Background: Domain-specific large language models (LLMs) like Ortho GPT have potential advantages over general-purpose models in medical education, offering improved factual accuracy and contextual relevance. This study evaluates the performance of Ortho GPT against general LLMs and senior medical students on validated orthopedic examination questions. Methods: Six LLMs (Ortho GPT 4o, ChatGPT 4o, ChatGPT 3.5, Perplexity AI, DeepSeek-R1, and Llama 3.3-70B) were tested using multiple-choice items from final-year medical student orthopedic exams in German language. Each model answered identical questions under standardized zero-shot conditions; accuracy rates and item-level results were compared using McNemar’s test, Jaccard similarity, and point-biserial correlation with student difficulty ratings. Results: Ortho GPT achieved the highest accuracy across models. McNemar’s tests revealed the significant superiority of Ortho GPT over DeepSeek (p = 2.33 × 10⁻³⁵), Llama 3.3-70B (p = 1.11 × 10⁻³²), and Perplexity (p = 4.01 × 10⁻⁵). Differences between Ortho GPT and ChatGPT 4o were non-significant (p = 0.065), suggesting near-equivalent performance to the strongest general model. No LLM showed correlation with student item difficulty (|r| < 0.07, p > 0.05), indicating that models solved items independently of human-perceived difficulty. Jaccard indices suggested moderate overlap between Ortho GPT and ChatGPT 4o, but distinct response profiles compared with general LLMs. Conclusions: These findings illustrate the superiority of Ortho GPT in orthopedic exam accuracy and context relevance, attributed to its specialized training data. The domain-specific approach enables performance matching or exceeding top general LLMs in orthopedics, emphasizing the importance of domain specialization for reliable, curriculum-aligned support in medical education.

Background: Up to 50% of patients with benign prostate hyperplasia (BPH) face post-operative complications after transurethral prostate Surgery. This includes nearly 15% of patients suffering from prolonged post-operative pelvic pain (pPPP) consisting of dysuria and prostatodynia for sometimes several months post-surgery. This study elucidates and proposes a definition of the multi-dimensional nature of prolonged post-operative pelvic pain (pPPP) after transurethral prostate surgery by providing real-world data on therapeutic options and their efficacy. Methods: German and international urologic practitioners participated in an online-survey after invitation via social media accounts and newsletters. The survey included questions on the amount of expertise, the therapeutic regimens for prolonged post-operative pelvic pain (pPPP) and the expected therapy outcome. Participation was voluntary and uncompensated. Chi-Square tests and Student’s t-tests were used for descriptive statistics. Results: 67 German urologists participated in a 9-question online Survey. 94,0% treated patients with lower urinary tract symptoms and 85,1% disclosed their therapeutic regime for prolonged post-operative pelvic pain (pPPP). The most common treatments included anti-inflammatory medication (69,6%), anti-cholinergics (53,6%), alpha-blockers (51,8%) and pelvic physiotherapy (50,0%). Over half of the patients responded to the therapeutic approach, but only 5,4% of urologists anticipated full pain relief after one year. These findings are closely aligned with a recent international survey (n=230). Notably, German urologists more frequently prescribed anti-cholinergics (53,6% vs. 28,7%, p = 0,0004), herbal remedies like saw palmetto (25,0% vs. 6,5%, p < 0,0001) and non-pharmacological therapies (82,1% vs. 49,1%, p < 0,0001), but less anti-inflammatory drugs (69,6% vs. 88,7%, p = 0,0003), gabapentin/pregabalin (8,9% vs. 42,2%, p < 0,0001) and opioids (0% vs 5,7%, p = 0,0221). Based on these results a structured definition and therapy plan for prolonged post-operative pelvic pain (pPPP) is proposed. Conclusion: Prolonged post-operative pelvic pain (pPPP) is a common challenge for urologists. Despite various therapeutic options, treatment outcomes and practitioner confidence remain suboptimal. Further research and attention to prolonged post-operative pelvic pain (pPPP) are essential to develop evidence-based guidelines for effective patient management and prevention of chronic pain syndromes.

