BACKGROUND AND OBJECTIVE:Aquablation and laser enucleation of the prostate (LEP) are treatments for alleviation of lower urinary tract symptoms (LUTS) that have not yet been directly compared in a prospective randomized trial. This study was designed to evaluate these treatments in terms of LUTS improvement and safety in men with large prostates. METHODS:WATER III is an investigator-initiated, international, multicenter, nonblinded, prospective noninferiority trial that includes randomized and nonrandomized participants. Eligible patients had moderate to severe LUTS and a large prostate volume (80-180 ml). The primary efficacy endpoint was the change in International Prostate Symptom Score (IPSS) from baseline to 3 mo. The primary safety endpoint was the incidence of Clavien-Dindo (CD) grade ≥2 or persistent CD grade 1 complications that had not resolved by 3 mo. Bayesian analyses were used to assess noninferiority. KEY FINDINGS AND LIMITATIONS:A total of 202 men were enrolled in the study, of whom 186 underwent surgery (98 Aquablation, 88 LEP). At 3 mo, data were available for 170 patients, including 66 randomized and 104 nonrandomized men. Both treatments showed similar mean IPSS improvement at 3 mo: -12.9 ± 6.9 with Aquablation versus -13.1 ± 7.5 with LEP, with an estimated difference of 0.93 (95% credible interval [CrI] -1.48 to 3.53) and noninferiority probability of >0.999. The incidence of CD grade ≥2/persistent grade 1 complications was 40.8% in the Aquablation group versus 56.8% in the LEP, with an estimated difference of -9.4% (95%CrI -31.8% to 12.9%; noninferiority probability 0.952). Retrograde ejaculation was less frequent after Aquablation (14.8% vs 77.1%; p < 0.001). Persistent stress urinary incontinence (SUI) was absent following Aquablation versus 9.3% after LEP (p < 0.05). CONCLUSIONS AND CLINICAL IMPLICATIONS:Aquablation demonstrated noninferior short-term LUTS relief and similar safety compared to LEP, with superior ejaculation preservation and avoidance of SUI in short-term follow-up.

Abstract Background Standardised structured reporting (SR) aims to improve the clarity, completeness, and clinical applicability of radiological reports. For non-contrast computed tomography (NCCT) of urinary stones, a reporting template was developed collaboratively by the German Radiologic Society and the German Society of Urology. This study evaluates urologists’ satisfaction with SR compared to free-text reports (NR). Methods A randomised controlled trial was conducted with 200 NCCT reports (100 SR, 100 NR). Five urologists of varying experience levels assessed the reports using a questionnaire, covering content, formal aspects, clinical consequences, and overall report quality. Scores were based on a 6-point Likert scale (0–6). Results Structured reports significantly outperformed free-text reports in all evaluated domains (p < 0.001). SR provided clearer descriptions of stone characteristics and radiographic signs, enabling precise clinical decision-making. The overall satisfaction score for SR was 5.83 ± 0.56 compared to 4.18 ± 1.13 for NR. Formal aspects, such as report structure, also showed marked improvements in SR. Conclusion The findings demonstrate SR’s superiority in clinical utility, completeness, and clarity. By facilitating Artificial Intelligence integration and secondary data analysis, SR offers additional advantages. Broader adoption requires promoting user acceptance and validating translated versions for international use.

Background and objective Endoscopic enucleation of the prostate (EEP) using holmium:YAG laser (HoLEP) is widely regarded as the surgical gold standard for surgical management of benign prostatic hyperplasia. EEP with a pulsed thulium:YAG laser (ThuLEP) has emerged as an alternative with distinct physical properties that may influence surgical performance. However, evidence on the real-world impact of switching between laser platforms remains limited. Methods In this retrospective single-center study, we analyzed 2688 consecutive EEP procedures performed between 2015 and 2025. Three high-volume surgeons transitioned from HoLEP (n = 1516) to ThuLEP (n = 1172) without retraining. Baseline characteristics, complication rates, and efficiency metrics were compared. Segmented regression analysis was used to evaluate temporal changes in performance across the laser transition. Key findings and limitations Baseline parameters were comparable between the HoLEP and ThuLEP groups. ThuLEP was associated with significantly lower incidence of postoperative urinary retention (5.6% vs 9.3%; p = 0.0005) and a lower need for transurethral coagulation (3.0% vs 4.6%; p = 0.0471). EEP efficiency was higher with ThuLEP (0.93 ± 0.49 vs 1.64 ± 1.03 g/min; p < 0.001), accompanied by higher energy consumption (898.2 ± 692.1 vs 1,051.7 ± 1,003.3 J/g; p < 0.001). Segmented regression revealed an initial rise in efficiency after the transition, followed by mild performance fluctuations, which indicates a short adaptation phase. Conclusions and clinical implications A transition from HoLEP to ThuLEP with a pulsed thulium:YAG laser is safe and feasible in experienced hands. ThuLEP was associated with higher enucleation efficiency and a statistically significant improvement in hemostatic control, without an increase in complication rates. These findings highlight the procedural adaptability of laser EEP techniques and support the clinical viability of platform switching in high-volume settings. Patient summary We looked at outcomes in >2600 patients who underwent prostate surgery using two different laser systems. After switching from a holmium laser to a thulium laser, surgeons performed procedures more efficiently and with fewer cases of urinary retention and bleeding. This suggests that experienced surgeons can safely switch to newer laser systems without compromising patient care.

