Educational value assessment of YouTube surgical videos of bladder hydrodistention for surgeons

Introduction

Interstitial cystitis/bladder pain syndrome (IC/BPS) is defined as a chronic inflammatory bladder disorder characterized by sterile inflammation, accompanied by urinary frequency, urgency, and persistent pelvic pain (1). Current epidemiological evidence indicates that the global prevalence of IC/BPS ranges from 0.01% to 6.5% (2). While the disease is rarely life-threatening, it exerts a profoundly detrimental impact on patients’ daily activities, physical health, social interactions, psychological well-being, and overall quality of life (QoL) (3). Given that the underlying etiology of IC/BPS remains elusive, the primary therapeutic objectives are to alleviate bladder pain, reduce urinary urgency and frequency, and improve patients’ QoL (4). Among the available treatment modalities—including conservative management, pharmacotherapy, and surgical intervention—bladder hydrodistention has long been recognized for its clinical efficacy (5). This intervention exerts its therapeutic effects by stretching the bladder wall, disrupting aberrant neural signal transduction, and facilitating tissue repair and regeneration (6).

E-learning, also referred to as online learning, leverages electronic technologies to facilitate knowledge acquisition and skill development, transcending the temporal and spatial constraints inherent in traditional classroom-based education and thereby emerging as an innovative and pragmatic pedagogical approach. Among the extensive array of online platforms, YouTube has evolved into the world’s second most popular search engine, owing to its high accessibility, user-friendly interface, and vast repository of diverse content (7,8). An increasing number of patients are turning to such platforms for preoperative health education and postoperative rehabilitation guidance (9), while a growing cohort of medical students are also leveraging these platforms to acquire practical clinical skills (10).

Currently, a diverse array of surgical procedure videos is available on YouTube. However, YouTube’s algorithm prioritizes user engagement over content accuracy, leading to the widespread dissemination of unverified information. For instance, 25% of the most frequently viewed coronavirus disease 2019 (COVID-19) related videos contain erroneous content (11). This issue extends to urology-focused content as well: for example, a study by Zhang et al. on holmium laser enucleation of the prostate (HoLEP) demonstrated that high-quality, evidence-based videos remain scarce (8). Bladder hydrodistention, an established effective intervention for IC/BPS, is also represented by a large volume of related videos on YouTube. However, driven by the same engagement-prioritizing algorithm, these videos face the same risk of prioritizing viewability over scientific rigor. Therefore, it is imperative to conduct a systematic evaluation of the scientific validity, transparency, and comprehensibility of YouTube videos pertaining to bladder hydrodistention.

Against this backdrop, we employed four validated assessment instruments—the Journal of the American Medical Association (JAMA) score, the Global Quality Scale (GQS) score, the Modified Discriminant (M.DISCERN) Score, and the Laparoscopic Surgery Video Educational Guidelines (LAP-VEGaS)—to conduct a multidimensional evaluation of bladder hydrodistention videos hosted on YouTube, while additionally exploring their correlations with user engagement metrics. The primary aim of this study was to assess the educational efficacy of these bladder hydrodistention videos for medical professionals. Furthermore, the insights derived from this research are expected to inform the development of a comprehensive, disease-specific educational video checklist tailored explicitly to bladder hydrodistention, addressing the current paucity of standardized guidance in this domain. We present this article in accordance with the STROBE reporting checklist (available at https://tau.amegroups.com/article/view/10.21037/tau-2026-0421/rc).

Methods

Search strategy

This cross-sectional study retrieved relevant videos from YouTube (https://www.youtube.com), with the keyword “bladder hydrodistention” used for searching and a retrieval deadline of December 15, 2025. YouTube’s default “relevance” algorithm was applied for result sorting, and an initial sample of 80 videos was selected. Notably, all surgical videos featuring bladder hydrodistention—whether performed as standalone procedures or combined with electrocoagulation of Hunner lesions—were included. The exclusion criteria were implemented in the following order: (I) non-English content; (II) videos with a duration of less than 60 seconds; (III) content unrelated to hydrodistention of the bladder; (IV) advertising or sponsored content.

