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BACKGROUND In the modern era of healthcare, advancements in artificial intelligence and natural language processing have allowed for the development of chatbots that can assist in answering patient questions and providing healthcare information [1]. One such chatbot is ChatGPT, a large language model trained by Open AI. ChatGPT can provide accurate and relevant information in various medical specialties, including urology. However, the reliability and accuracy of ChatGPT’s information compared to those provided by human specialists have yet to be thoroughly investigated, neither for version 3.5 nor version 4. One such Previous study have shown that chatbots can be a valuable resource for patients seeking healthcare information. However, concerns have been raised regarding the accuracy and reliability of the information provided by these systems. [2] As such, it is essential to evaluate the performance of chatbots compared to human specialists to determine their potential role in healthcare. OBJECTIVE Our study compares two ChatGPT versions’ behaviors, knowledge and interpretation capacity based on an Academic Institution’s expert healthcare providers’ sights and approaches, European Association of Urology Guidelines, and literature reviews by this 3 staged survey. METHODS Our study has three main steps to evaluate the effectiveness of ChatGPT in the urologic field. We generated 35 questions on urology that were extracted from our institution’s experts who have at least 10 years of experience in their fields, such as Andrology, Pediatric Urology, Functional Urology, Endourology, and Urooncology. Study data were collected and managed using REDCap [3,4] electronic data capture tools licensed to Urology Department of Marmara University, School of Medicine. All responses were evaluated for consistency with the 2023 European Urological Society Guidelines and were double-checked by another academic expert. Then we created an answer key, and after each question was posed to ChatGPT version 3.5 and ChatGPT version 4 separately. The answers of two ChatGPT versions were compared with chi-square Fisher’s Exact Test. This comparison was used to assess the reliability of ChatGPT versions’ usage on a medical care providers’ clinical practice habits and decision-making, high-quality evidence, and provide responses by evidence-based medicine (EBM) The next step aimed to assess the reliability of ChatGPT versions about the current debate topics, even between the academic urologists and mentors of the field. As the debate questions do not have an absolute answer, the success rate and approach of chatGPT were assessed regarding the experts’ most common opinions. In this context, we prepared a total of 15 "Debate Questions" for the experturologists who work at Marmara University, School of Medicine, and collected the answers via an online survey. The consistent answers between the health care providers were assessed and compared with ChatGPT versions’ answers. For this comparision, Fisher’s exact test was used. The last part of the study was prepared to assess the reliability of ChatGPT versions’ recommendations and directives that were most asked by patients on the internet. Those ten questions were generated after an interview with healthcare professionals and patients admitted to our outpatient clinic. ChatGPT versions 3.5 and 4 were asked those questions separately, and their answers and medical directions were noted. Afterwards, the answers were assessed by the academic urologists scoring them from 0 to 10 Our three staged survey was analyzed both quantitative and qualitatively. Comparison with Chi-Square tests for all steps is made by IBM SPSS for Statistics for Windows, Version 27.0 (IBM Corp. Released 2020. IBM SPSS Statistics for Windows, Version 27.0. Armonk, NY: IBM Corp) RESULTS The overall success rate between ChatGPT version 3,5 versus version 4 was different at statistically significant level, in favour of version 4 (p=0,022) regarding the first step of our study (Table 2) Version 4 provided correct answers to 25 questions out of 35 while version 3,5 provided only 19(%71,4 vs %54).The questions which were answered incorrectly by both versions were measuring clinical decision-making and experience in general. The second step of our study was prepared to see the reaction of chatGPT versions on debate situations in urology.13 questions out of 15 were replied to with the same answers by %50 or more of the experts, therefore we assessed those answers as references because an answer key actually did not exist due to medical care providers’ different clinical approaches. 5 out of those 13 reference questions were replied the same by ChatGPT v 3,5 (%38,4) while ChatGPT v 4 replied the same 3 out of 13 (%23), the P value was 0,510 (Table 3) The last step was assessing the ChatGPT’s recommendations and guidance on patients’ commonly asked ten questions by scoring each from 0 to 10. Mean value for version 3.5 was 8.6 while version 4’s was 8.2 out of 10 points. The Fisher’s Exact Test did not demonstrate any statistical difference between the ChatGPT versions in informing patients (Table 1). Also according to the experts’ ratings on Step 3, Table 1; the success rate seemed sufficient enough. CONCLUSIONS Our study showed that ChatGPT version 3.5 and version 4 were both successful in informing patients and providing medical directions but not directly providing treatment options or experience-based decision-making. The significance between the two versions of ChatGPT for the first step’s 35 questions was thought to be due to the improvement of ChatGPT’s literature and data synthesis abilities. The insignificance between the two ChatGPT versions’ answers in the second and third steps was thought to be due to a lack of patient follow-up and see real-world experience. The competency of ChatGPT on medical licensing exams has been demonstrated by a recent study. [5] Our study also showed the competency of ChatGPT in answering general knowledge questions.Information is now incredibly accessible and readily available in the age of artificial intelligence. A chatbot is a computer program that uses artificial intelligence (AI) and natural language processing (NLP) to understand questions and automate responses to them, simulating human conversation. These technologies rely on machine learning and deep learning —elements of AI, with some nuanced differences to develop an increasingly granular knowledge base of questions and responses that are based on user interactions. This improves their ability to predict user needs accurately and respond correctly over time. Considering the burnout of physicians all over the world, it is essential to reach good quality information both from literature and guidelines without taking away much time. [6] There have been several studies comparing AI’s and real doctors[7], but for the time being it is a better option to use it to ease healthcare services provided by professionals and support clinical practice such as creating discharge summaries, triaging patients and patient information forms etc. [7,8] Another issue is to give patients a high-level service about medical systems and direct referee them to the healthcare they need, even when the medical system is overloaded. On the other end of the scale, there are concerns about its utilization in real-world situations and also ethical issues regarding patient data sharing and scanning.[9] It has previously been shown that the ChatGPT, brought wrong information and misreferred the resources [10] In this study we demonstrated that the responses gathered from both versions of ChatGPT was not always in concordance with the responses of the experts in the area. In order to that, the lack of field competency caused the variable and inappropriate results. And make scientists think the fact that versions’ development is crucial in guideline-based information based on our study’s first two steps. Also it should be noted that AI is not always competent enough to assess patients medical and socioeconomic conditions. It also lacks information about the availability of therapeutic and diagnostic tools at the selected center. This lack of information may cause AI to give unrealistic or unfit responses which in turn may cause a trust issue between patients and physicians. [11] Our study illustrates that, it may be a logical approach to use ChatGPT versions as an assistant for routine daily healthcare services but ChatGPT should not be used to plan the treatment of patients nor to replace doctors. The patient information system may be developed even further and may be much more beneficial for high-volume centers to provide high-quality patient care while saving man force and time. Therefore, as a free chatbot “ChatGPT version 3.5” is competent enough to inform for non- heathcare professional individuals seeking practical and fast medical directions. It may also be beneficial for healthcare professionals to use ChatGPT verison 4 for well-known guideline-based information since it achived a high score in step 1 of this study. There are several limitations of this study that need to be acknowledged. First, conditions are assessed in just one language(English). The real-world experience of patient counselling requires a mother-language engine to see if people could or not impress themselves correctly and understand the directives given by chatbots. Also, another limitation is that the reference answers were only based on seven urology experts in a single center, expanding the observers to multiple may change the results as mentioned before.[12] This research has encourages academic institutions to further investigation AI and expanding the sample size. We believe that AI will ease healthcare providers’ workload and may prevent burnout of physicians while assisting them under professional supervision. But our results clearly demonstrate that the accuracy and security of the information obtained with generative AI models should be strictly controlled, and the decisions taken during the patient treatment and follow-up process should never solely based on the information obtained with the AI.