OBJECTIVES:Laser lithotripsy carries an inevitable risk of collateral tissue injury. This study compared the safety profiles of pulsed Holmium:YAG and Thulium:YAG lasers by examining their effects on soft tissue under laser settings relevant to lithotripsy, using ex vivo porcine kidney models. METHODS:Direct laser impacts were applied to porcine renal parenchyma and pelvis at constant fiber movements and clinical laser settings (0.2-3.5 J, 10-40 Hz, 2-40 W), with high-power extensions for the Thulium:YAG laser up to 80 W/200 Hz. From 560 histological sections, coagulation and cutting depths were measured and clustered. RESULTS:At equivalent power, the Thulium:YAG laser operated with longer pulses than Holmium:YAG, reducing pulse energy per time (pulse power ≤ 3362 vs. ≤ 7777 W). Holmium:YAG laser produced deeper lacerations up to 9.3 mm in renal parenchyma, compared to 5.0 mm with the Thulium:YAG laser. In renal pelvis, maximal cut depth was 3.6 mm with Holmium:YAG-twice as that observed with the Thulium:YAG. While pulse power was a primary determinant for soft tissue damage, high frequencies (100-200 Hz) did not elevate it. Cluster analysis identified laser-specific damage profiles: Thulium:YAG favored coagulative damage at limited depths, whereas Holmium:YAG induced deep lacerations with limited coagulation and tissue detachment. CONCLUSION:Soft tissue safety and complication risk depend on laser parameters and choice of technology. Reduced pulse powers maximize safety, instead pulse frequency seems safe to elevate for improved efficiency. At power levels beyond 20 W, Thulium:YAG benefited from longer pulses showing safer profiles, with shallower penetration and more reliable coagulation compared to Holmium:YAG.

Surgical planning and training based on machine learning requires a large amount of 3D anatomical models reconstructed from medical imaging, which is currently one of the major bottlenecks. Obtaining these data from real patients and during surgery is very demanding, if even possible, due to legal, ethical, and technical challenges. It is especially difficult for soft tissue organs with poor imaging contrast, such as the prostate. To overcome these challenges, we present a novel workflow for automated 3D anatomical data generation using data obtained from physical organ models. We additionally use a 3D Generative Adversarial Network (GAN) to obtain a manifold of 3D models useful for other downstream machine learning tasks that rely on 3D data. We demonstrate our workflow using an artificial prostate model made of biomimetic hydrogels with imaging contrast in multiple zones. This is used to physically simulate endoscopic surgery. For evaluation and 3D data generation, we place it into a customized ultrasound scanner that records the prostate before and after the procedure. A neural network is trained to segment the recorded ultrasound images, which outperforms conventional, non-learning-based computer vision techniques in terms of intersection over union (IoU). Based on the segmentations, a 3D mesh model is reconstructed, and performance feedback is provided.