Video metrics

Following initial screening, 33 videos were ultimately included in the final analysis. All YouTube videos were independently screened by two reviewers. To ensure the reliability of the screening process, a third reviewer was consulted to resolve any discrepancies between the two primary reviewers. Their scores were compared using Cohen’s kappa, showing near-perfect agreement (κ=0.80–0.95, Landis & Koch criteria) (12).

All video-related data were extracted and recorded, with the video classification criteria specified as follows: (I) source of upload (independent health information website, urologist, other); (II) content type (general information, surgery, surgery + information, or patient experience); (III) region (Europe, Asia, or America); (IV) audio availability; and (V) subtitle availability.

All other video-related data were systematically extracted and documented as follows: (I) the duration of content in seconds; (II) the time since upload in months; (III) the number of views; (IV) the number of likes; (V) the number of dislikes; (VI) the number of comments; (VII) view ratio, the number of views per day; (VIII) like ratio [likes / (likes + dislikes)]; and (IX) Video Power Index (VPI), defined as like ratio × view ratio (views per day) / 100 (13).

Video evaluation

This study initially assessed video quality using the JAMA score and the GQS score. The JAMA score employs a 4-point scale, where 1 point is awarded for meeting each of the four predefined criteria, yielding a total possible score ranging from 0 to 4 (14). The criteria are as follows: (I) authorship: complete professional backgrounds and institutional affiliations of the author and participating contributors need to be submitted; (II) attribution: comprehensive copyright statements must be displayed visibly, with formal citations and original material origins noted for all embedded content; (III) currency: the original release date of published materials, together with timelines recording all follow-up revisions, must be retained and documented; (IV) disclosure: all potential competing interests, research grants, commercial sponsorships, promotional placements, auxiliary resources, and proprietary rights to video footage require thorough open disclosure.

The GQS score uses a 5-point scoring system, with a total score ranging from 1 to 5—higher scores indicate superior video quality (15). The scoring criteria and corresponding descriptions are specified as follows: (I) poor quality: incomplete data and misleading operational guidance, with negligible value in teaching; (II) generally sparse quality: fragmentary content and flawed operation methods, offering limited educational benefits; (III) moderate quality: key data covered yet partial omissions exist, delivering moderate educational utility; (IV) good quality: most core information included with minor gaps, effective for learning given full coverage of major themes; (V) excellent quality: comprehensive complete data and proper technical design, generating prominent educational value.

Then, the reliability of the included videos was assessed using the M.DISCERN score. This tool employs a binary scoring system, where 1 point is assigned for each affirmative response, with a total possible score ranging from 0 to 5 (16). The specific evaluation items are as follows: (I) Does the material state explicit objectives and fully realize these targets? (II) Does the content draw on credible informational resources? (III) Is the content delivered objectively without one-sided or biased stances? (IV) Are extra reference materials attached for patients to look up further relevant details? (V) Does the work elaborate on unclear or unconfirmed research domains?

This study utilized the LAP-VEGaS scale to evaluate whether the included operative videos conformed to standardized procedural assessment criteria. Although LAP-VEGaS was initially developed for the appraisal of minimally invasive surgical footage, it establishes a generalizable peer-assessment framework suitable for other minimally invasive endoscopic interventions. Prior work has validated the reliability and feasibility of this rating tool for video assessment of endoscopic surgical procedures (17,18). Each item in this tool is rated on a 3-point scale: absent (0 points), moderately present (1 point), or fully present (2 points). The total score is calculated as the sum of scores for all 9 items, ranging from 0 to 18. Based on the total scores, the videos were categorized into three quality tiers: low quality (0–6 points), moderate quality (7–12 points), and high quality (13–18 points) (19).

