Editors’ Choice

You have accessJournal of UrologyEditors' Choice1 Mar 2024Editors' Choice D. Robert Siemens and Julian Wan D. Robert SiemensD. Robert Siemens https://orcid.org/0000-0002-3203-6468 and Julian WanJulian Wan https://orcid.org/0000-0002-6603-5076 View All Author Informationhttps://doi.org/10.1097/JU.0000000000003838AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail A Randomized Controlled Trial of a Web-Based Management Support System for Children With Urinary Incontinence: The eADVICE Trial Urology is a surgical specialty that serves many nonsurgical patients. That is a reality particularly true for pediatric urologists who manage patients with issues related to incontinence, and bladder and bowel dysfunction. These conditions, while clearly important to the child and family due to their social effects (eg, limiting overnight visits with grandparents, sleepovers, and summer and specialty camps), are also time-consuming, requiring longer detailed visits that are not as easily streamlined into a 15- to 20-minute clinic slot. This can lead to long wait times before a patient can be seen in a specialty clinic. One method of dealing with this situation has been to train advanced practice providers to handle the bulk of patients who present with incontinence or bladder and bowel dysfunction. The near ubiquity of the internet offers another method. A web-based computer program could be used to screen and provide basic general advice prior to a face-to-face visit. If effective, it might even lead in theory to families opting to cancel the visit. Caldwell et al present a multicenter randomized controlled trial examining the effect of a web-based program on children (age 5-18 years) on a waitlist to be seen in a tertiary specialist clinic.1 Their program used animated computer characters (embodied conversational agents) to engage the patients, make an assessment, and offer treatment advice. Data were gathered at enrollment, 6 months, and 12 months. The authors found that 120 patients who used the web-based program had a statistically significantly higher continence rate at 12 months than the 119 controls. Interestingly, the number of families who still desired a face-to-face visit despite superior results from the web-based program remained unchanged. Perhaps the families still wanted the reassurance of a face-to-face visit with a specialist. Perhaps after waiting 6+ months, there is such a psychological commitment that to cancel the appointment may be too unpalatable. In the US we are now facing a developing shortage of urologists.2 The demographic data suggest that this will get worse before it gets better.3 The 2022 AUA Census found 50% of practicing urologists are age 55 years or older. It is not hard to imagine the effect on access once that cohort retires and fades out of the workforce, even with expanded numbers of advanced practice providers. Could interactive programs using embodied conversational agents, and the evolving world artificial intelligence (AI) offer further options, and would these lead to a reduction of wait lists? As people use AI programs in their daily life (eg, to help write term papers, do research, generate summaries), would that lead to greater confidence in medical AI—enough to cancel a face-to-face appointment? Our colleagues in the 50% under age 55 years old will no doubt see the results. Trust in Digital Health Information Among Black Patients In this issue of The Journal of Urology®, Loeb et al address the dual challenge of misinformative content and the underrepresentation of Black adults in online prostate cancer information.4 Conducting focus groups with Black patients, the research identifies key themes influencing trust in online health information. Such qualitative research, rare in our clinical journals, underscores the potential of underrepresentation to exacerbate health disparities, and the authors expound on the importance of creating an inclusive and trustworthy online health information environment for our patients. Phosphodiesterase Type 5 Inhibitors and Biochemical Recurrence Given the frequency of patients taking phosphodiesterase type 5 inhibitors (PDE5is) after localized prostate cancer treatments, conflicting reports of its associations with outcomes are worthy to explore more fully. Flores et al add to our understanding, as the authors analyzed a substantial dataset of 4630 patients to evaluates PDE5i exposure's impact on biochemical recurrence after prostatectomy.5 This comprehensive analysis finds no evidence of an increased risk of biochemical recurrence associated with any PDE5i use or the duration of PDE5i use in the first year. The authors conclude that we can reassure patients prescribed PDE5i that its use does not elevate the risk of treatment failure. Prospective Assessment After Removal of Nonobstructing Renal Stones Flank pain associated with stone disease is conventionally attributed to obstructive stones but there is lingering controversy in clinical guidelines regarding the role of treating non-obstructing calyceal stones. Bhojani et al in this multicenter observational trial challenge this paradigm.6 With 43 recruited patients, the study reveals that surgical removal of nonobstructing kidney stones results in a significant reduction in pain and improvement in the Wisconsin Stone Quality of Life score. The authors conclude that the surgical removal of these symptomatic kidney stones offers significant benefits, supporting its recommendation as a viable treatment option for patients seeking relief from these stones despite the lack of objective obstruction. REFERENCES 1. . A randomized controlled trial of a web-based management support system for children with urinary incontinence: the eADVICE trial. J Urol. 2024; 211(3):364-375. Link, Google Scholar 2. American Urological Association. Practicing urologist in the United States 2022. American Urological Association; 2023. https://www.AUAnet.org/common/pdf/research/census/State-Urology-Workforce-Practice-US.pdf Google Scholar 3. . Projected US urology workforce per capita, 2020-2060. JAMA Netw Open. 2021; 4(11):e2133864. Crossref, Medline, Google Scholar 4. Representation matters: trust in digital health information among Black patients with prostate cancer. J Urol. 2024; 211(3):376-383. Link, Google Scholar 5. Do phosphodiesterase type 5 inhibitors increase the risk of biochemical recurrence after radical prostatectomy?. J Urol. 2024; 211(3):400-406. Link, Google Scholar 6. Prospective multicenter evaluation of pain before and after removal of nonobstructing renal calculi: a CoRE initiative. J Urol. 2024; 211(3):436-444. Link, Google Scholar © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 3March 2024Page: 339-340 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information D. 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