Introduction:The aim of this study was to systematically review the available evidence on the feasibility and safety of robot-assisted radical prostatectomy (RARP) in patients with prostate cancer following laser enucleation of the prostate (LEP). Material and methods:A systematic search was conducted using PubMed (MEDLINE) and Web of Science online databases until 31 July 2025 with the search terms ("HoLEP" OR "endoscopic enucleation" OR "laser enucleation of the prostate" OR "ThuLEP" OR "ThuFLEP" OR "EEP" OR "LEP") AND ("robot assisted radical prostatectomy" OR "robotic assisted radical prostatectomy" OR "RARP") by incorporating the PICO formula (population, intervention, comparison, outcome). Results:Three studies were identified. Continence rates and recovery times differed between patients with prior LEP and those who were LEP-naïve. In one study, postoperative incontinence rates were significantly different between the prior HoLEP and HoLEP-naïve groups (74.0% vs 22.0%, p <0.001), whereas in the other two studies there was no significant difference between groups. Erectile function was documented in 2 studies, which exhibited no statistically significant differences between the prior-LEP group and LEP-naïve group. Complication rates across the studies remained relatively low (7.0-9.0%). Biochemical recurrence and positive surgical margins between the previous LEP and LEP naïve groups were comparable. Conclusions:In patients undergoing RARP after LEP, complications are low and the oncological outcomes are promising, similar to patients who are LEP-naïve. It is essential for surgeons to counsel patients on the potential for prolonged recovery, particularly in regard to continence and sexual function.

BACKGROUND: Up to 50% of patients with benign prostate hyperplasia (BPH) face post-operative complications after transurethral prostate Surgery. This includes nearly 15% of patients suffering from prolonged post-operative pelvic pain (pPPP) consisting of dysuria and prostatodynia for sometimes several months post-surgery. This study elucidates and proposes a definition of the multi-dimensional nature of prolonged post-operative pelvic pain (pPPP) after transurethral prostate surgery by providing real-world data on therapeutic options and their efficacy. METHODS: German and international urologic practitioners participated in an online-survey after invitation via social media accounts and newsletters. The survey included questions on the amount of expertise, the therapeutic regimens for prolonged post-operative pelvic pain (pPPP) and the expected therapy outcome. Participation was voluntary and uncompensated. Chi-Square tests and Student’s t-tests were used for descriptive statistics. RESULTS: 67 German urologists participated in a 9-question online Survey. 94,0% treated patients with lower urinary tract symptoms and 85,1% disclosed their therapeutic regime for prolonged post-operative pelvic pain (pPPP). The most common treatments included anti-inflammatory medication (69,6%), anti-cholinergics (53,6%), alpha-blockers (51,8%) and pelvic physiotherapy (50,0%). Over half of the patients responded to the therapeutic approach, but only 5,4% of urologists anticipated full pain relief after one year. These findings are closely aligned with a recent international survey (n=230). Notably, German urologists more frequently prescribed anti-cholinergics (53,6% vs. 28,7%, p = 0,0004), herbal remedies like saw palmetto (25,0% vs. 6,5%, p < 0,0001) and non-pharmacological therapies (82,1% vs. 49,1%, p < 0,0001), but less anti-inflammatory drugs (69,6% vs. 88,7%, p = 0,0003), gabapentin/pregabalin (8,9% vs. 42,2%, p < 0,0001) and opioids (0% vs 5,7%, p = 0,0221). Based on these results a structured definition and therapy plan for prolonged post-operative pelvic pain (pPPP) is proposed. CONCLUSION: Prolonged post-operative pelvic pain (pPPP) is a common challenge for urologists. Despite various therapeutic options, treatment outcomes and practitioner confidence remain suboptimal. Further research and attention to prolonged post-operative pelvic pain (pPPP) are essential to develop evidence-based guidelines for effective patient management and prevention of chronic pain syndromes.

Background and objective: Elevated intrarenal pressure (IRP) may increase the risk of complications in patients undergoing ureteroscopy. As there is limited clarity on a threshold value for high IRP, how to manage high IRP, or which patients are at greater risk of complications due to high IRP, we used the Delphi methodology to understand expert opinion in this area. Methods: The Delphi process comprised two online surveys and an in-person meeting. During the in-person meeting, areas of disagreement and consensus were explored. Consensus statements were developed and voted on to determine the level of consensus. The study was granted a waiver by HML IRB Research and Ethics (reference number 2193). Key findings and limitations: The pan-European panel started with 12 and ended with 11 experienced endourologists. Eleven consensus statements were developed. The statements cover topics such as the definition of high IRP, complications linked to high IRP, and patient risk factors for these complications. After anonymous voting, consensus was achieved for all the statements. Two had a strong level and nine had a moderate level of agreement. There was no consensus on an IRP threshold, although the majority would be concerned for patient safety at a pressure above 61-80 cm H2O. Conclusions and clinical implications: Any IRP above normal physiological levels should be considered high. High IRP during ureteroscopy is a concern for patient safety. It is important to understand links between high IRP, patient characteristics, and complications. We call for additional research to better understand these risks and to inform refinements to clinical practice. Patient summary: A group of experts were asked their opinion on pressure within the kidney (intrarenal pressure, IRP) during a procedure called ureteroscopy (URS), when a narrow telescope is passed through the bladder and into the tube connected to the kidney. Statements that the panel agreed on were developed. These statements show that there is a concern about high IRP during URS as it may be linked to a higher risk of complications for the patient. More research is needed to better understand high IRP and its link to patient outcomes. (c) 2025 The Author(s). Published by Elsevier B.V. on behalf of European Association of Urology. This is an open access article under the CC BY license (http://creativecommons. org/licenses/by/4.0/).

