Spyridon Basourakos, MD

The majority of practicing urologists, urology residents, and medical students with interest in the field utilize at least one of the apps provided by the American Urological Association. Over the past few years, the AUA has developed a number of apps that provide clinical guidance and preparation for exams.

This article illustrates the content of the six apps that are available from AUA (figure 1). The apps are free to AUA members unless otherwise specified.

This award-winning app, designed by leaders in urology, functions as an interactive guide that prepares urology graduates for their oral board exams. It is structured into about 60 interactive cases pertaining to 30 common urologic topics, inspired by the AUA clinical guidelines and knowledge from the AUA Core Curriculum. The app can be purchased online and a discount is provided to AUA active members.

This app (figure 2) provides up-to-date, evidence-based guidelines and best practice statements. It makes guidelines easily accessible in daily clinical practice whether you’re in the office or the operating room.

AUA Guidelines at a Glance for Primary Care Professionals

This app is a summary of the AUA guidelines for primary care physicians. Covered topics include management of hematuria, erectile dysfunction, BPH, and many others. These guidelines can assist the general practitioner in acquiring the appropriate workup for basic urologic diseases prior to referral to urology. (Not available for iOS 11.)

This trivia app (figure 3) inspires friendly competition by providing multiple-choice questions to test users’ knowledge of urology.

The AUA created this app to offer medical students a structured module of essential topics in urology. Since some medical schools do not offer a formal urology rotation, this app is beneficial for medical students interested in the field and those who want to improve their urologic knowledge.

With this app (figure 4), the AUA provides users with access to the comprehensive Core Curriculum, as well as other scientific resources to facilitate quality education, including videos, webcasts, textbooks, and abstracts from prior AUA annual meetings. The app interface allows users to bookmark key topics for later review.

 is a urology resident at Weill Cornell Medicine/New York-Presbyterian, and 

 is professor of urology, Weill Medical College of Cornell University, Weill Cornell Medicine/New York-Presbyterian, New York.

Articles

This article illustrates the content of the six apps that are available from AUA.

App review: AUA apps offer clinical guidance and more

One in three Americans is at risk for kidney disease, but early detection is often hampered by the inefficiency and inconvenience of the testing process. Healthy.io has pioneered a home testing service that facilitates diagnosis of potentially reversible renal dysfunction, which could help curtail the exorbitant economic burden of complications from chronic kidney disease.

Step 1: The patient obtains a kit with a color board and follows the instructions provided by the app.

Dip.io is an FDA-approved, home-based urinalysis test. It allows smartphones to function as a medical diagnostic tool through the corresponding Dip.io app. Introduced in 2018, Dip.io has already been commercialized in European countries and the United Kingdom. It has also been introduced and studied in the U.S. A study involving the National Kidney Foundation and Geisinger Health has suggested that the product allows kidney patients to actively participate in and adhere to their medical care. Dip.io smartphone urinalysis kits can also help improve albuminuria screening, as well as improve management of chronic kidney disease.

Step 2: After dipping the stick in urine, the patient inserts it into the color board.

Dip.io is modeled after the urinalysis dipstick, which is able to measure 10 different parameters. The parameters are analyzed with a semi-quantitative method and include leukocytes, nitrates, glucose, ketones, protein, blood, pH, urobilinogen, bilirubin, and specific gravity. Furthermore, the kit provides a semi-quantitative analysis of microalbumin (10-150 mg/L), creatinine (10-300 mg/dL), and albumin-to-creatinine ratio (mg/g).

Step 3: The color board is scanned with the smartphone camera and submitted for analysis.

"The app provides detailed instructions as well as a “virtual nurse chatbot” to guide the patient through the steps"

The app provides detailed instructions as well as a “virtual nurse chatbot” to guide the patient through the steps. The kit comes with disposable test strips that can be accurately interpreted by the Dip app once the patient scans the dipstick against the color board. The app provides test results immediately to both patients and their clinician through an electronic platform (figures). Urinalysis based on smartphone technology has been suggested to be equivalent to lab-based devices.

Steps 4 and 5: The results are made available to the patient and the provider electronically.

Healthy.io kits can be purchased by health care organizations, but not yet by end consumers in the U.S. In the future, the availability of kits across pharmacies, as is the case in the UK, will help further improve access to preventive care and management of chronic kidney disease.

is a urology resident at Weill Cornell Medicine/New York-Presbyterian, and 

is professor of urology, Weill Medical College of Cornell University, Weill Cornell Medicine/New York-Presbyterian, New York. 

of Healthy.io for providing information on the Dip.io app.

Spyridon P. Basourakos, MD, and Alexis E. Te, MD, review the Dip.io app.

App review: Dip.io brings urinalysis to your smartphone

UpToDate is one of the most trusted medical reference tools with evidence-based clinical information for daily practice. UpToDate, a Wolters Kluwer brand, initially started as a web-based nephrology resource in 1992 and has since been broadened to encompass multiple specialties, including urology. In recent years, UpToDate has become more readily accessible with the development of a mobile app for smartphones and tablets.

