Clinical Research Directory

Development of an AI-Agent for Urological Disease Diagnosis and Treatment

Urological diseases such as urinary stones, prostate cancer, and bladder cancer are very common and often require highly specialized diagnosis and treatment. Today, the quality of care can vary between doctors, and there are not enough urology specialists to meet patient demand. Artificial intelligence (AI) may help doctors make faster and more consistent decisions. This study aims to develop and test an AI-powered assistant called "UroAgent" that supports doctors in diagnosing and treating urological diseases. UroAgent is built on a large language model trained specifically for urology and is connected to tools that help it retrieve medical knowledge and analyze images. To build and test UroAgent, the research team will use 1,500 past patient records from 2010-2025 and collect 500 new patient cases for validation, for a total of 2,000 cases. This is an observational study: no patient's medical treatment will be changed because of it. The goal is to create a reliable AI tool that helps improve urological care for patients.

Prevention of Urinary Stones With Hydration

A randomized clinical trial to investigate the impact of increased fluid intake and increased urine output on the recurrence rate of urinary stone disease (USD) in adults and children. The primary aim of the trial is to determine whether a multi-component program of behavioral interventions to increase fluid intake will result in reduced risk of stone disease progression over a 2-year period.

Retrograde Ureteral Catheterization Is Not Essential in Percutaneous Nephrolithotomy: A Randomized Controlled Trial

Percutaneous nephrolithotomy (PCNL) is currently the first-line treatment for upper urinary tract stones larger than 2 cm. It is minimally invasive and enables rapid recovery, thus winning the approval of patients . In the traditional PCNL procedure, a ureteral catheter is first retrogradely inserted into the ureter on the affected side with the patient in the lithotomy position, and then the patient is changed to the prone position for percutaneous renal puncture and stone extraction . The inserted catheter can be used for retrograde injection of water or contrast agents, which facilitates percutaneous renal puncture and also prevents stone fragments from entering the ureter during the lithotripsy process . However, under the lithotomy position, disinfection, draping, and intubation are carried out first, and then the patient is turned to the prone position for another round of disinfection and draping, which is cumbersome and requires a long surgical preparation time. In recent years, with the enrichment of urologists' experience in percutaneous renal puncture and the improvement of the quality of ultrasound images, the application of percutaneous renal puncture and fistulization guided by ultrasound has become more and more widespread . Experienced urologists can even puncture the target renal calyx without the need for retrograde intubation and injection of water to form an "artificial hydronephrosis". Combined with intraoperative contrast verification through the puncture needle, accurate puncture can be ensured. This saves the surgical time required for the traditional PCNL, which involves retrograde intubation in the lithotomy position followed by a change to the prone position, and also avoids the risk of infection that may be increased due to elevated renal pelvic pressure during retrograde injection. However, failure to place a retrograde catheter during PCNL may increase the difficulty of puncture and the risk of stone fragments entering the ureter during the lithotripsy process. We adopt the split-leg prone position, and when necessary, retrograde ureteroscopic operations can be performed. In this way, various needs for anterograde and retrograde operations can be met in a single position . Direct percutaneous renal puncture and stone extraction under the guidance of ultrasound combined with X-ray without retrograde intubation in the split-leg prone position has both advantages and disadvantages, posing a challenge to surgeons. To verify the safety and feasibility of this technique, we have launched this clinical randomized controlled trial for verification.

Occupational Situation and Return to Work of Urological Patients

This study will examine the work status of all adult patients admitted over a 6-month period to the University Hospital in Kraków, Poland, for treatment of urological diseases. All admitted patients will be surveyed about their job situation. Patients who are occupationally active and undergoing major oncological surgeries (such as radical cystectomy, prostatectomy, or nephrectomy) or procedures for urinary tract stones will also complete a quality-of-life questionnaire and be followed up by phone at 3 and 6 months. The goal is to learn how treatment affects patients' ability to return to work and their well-being, to help guide support and rehabilitation strategies.

ESWL for Distal Ureteric Stone: Supine Versus Prone

Extracorporeal shockwave lithotripsy (ESWL) for urinary stone is common and widespread nowadays. Approximately 80% of urinary stones are treated by ESWL. Traditionally distal ureteric stones are treated with ESWL in the prone position. However, as some patients cannot tolerate lying in the prone due to medical illness such as chronic obstructive pulmonary disease (COPD), some authors have reported using the supine approach of ESWL for treatment of distal ureter stones. No serious complications had developed in the patients who underwent supine approach. Only minor complications such as self-limiting blood in the urine, painful passage of urine, or local pain that had responded to oral painkillers. There were no serious complications encountered in children as well. In the most recent retrospective review by Tolley et al, they had revealed that patients who had underwent supine ESWL for distal ureteric stones had an improved stone-free rate compared with the traditional prone approach. Patient with radio-opaque distal ureteric stones (stones below the sacroiliac joint) on KUB X-ray, who have opted for ESWL treatment, are randomized into two groups: one undergoing ESWL in the supine position and the other undergoing ESWL in the prone position. Patients will be observed for two hours after ESWL before being discharged. Oral painkillers as necessary will be provided to the patient. The patients will have a KUB Xray at 2 weeks post-ESWL, and then monthly afterwards if required. If there are residual stones at the 2-week follow-up, the patient will be offered ESWL again. Patients are free to withdraw from the study at any time and will continue to be managed as per usual. The investigators aim to have 130 patients, with 65 patients in each group with an interim analyses to be performed when 66 patients have been recruited (33 patients in each group).