Objectives: ChatGPT is a large language model that is able to generate human-like text. The aim of this study was to evaluate ChatGPT as a potential supplement to urological clinical practice by exploring its capacity, efficacy and accuracy when delivering information on frequently asked questions from patients with bladder cancer. Methods: We proposed 10 hypothetical questions to ChatGPT to simulate a doctor–patient consultation for patients recently diagnosed with bladder cancer. The responses were then assessed using two predefined scales of accuracy and completeness by Specialist Urologists. Results: ChatGPT provided coherent answers that were concise and easily comprehensible. Overall, mean accuracy scores for the 10 questions ranged from 3.7 to 6.0, with a median of 5.0. Mean completeness scores ranged from 1.3 to 2.3, with a median of 1.8. ChatGPT was also cognizant of its own limitations and recommended all patients should adhere closely to medical advice dispensed by their healthcare provider. Conclusions: This study provides further insight into the role of ChatGPT as an adjunct consultation tool for answering frequently asked questions from patients with bladder cancer diagnosis. Whilst it was able to provide information in a concise and coherent manner, there were concerns regarding the completeness of information conveyed. Further development and research into this rapidly evolving tool are required to ascertain the potential impacts of AI models such as ChatGPT in urology and the broader healthcare landscape.

In Australia, approximately 3 % of all cancers diagnosed each year are renal cancers. Renal Cell Carcinoma (RCC) represents 90 % of all primary renal malignancies. RCC are slow growing and often asymptomatic, thus are often found incidentally.

Slow urinary flow is a common lower urinary tract symptom (LUTS) that frequently prompts men to consult their primary care physician. While bladder outlet obstruction (BOO) is well recognised, underactive bladder (UAB) remains underappreciate despite its significant impact on quality of life. This review highlights the pathophysiology, clinical features, and diagnostic challenges and approach to UAB in men. Improving recognition of UAB as a distinct condition separate from other LUTS aetiologies, it can facilitate earlier diagnosis and management. Slow urinary flow is highly prevalent, particularly in an ageing population. UAB is characterised by impaired detrusor muscle activity, leading to slow urinary flow, hesitancy, straining and incomplete bladder emptying. The overlap in symptoms with BOO often leads to misdiagnosis, delaying appropriate intervention. UAB has multiple underlying causes including, neurogenic, myogenic, iatrogenic and idiopathic factors. Diagnosis is further complicated by the limited availability of urodynamic studies, the gold standard for assessing detrusor underactivity. Current management options remain limited with no definitive treatments. Current strategies focus on behavioural modifications, pelvic floor exercises, timed voiding, sacral neuromodulation and intermittent catheterisation. Increased awareness of UAB among primary care physicians and urologists is essential for timely diagnosis and intervention. Recognition of UAB as a distinct clinical entity will lead to a reduction in potential complications and significant improvement in the quality of life of affected men.

Background: To detail the outcomes of an open midline extraperitoneal (midline EP) approach to post-chemotherapy retroperitoneal lymph node dissection (PC-RPLND) for metastatic testicular cancer. Methods: We analysed our prospectively maintained operative database from April 2020 to February 2023 for cases of midline EP approach to PC-RPLND, identifying a total of 11 patients across two hospitals in Sydney, Australia. Demographic and perioperative data was obtained from electronic medical records, including preoperative factors such as cancer staging and preoperative treatment. Results: Eleven patients were included in this study. The median age was 37 years with a median ASA grade of 3. There were a total of six left-sided and five right-sided cases. A modified template was used in eight cases, and a bilateral template was used in three. Tumour staging ranged from Stage IIA– IIIB, with a median maximal retroperitoneal tumour size post chemotherapy of 4.2 cm. Preoperative histology identified 4 cases of seminoma and 7 cases of nonseminomatous germ cell tumours (NSGCT). The median length of the procedure was 300 min, blood loss was 300mL, length of stay was 5 days, and post-operative days until bowel opening was 2 days. The median lymph node yield was 18, with active malignancy identified in five cases. There were four early complications and no late complications. 91% of the patients had preserved ejaculatory function. Conclusions: The open midline EP approach to PC-RPLND has demonstrated acceptable perioperative outcomes compared to other open surgical approaches, enabling surgeons to complete complex cases. Therefore, the midline EP approach should be considered when performing PC-RPLND.

A computed tomography intravenous pyelogram (CT IVP) is a very common investigation performed for a wide range of urological presentations such as abdominal pain and haematuria. We report a rare case of spontaneous calyceal rupture and associated haemorrhage during a CT.

Background: Transperineal prostate biopsy (TPPB) has become the preferred diagnostic approach due to superior apical sampling and a lower risk of post-biopsy sepsis, without compromising cancer detection. Although routinely performed under general anaesthesia in Australia, early post-operative pain remains common. Periprostatic nerve block (PPNB) improves tolerability when TPPB is performed under local anaesthesia, but its efficacy as an adjunct under general anaesthesia is unknown. This pilot trial evaluates whether PPNB reduces early post-operative pain and analgesic requirements following TPPB under general anaesthesia. Clinical Trial Design and Timeframe: A multicentre, double-blind, RCT conducted across three tertiary centres in Sydney, Australia. Men undergoing TPPB under general anaesthesia are randomised 1:1 to receive bilateral PPNB with lignocaine or placebo immediately prior to biopsy. Endpoints: The primary endpoint is post-operative pain measured using a 10-point visual analogue scale prior to discharge. Secondary endpoints include post-operative analgesic consumption, complication rates, procedure duration, and number of biopsy cores. Data Sources and Statistical Analysis Plan: Clinical and outcome data are collected prospectively. Between-group comparisons will be performed using independent-samples t-tests or Mann–Whitney U tests, as appropriate. Categorical outcomes will be analysed using χ² or Fisher’s exact tests. Statistical significance is defined as p < 0.05. Strengths and Limitations: This multicentre, double-blind randomised design strengthens internal validity, although the modest sample size and reliance on early patient-reported pain may limit detection of smaller effects and longer-term outcomes.