Statistical analysis

Data were initially entered into a Microsoft Excel spreadsheet (Microsoft Corp., Redmond, WA, USA), and subsequent statistical analyses of the study results were performed using IBM SPSS Statistics 27.0 (IBM Corp., Armonk, NY, USA). Descriptive statistics were reported as follows: for continuous variables, the mean, median, and standard deviation were presented; for categorical variables, frequencies (n) and corresponding percentages (%) were summarized. Correlations between variables were evaluated using the Pearson correlation coefficient (for normally distributed continuous variables) and the Spearman correlation coefficient (for non-normally distributed continuous or ordinal variables). The chi-square test was applied for comparisons of categorical data. The Kruskal-Wallis test was used to compare median scores across multiple independent groups. Statistical significance was set at a two-tailed P<0.05.

Results

Among the 33 included videos, the majority were uploaded by practicing urologists (48.5%, n=16). The number of videos from independent health information websites (24.2%, n=8) was comparable to that from other sources (27.3%, n=9), which included patients, academic centers, and private hospitals. In terms of content classification, the most prevalent category was surgery (33.3%), followed by patient experience (27.3%). General informational content accounted for 21.2%, whereas “surgery + information” was the least common (18.2%). Geographically, the largest share of videos originated from America (39.4%), followed by European videos (33.3%), whereas Asia accounted for the remaining 27.3%. While 66.7% of videos included audio, only 21.2% had subtitles. The median score for the JAMA score was 2 (score range: 1–4). This median value was identical to those yielded by both the GQS score (score range: 1–5) and the M.DISCERN score (score range: 1–5). Among them, 17 surgery-related videos were assessed via LAP-VEGaS, with a median score of 6 (score range: 3–15) (Table 1).

Correlation analyses revealed a significant positive correlation among the JAMA score, GQS score, and M.DISCERN score. Additionally, the JAMA score exhibited a significant positive correlation with most video metrics, including video views (r=0.350, P=0.046), views per day (r=0.409, P=0.02), likes (r=0.380, P=0.03), and the VPI index (r=0.411, P=0.02). In contrast, neither the GQS score nor the M.DISCERN score showed a significant correlation with video metrics (all P>0.05). All results are shown in Figure 1.

Figure 1 Correlation heatmap of the M.DISCERN score, GQS score, JAMA score, and video metrics. *, P<0.05; ***, P<0.001. GQS, Global Quality Scale; JAMA, Journal of the American Medical Association; M.DISCERN, Modified Discriminant; VPI, Video Power Index.

The results showed significant differences among video categories across the three evaluation tools (JAMA: P=0.02; GQS: P<0.001; M.DISCERN: P=0.001). The overall reliability of videos involving “surgery + information” was superior to that of the other three content categories (Table 2). However, no significant differences were observed across the three evaluation tools with respect to video upload sources (JAMA: P=0.27; GQS: P=0.35; M.DISCERN: P=0.51) or regions (JAMA: P=0.677; GQS: P=0.17; M.DISCERN: P=0.18) (Table 2).

Subsequently, the M.DISCERN score was used for stratification, with 30.3% (n=10) of videos rated poor (score =1), 48.5% (n=16) rated fair (scores =2–3), and only 21.2% (n=7) rated high (scores =4–5). Specifically, independent health information websites primarily uploaded videos rated fair (n=6, 75.0%), with an equal proportion of poor and high reliability content (n=1, 12.5%). Notably, videos uploaded by urologists were predominantly classified as poor reliability (n=7, 43.8%). However, urologists accounted for the largest share of high-reliability video uploaders across all contributor groups (n=5, 71.4%) (Table 3).

Analysis of video metrics and reliability ratings revealed that high‑reliability videos had a longer median duration than poor‑reliability videos (341 vs. 157 s, P=0.02), though the fair‑reliability group contained several exceptionally long videos and yielded the highest median duration among all three groups. No significant differences were observed in likes (P=0.10), comments (P=0.75), views (P=0.27), daily views (P=0.10), and VPI (P=0.10) across reliability levels (Table 3).

