The French journal of urology最新文献

{"title":"Trends in surgical treatment of female stress urinary incontinence in France over the past decade (2015-2024).","authors":"Claire Richard, Jean-Nicolas Cornu, Caroline Thuillier, Caroline Brandon, Sandrine Campagne-Loiseau, Pierre-Olivier Bosset, Laurence Donon, Lucie Even, Frederic Girard, Rebecca Haddad, François Herve, Sophie Hurel, Julia Klap, François Meyer, Caroline Plassais, Thibault Thubert, Adrien Vidart, Benoit Peyronnet","doi":"10.1016/j.fjurol.2025.103044","DOIUrl":"10.1016/j.fjurol.2025.103044","url":null,"abstract":"<p><strong>Introduction: </strong>Over the past decade, the COVID-19 crisis, controversies, and subsequent regulations regarding the use of polypropylene mid-urethral slings have likely influenced surgical practice in the management of female stress urinary incontinence (SUI). The aim of this study was to assess the evolution of surgical techniques for female SUI over the last 10 years.</p><p><strong>Methods: </strong>National activity data were extracted from the PMSI (Programme de Médicalisation des Systèmes d'Information) database using the online OpenCCAM tool. The analysis included procedures coded between 2015 and 2024: transobturator sling (TOT, JDDB005), retropubic sling (TVT, JDDB007), Burch colposuspension (JDDA002 and JDDC002), autologous fascial sling (JDDA004), bulking agents (JELE001), and artificial urinary sphincter (AUS, JELA001). Adjustable balloons were excluded due to the absence of a specific code.</p><p><strong>Results: </strong>Between 2015 and 2024, TOT use decreased by 69%, from 25,225 to 7887 procedures. TVT remained stable at around 6800 procedures annually after a temporary decline during the COVID period. Burch colposuspension decreased threefold, with a shift toward laparoscopic approaches. Autologous sling procedures doubled but remained rare (89 cases in 2024). Bulking agents injections increased exponentially, multiplying ninefold (226 to 2,123). AUS use remained stable. Mean hospital stay (LOS) decreased across all techniques, particularly for slings (TOT: 1.6 to 0.6 days; TVT: 1.8 to 0.5 days).</p><p><strong>Conclusion: </strong>Over the past decade, surgical management of female SUI in France has profoundly evolved: a marked decline in TOT, an exponential rise in bulking agents, stable use of TVT, and diversification of alternatives. Current practice is moving toward shorter hospital stays, broader therapeutic options, and greater adaptation to patient profiles and preferences.</p><p><strong>Level of evidence: 4: </strong></p>","PeriodicalId":516865,"journal":{"name":"The French journal of urology","volume":" ","pages":"103044"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145544685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postoperative follow-up and long-term outcome of combined liver-kidney transplantations.","authors":"Florence Chin A Sen, Thierry Lebret, Yanish Soorojebally, Alexandre Hertig, François Gaudez, Federica Dondero, Yann Neuzillet","doi":"10.1016/j.fjurol.2026.103083","DOIUrl":"10.1016/j.fjurol.2026.103083","url":null,"abstract":"<p><strong>Introduction: </strong>The use of combined liver-kidney transplantation (CLKT) in the management of patients with concomitant failure of both organs is becoming increasingly common. However, European data regarding postoperative outcomes and long-term prognosis in adult patients remain limited. This study aimed to describe short- and long-term outcomes after CLKT in a multicentre French cohort.</p><p><strong>Material and methods: </strong>We conducted a retrospective observational study including all adult patients who underwent CLKT between January 2010 and December 2024 across three Parisian transplant centers. Data were collected from institutional medical records and the national registry of the Agence de la biomédecine. Variables analyzed included recipient and donor characteristics, perioperative parameters, immunological data, and postoperative outcomes. Survival was estimated using the Kaplan-Meier method.</p><p><strong>Results: </strong>Forty-one patients were included (median age 53years; 71% male). The main indications were cirrhosis (46%) and polycystic liver-kidney disease (39%). DGF occurred in 42% of patients and was significantly associated with postoperative complications (P=0.012), and long-term dialysis (P<0.01). At 1year, non-preserved renal function (40% of patients) correlated with DGF and early complications. Three patients (7.5%) developed postoperative liver dysfunction, which strongly impacted both patient and graft survival. Overall survival was 87.8% at 6months, 62.1% at 5years, and 23.5% at 10years. Death-censored kidney graft survival reached 78.2% at 5years.</p><p><strong>Conclusion: </strong>CLKT offers satisfactory long-term outcomes in carefully selected adults, despite high early morbidity. Early renal and hepatic dysfunctions are major prognostic factors, highlighting the need for optimized perioperative management and improved patient selection.