confirming noninferiority. The median IC duration was 10 minutes in both groups, although the between-group difference was significant (<i>p</i> = 0.020). The QoR-15 score favored the control group (<i>p</i> = 0.019).</p><p><strong>Conclusions: </strong>ChatGPT-assisted IC is noninferior to conventional physician-led IC in reducing PA without prolonging the IC process. These findings suggest a potential role for large language models as complementary tools within physician-led IC.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":"1310-1317"},"PeriodicalIF":3.2,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148653915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}