Aim We previously reported that some urodynamic parameters change with repetitive filling in children with neurogenic lower urinary tract dysfunction (LUTD). In this study, we aimed to search if three-times repeated filling cystometries (FC) and pressure-flow studies (PFS) would change the urodynamics parameters in children with non-neurogenic LUTD. Materials and Methods All children with three repeated FC and PFS between June 2017 and December 2018 were included in the study. Urodynamic reports and charts were evaluated retrospectively. The first sensation of bladder filling (FSBF), maximum cystometric capacity (MCC), detrusor pressure at the FSBF (P-det.first.sens), maximum detrusor pressure during filling (P-det.fill.max), presence of detrusor over activity, compliance, maximum urine flow (Qmax), detrusor pressure at the maximum urine flow (PdetQmax), residual urine and presence of detrusor sphincter dyssynergy (DSD) were compared among three-times repeated urodynamic studies. Results Forty children were included in the study. 27 (67.5%) were girls and 13 (32.5%) were boys. Median age was 9 (3.4-17) years. Indications were LUTD with low grade vesicoureteral reflux in 19 (47.5%), LUTD refractory to conservative management in 13 (32.5%), urinary tract infection with LUTD in 6 (15%) and secondary enuresis in 2 (5%). P-det.first.sens, presence of DO, MCC, Qmax, PdetQmax, residual urine, flow pattern, and presence of DSD were comparable in all three repeated tests. The third FC may show decreased filling detrusor pressures and increased compliance with no change on capacity. Conclusion In children with non-neurogenic LUTD, three-times repeated FC and PFS present comparable results except FSBF, P-det.fill.max,P- and compliance at the third test.