</p><p><strong>Level of evidence: 4: </strong></p>","PeriodicalId":516865,"journal":{"name":"The French journal of urology","volume":" ","pages":"103083"},"PeriodicalIF":1.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146095314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Satisfaction and quality of life assessment following laparoscopic sacrocolpopexy for pelvic organ prolapse - 16-year experience.","authors":"Weronika Kopytek, Jeanne Beirnaert, Thierry Roumeguère","doi":"10.1016/j.fjurol.2025.103045","DOIUrl":"10.1016/j.fjurol.2025.103045","url":null,"abstract":"<p><strong>Introduction: </strong>Pelvic organ prolapse (POP) can be managed conservatively; however, surgical treatment may be required in some cases. Laparoscopic sacrocolpopexy is considered the gold standard procedure, yet long-term data on patient satisfaction and quality of life remain limited. This study aimed to evaluate long-term satisfaction and quality of life outcomes in patients undergoing laparoscopic sacrocolpopexy.</p><p><strong>Methods: </strong>Patients who underwent laparoscopic sacrocolpopexy between 2000 and 2016 were invited to complete the validated French version of the Prolapse Quality of Life questionnaire and a self-assessment questionnaire. Preoperative and postoperative data up to one year after surgery were retrieved from medical records.</p><p><strong>Results: </strong>Among patients with available contact information, 45.00% responded, with a mean follow-up of 16.32±4.98 years. Only 29.85% reported POP-related symptoms, and overall satisfaction reached 68.66%. Most Prolapse Quality of Life scores were below 50, indicating a low impact of POP on daily life. In terms of symptom impact, 34.33% of patients reported that constipation affected them a lot, followed by urge incontinence 26.87%, stress urinary incontinence 16.42%, and voiding difficulties 8.96%.</p><p><strong>Conclusions: </strong>Laparoscopic sacrocolpopexy provides durable functional results, with patients maintaining a good quality of life despite persistent POP symptoms. Although some bowel or urinary symptoms remain, overall satisfaction is high, confirming this procedure as a reliable long-term solution for POP management.</p><p><strong>Level of evidence: 5: </strong></p>","PeriodicalId":516865,"journal":{"name":"The French journal of urology","volume":" ","pages":"103045"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145590709","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adjustable retropubic sling (Remeex®) for the treatment of male stress-urinary-incontinence after prostatectomy: Middle-term results and patient satisfaction.","authors":"Anne Maene, Marion Righini, Laurent Cabaniols, Aram Atamian, Stephane Droupy, Thierry Roumeguere, Laurent Wagner","doi":"10.1016/j.fjurol.2026.103074","DOIUrl":"10.1016/j.fjurol.2026.103074","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the mid-term outcomes of the adjustable retropubic sling (Remeex®) in the treatment of post-prostatectomy stress urinary incontinence (PPUI) in men.</p><p><strong>Methods: </strong>This prospective bicentric observational study was conducted at two French tertiary centers between December 2016 and December 2024. Sixty-six men with persistent PPUI were included after exclusion of deaths and loss to follow-up. Patients were selected based on incontinence severity, failure of pelvic floor rehabilitation, and informed preference. Outcomes were assessed using the 24-hour pad test, social continence (0-1 pad/day), Patient Global Impression of Improvement, and complication rates. The primary endpoint was social continence at mid-term follow-up.</p><p><strong>Results: </strong>After a mean follow-up of 48months, social continence (0-1 pad/day) was achieved in 55% of patients. A≥50% improvement in the 24-hour pad test was observed in 71% of patients. The mean pad test weight significantly decreased from 218.7g preoperatively to 98.1g postoperatively (P<0.05). Postoperative adjustability was frequently required, with 89% of patients undergoing at least one adjustment and a mean of two adjustments per patient, mainly within the first six months. Complications were limited, with no urethral erosion and an explantation rate of 6%.</p><p><strong>Conclusion: </strong>The Remeex® adjustable retropubic sling demonstrated acceptable safety and satisfactory mid-term effectiveness in selected patients with mild to moderate PPUI. Postoperative adjustability represents an inherent component of the technique and should be anticipated during patient counseling.</p><p><strong>Level of evidence: 4: </strong></p>","PeriodicalId":516865,"journal":{"name":"The French journal of urology","volume":" ","pages":"103074"},"PeriodicalIF":1.