Benign prostatic hyperplasia (BPH) is the most common etiology for male lower urinary tract symptoms, affecting roughly 44% of men aged 40 to 59 years to 70% of men over the age of 80.¹ In addition to its bothersome symptoms, research has demonstrated that lower urinary tract symptoms can lead to considerable impairment in one’s quality of life, with more pronounced effects on anxiety and depression compared to other chronic conditions like diabetes, gout, and hypertension.² The all-encompassing manifestations of BPH can drive people to search for answers and therapies to alleviate their symptoms. When making time for doctor’s appointments and confronting medical bills can be overwhelming, it may become more convenient to turn to the internet for health-related concerns.

Symptomatic BPH may drive patients to seek information from a variety of sources. YouTube is one of the most prominent platforms for videos on a global scale, but its vast reach and influence can also make it a medium for the spread of unverified information. Previous studies have demonstrated that the quality of health-related information on the platform is subpar, with a tremendous likelihood of coming across inaccurate or unreliable information.³ There is an abundance of videos with BPH-related content on YouTube, but the accuracy of information in these videos remains unevaluated. To bridge this gap and provide a comprehensive assessment of the data on the video-sharing platform, we sought to systematically evaluate the quality of information presented in YouTube videos related to BPH.

A search was performed in March 2022 for the top 50 YouTube videos using the keywords “enlarged prostate treatment” and sorted by “relevance.” The reliability and quality of videos were graded using the standardized and validated DISCERN tool, while their understandability and actionability were analyzed with PEMAT (Patient Education Materials Assessment Tool).^4,5 The average of 3 reviewers’ DISCERN and PEMAT scores for each video was calculated to determine the mean scores for analysis.

The top 50 most popular videos accounted for 37,135,760 total views and 20,745 comments. Ninety-four percent were produced by non-medical institutions, 22% featured a physician, and 18% featured a urologist. User comments/engagement were analyzed, and 94% requested medical advice, 91% provided advice, and 89% provided support, as several comments had posed both questions and answers. Videos featuring a physician had more user comments (640 vs 401, P = .24; Table 1). The average DISCERN score was 2.9 with 68% of videos rated as moderate to poor quality (DISCERN ≤3). Videos featuring a physician had a higher DISCERN quality score (2.7 vs 3.3, P = .003; Table 2). Seventy percent of videos promoted home remedies/supplements for management of BPH. These videos were more actionable than ones without (0.37 vs 0.26, P = .04). Sixty-nine percent of home remedy videos contained a link to purchase a featured product.

Table 1. Video Characteristics and User Social Engagement

Table 2. DISCERN and PEMAT Scores

This study has demonstrated that physician presence in a YouTube video on BPH can positively influence the quality of information. In concurrence with a prior study, videos with a physician presence had notably higher DISCERN scores and overall video quality than those without a physician.⁶ Physicians also incited greater interaction with videos, as there were significantly more comments for videos that had their presence. However, the probability of a physician being featured in such videos remains markedly low, with an even lower likelihood of the physician being a urologist.

The scarcity of physician-backed information on this media platform leaves room for possible erroneous conclusions and advice to be disseminated to the public. A study conducted in 2014 showed that 63% of the top 100 YouTube results for BPH were either poor in quality or provided only basic information on the topic, similar to the percentage yielded in our study.⁷ However, our standardized methods of scoring video content identified a 5% increase in substandard video quality from the previous study, perhaps suggesting that, recently, there has been further propagation of misinformation on YouTube.

In addition to the possible increase in misinformation, there is a significant quantity of BPH videos that aim to sell a featured product. Similar to previous studies, roughly 70% of home remedy videos displayed signs of advertising. According to the AUA BPH guidelines, there has not been any research that has definitively supported the efficacy of any herbal supplement in the treatment of BPH, yet these data show that a marketing incentive could negatively impact the validity of information in medical videos for financial gain and other possible conflicts of interest.⁸ YouTube’s terms of service display their firm stance against the spread of misinformation on their platform, which could result in the suspension or permanent ban of accounts that go against their policies.⁹ However, there are clearly limitations to how effective their respective safeguards are as medical misinformation continues to be widespread.

The limitations to this study include the potential for bias in the grading scales among the video reviewers, which was minimized by having 3 designated reviewers for each video. Furthermore, urologists and other physicians were identified if they stated their credentials in their channel or within the video. Individuals were not classified as physicians if such information was not depicted in the video.

In summary, patients are extremely engaged in their search for BPH-related content in YouTube videos. Unfortunately, these videos were shown to be largely inaccurate and unreliable. Videos with physicians had higher quality than those without, but less than 25% of the most popular BPH videos on YouTube featured a physician, let alone a urologist. Other forms of social media, such as TikTok, have also been identified for having a lack of accurate urologic information.¹⁰ Without a stronger urologist presence on these platforms, patients will continue to view poor-quality videos rife with misinformation and predatory links to purchase products online. However, there is still a lack of action being taken to minimize such inaccuracies. Future studies are warranted to pinpoint reliable sources of online media and if certain measures of improving reliability, such as routine information screening, can bolster accuracy of widespread information.

Disclosures: No funding was required for this research study. Institutional Review Board approval was deferred for this study as it did not involve human subjects. In the interest of full disclosure, the Authors affirm that they have no conflicts of interest that could influence the objectivity, integrity, or interpretation of the research presented in this paper.