Journal of endourology最新文献

{"title":"The Most Accurate Technique and Formulation for Prostate Volume Estimation: A Comparative Analysis of Transrectal Ultrasonography, Magnetic Resonance Imaging, and Three-Dimensional Segmentation.","authors":"Sinharib Citgez, Kadir C Sahin, Göktuğ Kalender, Mehmet H Gultekin, Ugurcan Sayili, İpek Sertbudak, Iclal Gurses, Hamdi Ozkara","doi":"10.1089/end.2024.0839","DOIUrl":"https://doi.org/10.1089/end.2024.0839","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> Prostate volume estimation is of great importance for patient evaluation in a urologist's clinical practice. The accuracy and superiority of the techniques used in volume calculation have always been the subject of debate. Therefore, we conducted a comparative analysis between the volumes derived from transrectal ultrasonography (TRUS), multiparametric prostate magnetic resonance imaging (MpMRI), and three-dimensional (3D)-constructed MpMRI images of patients, who underwent retropubic radical prostatectomy at our institution. <b><i>Methods:</i></b> The data of patients with preoperative TRUS and MpMRI who underwent radical prostatectomy (Rp) in our clinic between August 2021 and February 2023 were retrospectively reviewed. The prostatectomy specimens were taken to the pathology department without exposure to any fixative and measured with the water displacement method. All axial T2-weighted sequences were segmented by a single surgeon using 3D Slicer (v. 5.6.2) software, and all measurements were compared with the specimen volume measured at the pathology laboratory. <b><i>Results:</i></b> A total of 150 patients were included in this study. The median prostate volumes estimated by TRUS-ellipsoid, TRUS-bullet, MpMRI, and 3D segmentation were 43.45 cc (min.-max.: 15.1-122.6), 54.32 cc (min.-max.: 18.9-153.3), 44.05 cc (min.-max.: 15.4-128.9), and 43.11 cc (min.-max.: 14.3-110.6), respectively. The median Rp specimen volume measurement in the pathology department was 42 cc (min.-max.: 12-114). When the measurement techniques were compared between each other, it has been shown that the statistically significant difference was caused by TRUS-bullet measurement. No statistically significant difference between the other three measurement techniques as well as between them and the specimen volume measurements were detected. <b><i>Conclusion:</i></b> Consistent with the findings of previous studies, MpMRI has provided estimations closer to pathology measurements and 3D segmentation allows even more precise measurements. However, considering accessibility, reproducibility, time efficiency, and cost, TRUS-based measurements can be safely used in clinical practice, especially using the ellipsoid formula.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143784386","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":"Surgical Gesture Utilization and Efficacy Trends Between Retractions in Surgeons Performing the Robot-Assisted Nerve-Sparing Prostatectomy.","authors":"Umar Ghaffar, John Heard, Runzhuo Ma, Cherine Yang, Jonathan Varghese, Randy G Tsai, Peter Wager, Eman Dadashian, Christian Wagner, Graciela Gonzalez-Hernandez, Andrew J Hung","doi":"10.1089/end.2024.0572","DOIUrl":"https://doi.org/10.1089/end.2024.0572","url":null,"abstract":"<p><p><b><i>Objective</i></b><i>:</i> Surgical gestures, defined as the smallest meaningful interactions of surgical instruments with tissue, are a novel approach to objectively deconstruct surgery. We have previously classified gestures among three major categories: blunt, sharp, and supporting. Retraction is a supporting gesture, which involves placing tissue on stretch to gain better access to surgical site and to allow tension for effective tissue dissection. We aim to assess utilization and efficacy trends of gestures between these retractions, based on surgeon experience and the anatomical location where gestures are performed. <b><i>Methods</i></b><i>:</i> Robotic prostatectomy surgical videos from two centers were captured and manually annotated to identify each surgical gesture, its efficacy and anatomical location, using a classification system previously published. Surgeons were separated by median split-high experience (HE) <i>vs</i> low experience (HE). Sequences of gestures within each sequential retraction gesture were labeled as retraction units (RUs). RUs were split equally into quartiles based on number of gestures in that RU and trends in gesture efficacy were described. <b><i>Results</i></b><i>:</i> Overall, 61 surgical videos were annotated to identify 21,045 gestures. Median gestures per case were 222 (interquartile range [IQR]: 163-364) and 337 (IQR: 222-398) for surgeons with HE and LE, respectively. HE surgeons had fewer RUs (<i>p</i> < 0.001), higher gestures per RU (<i>p</i> = 0.031) and greater gesture efficacy (<i>p</i> = 0.023) per RU. There was a significant decline in gesture efficacy for blunt gestures as evaluated from first to last quartile within each RU (<i>p</i> < 0.001). This decline was evident for both HE (<i>p</i> < 0.001) and LE surgeons (<i>p</i> = 0.009) and irrespective of the anatomical location (pedicle, <i>p</i> = 0.04; lateral fascia, <i>p</i> = 0.01). <b><i>Conclusion</i></b><i>:</i> Experienced surgeons demonstrated higher gesture efficacy, fewer retractions, and more gestures per RU. Decline in gesture efficacy for blunt gestures is apparent across each RU irrespective of surgeon experience and anatomical location, suggesting re-retract during dissection is an active and dynamic activity.