Flexible ureteroscopy is a widely used surgical procedure for diagnosing and treating various urinary tract conditions, particularly kidney stones. Ensuring the complete extraction of all stones is crucial to prevent recurrence and the need for auxiliary interventions. Visual SLAM-based navigation systems have been proposed to assist surgeons by simultaneously estimating the 3D structure of the kidney and tracking the ureteroscope's tip position. However, most existing solutions assume a completely static environment, which does not account for the intraoperative situation. In this study, we extend the work of Oliva Maza et al. by incorporating real-time visual segmentation of kidney stones and surgical tools using either YOLOv7-E6E and segment anything or YOLO11m-seg. Our method discards pixels corresponding to instruments due to their inherent dynamic nature, while kidney stone pixels are incorporated into the SLAM framework but classified as potentially dynamic map points, allowing for their disappearance. This refinement enhances the robustness and the accuracy of ureteroscope position estimation for surgical navigation. To evaluate our approach, we recorded multiple datasets for both segmentation and ureteroscope pose estimation. Experimental results show an average improvement in ureteroscope pose estimation of 35.4% when using YOLOv7-E6E with SAM, and 52.49% when using YOLO11m-seg.

Introduction: Holmium laser enucleation of the prostate (HoLEP) is an established surgical technique for treating benign prostatic enlargement with bladder outlet obstruction. Although HoLEP offers advantages such as reduced hospital stays and lower complication rates compared with traditional transurethral resection of the prostate, it presents a steep learning curve for surgeons. The number of procedures required to achieve proficiency remains debated, with estimates differing widely. This study aims to analyze the HoLEP learning curve beyond 200 cases, evaluating perioperative efficiency and complication rates in high-volume surgeons. Materials and Methods: A retrospective analysis was conducted on 1724 HoLEP procedures performed between 2015 and 2022 by six surgeons, three of whom had performed over 200 cases each. Key parameters assessed included operative time, enucleation efficiency, energy use, and complication rates. Statistical analyses included univariate and multivariate regression models to identify predictors of postoperative complications and efficiency improvements. Results: The mean patient age was 70.48 years, with an average prostate volume of 93.43 g. The mean operative time was 80.68 minutes, with significant efficiency improvements correlating with increased surgeon experience (p < 0.001). Complication rates, including bleeding necessitating coagulation (4.7%) and urinary retention (9.3%), decreased significantly beyond 350 cases. Learning curves demonstrated a nonlinear reduction in complications and a continuous increase in surgical efficiency, with operative proficiency plateauing after approximately 350 procedures. Conclusion: Contrary to previous studies suggesting HoLEP proficiency after 50 to 60 cases, our findings indicate ongoing improvements beyond 200 cases, with stable complication rates achieved after 350 procedures. Structured mentorship programs and simulation-based training could facilitate faster learning and enhance patient outcomes.

Background: Non-muscle invasive bladder cancer (NMIBC) has limited therapeutic options and high recurrence rates. Photoimmunotherapy (PIT) enables targeted tumor ablation using antibody-photosensitizer conjugates and light activation. We evaluated EGFR, Nectin-4, and TROP-2 as PIT targets using cysteine-modified antibodies conjugated to the photosensitizer WB692-CB2. Methods: Antibodies derived from Cetuximab (Cmb, anti-EGFR), Enfortumab (Enf, anti-Nectin-4), and Sacituzumab (Sac, anti-TROP-2) were engineered with T120C and D265C mutations in the heavy chains for site-specific dye conjugation. Binding of the conjugates to BC cells was tested by flow cytometry and light-induced cytotoxicity of the conjugates, alone or in combination, was assessed by viability assays following irradiation. Results: Cysteine-modified antibodies were produced as intact IgG molecules and were efficiently conjugated with WB692-CB2 without loss of antigen specificity. SacT120C/D265C-WB692-CB2 showed the highest target binding and achieved near-complete cell killing at a red-light dose of 32 J/cm2. CmbT120C/D265C-WB692-CB2 required a fourfold higher light dose for comparable efficacy, while EnfT120C/D265C-WB692-CB2 demonstrated lower potency. No cytotoxicity was observed in antigen-negative cells. Combined treatment enhanced cytotoxicity, indicating additive phototherapeutic effects. Conclusions: Our findings suggest that PIT targeting EGFR, Nectin-4, or TROP-2 merits further preclinical development as a targeted therapeutic approach for NMIBC, including potential combinatorial or personalized strategies.