© 2023 Wiley Periodicals LLC.Aim: The aim of the study is to compare the intra- and inter-observer interpretations of the same uroflowmetry study at two different times. Materials and Methods: Two-hundred children with a voided volume of 50% above the expected bladder capacity were included. All traces were asked to be evaluated by 11 observers two times in a time span of 1 month. These observers consist of pediatric urologists (n = 2), pediatric urology fellows (n = 2), urology residents (n = 5), and certified urodynamics nurses (n = 2). Each uroflowmetry was asked to be assessed for three domains: voided volume (VV), detrusor sphincter dyssynergia (DSD), and flow curve pattern (FCP). Results: Of the 200 patients with a median age of 10 (4–18) years, 128 (64%) were girls and 72 (36%) boys. The maximum flow rate and the median voided volume were found to be 20 (4–61) mL/s and 232 (116–781) mL. The Fleiss\" kappa coefficient of VV, DSD, and FCP in the first assessment was 0.510, 0.501, and 0.346. In the second assessment, κ values were 0.530, 0.422, and 0.373. The best-agreed findings were similar at both times. These were found to be low VV (0.602 and 0.626) and intermittent pattern (0.500 and 0.553). Interpreters were found to have a statistically significant difference in agreement with their own interpretation at different times. Conclusion: Both inter- and intra-observer reliability of the agreement point out the problem in the standardization of uroflowmetry. Inter- and intra-observer reliability of uroflowmetry interpretation can be increased by defining precise numbers and numerical algorithms.

Objective: To determine the normal vertical urethral meatus length (ML), maximum glanular width (MGW), the glanular seam length (between the lowest edge of urethral meatus and the glans closure line corona) (GSL) and GSL/ML ratio in all age groups. Materials and Methods: Consecutive patients presented to urology and pediatric urology outpatient clinics were included in the study. Penile abnormalities, known endocrinological disorders, history of penile/urethral surgery were excluded. MGW, ML, and GSL were measured with a caliper. Glanular and meatal measurements were compared according to ages. Results: A total of 1398 boys and men (380 (27.18%) prepubertal (1-12), 203 (14.52%) adolescent (13-19), and 815 (58.30%) postpubertal (19-93)) with a median age of 31 years (range: 1-93) were included in the study. In consecutive age groups, ML and GSL gradually increased and became steady between 16-19 & 20-30 age groups and 10-12 & 13-15 age groups, respectively. On the other hand, MGW gradually increased until 20 years of age and became steady at median of 35 mm over 20 years of age. Another interesting finding was a rather stable GSL/ML ratio in all age groups. Pairwise comparison of different age groups seemed to be similar and suggests a fixed ratio of 1.33 (IQR: 0.6). Conclusion: The normal glanular and meatal measurements may guide the surgeons for better cosmetic results during hypospadias repair. The GSL/ML ratio appears to be a stable measure for all ages to achieve better cosmetic results.

There are scanty data on the rate of abnormal Tc-99 m dimercaptosuccinic acid (DMSA) renal scintigraphy and associated factors in children older than 5 years with diagnosis of VUR. We do not have knowledge about which older children should undergo DMSA after VUR diagnosis. This study aims to assess the rate of abnormal DMSA findings and associated factors in children older than 5 years of age diagnosed with VUR. We retrospectively reviewed the medical records of 258 children with VUR diagnosed at or older than 5 year age. 179 children [42 (23.5%) males and 137 (76.5%) females] with complete data were included. 268 reflux units were compared according to gender, bilaterality, grade, reflux phase at voiding cystourethrography, febrile urinary tract infection (fUTI), lower urinary tract dysfunction (LUTD), and DMSA findings with uni- and multivariate analysis. The median age was 110 (60–216) months. VUR grades were I, II, and III in 197 (73.6%) units and IV–V in 71 (26.4%). 138 (51.5%) renal units had abnormal DMSA. VUR grade (p