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145947084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Imaging of sub-urethral slings: State of the art.","authors":"Marie Florin, Edouard Poncelet, Raphaële Renard-Penna, Marc Bazot","doi":"10.1016/j.fjurol.2026.103086","DOIUrl":"10.1016/j.fjurol.2026.103086","url":null,"abstract":"<p><strong>Objectives: </strong>The mid-urethral synthetic sling (MUS) is a widely used surgical intervention for stress urinary incontinence (SUI). This study aims to evaluate the complexities of diagnosing and managing complications related to MUS through various imaging techniques.</p><p><strong>Methods: </strong>This study reviews the application of different imaging modalities in patients presenting with recurrent or new symptoms following MUS surgery. The focus is on comparing the effectiveness of US and MRI in identifying the position and potential complications of pelvic slings. The use of voiding cystourethrography and CT is also discussed, although these techniques are less frequently employed due to their limited ability to directly depict mid-urethral slings.</p><p><strong>Results: </strong>US was found to be more effective in depicting mid-urethral slings within the urethrovaginal space, while MRI excelled in visualizing the sling arms in the retropubic space and obturator foramen. MRI was also superior in identifying infectious complications. However, both US and MRI faced challenges in distinguishing scarring from the slings and mesh.</p><p><strong>Conclusions: </strong>Effective diagnosis and management of MUS complications require a comprehensive understanding of the strengths and limitations of various imaging modalities. US and MRI are the primary tools, with MRI being particularly useful for detecting infectious complications and visualizing sling arms in specific anatomical regions.</p>","PeriodicalId":516865,"journal":{"name":"The French journal of urology","volume":" ","pages":"103086"},"PeriodicalIF":1.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146196009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial intelligence and infertility: A systematic review.","authors":"Al Mahdi Bazir, Hamid El Kaddoury, Valentine Tollet, Georges Mjaess, Thierry Roumeguère","doi":"10.1016/j.fjurol.2026.103092","DOIUrl":"10.1016/j.fjurol.2026.103092","url":null,"abstract":"<p><p>Artificial intelligence (AI) is reshaping the field of male reproductive medicine, offering new possibilities for diagnosis and treatment. This review highlights AI's growing role in fertility medicine - from more accurate sperm assessments to data-driven treatment optimization - showing how these tools are reshaping clinical decision-making. Notably, predictive modeling is emerging as a powerful tool for developing individualized treatment strategies, potentially transforming patient management paradigms. The integration of these technologies into clinical practice presents both opportunities and challenges. Ethical considerations surrounding data privacy and the appropriate use of these automated systems in medical decision-making require careful attention. As these technologies continue to evolve, they are poised to transform male fertility care by combining advanced analytics with clinical expertise. The future of andrological care will require thoughtful integration of technological advancements while safeguarding core principles of medical ethics, keeping clinician oversight, and preserving patient-centered practice.</p>","PeriodicalId":516865,"journal":{"name":"The French journal of urology","volume":" ","pages":"103092"},"PeriodicalIF":1.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147367736","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Infrapubic approach for inflatable penile prosthesis: Perioperative and long-term outcomes.","authors":"Mehdi El Akri, Claire Richard, Jean-Pierre Graziana, Romain Mathieu, Quentin Vesval, Gregory Verhoest, Juliette Hascoet, Karim Bensalah, Benoit Peyronnet, Zine-Eddine Khene, Lucas Freton","doi":"10.1016/j.fjurol.2026.103087","DOIUrl":"10.1016/j.fjurol.2026.103087","url":null,"abstract":"<p><strong>Introduction: </strong>Erectile dysfunction (ED) impacts nearly 150 million men worldwide. Inflatable penile prosthesis (IPP) placement is considered after oral pharmacological treatments and intracavernous injections. This surgery is often performed through a penoscrotal approach. However, infra-pubic approach seems to allow faster activation of the prosthesis, with similar complication and satisfaction rates. The objective of this study was to evaluate the perioperative and long-term outcomes following inflatable penile prosthesis implantation using the infrapubic approach.</p><p><strong>Methods: </strong>The medical records of all patients who underwent inflatable penile prosthesis (IPP) placement via the infrapubic approach between 2010 and 2022 at two centers were retrospectively reviewed. Preoperative data and intraoperative data were collected. Postoperative complications occurring within 30 days after implantation were also recorded. Device survival without explantation or reoperation was assessed from the date of implantation to the last follow-up visit, using the Kaplan-Meier method. Sexual function and satisfaction were assessed at the end of the follow-up period.