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143772526","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":"Amount of Ipsilateral Parenchymal Volume Preserved Is a Key Determinant of Split Renal Function after Robot-Assisted Partial Nephrectomy.","authors":"Ken Kawada, Kojiro Ohba, Masaharu Oki, Yuta Mukae, Hiromi Nakanishi, Kensuke Mitsunari, Tomohiro Matsuo, Yasushi Mochizuki, Ryoichi Imamura","doi":"10.1089/end.2024.0857","DOIUrl":"https://doi.org/10.1089/end.2024.0857","url":null,"abstract":"<p><p><b><i>Objective:</i></b> To identify factors associated with preserved split renal function (SRF) after robot-assisted partial nephrectomy (RAPN). <b><i>Patients and Methods:</i></b> The study included patients who underwent RAPN at Nagasaki University Hospital between November 2016 and December 2023. SRF was determined by 99mTc-dimercaptosuccinic acid renal imaging and the estimated glomerular filtration rate, with measurements obtained before and 6 months after surgery. The ipsilateral parenchymal volume (IPV) was measured at the same time. More than 90% SRF after surgery was considered to indicate successful preservation of renal function (the successful group), and ≤90% SRF was considered failure to preserve renal function (the unsuccessful group). The factors most relevant to SRF were sought in univariate and multivariate analyses. <b><i>Results:</i></b> Data for a total of 169 patients were analyzed. The median SRF was 32.04 mL/min/1.73 m² (interquartile range [IQR] 25.95, 38.06) before surgery and 27.33 mL/min/1.73 m² (IQR 21.64, 34.32) after surgery. The median SRF preservation rate was 88% (IQR 78.4, 97.0), with 94 cases (55.6%) having SRF >90% and 75 cases (44%) having SRF ≤90%. The median IPV on the surgical side was calculated by the software to be 152.2 cm³ (IQR 126.9, 186.6) preoperatively and 127.3 cm³ (IQR 102.9, 161.3) postoperatively, with a median preservation rate of 84.6% (IQR 72.2, 89.7). Univariate analysis showed significant between-group differences in diabetes status, RENAL Nephrometry score, operation time, warm ischemia time, whether or not parenchymal sutures were needed, and the amount of IPV preserved. Only percentage of IPV preserved remained significant in multivariate analysis. <b><i>Conclusion:</i></b> The findings of this study suggest that the residual IPV is an important determinant of SRF after RAPN.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143752828","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":"Medium-Term Outcomes after Primary Whole-Gland High-Intensity Focused Ultrasound Ablation for the Treatment of Prostate Cancer: A Single-Center Experience.","authors":"Éder Silveira Brazão, Renato Almeida Rosa de Oliveira, Rafael Ribeiro Zanotti, Daniel Coser Gomes, Thiago Camelo Mourão, Victor Espinheira Santos, Cássia da Silva, Thiago Borges Marques Santana, Walter Henriques da Costa, Gustavo Cardoso Guimarães, Stênio de Cássio Zequi","doi":"10.1089/end.2024.0539","DOIUrl":"https://doi.org/10.1089/end.2024.0539","url":null,"abstract":"<p><p><b><i>Objectives:</i></b> Our aim was to assess the oncologic and functional outcomes of primary whole-gland high-intensity focused ultrasound (WG-HIFU) treatment for non-metastatic prostate cancer (PCa). <b><i>Patients and Methods:</i></b> We retrospectively analyzed data from 227 men treated with WG-HIFU at a single center between 2011 and 2019. Patients with prostate-specific antigen (PSA) greater than 20 ng/mL, positive nodes, or missing data were excluded. Primary outcome was failure-free survival (FFS). Failure was defined as any recurrence requiring salvage radical or systemic treatment, metastasis, or PCa-specific death. <b><i>Results:</i></b> The median follow-up was of 47 months. FFS rates at 1, 3, and 5 years were 97%, 82%, and 75%, respectively. The 5-year FFS rates were 91%, 78%, and 59% for the low-, intermediate-, and high-risk patients, respectively. The 5-year metastasis-free survival and cancer-specific survival rates were 93% and 97%, respectively. The overall pad-free continence and social continence rates were 83% and 95%, respectively. Approximately 62% of previously potent patients undergoing WG-HIFU maintained erections sufficient for penetration. Bilateral nerve-sparing (NS) improved functional outcomes, with 68.6% achieving sufficient erections and 89.6% achieving pad-free continence. Clavien-Dindo grade 3 complications occurred in 22%. Higher PSA, clinical T stage, biopsy grade group, and nadir PSA levels were independently associated with treatment failure. <b><i>Conclusion:</i></b> WG-HIFU combined with transurethral resection of the prostate provides good medium-term oncologic control in appropriately selected patients and tolerable results in terms of genitourinary toxicity. Bilateral NS was associated with better urinary and erectile function.