Pathways for Innovation in Urology

The pages of this month’s Société Internationale d’Urologie Journal (SIUJ) feature important contributions addressing the clinical implementation of innovation and technology in Urology. As a specialty, we have long prided ourselves on being at the forefront of technological advancement, and the articles in this issue lay a strong foundation for continued expansion into new domains.

Alberto et al. review the barriers to integrating transformative surgical technologies into clinical practice and propose a structured guide for navigating this challenging process [1]. While pathways for development, regulatory approval, and clinical integration of drugs are generally well established, device implementation remains less clearly defined. The process described in Australia is notably complex, involving numerous stakeholders. Although the pathways in the UK and the USA differ in specific details, many of the lessons are broadly applicable.

Each stakeholder in technology adoption faces unique challenges. Clinicians may be skeptical of innovations that disrupt established workflows and require significant time investment to learn new techniques. Regulatory agencies prioritize patient safety, while payers demand evidence of cost-effectiveness and value. Hospitals must assess feasibility within their existing infrastructure, resulting in decentralized, institution-by-institution implementation. Patients, understandably, seek improved outcomes. In the absence of government or insurance reimbursement, costs may fall to the hospital and/or patient, limiting widespread adoption. Ideally, each incremental improvement would undergo post-implementation auditing to confirm effectiveness, yet such evaluation also requires dedicated funding.

Rather than dwelling on these complexities, the authors present a pragmatic five-phase framework for technology implementation: (1) technology development, (2) regulatory compliance, (3) research and experimentation, (4) finalization for product launch, and (5) product launch and assessment. This framework has potential applicability beyond the Australian context.

While Alberto et al. focus primarily on novel devices, a parallel wave of innovation is transforming our field through artificial intelligence (AI) [1]. In this issue, Ho et al. report on the attitudes of 464 urologists from 47 countries toward AI [2]. Their survey revealed a strong appetite for adoption among a predominantly young (66% < 40 years), male (87%), and academic (67%) cohort: 80% anticipated integrating AI into clinical practice, and 85% expected to use it in research. Among those with AI experience, most applications were in research, but 58% believed AI would have its greatest impact in administrative tasks, with similar proportions recognizing its potential in patient education.

Alongside the great opportunity provided by AI, respondents acknowledged important barriers, including the need for formal AI training (77% reported having no AI training) and the resolution of regulatory issues related to data privacy and security. More than half of the respondents also expressed concern regarding the accuracy of AI-generated data. These findings underscore the need to design targeted programs to address these gaps and facilitate AI adoption. The prevailing sentiment is not if AI will be implemented in Urology, but when and how.

As a surge of AI-based technologies reaches our specialty, the lifecycle of transformative technology—highlighted by Alberto et al.—is instructive: research and development leads to experimental use, innovation, and general adoption, followed ultimately by obsolescence [1]. AI is now entering general adoption in certain domains, although significant innovation remains ahead. While we often view general use as the goal of innovation, it is also the step preceding obsolescence. In this context, obsolescence is not a failure, but rather a sign that our field continues to advance—always striving toward the next breakthrough.