Abstract

Objective

This study aimed to evaluate the reliability and quality of YouTube videos of transperineal prostate biopsy (TP-bx) procedures using different scoring systems.

Materials and Methods

Video searches were conducted on YouTube using the keyword ‘transperineal prostate biopsy’. All English-language videos longer than 2 minutes featuring the TP-bx procedure were ranked by relevance and popularity. Global quality scores (GQS) and reliability scales were used to analyze video quality and content. The validated video power index (VPI) was used to assess video popularity, and the TP-bx score (TPBs) was used to measure video content value.

Results

While experts (53.3%) comprised the main category among the 60 videos included in the study, the largest target group was physicians (88.3%). Technical information (43.3%) constituted the main content, and the region with the highest uploads was the United States (56.7%). The majority of videos included audio (96.7%); 33.3% focused mainly on single free-hand. The median scores of VPI, GQS, and TPBs were 0.03, 3, and 12.5, respectively. These scores are correlated. GQS and modified DISCERN scores were significantly higher for academic and technical videos (p=0.041, p=0.000), while Journal of the American Medical Association scores were significantly higher for academic and audio videos (p=0.001, p=0.004). Similarly, academic and technical videos were found to be of high quality (p<0.001).

Conclusion

The use of TP-bx videos is not yet standardized and is less effective than written resources. Healthcare professionals have a responsibility to create these resources and direct patients to reliable sources of information.

What’s known on the subject? and What does the study add?

Transperineal prostate biopsy is recommended to reduce the risk of infectious complications. Given that patients and physicians rely on YouTube videos for information, assessing the reliability of video sources is crucial. This study aimed to assess the quality and reliability of transperineal prostate biopsy videos.

Introduction

Prostate cancer is the second most prevalent solid-organ cancer after lung cancer, with sixty percent of cases occurring in the geriatric population (1-3). It remains a major issue in public health. Nonetheless, conducting a prostate biopsy is crucial for diagnosing and treating cancer (4).

Traditionally, prostate biopsies have been conducted using a transrectal approach (4, 5). Nonetheless, the occurrence of infectious complications and the emergence of resistant strains linked to transrectal methods have prompted the exploration of alternative techniques (5). As a result, the transperineal method has garnered attention. Transperineal prostate biopsy (TP-bx) has become the preferred approach due to its comparable prostate cancer detection rates, minimal infectious complications, reduced antibiotic use, and straightforward access to anterior prostate tissue (5).

YouTube, established in the early 2000s, is a video platform that has gained global popularity due to its user-friendly features (6). Although it serves as a medical information resource, the platform also poses a risk of disseminating misinformation because the accuracy of uploaded videos is not verified (7).

Numerous medical conditions have been repeatedly evaluated in YouTube videos (8-12). However, the increasingly popular TP-bx has not yet been assessed. This study aims to fill this gap in the existing literature.

Materials and Methods

On August 11, 2025, we searched for the term “transperineal prostate biopsy” on https://www.YouTube.com/ and organized all videos featuring the TP-bx procedure by relevance and popularity. All English-language videos exceeding 2 minutes in length that were pertinent to the subject were examined. Videos lacking English audio or subtitles, those that were repetitive or unrelated to TP-bx, or those shorter than two minutes were excluded. Because all videos were publicly available on YouTube, institutional review board or ethics committee approval was not required for this study. An informed consent form was not required for the video evaluation because the video provider provides free access to the general public.

Once the videos included in the study were cataloged, they underwent independent analysis and scoring by two urologists, Reha Girgin and Engin Denizhan Demirkıran. The level of agreement between the raters was assessed using a weighted kappa score. In cases of discrepant scores, a third evaluator, Yavuz Mert Aydın, was brought in, and the score agreed upon by the majority of evaluators was adopted.

Video quality and content were evaluated using the DISCERN scale, the global quality score (GQS), the Journal of the American Medical Association (JAMA) scoring system, and the newly introduced TP-bx score (TPBs).

Video quality was categorized into three levels according to GQS scores: scores of 1-2 were deemed insufficient, a score of 3 was considered moderate, and scores of 4-5 were rated as good.

DISCERN serves as the inaugural standardized quality index for consumer health information, enabling manufacturers, healthcare professionals, and patients to assess written details about treatment options (13). In this study, we employed the modified DISCERN score, which includes five questions (14).

The GQS is a five-question scale designed to assess the quality, flow, and user-friendliness of Internet videos; each question is rated from 1 to 5. Scores of 1 or 2 indicate low quality, a score of 3 signifies medium quality, and scores of 4 or 5 denote high quality (15).