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143709583","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":"Robot-Assisted Laparoscopic Pyeloplasty in Infants Under 3 Months: Single-Institution Study Findings, Safety Measures, and Success Strategies.","authors":"Wei Li, Xinjin She, Chao Chen, Bo Shi, Peng Chen, Jingchu Luo, Zuxin Yuan, Weichao Li, Hai Zhu, Yige Luo","doi":"10.1089/end.2024.0717","DOIUrl":"https://doi.org/10.1089/end.2024.0717","url":null,"abstract":"<p><p><b><i>Background:</i></b> At present, there is a lack of cohort studies on robot-assisted laparoscopic pyeloplasty (RALP) for the treatment of ureteropelvic junction obstruction (UPJO) in infants under 3 months of age. This study aims to enhance the understanding of the safety and efficacy of RALP in this specific infant population. <b><i>Methods:</i></b> We retrospectively analyzed the clinical data of children with UPJO who underwent unilateral pyeloplasty at our center from January 2019 to June 2022. We categorized the children based on their ages: those younger than 3 months old comprised the RA group (25 cases), whereas those aged 3 months to 3 years old formed the RB group (25 cases). We collected and statistically analyzed the baseline data, perioperative details, postoperative complications, and the recovery of split renal function (SRF) along with the improvement in hydronephrosis for both patient groups. <b><i>Result:</i></b> Both age groups successfully underwent the operation without requiring conversion to open surgery. There were no significant differences observed in the operation time or postoperative hospitalization duration between the two groups (<i>P</i> > 0.05). Following surgery, both groups showed significant improvements in anteroposterior diameter (APD) and SRF (<i>P</i> < 0.05). However, there was no significant discrepancy noted in the recovery of APD and SRF between the two groups postoperatively (<i>P</i> > 0.05). Additionally, there were no significant variations in postoperative complications between the two groups (<i>P</i> > 0.05). <b><i>Conclusion:</i></b> Given the mature and stable nature of the surgical technique, RALP proves effective in treating UPJO in infants younger than 3 months, yielding favorable therapeutic outcomes.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143670036","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":"Ureteroscopy and Laser Lithotripsy for Large (≥2 cm) Upper Tract Urinary Stones in Pediatric Patients: Outcomes from a Pediatric Endourology Referral Center.","authors":"Victoria Jahrreiss, Stephen Griffin, Bhaskar Somani","doi":"10.1089/end.2024.0587","DOIUrl":"https://doi.org/10.1089/end.2024.0587","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> The global prevalence of pediatric urolithiasis is increasing. Managing large urinary stones in pediatric populations poses a particular clinical challenge. This study evaluates the safety and efficacy of ureteroscopy and laser stone fragmentation (URSL) for treating large upper urinary tract stones in pediatric patients. <b><i>Methods:</i></b> A retrospective analysis of the prospective database was conducted on pediatric patients who underwent URSL for stones ≥2 cm between 2011 and 2023 (14 years) at the University Hospital Southampton, UK. Patient demographics, stone characteristics, operative details, stone-free rates (SFR), and complications were analyzed. <b><i>Results:</i></b> In total, 23 patients (median age 11 years) underwent URSL. The mean total stone length was 24.7 ± 6.49 mm, with 12 (52.2%) having multiple stones. Prestenting, ureteral access sheath, and postop stenting were used in 9 (39.1%), 4 (17.4%), and 10 patients (43.5%), respectively. Holmium laser was used, and the SFR after the first procedure was 91.3%, with no procedural complications. There was only one complication (postoperative fever, Clavien-Dindo I) reported. The median length of stay was 1 day. <b><i>Conclusion:</i></b> URSL is safe and efficient for treating large upper tract urinary stones in pediatric patients, demonstrating high SFR and low complication rate. This could offer an alternative treatment modality to percutaneous surgery in large upper urinary tract stones, although parents need to be adequately counseled about it.