Tag Archive for: aotw 22-04-2020


Article of the week: Information on surgical treatment of benign prostatic hyperplasia on YouTube is highly biased and misleading

Every week, the Editor-in-Chief selects an Article of the Week from the current issue of BJUI. The abstract is reproduced below and you can click on the button to read the full article, which is freely available to all readers for at least 30 days from the time of this post.

In addition to this post, there is an editorial written by a prominent member of the urological community and a visual abstract for a swift overview of the article. Please use the comment buttons below to join the conversation.

If you only have time to read one article this week, we recommend this one. 

Information on surgical treatment of benign prostatic hyperplasia on YouTube is highly biased and misleading

Patrick Betschart*, Manolis Pratsinis*, Gautier Müllhaupt*, Roman Rechner*, Thomas RW Herrmann, Christian Gratzke, Hans–Peter Schmid*, Valentin Zumstein* and Dominik Abt*

*Department of Urology, Cantonal Hospital St Gallen, St Gallen, Urology Clinic, Spital Thurgau AG, Frauenfeld, Switzerland, and Department of Urology, Albert–Ludwigs–University, Freiburg, Germany



To assess the quality of videos on the surgical treatment of lower urinary tract symptoms associated with benign prostatic hyperplasia (LUTS/BPH) available on YouTube, given that such video‐sharing platforms are frequently used as sources of patient information and the therapeutic landscape of LUTS/BPH has evolved substantially during recent years.

Materials and Methods

A systematic search for videos on YouTube addressing treatment options for LUTS/BPH was performed in May 2019. Measures assessed included basic data (e.g. number of views), grade of misinformation and reporting of conflicts of interest. The quality of content was analysed using the validated DISCERN questionnaire. Data were analysed using descriptive statistics.

Fig. 1. Degree of misinformation compared to currently available evidence on surgical BPH treatment 7 (no: green; very little: light green; moderate: light blue; high: light red; extreme: dark red), rate of commercial bias (yes: red; no: light green) and rate of declaration of conflicts of interests (COI; yes: blue; no: orange) for the analysed videos divided by topics. BipolEP, bipolar enucleation of the prostate; HoLEP, holmium laser enucleation of the prostate; iTIND, temporary implantable Nitinol device; PAE, prostatic artery embolization; ThuLEP, thulium laser enucleation of the prostate


A total of 159 videos with a median (range) of 8570 (648–2 384 391) views were included in the analysis. Only 21 videos (13.2%) were rated as containing no misinformation, 26 (16.4%) were free of commercial bias, and two (1.3%) disclosed potential conflicts of interest. According to DISCERN, the median overall quality of the videos was low (2 out of 5 points for question 16). Only four of the 15 assessed categories (bipolar and holmium laser enucleation of the prostate, transurethral resection of the prostate and patient‐based search terms) were scored as having moderate median overall quality (3 points).


Most videos on the surgical treatment of LUTS/BPH on YouTube had a low quality of content, provided misinformation, were subject to commercial bias and did not report on conflicts of interest. These findings emphasize the importance of thorough doctor–patient communication and active recommendation of unbiased patient education materials.

Editorial: Fake news about benign prostatic hyperplasia on YouTube

YouTube is a widely used video‐sharing and social networking platform. It contains a large volume of content about medical topics, including urological conditions. In this issue of BJUI, Betschart et al. [1] examined the quality of 159 YouTube videos about surgical treatment of BPH with ≥500 views. The median overall quality of videos was poor (2 out of 5 possible points) based on validated criteria for the assessment of consumer health information. Nearly 87% of videos contained some misinformation and 84% had commercial bias.

We previously reported similar findings in the first 150 videos in a YouTube search for prostate cancer [2]. The median overall quality of videos was moderate (3 out of 5 points), and 77% contained biased and/or misinformative content in the video or comments beneath it. Furthermore, videos with lower expert‐rated quality had higher user engagement.

In the study by Betschart et al. [1], most of the YouTube videos about BPH had very good production quality, and 69% were posted by healthcare providers (e.g., doctor, clinic, hospital or university). These attributes might lead health consumers to have more trust in the information that is provided. In fact, they found that two‐thirds of videos with the most views in each topic had a quality score below the median score for videos about that topic.

Unfortunately, these issues are pervasive across many health domains. A recent review article reported on the prevalence of commercial bias and misinformation in social media posts about a variety of urology topics, including female pelvic medicine, endourology, sexual medicine, and infertility [3].

What can be done to combat the large quantity of misinformative urological information circulating online? For BPH on YouTube alone, Betschart et al. [1] reported that there were >12 000 videos as of May 2019. It is not practical for medical experts to manually vet the vast and continually changing repository of online medical information.

One future possibility is the development of computational tools to help evaluate the quality of information. For example, using an annotated dataset of 250 YouTube videos about prostate cancer, we created an automatic classification model for the identification of misinformation with an accuracy of 74% [4]. Further study is warranted to develop and test the use of machine learning to help filter the quality of online content.

As healthcare providers, what can we do to address these problems in the near‐term? We previously reported that USA adults who perceive worse patient‐physician communications are significantly more likely to watch health videos on YouTube [5]. This highlights the importance of shared decision‐making and proactively directing our patients to trusted sources of information. A curated list of reputable sources of online urological health information is presented in a recent review [6]. In addition, healthcare providers should be encouraged to actively participate in social media to flag any content that is inaccurate or dangerous and to help provide accurate information to the public. The BJUI, European Association of Urology, and AUA have all published guidance regarding best practices for social media engagement, which should be incorporated into urological education in the future [7].

In conclusion, social networks have a huge global audience and offer great potential to benefit the care of BPH and other urological conditions. However, to meet this potential and offset the risks will require significant ongoing efforts from the urological community.

by Stacy Loeb


  1. Betschart P, Pratsinis M, Müllhaupt G et al. Information on surgical treatment of benign prostatic hyperplasia on YouTube is highly biased and misleading. BJU Int 2020; 125: 595-601
  2. Loeb S, Sengupta S, Butaney M et al. Dissemination of misinformative and biased information about prostate cancer on YouTube. Eur Urol 2019; 75: 564– 7
  3. Loeb S, Taylor J, Borin JF et al. Fake News: Spread of misinformation about urological conditions on social media. Eur Urol Focus 2019 [Epub ahead of print].
  4. Hou R, Perez‐Rosas V, Loeb S, Mihalcea R. Towards Automatic Detection of Misinformation in Online Medical Videos. International Conference on Multimodal Interaction. Suzhou, Jiangsu, China: ACM, 2019. Available at: https://arxiv.org/abs/1909.01543. Accessed January 2020
  5. Langford A, Loeb S. Perceived patient‐provider communication quality and sociodemographic factors associated with watching health‐related videos on YouTube: a cross‐sectional analysis. J Med Internet Res 2019; 21: e13512. 
  6. Langford AT, Roberts T, Gupta J, Orellana KT, Loeb S. Impact of the internet on patient‐physician communication. Eur Urol Focus 2019: 31582312 [Epub ahead of print].
  7. Taylor J, Loeb S. Guideline of guidelines: social media in urology. BJU Int 2020; 125: 379-382

Visual abstract: Information on surgical treatment of benign prostatic hyperplasia on YouTube is highly biased and misleading

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