For Urologists, the Future Is Now

“At DSUI we are using AI for prostate biopsies and to access kidneys. We also are using AR in the clinic to better explain the anatomy to patients in terms of the diseases that they have in the genitourinary realm,” Dr. Parekh said.

AI and AR are impacting not only patient care, but also physicians’ well-being and job satisfaction, Dr. Parekh added. AI algorithms are increasing physician productivity and decreasing physician burnout. Among the examples, AI enhances and augments surgical documentation, taking much of the burden of having to memorize surgical steps and write them after sometimes long surgeries off of surgeons’ shoulders.

Dr. Parekh realized the transition from these being the “future” to “present” tools in urology at DSUI’s signature “Urology on the Beach” meeting in January 2025.

In 2024, a panel of DSUI and other nationwide experts gathered during an innovation session at the annual meeting to share their plans for implementing and studying AI and AR technologies in the specialty.

“At this year’s meeting, many of the same panelists shared tremendous progress with AI and AR in mainstream patient care, in only one year’s time,” Dr. Parekh said. “AI is not the future. It is the present.”

Bruno Nahar, M.D., is among those at DSUI testing the use of AR headsets in the operating room to zero in on suspicious lesions during transperineal biopsy procedures.

“We’re uploading MRI and slide images to the headset — basically overlaying the images on the patient to see exactly where the lesion is. You can even measure the distance from the probe into the lesion by using the augmented reality, which can potentially help with targeting and making sure you’re hitting the right spot on the prostate,” said Dr. Nahar, associate professor of urologic oncology and the Eric and Elizabeth Feder Family Endowed Chair in Urologic Oncology Research at the Miller School.

Sanoj Punnen, M.D., professor of urologic oncology at DSUI, who also is gaining experience with AR headsets during transperineal biopsies, said early indications are that the technology improves economy of motion, ergonomics of the procedure, might make the procedure faster “because everything is where you’re looking.”

This is part of an innovative AR-guided biopsy method for prostate cancer diagnosis research project being conducted at DSUI, directly comparing its effectiveness to traditional micro-ultrasound techniques.

“Early studies suggest AR could offer enhanced precision, potentially improving diagnostic accuracy and patient outcomes,” said Archan Khandekar, M.D., clinician instructor in urologic oncology at DSUI.

DSUI and UHealth collaborate with many types of companies, academic centers and experts to harness AI and AR capabilities. In the surgical intelligence space, DSUI works with Theater, a company that uses next-gen AI and computer vision technology to capture and analyze surgical data in real time. As a result, the technology generates meaningful, unbiased, actionable insights for surgeons while they’re operating.

In partial nephrectomy procedures, a Computer Vision-based artificial intelligence system has demonstrated highly accurate measurements of warm ischemia times, as validated in a published study by DSUI faculty.

Preliminary, unpublished findings presented by Dr. Khandekar suggest that this AI system also effectively identifies nephrectomy cases likely to require urgent postoperative laboratory assessments. Specifically, the AI model looking at visual cues during the surgery, correctly predicted 70% of cases with significant postoperative elevations in creatinine and 60% of cases with notable decreases in hemoglobin levels. Utilizing this predictive capability as part of a quality improvement initiative has the potential to significantly reduce unnecessary laboratory testing and enhance patient care efficiency.

Urologists at DSUI are pioneering a “clinic of the future” model utilizing augmented reality technology to enhance patient care. According to Dr. Khandekar, this innovative approach helps patients better understand their procedures by visualizing their scans through Microsoft HoloLens AR glasses. DSUI’s robust IT infrastructure seamlessly enables scans from CDs or internal PACS systems to be integrated into the AR hardware.

In a recent prospective study, DSUI researchers found that AR significantly improved patient comprehension of renal mass imaging findings without increasing anxiety. Additionally, AR technology promises enhanced preoperative visualization for surgeons, potentially improving intraoperative decision-making, though this was outside the scope of the current study. “Patient satisfaction was exceptionally high, with more than 94% expressing they would recommend AR experiences to others,” he said.

DSUI integrated large language models in its documentation system, reviewing nearly 3,000 surgical events and significantly improving operative reporting accuracy.

“The AI identified discrepancies where 20.2% of events were missing and 1.2% inaccurately reported,” Dr. Khandekar said. “Instead of the physician going back and writing the whole op note, the AI algorithm writes the op notes for the case and the surgeon goes back to edit it.”

The model could reduce burnout among urologists burdened by the time they spend on documentation.

Kidney stone treatment stands to benefit greatly from innovation. At the American Urological Association 2025 conference in April, DSUI researchers presented their findings from implementing a sophisticated natural language processing system in kidney stone analysis. The system automatically extracts stone composition data from thousands of patient reports and achieved perfect accuracy in a tested sample, vastly improving research efficiency and clinical management of kidney stones, Dr. Khandekar said.

Young DSUI faculty innovators are also taking AI and computer vision to new heights by teaching machines how to do the more tedious, albeit important, part of a common kidney stone procedure.

Jonathan Elliott Katz, M.D., a DSUI endourologist, is co-principal investigator of the DSUI-funded Automation in Surgery Lab. This unique initiative is a collaboration between the University of Miami’s Department of Computer Science and DSUI. And its aim is to develop surgical assistance for ureteroscopy with laser lithotripsy.

“To be clear, this is not intended to replace human surgeons. It’s to help with the most tedious aspects, which in this case is to laser the stone into fine dust, where precision and patience is so important,” Dr. Katz said.

To do this, Dr. Katz and the research team are creating a robot paired with a digital simulation of the robot and an off-the-shelf ureteroscope using software that allows for high-fidelity simulation with real physical properties.

“If you can replicate the kidney, stone, laser, ureteroscope and robot, you can start to do the procedure a thousand different ways, a million different times and train based on reinforcement learning. The idea is to port that to a bench top model and, one day, port that into humans,” he said.

The team, which started the project in 2024, built a robot to control the ureteroscope and is working on a high-fidelity kidney and kidney stone before attempting to break the stone. “I don’t know of any other surgical group with a multidisciplinary lab like this,” Dr. Katz said. “It’s why I joined the faculty here.”