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657368","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":"Initial Urological Surgery Using a New Domestic Single-Port Surgical Robotic System.","authors":"Lin Zhang, Huiqin Zhou, Zhiyong Wen, Hang Zheng, Kun Yang, Xinghuan Wang","doi":"10.1089/end.2024.0822","DOIUrl":"https://doi.org/10.1089/end.2024.0822","url":null,"abstract":"<p><p><b><i>Purpose:</i></b> To determine the feasibility and safety of a new domestic single-port surgical robot in urologic partial nephrectomy and radical prostatectomy, as measured by the primary metric outcome (surgical success rate). In addition, this study measured important perioperative surgical outcomes, such as operative time, blood loss, postoperative length of stay, docking time, and thermal ischemia time, and reported pathologic data using the surgical robot. <b><i>Materials and Methods:</i></b> This prospective, single-center, single-group clinical study was conducted between August 2023 and October 2023. One surgeon used a new domestic single-port surgical robot (EDGE SP1000) to perform six urologic procedures, including three partial nephrectomies and three extraperitoneal radical prostatectomies. Perioperative data were prospectively recorded, early oncologic outcomes were assessed based on the surgical margin status, and equipment ergonomic comfort was assessed using the National Aeronautics and Space Administration Task Load Index (NASA-TLX). <b><i>Results:</i></b> All six procedures were effectively completed without conversion to open surgery, laparoscopy, or use of multiport robots. The average total operation time was 207.92 ± 32.42 minutes, estimated blood loss was 100 mL (10-900 mL), and postoperative hospital stay was 8.67 ± 1.33 days. The average docking time was 16.25 ± 5.68 minutes, and warm ischemia time was 17.00 ± 2.65 minutes. None of the patients required perioperative blood transfusion. All pathologic examination margins were negative. No serious perioperative complications occurred (Clavien-Dindo grade 3). The surgeon reported that the device was comfortable to use, with a NASA-TLX score of 35.67 ± 4.23. <b><i>Conclusions:</i></b> It is safe and feasible to perform urologic procedure using the EDGE single-port endoscopic surgical robot (EDGE SP1000) control system.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657342","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":"Trifecta of Same-Day Discharge after Single-Port Robotic-Assisted Simple Prostatectomy.","authors":"Hakan Bahadir Haberal, Luca Lambertini, Matteo Pacini, Giulio Avesani, Fabio Maria Valenzi, Muhannad Aljoulani, Ruben Calvo Sauer, Juan Ramon Torres-Anguiano, Simone Crivellaro","doi":"10.1089/end.2024.0930","DOIUrl":"https://doi.org/10.1089/end.2024.0930","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> There are numerous options available for the surgical treatment of benign prostate hyperplasia, and single-port robotic-assisted simple prostatectomy (SP-RASP) has emerged as a novel method in this field. In this study, we aim to define the trifecta of same-day discharge (SDD) and identify the factors associated with the trifecta of SDD following SP-RASP. <b><i>Materials and Methods:</i></b> Data from 95 patients who underwent SP-RASP between February 2020 and July 2024 at a single center by a single surgeon were evaluated. The trifecta of SDD was defined as a patient being discharged on the same day without experiencing any 90-day postoperative complications and no readmissions. The factors associated with predicting the trifecta of SDD were investigated. <b><i>Results:</i></b> A total of 95 SP-RASP cases were successfully performed without the need for conversion to alternative approaches, and 54 patients (56.8%) were included in the trifecta of the SDD-achieved group. The reasons for failure included 23 patients (24.2%) requiring postoperative hospitalization from the recovery area, 24 patients (25.3%) experiencing postoperative complications, and 2 patients (2.1%) needing readmission within 90 days after discharge. There was a 0% incidence of major postoperative complications (≥Clavien-Dindo grade 3). When comparing the groups, trifecta-achieved patients showed lower estimated blood loss, smaller specimen weight, lower percentage of adenoma removed, and a reduced rate of opioid prescriptions at discharge (<i>p</i> = 0.005, 0.033, 0.025, and 0.026, respectively). In the multivariate logistic regression analysis, specimen weight was the only factor significantly associated with trifecta following SP-RASP (<i>p</i> = 0.018). <b><i>Conclusion:</i></b> In our cohort, 56% of patients were classified within the trifecta group, with no major postoperative complications observed following SP-RASP. Specimen weight was the only independent predictor of trifecta achievement in these patients.