Background To provide more evidence in urolithiasis research, we have established the German Nationwide Register for RECurrent URolithiasis (RECUR) using local clinical data warehouses (CDWH). For RECUR and other registers relying on digitalized clinical data, it is crucial to ensure the data’s reliability for answering scientific questions. In this work, we aim to compare the results of different CDWH-based queries on urolithiasis cases next to manual case extraction from the primary source. Methods Sources for data extraction included the Medical Center University of Freiburg (MCUF) hospital information system (HIS), MCUF performance data (a clinical data set with merged data from patients including data from vari-ous time points throughout their treatment), and MCUF reimbursement data. We extracted data on caseloads in urolithiasis algorithmically (performance and reimbursement data) and compared those to a reference group compiled of man-ually extracted data from the local HIS and algorithmically extracted data. Results Algorithmic extraction based on performance data resulted in correct and complete case identification as compared to the reference group. The case numbers from manual extraction from HIS data and algorithmic extraction from reimbursement data differed by 14% and 12%, respectively. The reasons for devi-ations in HIS data included human errors and a lack of data availability from different wards. Deviations in reimbursement data arose primarily due to the merging of cases in the context of reimbursement mechanisms. As the CDWH at MCUF is part of the German Medical Informatics Initiative (MII), the results can be transferred to other medical centers with similar CDWH structure. Conclusions The current study provides firm evidence of the importance of clearly defining a study’s target variable, e.g., urolithiasis cases, and a thorough understanding of the data sources and modes used to extract the target data. Our work clearly shows that, depending on various data sources, a case is not a case is not a case.

Background.: This monocentric, randomized controlled trial aims to compare the outcomes of kidney transplant recipients with magnetic double-J (DJ) stents versus conventional DJ stents. Specifically, we assessed stent-related symptoms, procedural difficulties, pain and duration of removal, and associated costs. Methods.: A total of 30 patients were randomly assigned to receive either a magnetic DJ (mDJ) stent or a conventional, standard DJ (sDJ) stent during kidney transplantation using the Lich-Gregoir technique. Quality of life was evaluated with the USSQ 7–10 d postoperation. sDJs stents were removed cystoscopically by a urologist while mDJ stents were removed bedside by a transplant surgeon. The duration of removal and procedure-associated pain were documented. Questionnaires for physicians and patients were used to assess peri-interventional experience and issues. Additionally, costs associated with the removal of both stents were analyzed. Results.: Quality of life showed no differences between the groups. Stent removal was successful in all cases, with no differences in duration of removal (P = 0.24) or major issues. Patients reported comparable pain levels during the removal of mDJs (P = 0.55) and higher satisfaction, although this was not statistically significant (P = 0.27). Cost analysis revealed a reduction of approximately €172 with the use of mDJ. Conclusions.: The use of mDJ stents in kidney transplantation is a safe alternative associated with comparable pain during removal. Additionally, it offers cost savings and reduces the logistical burden for both patients and hospitals.

Endoscopic enucleation of the prostate (EEP) using holmium:YAG laser (HoLEP) is widely regarded as the surgical gold standard for surgical management of benign prostatic hyperplasia. EEP with a pulsed thulium:YAG laser (ThuLEP) has emerged as an alternative with distinct physical properties that may influence surgical performance. However, evidence on the real-world impact of switching between laser platforms remains limited. In this retrospective single-center study, we analyzed 2688 consecutive EEP procedures performed between 2015 and 2025. Three high-volume surgeons transitioned from HoLEP (n = 1516) to ThuLEP (n = 1172) without retraining. Baseline characteristics, complication rates, and efficiency metrics were compared. Segmented regression analysis was used to evaluate temporal changes in performance across the laser transition. Baseline parameters were comparable between the HoLEP and ThuLEP groups. ThuLEP was associated with significantly lower incidence of postoperative urinary retention (5.6% vs 9.3%; p = 0.0005) and a lower need for transurethral coagulation (3.0% vs 4.6%; p = 0.0471). EEP efficiency was higher with ThuLEP (0.93 ± 0.49 vs 1.64 ± 1.03 g/min; p < 0.001), accompanied by higher energy consumption (898.2 ± 692.1 vs 1,051.7 ± 1,003.3 J/g; p < 0.001). Segmented regression revealed an initial rise in efficiency after the transition, followed by mild performance fluctuations, which indicates a short adaptation phase. A transition from HoLEP to ThuLEP with a pulsed thulium:YAG laser is safe and feasible in experienced hands. ThuLEP was associated with higher enucleation efficiency and a statistically significant improvement in hemostatic control, without an increase in complication rates. These findings highlight the procedural adaptability of laser EEP techniques and support the clinical viability of platform switching in high-volume settings. We looked at outcomes in >2600 patients who underwent prostate surgery using two different laser systems. After switching from a holmium laser to a thulium laser, surgeons performed procedures more efficiently and with fewer cases of urinary retention and bleeding. This suggests that experienced surgeons can safely switch to newer laser systems without compromising patient care.