Nowadays, surgical treatment of kidney stones is solved by a more detailed examination of all alternatives by the patient, with multiple endourological modalities and the use of a shared decision-making mechanism between patient and physician. In contrast to conventional treatments, technological developments offer less invasiveness and a higher stone-free rate. In addition, patient involvement in treatment decisions increases the success of the procedure and patient satisfaction [13–14]. One of the most important sources of information for patients today is the internet and the video portal YouTube which plays an important role, especially when searching for surgical treatment procedures. Recently, a lot of reseach has been done on the potential of YouTube videos to help patients with health decisions and chronic diseases. Furthermore, it is noteworthy that the producers of these videos and the viewer-patient group are trying to reach the acceptable standards that are currently used [15, 16].
A recent study questioned whether PCNL, one of the endourological stone treatment procedures, generated more interest on social media platforms than URS and ESWL, but the quality of the video was insufficient in terms of content and information . In parallel, in our current study, despite the high rate of specialists uploading (61.9%) of patient-targeted mPCNL videos, the evaluator scoring (GQS, Reliability Scores, mPNLScores) and the lower VPI suggest that healthcare professionals should take more responsibility in such studies.
In the current study, the statistically significant high value of VPI, video length, and evaluator scores in academic-sourced, Physicians-targeted, and English-sounded videos was noted with higher median values in the Entire and Comprehensive subgroups within the video content and procedure categories. This result shows that academic videos have more comprehensive and higher quality content in the subgroup analysis.
In the study of Spradling et al. it was found that the most important factors for patient preference in the choice of kidney stone treatment were a high stone-free rate, minimal hospital stay and a lower risk of complications . Although in our study, the stone-free rate was shared in the patient-targeted videos, it was notable that the rate of mentioning postoperative complications and hospitalisation was lower than the academic and physician-targeted uploads ( Physicians and Patients mPNLs 11,5 (4–15) and 9 (3–15), respectively; p < 0,001).
There are only a few articles in the literature on the informative role of social media and internet search engines in kidney stone surgery. Sood et al. in their study, in which they categorize videos as useful, misleading and personal views, they did not use any scoring for useful categorization and sought the condition of ‘correct information about any aspect of disease: prevention, symptoms, treatments, or other information'. While they didn't include healthcare professionals in the uploading source, they found that the high percentage of useful videos uploaded by the University Channel provided the best overall coverage with a statistically significant average viewership/day and rating ratio . In support of this statement, in our study, VPI, which had a high correlation with evaluator scores, was found to be statistically significantly higher in academic videos with high evaluator scores. As a result, these characteristics could be guided viewers to useful videos.
In a national video reliability study in which PNL and URS were the most frequently mentioned treatment modalities, the weighted loading source was urologists or academicians, and a higher rating rate was found compared to other sources . If we do not count the intense interest in herbal therapy/ alternative medicine videos in both studies based on [18, 19], the videos of health professionals with high accuracy and monitoring rate are a promising result commented on YouTube-based knowledge and education augmentation.
Thanks to the technological developments, the transition from open surgical methods to endourological procedures in the treatment of kidney stones has achieved higher stone-free rate with minimal morbidity, and recently, a higher stone-free rate has been achieved with miniaturized methods has been modified with a smaller tract diameter, minimal postoperative scar tissue, shorter hospitalizations and less labor loss. While ESWL had the highest Search Volume Index between 2011 and 2017, the increase in the application rates of mPCNL and RIRS, which stand out as the most minimally invasive surgical methods today, is also reflected in the video rates on popular video sharing sites [20, 21]. In the study of Pratsinis et al., RIRS videos were the most frequently defined but had the lowest content quality score, while the PCNL procedure with less video ratio had higher content quality. It was recommended that YouTube videos should not guide treatment selection because the uploads included in the study had high audio, good video quality and high viewership, but low content quality in the evaluation survey . Nowadays, the relationship between internet search data and disease prevalence also directs marketing and advertising strategies. The low VPI and evaluator scores of patient-targeted videos in the current study suggests that commercial and advertising concerns are prominent in video sharing platforms compared to information and content richness. In our study, the most common video type in video content categorization was operation procedure videos, while we found higher evaluator scores and longer video duration (p < 0.001) and lower VPI (1,04 [0–81,10]; p:0,224) in the Comprehensive subgroup in which more than one subject was discussed. We attributed this statistical difference to the fact that the uploads were mostly academic-sourced and physicians-targeted videos. Once again, the high VPI (1,256 [0–55,75]; p:0,015) and evaluator scores (for GQS 4 [1–5]; p:<0,001, for Reliability 3 [1–5]; p:<0,001, for mPNLs 10,5 [4–15]; p: 0,007) of the English-sounded videos show that healthcare professionals should pay more attention to audio asistance and product quality of uploads instead of subtitled videos in order to direct the target audience to scientific products.
Although there is no specific study evaluating YouTube videos on PCNL in the literature, PCNL videos were also evaluated in the surgical treatment of kidney stones, and despite conflicting comments for the overall video quality among these studies, acceptable survey scores were reported for PCNL videos. [18, 19, 21]. However, the lack of a check list score in the mentioned studies and the fact that some studies do not consider videos on full objective criteria make the accuracy and reliability of PCNL videos questionable. In the current study, validated GQS and reliability scores as well as mPCNL scoring created by 2 endourologists were used to evaluate mPCNL videos, which has a specific treatment modality for kidney stone surgery. The high correlation of these three scorings with each other confirmed the objectivity of our checklist scoring and the results we obtained.
In a recent study, on the analysis of videos on RIRS which has a similar indication area as mPCNL, video content and evaluation scores were found to be lower than our study. The median (interquartile range) GQS, JAMAS, RIRSSS, and VPI scores were 2 (1–3), 1 (1–2), 2 (1–5), and 0.41 (0.08–1.29), respectively (22). In his study, Tonyali has emphasized that the informative value of RIRS videos is insufficient for patients, due to the low rate of patient-targeted videos (12.7%) and evaluation scores, and the content of the videos usually consists of technical aspects (84.1%). While only 2 evaluators were scoring in the study, the controversial videos were discussed again and a consensus was reached. In our study, despite the high kappa analysis score, we believe that evaluator scores provide a more objective consensus score by seeking the opinion of a third author for the controversial videos. In our study, the rate of patient-targeted video (61.9%) and operation procedure video (68.3%) was found to be higher. However, the low VPI and evaluator scores of these videos indicate that the educational and procedural selection value should be questioned. In both studies, two procedures, which use high technology and are frequently used in current stone surgery, were discussed, but RIRS came to forefront with its more physician targetted side and the technical information it contained. The similar steps of mPCNL to standard PCNL explain the neglect of the technical aspect of the procedure.