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143649133","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":"Enhanced Artificial Intelligence in Bladder Cancer Management: A Comparative Analysis and Optimization Study of Multiple Large Language Models.","authors":"Kun-Peng Li, Li Wang, Shun Wan, Chen-Yang Wang, Si-Yu Chen, Shan-Hui Liu, Li Yang","doi":"10.1089/end.2024.0860","DOIUrl":"https://doi.org/10.1089/end.2024.0860","url":null,"abstract":"<p><p><b><i>Background:</i></b> With the rapid advancement of artificial intelligence in health care, large language models (LLMs) demonstrate increasing potential in medical applications. However, their performance in specialized oncology remains limited. This study evaluates the performance of multiple leading LLMs in addressing clinical inquiries related to bladder cancer (BLCA) and demonstrates how strategic optimization can overcome these limitations. <b><i>Methods:</i></b> We developed a comprehensive set of 100 clinical questions based on established guidelines. These questions encompassed epidemiology, diagnosis, treatment, prognosis, and follow-up aspects of BLCA management. Six LLMs (Claude-3.5-Sonnet, ChatGPT-4.0, Grok-beta, Gemini-1.5-Pro, Mistral-Large-2, and GPT-3.5-Turbo) were tested through three independent trials. The responses were validated against current clinical guidelines and expert consensus. We implemented a two-phase training optimization process specifically for GPT-3.5-Turbo to enhance its performance. <b><i>Results:</i></b> In the initial evaluation, Claude-3.5-Sonnet demonstrated the highest accuracy (89.33% ± 1.53%), followed by ChatGPT-4 (85.67% ± 1.15%). Grok-beta achieved 84.33% ± 1.53% accuracy, whereas Gemini-1.5-Pro and Mistral-Large-2 showed similar performance (82.00% ± 1.00% and 81.00% ± 1.00%, respectively). GPT-3.5-Turbo demonstrated the lowest accuracy (74.33% ± 3.06%). After the first phase of training, GPT-3.5-Turbo's accuracy improved to 86.67% ± 1.89%. Following the second phase of optimization, the model achieved 100% accuracy. <b><i>Conclusion:</i></b> This study not only establishes the comparative performance of various LLMs in BLCA-related queries but also validates the potential for significant improvement through targeted training optimization. The successful enhancement of GPT-3.5-Turbo's performance suggests that strategic model refinement can overcome initial limitations and achieve optimal accuracy in specialized medical applications.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143649127","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":"Drivers of Cost Variability of Ureteroscopy with Laser Lithotripsy at an Academic Institution.","authors":"Tyler Bergeron, Ilir Agalliu, Alexander C Small, Dima Raskolnikov","doi":"10.1089/end.2024.0801","DOIUrl":"https://doi.org/10.1089/end.2024.0801","url":null,"abstract":"<p><p><b><i>Objective:</i></b> Ureteroscopy with laser lithotripsy (URS/LL) requires significant disposable equipment including wires, baskets, lasers, and stents. Surgeons choose this equipment based on preference, with higher- and lower-cost options available. We sought to explore factors that affect cost variability among urologists performing URS/LL within a single academic medical center. <b><i>Patients and Methods:</i></b> We retrospectively reviewed all patients who underwent URS/LL at our institution between September 2022 and June 2023. A weighted cost for each item's contribution to total cost was generated. Bivariate and then multivariate median regression models were generated to identify variables associated with higher total surgical cost. Statistical significance was considered <i>p</i> < 0.05. <b><i>Results:</i></b> A total of 311 patients underwent URS/LL during the study period with 14 different surgeons. The total median cost of disposable equipment for the entire cohort was $1488/operation. On multivariate regression, basket cost above the cohort median or specialized catheter cost above the cohort median was associated with increased total surgical cost (<i>p</i> < 0.001). Fellowship training in endourology was associated with a decreased cost of $90.40 per case (<i>p</i> < 0.05). <b><i>Conclusions:</i></b> There is significant variability in the cost of ureteroscopy, even at a single institution where all surgeons have access to identical supplies. Attention to specific categories of equipment, which appear to be associated with higher total cost, as well as the potential differences in technique between surgeons with varied training, may help to identify opportunities for institutional cost savings.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657354","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}