The JAMA scoring system serves as a tool for assessing the quality and trustworthiness of videos found on health-related websites. It includes four criteria, each of which can receive a score of 1 (16).

The TPBs for TP-bx was developed by our clinic’s urologists (Reha Girgin, Engin Denizhan Demirkıran, Yavuz Mert Aydın), who have extensive experience with transrectal prostate biopsies in their routine practice, by modifying the scoring system established by Jain et al. (7) This score comprises 16 questions assessing the procedure, imaging techniques, and potential complications associated with TP-bx. The scoring scale ranges from 0 to 42 (Figure 1).

Since 2014, the patient education materials assessment tool (PEMAT) questionnaire has been employed to assess audiovisual content in two primary domains: understandability and actionability (17). The understandability section includes thirteen questions, while the actionability section comprises four questions; responses are “agree,” “disagree,” or “not applicable.” To determine the total understandability and actionability scores for each video, the following formula is used: (total score/total possible score×100). A score exceeding 70% indicates the video is understandable or actionable (18).

The categorization of the videos is shown in Table 1.

The popularity of each video was assessed using the video power index (VPI), calculated by Erdem and Karaca’s (19) formula: (like rate×view rate)/100. The like rate and view rate are calculated as “like/dislike+dislike^*100” and “number of views/time on YouTube,” respectively (20).

Statistical Analysis

Median (min-max) and frequencies were used to describe demographic data. The Mann-Whitney U test and the Kruskal-Wallis test were used to compare two groups and three or more groups, respectively. The Dunn-Bonferroni method was used for post-hoc analysis of the Kruskal-Wallis test to assess statistical significance. Bivariate correlation analysis was performed using Spearman’s rank correlation test. Statistical analysis was performed at the 95% confidence level and using a significance threshold of p<0.05. All analyses were performed using the IBM SPSS Statistics for Windows, version 22 (Armonk, NY, USA).

Result

After excluding 114 of the 174 videos listed (Figure 2) the categorical and demographic characteristics of the 60 videos included in the study are documented in Table 1. The kappa analysis scores, which assess inter-rater variability for the specified parameters, indicated overall consistency. The weighted kappa scores for GQS, DISCERN, JAMA, PEMAT-understandability (PEMAT-U), PEMAT-actionability (PEMAT-A), and TPBs were 0.803, 0.855, 0.875, 0.855, 0.892, 0.873, and 0.809, respectively. The primary source of video uploads was academia (53.3%), and the main target audience was physicians (88.3%). The largest proportion of the video content focused on technical information (43.3%), and the United States was the leading region for uploads (56.7%). Most videos (96.7%) had English audio; 33.3% focused on the single free-hand technique. The videos had between 96 and 1,554,846 views. The duration of the longest video was 4,161 seconds, while the shortest lasted 136 seconds. The number of likes varied between 0 and 2,300, and none of the videos received any dislikes. The median time since the videos were uploaded to YouTube was 4,076 days (Table 1).

Alongside the quality of the videos categorized by GQS [median: 3 (1-5)], m DICERN [median: 3 (1-5)], JAMA [median: 2 (1-4)], and TPBs scores [median: 12.5 (6-25)] (Table 1).

In the video category, both GSQ and mDICERN were statistically significant with respect to content (p<0.05). JAMA reported statistically significant differences in videos by category and language format (p<0.05). However, the TPBs score was not statistically significant for any video feature (Table 2). For videos, PEMAT-U scores differed significantly with respect to process and animation format (p<0.05). However, the scores for VIP, PEMAT-A, and TPBs were not statistically significant for any video feature (Table 2).

Upon examining the video categories, it becomes evident that academic content scores higher on GSQ (3.28±1.05, 0.041), DISCERN (3.78±1.26, 0.000), and JAMA (2.85±0.79, 0.001). Although the differences in VPI and TPBs scores within the academic subgroup are not statistically significant, they remain higher (Table 2).

Within the content-categorization subgroup, GSQ and mDICERN scores were notably higher for “technical information,” with values of 3.11±1.34 (p=0.000) and 3.73±1.22 (p=0.028), respectively. Although the differences did not reach statistical significance, the scores for VPI, JAMA, and TPBs were higher in the ‘comprehensive technical and practical information’ subgroup (Table 2).

When categorizing video procedures, the GQS, mDICERN, and JAMA scores were higher for videos that did not specify a particular procedure; however, the difference was not statistically significant. Conversely, the PEMAT-U score was notably lower in videos lacking a focus on a specific procedure. The VIP score was elevated in videos featuring the “single free hand” procedure, while the TPBs score was higher in videos showcasing the “devise free procedure,” yet neither of these differences reached statistical significance (Table 2).