</p><p><strong>Results: </strong>One hundred and sixteen patients were included in the study. The median age was 63 years (IQR: 55.5-68.0). The median follow-up time was 81.5 months (IQR: 35-119). We observed a 3.4% (4 patients) device infection rate, with one early and three late infections. Eleven patients (9.5%) required late reoperation: two patients for crossover, two patients for implant lengthening, one patient for implant dysfunction, and two patients for unknown reasons. Four patients (3.4%) required late device explantation: two for late infections, one for chronic pain and one for unknown reasons. The median Patient Global Improvement Index score at the end of follow-up was 2/7 (better) (IQR: 1-3). Thirty-one patients (26.7%) reported glans hypoesthesia. In univariate Cox regression analysis, procedures performed by high-volume surgeons were associated with a significantly reduced risk of reoperation (HR=0.28, P=0.034).</p><p><strong>Conclusions: </strong>The infrapubic approach is a reliable and reproducible technique. Comparative prospective studies could help clarify its causal link to glans hypoesthesia and guide surgeons in selecting the most appropriate surgical approach.</p><p><strong>Level of evidence: </strong>Level 4.</p>","PeriodicalId":516865,"journal":{"name":"The French journal of urology","volume":" ","pages":"103087"},"PeriodicalIF":1.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146138205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Kidney transplantation in adult candidates with obesity: Guidelines by the Association Française d'Urologie and Société Francophone de Transplantation.","authors":"Marc-Olivier Timsit, Judith Aron-Wisnewsky, Thomas Bessede, Diana Kassab, Lucile Amrouche, Lucas Bento, Thibaud Bertrand, Sophie Caillard-Ohlmann, Laurent Genser, Anne-Elisabeth Heng, Anne-Sophie Joly, Emilie Montastier, Pauline Moreau, Myriam Pastural, Florence Poinard, Thomas Prudhomme, Emilien Seizilles de Mazancourt, Brigitte Thevenin-Lemoine, Tigran Poghosyan, Sarah Drouin, Thibaut Culty","doi":"10.1016/j.fjurol.2026.103100","DOIUrl":"10.1016/j.fjurol.2026.103100","url":null,"abstract":"<p><strong>Introduction: </strong>Patients with obesity have a reduced access to kidney transplantation due to the higher risk of surgical and medical complications. Our aim was to provide clinical guidelines in this population focused on: (i) the main anthropometric parameter that contraindicates open kidney transplantation; (ii) other clinical factors to consider before transplantation; (iii) contraindications to robot-assisted transplantation; (iv) efficient and safe weight loss methods for kidney transplantation candidates with obesity.</p><p><strong>Methods: </strong>After a systematic review of studies published between January 2010 and June 2025 performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria, these guidelines were developed by a multidisciplinary task force and reviewed by independent experts.</p><p><strong>Results: </strong>In total, 153/962 publications met the inclusion criteria. The decision to allow kidney transplantation should not be based solely on Body Mass Index (BMI), but also on skin-to-vessel distance and pelvis angle. Robot-assisted kidney transplantation may be considered in highly selected patients with obesity and limited vascular disease, even those with grade 3 obesity. Patients with frailty should receive appropriate care before weight loss therapies. After appropriate nutritional preparation, bariatric surgery should be considered fairly quickly in patients with kidney failure and grade ≥ 2 obesity (grade B), or grade 1 obesity and poorly controlled type 2 diabetes. While Roux-en-Y gastric bypass achieves superior long-term weight loss than sleeve gastrectomy, it is associated with an increased mortality and morbidity. Pharmacological treatment (mainly GLP-1 agonists) is currently evaluated for weight loss in this population.</p><p><strong>Conclusions: </strong>These guidelines allow personalizing the management in kidney transplantation candidates with obesity.</p>","PeriodicalId":516865,"journal":{"name":"The French journal of urology","volume":" ","pages":"103100"},"PeriodicalIF":1.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147583382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-world data on neoadjuvant chemotherapy for localized muscle-invasive bladder cancer (2015-2024): A single-center retrospective study.","authors":"Tanguy Maurice, Armelle Pillet, Sheik Emambux, Nicolas Isambert, Caroline Chapelle, Simon Bernardeau, Mikael Abi Abdallah, Maxime Vallee, Stessy Kutchukian","doi":"10.1016/j.fjurol.2026.103093","DOIUrl":"10.1016/j.fjurol.2026.103093","url":null,"abstract":"<p><strong>Introduction: </strong>The aim of this study was to evaluate the real-world effectiveness of neoadjuvant chemotherapy (NAC) regimens for muscle-invasive bladder cancer (MIBC) and to identify factors that may influence treatment response.