Aims Psychological morbidities play a major role in idiopathic lower urinary tract dysfunction (iLUTD). The aim of the Think Tank (TT) was to discuss the relevance of psychological morbidities in idiopathic LUTD over the life span, including overactive bladder (OAB) or dysfunctional voiding (DV) and methods of assessment. Methods The paper is based on a selective review of the literature and in-depth discussions, leading to research recommendations regarding the assessment of psychological morbidities in iLUTD on children and adults held during the TT of the International Consultation on Incontinence Research Society in 2019. Results Psychological comorbidities affect the health behaviors and treatment outcomes in patients with iLUTD. Both clinically relevant comorbid mental disorders, as well as subclinical psychological symptoms have a major impact and negatively influence incontinence treatment. Research is needed to elucidate mechanisms underlying iLUTD and psychological comorbidities. Clinical studies are needed to determine how perception generation and cognition impacts on the relationship of urinary perceptions, symptoms, and objective urodynamic function. Due to high psychological comorbidity rates, screening with validated, generic questionnaires for emotional and behavioral disorders in children with nocturnal enuresis, daytime urinary incontinence, and fecal incontinence is recommended. Brief screening is recommended for all adults with iLUTD, especially with OAB and DV, who are refractory to treatment. Conclusions Due to the high rate and relevance in clinical practice, screening for psychological comorbidities is recommended for all age groups. The research recommendations of this TT may be followed to improve the assessment of psychological morbidities in iLUTD.

Aim To explore the effects of experimental subarachnoid hemorrhage (SAH) on rabbit urinary bladder and to assess the potential protective effects of hyperbaric oxygen therapy (HBOT). Methods A total of 15 male New Zealand white rabbits were divided randomly to one of three groups: group I was spared as the control group (n = 5), group II was exposed to SAH, received no treatment, and acted as the SAH group (n = 5) and group III was exposed to SAH and received five sessions of HBOT (started 12 hours after SAH induction and was given twice daily for the first 2 days and once on the third day) and acted as the treatment group (n = 5). At 72 hours after the SAH induction, bladders from all animals were removed for in vitro organ bath experiments and biochemical analyses. Results Isometric tension studies revealed that compared to group I, the contractile responses of the strips to carbachol in group II were significantly decreased whereas HBOT restored the contractile responses (P < .05). Caspase-3 and nitric oxide synthase (NOS) activities of bladder tissues were significantly increased in group II when compared with group I, whereas caspase-3 and NOS activities were significantly decreased in the tissues of group III (P < .01). Conclusions Subarachnoid hemorrhage stimulates apoptosis of the rabbit bladder and impairs the contractile response of the rabbit bladder to carbachol. HBOT creates a protective effect in rabbit bladder tissues and restores SAH-induced changes. WOS:000536779200001 2-s2.0-85085891785 PubMed: 32483860

Herein, we aimed to review, report, and discuss the role of cystoscopy and clinical phenotyping in interstitial cystitis/bladder pain syndrome (IC/BPS). For this purpose; a comprehensive nonsystematic review of the relevant literature was conducted. We reviewed articles published in English and indexed in the PubMed, Embase, and Google Scholar databases. Original manuscripts, review articles, case series, and case reports were taken into consideration. Data regarding the indications for, technique, and possible findings of cystoscopy with hydrodistension (HD) and biopsy, as well as clinical implications of cystoscopic information and the concept and use of clinical phenotyping within the context of IC/ BPS were extracted and discussed. IC/BPS is diagnosed based on symptomatic assessment and exclusion of confusable diseases. There is no universal agreement upon the evaluation and diagnostic algorithm of IC/BPS. The majority of the guidelines recommend cystoscopy with HD and biopsy as a diagnostic prerequisite. Various different techniques have been described for cystoscopy with HD. General or epidural anesthesia is more commonly preferred and advocated while assessing endoscopic alterations in patients suspected of having IC/BPS. Cystoscopy with HD and biopsy enables more objective exclusion of confusable diseases. It also provides the basis of the European Society for the Study of Interstitial Cystitis classification. Patients with IC/BPS who demonstrate positive cystoscopic (glomerulations and/or Hunner lesion) and histologic findings have a more severe symptomatology and may benefit from lesion-targeted endoscopic treatments. Clinical phenotyping has been implemented for IC/BPS and may be used for individualized assessment and treatment.