This study adopted the LAP-VEGaS scale to assess surgical-related videos, and the findings indicated that the majority of these videos were of low-to-moderate quality, with only two rated as high quality. Specifically, among all video metrics, only upload time exhibited a significant difference (P=0.044). No significant differences were observed in durations (P=0.33), likes (P=0.08), comments (P=0.15), views (P=0.08), daily views (P=0.08), and VPI (P=0.08) across reliability levels (Table 4).

Discussion

In this cross-sectional evaluation of YouTube videos concerning bladder hydrodistention for IC/BPS, we found that the overall quality and reliability of available content were modest. Three findings are particularly noteworthy. First, only the JAMA score (transparency-focused) correlated positively with engagement metrics—including views, views per day, likes, and VPI—whereas other assessment tools did not show significant correlations with these indicators (20). Second, content type—rather than upload source or region—was the key discriminator of informational value: “surgery + information” videos consistently achieved the highest scores among all tools, while patient-experience videos performed nearly the worst in terms of transparency and reliability measures. Third, when stratified by M.DISCERN or LAP-VEGaS scores, engagement metrics did not differ significantly across reliability strata—suggesting that viewers are not reliably “rewarding” evidence-based content through routine YouTube interactions. Collectively, these results indicate that bladder hydrodistention videos on YouTube currently offer limited educational utility for surgeons.

A central pattern in our data is the asymmetric relationship between engagement and evaluation instruments. JAMA evaluates “surface transparency”, while GQS and M.DISCERN better capture comprehensibility, balance, evidentiary grounding, and acknowledgment of uncertainty (8,21). The positive correlation between JAMA and engagement metrics may therefore reflect a behavioral tendency of viewers to respond to signals of legitimacy that are quickly inferable during viewing, even if deeper educational completeness remains variable. In contrast, the lack of association between engagement and GQS/M.DISCERN suggests that view counts and likes are not robust indicators of didactic adequacy or reliability in this domain. This observation is consistent with the conceptual premise motivating our study: YouTube’s algorithm prioritizes relevance and engagement, which may amplify content that is watchable rather than scientifically complete. Importantly, we also observed significant positive correlations among JAMA, GQS, and M.DISCERN themselves, implying that while these tools capture distinct dimensions, they still converge on an overarching construct of “better educational content”.

Across all tools, “surgery + information” videos were superior to others. Two mechanisms may plausibly explain this pattern. First, “surgery + information” is structurally more likely to integrate indications, procedural rationale, perioperative counseling, and expected outcomes, thereby directly mapping to M.DISCERN domains such as clarity of aims, use of reliable sources, and addressing uncertainty—elements that may be absent from purely technical demonstrations or narrative experience accounts. Second, this hybrid format likely reflects greater intentionality toward education rather than documentation, resulting in improved organization, explanations of key steps, and inclusion of context that benefits education.

We did not observe significant differences in upload source or region. While one might expect academic centers or specialist uploaders to outperform lay sources, our findings suggest that, in this topic area, being a clinician uploader is not sufficient to ensure educational completeness. Indeed, although urologists contributed the largest share of high-reliability uploads, a substantial fraction of urologist-uploaded videos still fell into the poor-reliability group. This internal heterogeneity may dilute aggregate source effects. Furthermore, the sample size and the highly variable nature of YouTube content may limit power to detect geographic or source-based differences. Consequently, the absence of significant differences should be interpreted as a call for standardization across uploader categories, rather than as evidence that all sources are equivalently reliable.

When videos were stratified by M.DISCERN and LAP‑VEGaS sores, high‑quality videos tended to have longer video duration, although this difference did not reach statistical significance. This likely reflects a simple but important educational reality: reliable procedural education requires time to articulate indications, steps, alternatives, and so on. However, the absence of significant differences in likes, comments, views, daily views, or VPI across reliability levels suggests that longer, more reliable content is not systematically rewarded by engagement metrics in this dataset (20,22).