Monocular Metric Depth Estimation (MDE) in endoscopic images is a crucial step to improve navigation during medical procedures, as it enables the estimation of dense, real-scale 3D maps of the organs. For instance, in monocular flexible ureteroscopy (fURS), accurate navigation and real-scale information are essential for locating and removing kidney stones efficiently. Currently, the most promising approach to infer depth from single passive cameras is by supervised training of large neural networks, so-called foundation models for MDE. However, the depth output of these models is biased when the training data domain does not fit the goal domain (both camera and scene). At the same time, one of the greatest challenges in medical imaging is the lack of annotated datasets, as obtaining real ground-truth (e.g., depth data) is difficult. To overcome this, simulation has become a valuable tool in ureteroscopic imaging research. In this study, we introduce KidneyDepth, a synthetic dataset designed to reduce the gap between simulated and real-world 3D imaging. It includes a variety of shapes (e.g. mesh from CT scan, geometric primitive forms) along with different textures and lighting conditions, generated by BlenderProc2 [7]. To assess the effectiveness of KidneyDepth, we fine-tune two state-of-the-art MDE models (Depth Anything V2 and ZoeDepth) and test their performance on both simulated and real ureteroscopic images. Additionally, we evaluate the validity of their output by using the inferred depths in the context of a RGB-D SLAM system. Our results show that training models on a synthetic dataset with diverse structures and lighting conditions improves depth estimation in real endoscopic images and our simulations show that these RGB-D images enhance overall SLAM accuracy. The KidneyDepth dataset can be found at https://zenodo.org/records/14893421.

Background. This monocentric, randomized controlled trial aims to compare the outcomes of kidney transplant recipients with magnetic double-J (DJ) stents versus conventional DJ stents. Specifically, we assessed stent-related symptoms, procedural difficulties, pain and duration of removal, and associated costs. Methods. A total of 30 patients were randomly assigned to receive either a magnetic DJ (mDJ) stent or a conventional, standard DJ (sDJ) stent during kidney transplantation using the Lich-Gregoir technique. Quality of life was evaluated with the USSQ 7–10 d postoperation. sDJs stents were removed cystoscopically by a urologist while mDJ stents were removed bedside by a transplant surgeon. The duration of removal and procedure-associated pain were documented. Questionnaires for physicians and patients were used to assess peri-interventional experience and issues. Additionally, costs associated with the removal of both stents were analyzed. Results. Quality of life showed no differences between the groups. Stent removal was successful in all cases, with no differences in duration of removal (P = 0.24) or major issues. Patients reported comparable pain levels during the removal of mDJs (P = 0.55) and higher satisfaction, although this was not statistically significant (P = 0.27). Cost analysis revealed a reduction of approximately €172 with the use of mDJ. Conclusions. The use of mDJ stents in kidney transplantation is a safe alternative associated with comparable pain during removal. Additionally, it offers cost savings and reduces the logistical burden for both patients and hospitals.

PurposeTo identify laser lithotripsy settings used by experts for specific clinical scenarios and to identify preventive measures to reduce complications.MethodsAfter literature research to identify relevant questions, a survey was conducted and sent to laser experts. Participants were asked for preferred laser settings during specific clinical lithotripsy scenarios. Different settings were compared for the reported laser types, and common settings and preventive measures were identified.ResultsTwenty-six laser experts fully returned the survey. Holmium-yttrium-aluminum-garnet (Ho:YAG) was the primary laser used (88%), followed by thulium fiber laser (TFL) (42%) and pulsed thulium-yttrium-aluminum-garnet (Tm:YAG) (23%). For most scenarios, we could not identify relevant differences among laser settings. However, the laser power was significantly different for middle-ureteral (p = 0.027), pelvic (p = 0.047), and lower pole stone (p = 0.018) lithotripsy. Fragmentation or a combined fragmentation with dusting was more common for Ho:YAG and pulsed Tm:YAG lasers, whereas dusting or a combination of dusting and fragmentation was more common for TFL lasers. Experts prefer long pulse modes for Ho:YAG lasers to short pulse modes for TFL lasers. Thermal injury due to temperature development during lithotripsy is seriously considered by experts, with preventive measures applied routinely.ConclusionsLaser settings do not vary significantly between commonly used lasers for lithotripsy. Lithotripsy techniques and settings mainly depend on the generated laser pulse's and generator settings' physical characteristics. Preventive measures such as maximum power limits, intermittent laser activation, and ureteral access sheaths are commonly used by experts to decrease thermal injury-caused complications.