Objective: To investigate the prevalence of voiding dysfunction (VD) and nocturnal enuresis (NE) in Turkish primary school children using a previously validated Dysfunctional Voiding Scoring System (DVSS) questionnaire and a self-administered questionnaire. Materials and Methods: The previously validated DVSS questionnaire was completed by the parents of 3015 randomly selected children. Another questionnaire was also administered for studying VD and NE rates, demographic characteristics, and learning or behavioral problems of children. Results: Of all children, 6.6% (n=199) had a score suggesting VD and 6.1% (n=185) had NE. No significant differences were found between children with and without VD in terms of age, gender, and fluid intake. Children with VD had significantly high rates of constipation (19.7% vs 5.2%; p

Objective: This study aims to investigate the neurourological and urodynamic findings of children with cerebral palsy (CP) that referred for dorsal rhizotomy surgery (DRS). Materials and Methods: All children with CP who were scheduled for selective DRS were assessed with a detailed medical history, physical exam, urinalysis and urodynamic studies to assess bladder function and urinary problems. Urodynamic studies included filling and voiding cystometry, detrusor leak point pressure, external anal sphincter electromyography, flow rate and residual urine volume. All investigations and definitions relied on the standardisation of the International Continence Society. Results: Overall, 24 boys and 10 girls were evaluated. The mean age of boys, and girls and the study group was 6.6 (1.7-9.8), 6.5 (3.5-11.4) and 6.6 (1.7-11.4) years, respectively. The most common complaints of the study group were urinary incontinence (58.8\%), encopresis (32.4\%) and constipation (17.6\%) and 41.2\% of patients needed diapers due to these problems. Twenty-five per cent (n=5) of male patients had an undescended testis. The most common clinical conditions at urodynamics, were low bladder compliance (85.3\%), detrusor overactivity (67.6\%), hyposensitive bladder (52.6\%) and low bladder capacity (41.2\%). Conclusion: Upper motor neuron lesions, like CP, may present with various urodynamic findings. However, patients with CP are not routinely seen by urologists. Our findings revealed serious neurological problems in children referred for DRS. Therefore, every child with CP who has a DRS plan should undergo a detailed urological examination at least once before the procedure.

Aims Chronic urinary retention occurring in young women is poorly understood and a cause may not be found in a majority of cases. Different psychological comorbidities and functional neurological symptom disorders (FNDs) have been reported; however, these have been poorly explored. Methods At the International Consultation on Incontinence Research Society meeting in 2019, a panel of clinicians generated a proposal to explore the relationship between psychological comorbidities, FNDs, and urinary retention in women with chronic idiopathic urinary retention. Results Psychological comorbidities such as depression and anxiety, and FNDs such as leg weakness and loss of consciousness, have been reported in women with idiopathic urinary retention. Individuals react differently to physical and emotional stressors, and experimental models have demonstrated a relationship between the stress response and developing urinary retention. Trauma, particularly sexual trauma, may be a shared risk factor for developing psychological comorbidities and urinary retention. Children with voiding postponement often suffer from psychological comorbidities and behavioral disturbances; however, there is no evidence to suggest that this progresses to urinary retention in adulthood. "Psychogenic urinary retention" has been described in the urology and psychiatry literature in the past, and anecdotal cases of successful voiding following psychotherapy have been reported, though the true pathophysiology of this entity is uncertain. Conclusion Psychological and functional disorder comorbidities are reported in women with chronic urinary retention. The nature of the association between urinary retention and functional neurological disorder comorbidities needs to be further explored in terms of a disorder of bladder-brain interaction.