Video sources indicate that videos from Asia scored higher on GQS, mDISCERN, JAMA, and TPBs, although these differences were not statistically significant (Table 2).

When videos are categorized by GQS into poor, medium, and high quality, JAMA, mDISCERN, and TPBs scores are higher in high-quality videos. Additionally, high-quality videos tend to be significantly longer. Videos that include academic and technical content are classified as high quality; those that are device-free and combined fall into the medium-quality category; commercial, practical, and advertising videos, as well as those targeting patients, are considered low quality (Table 3).

There were strong correlations between GQS and mDICERN (r=0.769) and between GQS and JAMA (r=0.626), as shown in Table 4. A moderate relationship was observed between TPBs and mDICERN, JAMA, and GSQ (r=0.452, r=0.523, and r=0.550, respectively). Additionally, weak inverse correlations were noted between PEMAT-U and GQS, mDISCERN, and JAMA (r=-0.299, -0.260, and -0.324, respectively). A weak inverse relationship was also observed between PEMAT-A and JAMA (r=-0.226). There was no association between VIP and any of the rater parameters, as indicated in Table 4.

Discussion

In our study, we assessed all aspects of TP-bx videos. The assessments indicated that the majority of the videos were of poor quality, irrelevant, and not patient-centered. Consequently, the video content was reviewed and excluded based on criteria from comparable studies in the literature (19, 21).

Social media is now a preferred source for patients because it is easily accessible, and YouTube is one such platform. It has been shown that patients turn to social media when they are unable to obtain the necessary information from healthcare professionals (22). It is emphasized that the quality of social media data can also determine the behavior of those who benefit from this information (23).

We employed scoring systems frequently cited in the literature to assess video quality (24, 25). Additionally, we examined the videos for their clarity and practical applicability (17). Furthermore, we used the TPBs scoring system, which we created anonymously for this study.

The TPBs scoring system we developed assesses the videos’ compliance with standards because patients may consider them sources of information. The literature has shown that medical videos increase patients’ ability to understand procedures before surgery and have a positive impact on patient satisfaction (26, 27). Patients still need easily accessible, comprehensive, and understandable visual materials.

Our research indicates that the absence of high-quality videos, even when they are aimed at healthcare professionals, prevents us from endorsing transperineal biopsy videos as reliable sources. This conclusion aligns with the findings of a study by Jain et al. (7), which assessed the quality of transrectal biopsy videos. As highlighted by Baran and Yilmaz Baran (23) in their urinary incontinence videos, our research similarly found that these videos generally lacked clarity and practical utility. While animated videos and those not detailing a specific procedure were the easiest to understand, none were applicable.

In our study, the videos primarily contained academic and technical information, were aimed at specialists, and lacked a specific methodology. Despite their higher quality, these videos are not expected to be preferred by patients. The limited quantity and straightforward nature of animated videos imply that they could be more beneficial for patients. Tonyali (28) highlighted this point in his research and recommended that publishers produce videos tailored specifically for patient use.

GQS is a scale used to determine whether a publication is useful to patients (29). In our study, we used GQS scores to classify video quality. Therefore, we conducted our evaluation similarly to Tonyali’s study (28). In our study, we found that the GQS correlates strongly with scores from JAMA, mDISCERN, and PEMAT. Therefore, we recommend that publishers produce videos based on these evaluation criteria.

Study Limitations

Our study had certain limitations. One of the main limitations was the small number of videos. Nonetheless, based on examples from the literature, we are confident that this quantity is adequate. Second, we input a single keyword into the search engine. It is evident that employing various keywords increases the likelihood of encountering irrelevant videos and obtaining inaccurate results. Even though the videos were assessed independently, the outcomes may reflect the reviewer’s perspective. Nonetheless, we believe that the approach employed in similar research establishes a benchmark. Future research should explore a broader range of videos by employing diverse search terms and utilizing different platforms. Third, the TPBs was developed by urologists experienced in performing transrectal prostate biopsies. Although they do not routinely perform TP-bx in their clinical practice, the TPBs, which was created based on their clinical experience and knowledge, was consistent, but needs further validation. It is recommended that standardized, patient-centered content be developed in partnership with medical institutions. Despite these limitations, we are confident that our study will contribute valuable information to the literature.

Conclusion

In conclusion, visual media offer patients a convenient way to access information. However, it appears that this resource remains below standard and is less effective than written sources. Unfortunately, this also applies to TP-bx videos. We believe that healthcare professionals have a responsibility to create these resources and to direct patients to reliable sources of information.