Dear Colleagues, This issue of “Urological Science,” number 37(2), shows how quickly modern urology is changing. New technologies and strong meta-analytical evidence are coming together to improve clinical outcomes and patient experiences. The articles below show how committed we are to precision medicine and patient-centered care, from the use of immersive virtual environments to the careful improvement of surgical techniques. One of the best parts of this issue is a thorough systematic review and meta-analysis by Azis et al that looks at how effective and safe virtual reality (VR) is as a way to divert patients who are having urological treatments. Urological diagnostics and therapies, including cystoscopy and prostate biopsies, frequently induce considerable patient discomfort and anxiety, underscoring the necessity for nonpharmacological adjuncts. The study, which looked at 830 people in 6 randomized controlled trials, shows that VR dramatically lowers patient-reported pain scores, heart rate, and systolic blood pressure during procedures. VR efficiently distracts from surgical stimuli by offering immersive, multimodal experiences, frequently showcasing tranquil natural vistas such as snowy mountains or undersea environments. The study importantly shows that these benefits can be had without much increasing the length of the surgery and with very little negative side effects. This research establishes a robust basis for the extensive clinical implementation of VR to improve patient comfort in outpatient environments. Continuing the theme of evidence-based surgical improvement, Mustafa et al report a new meta-analysis on how well tranexamic acid (TXA) works to reduce bleeding during transurethral resection of the prostate. Even though surgical techniques have improved, perioperative bleeding is still a big problem with transurethral resection of the prostate, and blood transfusions are sometimes needed. The scientists analyzed data from 13 studies with 1127 patients and discovered that giving TXA intravenously or on the skin is linked to a much lower drop in hemoglobin levels and less blood loss during surgery. Additionally, the administration of this antifibrinolytic drug was associated with decreased surgical durations and a reduction in the duration of catheterization. This meta-analysis presents strong evidence that TXA can enhance procedural efficiency and diminish perioperative complications in patients with benign prostatic hyperplasia, while additional multicenter trials are advocated to standardize the dose. Technology plays a part in more than just the operating room; it also plays a role in medical education and advanced oncology. Tan et al present a timely systematic evaluation assessing the efficacy of artificial intelligence chatbots in responding to urology board and guideline-based inquiries. Their results show a clear pattern of progress with each new edition, with ChatGPT-4.0 getting an average accuracy of 81.4%. The authors correctly point out that artificial intelligence should only be used as an addition to medical education, not as a replacement for it. In the field of advanced prostate cancer, Yamaguchi et al present substantial pathology results from a decade-long investigation into robot-assisted radical prostatectomy. Their study shows that sustained neoadjuvant hormone therapy for 10 months or more can cause a “vanishing cancer” effect, with 24% of patients reaching pT0 state. This indicates that extended neoadjuvant hormone therapy may substantially diminish positive surgical margins and biochemical recurrence in Japanese patients with advanced illness. Last but not least, Chen et al’s 17-year experience with 100 urethroplasties serves as a reminder of how reliable well-known surgical treatments like buccal mucosa graft-augmented urethroplasty are over time. In northern Taiwan, these methods still have success rates as high as 95%.
Hung‐Jen Wang (Wed,) studied this question.