Objective: To evaluate the clinical risk factors contributing to the development of extended spectrum beta-lactamase (ESBL)- producing asymptomatic bacteriuria in myelodysplastic children performing clean intermittent catheterization (CIC). Materials and Methods: The clinical risk factors for ESBL-producing bacteriuria were retrospectively investigated in 60 myelodysplastic children who had asymptomatic bacteriuria and were performing CIC. A total of 60 children were included in this study, 30 children (17 females, 13 males) with ESBL-positive bacteriuria in urine culture were identified as the study group and 30 age- and gender-matched ESBL-negative children (16 females, 14 males) served as controls. All children had neurogenic bladder due to myelodysplasia and had been used anticholinergics. The two groups were compared in terms of age, gender, presence of constipation and motor deficit, antibiotic prophylaxis, number of hospital admission, ultrasound findings, and presence of renal scarring in dimercapto succinic acid scintigraphy and urodynamic findings. Results: The mean age of the children was 77 +/- 50 months in study and 78 +/- 69 months in control groups. There was no statistically significant difference in terms of maximum bladder capacity, leak point pressure, constipation status and scarring. In study and control groups, 83\% and 46\% of children were on antimicrobial prophylaxis, respectively (p=0.007). Conclusion: ESBL-producing bacteriuria was found to be associated with long-term antibiotic prophylaxis. Thus, it was concluded that the use of antibiotics for asymptomatic bacteriuria should be kept to a minimum.

Several studies indicate that pelvic ischemia and oxidative stress may play a significant role in lower urinary tract dysfunction (LUTD), including detrusor overactivity (DO)/overactive bladder (OAB) and detrusor underactivity (DU)/underactive bladder (UAB). The present article addresses proposal 1: "Are oxidative stress and ischemia significant causes of bladder damage leading to LUTD?" from the 2019 International Consultation on Incontinence-Research Society (ICI-RS) meeting. Bladder ischemia in animals and humans is briefly described, along with the proposed progression from ischemia to LUTD. Bladder ischemia is compared with ischemia of other organs, and the ongoing development of pelvic ischemia animal models is discussed. In addition, the distribution of blood within the bladder during filling and voiding and the challenges of quantification of blood flow in vivo are described. Furthermore, oxidative stress, including potential biomarkers and treatments, and challenges regarding antioxidant therapy for the treatment of LUTD are discussed. Finally, seven critical research questions and proposed studies to answer those questions were identified as priorities that would lead to major advances in the understanding and treatment of lower urinary tract symptoms (LUTS)/LUTD associated with pelvic ischemia and oxidative stress.

Aims Lower urinary tract symptoms (LUTS) can be classified into symptom syndromes based on which symptoms are predominant. Overactive bladder (OAB) syndrome, a storage dysfunction, and underactive bladder (UAB) syndrome, a voiding dysfunction, are common syndromes, which urodynamic tests may show to be caused by detrusor overactivity (DO) and detrusor underactivity (DU), but can also be associated with other urethro-vesical dysfunctions. Sometimes OAB and UAB can coexist in the same patient and, if so, need a specific approach beyond treatment of the single and apparently opposing syndromes. Methods During its 2019 meeting in Bristol, the International Consultation on Incontinence Research Society held a literature review and expert consensus discussion focused on the emerging awareness of the coexisting overactive-underactive bladder (COUB). Results The consensus considered whether COUB is the combination of OAB and UAB syndromes, or a real unique clinical syndrome in the same patient, possibly with a common etiology. Definitions, pathophysiology, diagnosis, and treatment were discussed, and high-priority research questions were identified. Conclusions COUB (with or without urodynamic evidence of DO and DU) may be considered a real clinical syndrome, because it differs from single OAB and UAB, and may not be the combination of both syndromes. Urodynamic tests may be necessary in unclear cases or in cases not responding to initial treatment of the most troublesome symptoms. It is pivotal to define the evolution of the syndrome and the characteristic population, and to recognize predictive or phenotyping factors to develop a specific approach and adequate outcome measures.

Context Coronavirus disease 19 (COVID-19) has changed standard urology practice around the world. The situation is affecting not only uro-oncological patients but also patients with benign and disabling conditions who are suffering delays in medical attention that impact their quality of life. Objective To propose, based on expert advice and current evidence where available, a strategy to reorganize female and functional urological (FFU) activity (diagnosis and treatment). Evidence acquisition The present document is based on a narrative review of the limited data available in the urological literature on SARS-Cov-2 and the experience of FFU experts from several countries around the world. Evidence synthesis In all the treatment schemes proposed in the literature on the COVID-19 pandemic, FFU surgery is not adequately covered and usually grouped into the category that is not urgent or can be delayed, but in a sustained pandemic scenario there are cases that cannot be delayed that should be considered for surgery as a priority. The aim of this document is to provide a detailed management plan for noninvasive and invasive FFU consultations, investigations, and operations. A classification of FFU surgical activity by indication and urgency is proposed, as well as recommendations adopted from the literature for good surgical practice and by surgical approach in FFU in the COVID-19 era. Conclusions Functional, benign, and pelvic floor conditions have often been considered suitable for delay in challenging times. The long-term implications of this reduction in functional urology clinical activity are currently unknown. This document will help functional urology departments to reorganize their activity to best serve their patients. Patient summary Many patients will suffer delays in urology treatment because of COVID-19, with consequent impairment of their physical and psychological health and deterioration of their quality of life. Efforts should be made to minimize the burden for this patient group, without endangering patients and health care workers., Take Home Message COVID-19 disease has changed standard urology practice worldwide. Most efforts have focused on urologic oncology. An international panel composed of opinion leaders in 13 countries proposes comprehensive guidelines on how to manage female and functional urology patients.