Notably, the modest LAP-VEGaS scores align with a broader pattern seen across surgical education content online: videos frequently demonstrate intraoperative scenes but omit critical contextual items (patient selection, setup, key step narration, complication management, and outcomes reporting), limiting their utility for skill acquisition and safe translation to practice. This reinforces the need to move from “video presence” to “video pedagogy” (17). Lastly, it should be noted that several LAP-VEGaS items are not tailored to transurethral cystoscopic manipulations, which may compromise the content validity of this scale when applied to bladder-specific procedures.

Furthermore, we would like to highlight that there remains a lack of universal standardized protocols for bladder hydrodistention. Whether the absence of unified standards contributes to heterogeneous research outcomes warrants careful consideration. In this work, we compared our observations with prior investigations focusing on standardized surgical modalities including transurethral resection of the prostate (TURP) and HoLEP, yielding largely congruent findings (8,17). Although most surgeons have uploaded relevant operative videos to online platforms, the overall video quality remains suboptimal. High-quality educational videos require a combination of standardized surgical demonstrations and clear, patient-centered informative content. Collectively, these findings suggest that the lack of uniform procedural standards exerts negligible impacts on educational assessment scores, with variations in these metrics primarily driven by intrinsic video quality.

Our results have several practical implications. Given the overall modest reliability and the weak relationship between engagement and reliability, patients should be cautioned against using popularity cues as proxies for accuracy. Additionally, the generally low-to-moderate LAP-VEGaS performance indicates that YouTube hydrodistention videos should be treated as supplemental exposure rather than a standalone surgical learning tool, unless they meet checklist-level reporting standards. Finally, the consistent advantages of “surgery + information” videos, together with the persistent gap in transparency and reliability, provide the possibility of developing a hydrodistention-specific educational video checklist.

This study has limitations inherent to the design and to the YouTube ecosystem. First, it is a cross-sectional snapshot of a dynamic platform; rankings and engagement metrics can change over time, and content availability evolves. Second, our analysis was restricted to English-language videos and to videos retrieved under a single search phrase and YouTube’s default “relevance” sorting, which may not reflect personalized search experiences. Furthermore, only specialist urological terminology was adopted as search keywords to avoid retrieving large volumes of off-topic videos that would arise from synonymous or loosely related search terms under YouTube’s relevance sorting mechanism. While this targeted retrieval strategy may introduce mild selection bias, we argue that its confounding influence on our overall findings remains negligible. Meanwhile, no universally standardized protocol for bladder hydrodistention in IC/BPS has been established worldwide, leading to inter-institutional variation in surgical practice and potentially technical heterogeneity across the included operative videos. However, this inter-institutional technical heterogeneity exerts only mild, secondary interference on scores rather than fundamentally biasing total evaluation results. Finally, the modest sample size, especially for LAP-VEGaS analyses (n=17), may have limited statistical power to detect smaller differences across uploader types and regions.

Conclusions

In summary, although urologists have created numerous bladder hydrodistention videos, the overall transparency, reliability, and educational integrity of such videos remain suboptimal. Furthermore, videos integrating surgical procedures with explicit patient-oriented information demonstrate higher reliability and quality ratings. These findings emphasize the need for content creators to combine concise popular summaries, subtitles, and surgical shots to improve the overall quality and educational value of bladder hydrodistention videos for surgeons.

Acknowledgments

None.

Footnote

Reporting Checklist: The authors have completed the STROBE reporting checklist. Available at https://tau.amegroups.com/article/view/10.21037/tau-2026-0421/rc

Peer Review File: Available at https://tau.amegroups.com/article/view/10.21037/tau-2026-0421/prf

Funding: This study was funded by the Sichuan Provincial Department of Science and Technology (No. 2024YFFK0368), National Key Research and Development Program of China (No. 2023YFC3606000), and National Natural Science Fund of China (No. 82422015, 82270720, and 82400904).

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://tau.amegroups.com/article/view/10.21037/tau-2026-0421/coif). The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

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