title: Mid-urethral slings on YouTube: quality information on the internet?
abstract: OBJECTIVE
  Scant literature exists about the quality of urogynecological content on social media. Our objective was to measure the accuracy and comprehensiveness of YouTube videos related to mid-urethral sling (MUS) procedures.
  
  
  METHODS
  YouTube was searched using the terms "mid-urethral sling," "vaginal tape," "TVT," "TOT," "TVT surgery," and "TOT surgery." Duplicates and videos with less than 1,000 views were excluded. We developed a standardized questionnaire for this project, assessing each video's target audience, main purpose, relevance, informed consent elements, surgical steps, and bias. The primary outcome was the presence of all elements of informed consent. Inter-rater reliability (IRR) was calculated using the Fleiss' kappa statistic. Descriptive statistics were also obtained.
  
  
  RESULTS
  Five reviewers each rated 56 videos. Mean IRR was moderate (Fleiss' kappa 0.58 ± 0.24). Video content was classified as physician educational material (67.9 %), patient information (16.1 %), advertisement (10.7 %), lawsuit recruitment (1.8 %), and unclear (3.6 %). MUS was the primary topic for 82.1 % of the videos. The remainder discussed other types of anti-incontinence procedures or prolapse surgery. None of the videos mentioned all four elements of informed consent. Of 32 videos demonstrating surgical technique, none showed the complete list of pre-determined surgical steps. The mean number of listed steps was 7.6/16. Only four videos mentioned at least one post-operative patient instruction. A marketing element was shown in 26.8 % of videos.
  
  
  CONCLUSIONS
  Patient information about MUS on YouTube is lacking and often biased. Physicians and students viewing YouTube videos for educational purposes should be cognizant of the variability in the surgical steps demonstrated.
authors.affiliation: Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada. maryse.larouche@gmail.com.|St. Paul's Hospital, 1190 Hornby Street, 11th floor, Vancouver, BC, Canada, V6Z 2K5. maryse.larouche@gmail.com.
authors.forename: Maryse
authors.initials: M
authors.lastname: Larouche
authors.affiliation: Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Roxana
authors.initials: R
authors.lastname: Geoffrion
authors.affiliation: Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Darren
authors.initials: D
authors.lastname: Lazare
authors.affiliation: Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, ON, Canada.
authors.forename: Aisling
authors.initials: A
authors.lastname: Clancy
authors.affiliation: Centre for Health Evaluation and Outcome Sciences, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Terry
authors.initials: T
authors.lastname: Lee
authors.affiliation: Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Nicole A
authors.initials: NA
authors.lastname: Koenig
authors.affiliation: Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Geoffrey W
authors.initials: GW
authors.lastname: Cundiff
authors.affiliation: Department of Urology, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Lynn
authors.initials: L
authors.lastname: Stothers
mesh_terms: D005260:Female; D013509:Gynecologic Surgical Procedures; D006801:Humans; D061108:Social Media / Q000706:statistics & numerical data*; D053825:Suburethral Slings; D014741:Video Recording / Q000706:statistics & numerical data*
keywords: Medical education; Midurethral slings; Social media; Stress urinary incontinence; Suburethral slings; Surgical education