Die operativen Therapieansätze der benignen Prostatahyperplasie (BPH) wurden in den letzten Jahrzenten weiterentwickelt und diversifiziert. Während die Wirksamkeit der operativen Verfahren bei moderaten Prostatagrößen in zahlreichen Studien dokumentiert wird, bleibt die Datenlage bei großen Prostatavolumina >200 ml unzureichend. Hierdurch bleiben wichtige Fragen hinsichtlich ihrer Effektivität und Sicherheit offen. Aufgrund dessen ist die Auswahl und Anpassung der geeigneten Therapieoptionen für diese spezielle Patientengruppe oft eine große Herausforderung. In dieser Übersichtsarbeit werden nach einer umfassenden Literaturrecherche die aktuellen Erkenntnisse zu den operativen Therapiemöglichkeiten bei großen Prostatavolumina >200 ml zusammengefasst und diskutiert. Die operative Behandlung von Prostatavolumina >200 ml ist unabhängig von der gewählten Operationsmethode eine Herausforderung. Minimalinvasive Ansätze sollten heutzutage Standard sein. Die anatomische endoskopische Enukleation ist das Verfahren mit der geringsten Morbidität und ist prinzipiell größenunabhängig durchführbar. Da das Verfahren auch in Spinalanästhesie durchführbar ist, ist es auch für Patienten mit erhöhtem Narkoserisiko geeignet. Bei extremen Prostatavolumina stellt dieses Verfahren aber auch erfahrene Operateure vor Herausforderungen. Besonders in Kombination mit einer Adipositas sollte der Operateur verschiedene Exit-Strategien kennen. Die roboterassistierte Adenomenukleation bietet eine minimalinvasive Alternative, mit welcher begleitende Pathologien (Divertikel oder große Blasensteine) mitbehandelt werden können. Allerdings sind die Invasivität und das Narkoserisiko durch den abdominellen Zugang vergleichsweise höher. Jede Klinik und jeder Operateur sollte individuell entscheiden, in welcher Methode die größte Expertise vorliegt und welche Option für den jeweiligen Fall am besten geeignet ist. Sollte die Expertise begrenzt sein, ist es ratsam, den Patienten einem Zentrum mit entsprechender Spezialisierung zuzuweisen.

In flexible ureteroscopy (fURS) for kidney stones, the renal collecting system is inspected and stones are removed with a flexible ureteroscope (FU). One alternative to the fragmentation of stones and their removal with the help of graspers or extraction baskets is the dusting of stones with laser light. To support a single surgeon during a fURS procedure, in particular with the fine manipulation during dusting, we developed the CoFlex TOP system for the teleoperation of a handheld FU with three degrees of freedom. This paper describes the overall structure of the system, its kinematics and the hardware and software components. Subsequently, the system properties and its position repeatability are investigated and the system's feasibility for a tip positioning task in virtual reality is evaluated in a user study. Finally, we discuss the implications of the evaluation and sketch possible foci of a user study with urology surgeons.

Introduction Workload and stress in excess can lead to work disability. The aim of our study was to determine whether commercially available "activity trackers" can be used to make statements about the work - or stress load of different occupational groups.Material and methods The study was conducted at the University Hospital Freiburg, Germany. Four occupational groups with a total of 32 subjects were studied: senior physicians (SP, 4), assistant physicians (AP, 11), nursing staff (NS, 12) and administrative staff (AS, 5). The activity trackers were worn on five working days and one day off. Step frequency, distance and heart rate (HR) were measured, and workload was assessed using a visual analog scale.Results The highest workload was reported by SP, the lowest by AS. Male employees feel higher workload than female employees (p = 0.009). NS covered the greatest daily distance, AP the least (p = 0.001). There was a significant difference in average HF between AP and NS (p = 0.008). AS showed higher daily distance and maximum HF on days off compared to work days, and NS showed the opposite behavior. With increasing patient volume for ambulatory care, the average HF increased (p = 0.037) in NSs.Conclusion "Activity trackers" reliably provide body data during work. In our small sample, interesting differences and results on workload emerged. More data would require more subjects and more study variables.