</p><p><strong>Methods: </strong>We conducted a retrospective, single-center study from 2015 to 2024, analyzing real-world data on patients diagnosed with localized MIBC who received NAC prior to radical cystectomy. Patient demographics, pathological response rates and toxicities were recorded. Statistical analyses were performed to compare the outcomes between the two chemotherapy regimens and to identify factors affecting the pathologic response.</p><p><strong>Results: </strong>Eighty-nine patients were included, with 39 in the dose-dense MVAC (ddMVAC) group and 50 in the gemcitabine-cisplatin (GC) group. Twenty-five percent of the patients had a history of non-muscle-invasive bladder cancer (NMIBC). Patients treated with GC had a higher prevalence of cardiovascular disease (62 vs. 38% in the ddMVAC group) and lower glomerular filtration rates (84 vs. 92mL/min in the ddMVAC group). Dose reductions occurred in 38% of the GC group mainly due to thrombocytopenia and 13% in the MVAC group. There was no significant difference in postoperative complications between the two groups, although more severe complications (Clavien>2) occurred in the GC group. The complete response rate (ypT0N0) was similar in both groups with 56% for ddMVAC and 47% for GC. Multivariate analysis identified incomplete macroscopic transurethral resection of the bladder tumor and a history of NMIBC as factors negatively affecting the complete pathologic response rate.</p><p><strong>Conclusion: </strong>In this real-world study, incomplete TURBT and a history of NMIBC were independently associated with a lower pathological response to NAC, highlighting the importance of thorough initial tumor management. After 2022, favorable adherence to ddMVAC was observed without an apparent increase in severe toxicities in our cohort.</p><p><strong>Level of evidence: 4: </strong></p>","PeriodicalId":516865,"journal":{"name":"The French journal of urology","volume":" ","pages":"103093"},"PeriodicalIF":1.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147367815","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating AI chatbots in enuresis nocturna information: A comparative analysis of readability, reliability and quality.","authors":"Kemal Gumus, Ahmet Burak Yilmaz, Ali Furkan Cinbek, Haci Bektas Ozdemir, Kerem Gencer Kutman","doi":"10.1016/j.fjurol.2025.103062","DOIUrl":"10.1016/j.fjurol.2025.103062","url":null,"abstract":"<p><strong>Purpose: </strong>Nocturnal enuresis, defined as involuntary urination during sleep in children aged five years and older, is a prevalent condition affecting millions of children worldwide with significant psychosocial implications. While artificial intelligence-powered chatbots have rapidly emerged as accessible health guidance tools, the clarity, consistency, and reliability of their information remain uncertain.</p><p><strong>Methods: </strong>This study systematically compared the quality, readability, and clinical reliability of responses from three leading large language models (OpenAI GPT-4o, Google Gemini 2.5 Pro, and DeepSeek R1) to the 40 most frequently asked questions about childhood nocturnal enuresis. Designed as a cross-sectional observational study, questions identified through decade-long search engine data analysis were organized into four thematic categories and posed in Turkish to the chatbots. As the study exclusively analyzed publicly available AI outputs without involving human participants, institutional review board approval was not required. Responses were evaluated using the Flesch Reading Ease Score (FRES) and Flesch-Kincaid Grade Level (FKGL) for readability; Ensuring Quality Information for Patients (EQIP) and modified DISCERN (mDISCERN) tools for quality, applying a double-blind methodology. Group comparisons were conducted using ANOVA and post-hoc tests.</p><p><strong>Results: </strong>All chatbots generated texts in the \"difficult to read\" range (FRES: 33.6-40.9), requiring university-level comprehension (FKGL: 20.3-21.9), thereby substantially limiting accessibility for the target parent audience. DeepSeek demonstrated significantly superior performance on EQIP criteria (70.4±9.2), outperforming both Gemini (57.8±6.3) and GPT-4o (54.7±4.8) (P=0.003). However, mDISCERN scores remained low across all models (2.10-2.30, P=0.183).</p><p><strong>Conclusion: </strong>Current AI chatbots offer only limited potential as reliable and accessible health information sources on nocturnal enuresis and are not yet adequate for clinical use. Future developments must prioritize plain language implementation, structured information delivery, and alignment with current pediatric urology guidelines to transform digital health tools into genuinely beneficial and clinically reliable resources for families.</p><p><strong>Level of evidence: </strong>I.</p>","PeriodicalId":516865,"journal":{"name":"The French journal of urology","volume":" ","pages":"103062"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145688883","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}