For some years, the role of urodynamics (UDS) in female stress urinary incontinence (SUI) has been a topic of intense debate. The findings of the VaLUE and VUSIS-II randomised clinical trials (RCTs) published in 2012 appeared to suggest that UDS is not useful in women with uncomplicated SUI, with the result that several authoritative guidelines were amended and the routine use of UDS in this setting fell sharply. However, many experts have raised concerns about the design of these two RCTs and their subsequent interpretation - including the inappropriate generalisation of the findings beyond uncomplicated cases, which represent only a small minority of the overall patient population. In this paper, we consider a range of issues and confounding factors which raise doubts about how influential these RCTs should have been and reflect on the potential value of UDS both for objective diagnosis and patient counselling in female SUI.

Aims To assess the state of technologies for urodynamics that are less invasive than standard cystometry and pressure-flow studies and to suggest areas needing research to improve this. Methods A summary of a Think Tank debate held at the 2019 meeting of the International Consultation on Incontinence Research Society is provided, with subsequent analysis by the authors. Less-invasive techniques were summarized, classified by method, and possible developments considered. Discussions and recommendations were summarized by the co-chairs and edited into the form of this paper by all authors. Results There is a full spectrum of technologies available for less-invasive assessment, ranging from simple uroflowmetry through imaging techniques to emerging complex technologies. Less-invasive diagnostics will not necessarily need to replace diagnosis by, or even provide the same level of diagnostic accuracy as, invasive urodynamics. Rather than aiming for a technique that is merely less invasive, the priority is to develop methods that are either as accurate as current invasive methods, or spare patients from the necessity of invasive methods by improving early triaging. Conclusions Technologies offering less-invasive urodynamic measurement of specific elements of function can be potentially beneficial. Less-invasive techniques may sometimes be useful as an adjunct to invasive urodynamics. The potential for current less-invasive tests to completely replace invasive urodynamic testing is considered, however, to be low. Less-invasive techniques must, therefore, be tested as screening/triaging tools, with the aim to spare some patients from invasive urodynamics early in the treatment pathway.

AimsThe Think Tank aimed to discuss the pitfalls and advantages of current definitions in terms of research and management of underactive bladder (UAB). UAB broadly defines a symptom complex of bladder emptying problems and does not indicate a specific pathology. Detrusor underactivity (DU) is a urodynamic diagnosis from pressure-flow studies. The correlation of UAB with DU remains to be precisely determined. MethodsThe presentations and subsequent discussion, leading to research recommendations during the Think Tank of the International Consultation on Incontinence Research Society in Bristol, 2017, are summarized. ResultsTo develop more specific individualized management strategies, the Think Tank panel proposed (i) that, since defining a single type of index patient to represent all UAB will not fulfill all clinical research needs, several index patients should be defined by phenotyping of patients with UAB, including, children, young men and women, elderly male and female patients with co-existing DU and detrusor overactivity, and neurological patients with UAB; (ii) prospective longitudinal studies to assess the natural history of UAB, in the different target populations, based on different UAB phenotypes, should be initiated; (iii) DU should be precisely defined by urodynamic parameters; and (iv) work to develop validated specific questionnaires combined with non-invasive tests for screening, diagnosis and follow up, needs to be continued. ConclusionsThe precise relationship of UAB to DU remains to be defined. Phenotyping patients with UAB/DU, performing prospective trials of natural history, and developing symptom questionnaires and diagnostic investigations will improve our ability to identify and treat UAB/DU.

The pelvic floor is at an increased risk of damage during the lifespan of women. Pregnancy, vaginal delivery, aging, menopause, previous pelvic surgery, and lifestyle factors have a negative influence on the connective tissue and muscular components of the pelvic floor leading to urinary incontinence (UI). Pregnancy and vaginal delivery have been identified as the most important risk factors for incontinence. Cystocele, rectocele, uterine, vault prolapse, and/or incontinence can occur due to lacerations of the connective tissue support at different levels. Moreover, muscular damage of the levator complex can lead to widening of the levator hiatus, giving way to the descent of pelvic organs resulting in UI. Although some genetic abnormalities have been identified, their clinical implications remain unclear. Diagnostic evaluations should be performed in accordance with established evidence-based guidelines. Although short-term results of single-incision midurethral slings indicate similar efficacy to conventional midurethral slings, their long-term outcome is still not determined. Scientists continue to investigate the exact causes of stress UI as well as the optimum substitute material using the best surgical reconstructive approach. The recent European Association of Urology consensus statement underlines an imperative requirement for an optimal solution using minimal amount of material related to the indication and higher competence of surgeons for this surgery. High-quality trials with a longer follow-up are currently an unmet need.

WOS: 000419241300002, Objective: Predictive factors that could affect the cure and complication rates of midurethral slings (MUS) in the treatment of stress urinary incontinence (SUI) were investigated. Materials and Methods: A total of 594 women (outside-in transobturator in 285, inside-out transobturator in 91, and retropubic in 218) with SUI and who had undergone MUS were evaluated. The median age was 53.9 (27-82) years. Univariate analyses were done using chi-square test, Student's t-test and the Mann-Whitney U test. Multivariate analyses were done using logistic regression analysis to determine predictive factors affecting cure and complication rates. Results: The mean follow-up time was 48 months. The subjective cure rate was 84% and complication rate was 11.2%. On univariate and multivariate analyses, the cure rate was found to be increased in younger patients [odds ratio (OR): 0.97, 95% confidence interval (CI): 0.95-0.99, p=0.038] and in patients with pure SUI (OR: 2.17, 95% CI: 1.31-3.60, p=0.002). The type of surgery was the only statistically significant parameter affecting the complication rate, which was significantly higher in retropubic MUS procedure (OR: 6.28, 95% CI: 3.51-11.22, p

Objective: The aim of this study was to determine the significance of contralateral testis size in predicting monorchism in pediatric patients with unilateral undescended testis. Materials and Methods: The data of patients who underwent surgical operation by a single pediatric urologist for undescended testis between 2013 and 2016 was evaluated retrospectively. The patients were grouped as having monorchism (M), nonpalpable intra-abdominal testis (NPIAT), and palpable undescended testis (PUDT). The dimensions of the testes were measured ultrasonographically and recorded before operation. Patients with nonpalpable testis underwent diagnostic laparoscopy and patients with PUDT underwent inguinal orchiopexy. Results: A total of 57 children with a mean age of 31 (11-60) months were evaluated. Of the children, 12 had M, 9 had NPIAT and 36 had PUDT with a similar mean age (p>0.05). The size of the descended testis was found to be significantly small in NPIAT* and PUDT** groups compared to the M group (*p0.05). Conclusion: The size of the testis in the scrotum might help to localize the position of the undescended testis.

Objective: The aim of this study was to determine the effectiveness of the voiding dysfunction symptom score (VDSS) in evaluation of children with nocturnal enuresis. Materials and Methods: Four hundred children with nocturnal enuresis were included in the study. They were evaluated with VDSS, physical examination, urinalysis and 2-day voiding diary. All children with nocturnal enuresis symptoms were treated with desmopressin and/or urotherapy. However, children with overactive bladder symptoms were also treated with anticholinergics. Treatment success and change in VDSS were compared and assessed between different treatment methods. Results: Two hundred forty-five children (61.25%) were male and 155 (38.75%) were female. The mean age was 7.6 +/- 3.0 years (range: 5-18). The mean VDSS was 9.2 +/- 6.3. 35% of children with nocturnal enuresis had concomitant daytime symptoms. 126 children (31.5%) had a VDSS of nine or above and majority of these children were treated with anticholinergic therapy. VDSS questionnaire could not help determine treatment success in children with non-monosymptomatic nocturnal enuresis. However, children treated with urotherapy and desmopressine showed significant difference in VDSSs according to their treatment response. Conclusion: VDSS has shown to decrease after treatment in children with mono-symptomatic nocturnal enuresis. The treatment strategies should be checked and modified if VDSS does not decrease after proper therapy as this would increase the success of treatment.