After downloading the UpToDate app, providers will be prompted to sign in with appropriate credentials, obtained through personal or institutional subscriptions, to obtain access.

The home screen of the UpToDate app has a search box at the top and a menu of other features, such as My UpToDate, Calculators, Contents, Drug Interactions, and Settings (figure 1).

As users enter queries into the search box, the app automatically provides a list of relevant topics related to the search term(s). Once a topic is selected, the app subcategorizes the content into Adult, Pediatric, and Patient Education sections. Patient education materials enhance patient-provider rapport by involving patients in the management of their medical conditions.

"Content can also be bookmarked for ease of future access"

Content can also be bookmarked for ease of future access. For instance, when one inputs “UTI” into the search box, multiple UpToDate articles related to urinary tract infection appear (figure 2) and can be filtered based on the categories described above. For each topic, there is a basic outline that includes introduction, clinical manifestations, diagnosis, and treatment with access to pictures, tables, and algorithms (figure 3).

The top of the page contains information about the authors, editors, and disclosures. Furthermore, the dates of the last literature review and the last update to a given topic are provided 

 Hyperlinks to other relevant topics are provided in each article 

This tab tracks search history and bookmarks, which allows the user to easily revisit and organize favorite topics.

This section comprises a list of topics organized by medical specialty and also contains “Practice Changing UpDates” and “What’s New” tabs, include recent updates in practice guidelines, FDA approvals, and groundbreaking medical advances.

The UpToDate app facilitates the acquisition of clinically relevant numerical data by providing calculators for commonly used formulas. Calculators are organized either alphabetically or by specialty.

This tab is a recent addition to the app. It offers access to a database with drug-drug interactions, which improves patient safety in daily practice. This feature is offered in collaboration with 

, an online electronic drug reference solution.

UpToDate has been accredited by Accreditation Council for Graduate Medical Education. Providers can earn CME credits as they review clinical topics while logged into UpToDate. Credit can be redeemed at no extra cost and without additional testing.

UpToDate Advanced is a new feature of the UpToDate website released in early 2018. It allows the physician to receive patient-tailored recommendations through algorithms. Physicians input their patients’ symptoms and history into an interactive algorithm that can guide medical decisions. In addition, a lab interpretation feature helps physicians better understand unusual or challenging test results by providing differential diagnoses. Although only available on the UpToDate website thus far, it would be a valuable asset to the mobile app.

 is a urology resident at Weill Cornell Medicine/New York-Presbyterian Hospital, and 

 is professor of urology, Weill Medical College of Cornell University, Weill Cornell Medicine/New York-Presbyterian Hospital, New York.

In the first installment in a new series, Spyridon Basourakos, MD, and Alexis E. Te, MD, review the UpToDate app.

App review: UpToDate earns high marks for accessibility

Instant access to information via our mobile devices has become a daily necessity and has transformed how our modern world interacts. To help the modern urologist, we list and briefly review the best apps to get urologists at all levels of expertise through their day.

Our search was focused on apps available through the App Store (Apple) and Google Play (Android OS). Divided into major categories-guidelines, journal articles, management, and patient education tools-we list the apps relevant to our world that get the job done. Bold text indicates the terminology used to search for a given app.

(App Store/Google Play) serves as a quick reference for urologists on the most current evidence-based clinical guidelines and best practice guidelines published by the AUA (figure 1). (Publisher: American Urological Association [AUA])

(App Store/Google Play) mirrors the AUA Universitywebsite and includes access to the AUA Core Curriculum, which is a comprehensive reference divided into over 80 specialized sections. The app is a valuable tool for daily clinical practice and board exam preparation as it links to a number of resources, including webcasts, textbooks, videos, articles, and simulations. (Publisher: AUA)

(App Store/Google Play) provides a quick and easy way to access the content of the 2018 European Association of Urology (EAU) guidelines, organized into over 20 topics that discuss management, investigation, diagnosis, and follow-up of various urologic conditions. There are free versions of the pocket guidelines available with initial app installation; EAU members can access the remainder of the pocket guidelines, while non-EAU members are required to purchase them. (Publisher: EAU)

(App Store/Google Play) mirrors the SociÃ©tÃ© Internationale d’Urologie (SIU) Academy eLearning portal with access to numerous educational activities, including ePosters, webcasts, expert opinion videos and editorials, CME-accredited courses, interactive quizzes with surgical videos, and e-grand rounds and endourology series. The app also allows users to search for content related to topics of interest. SIU Academy App is available to SIU members. (Publisher: SIU/Multilearning Group)

(App Store/Google Play) allows providers to access the most up-to-date National Comprehensive Cancer Network (NCCN) algorithms and discussions for management decisions and interventions applicable to 97% of all patients with cancer. There are additional guidelines and pathways focused on prevention, screening, and supportive care. This app is available upon free registration at 

Major urology journals have also created apps to offer readers easy and quick access to current and archived editions. However, before entering a journal site, the most frequently used search engine for first finding a reliable academic reference remains 

(figure 2), offered by the National Library of Medicine, one of the most respected sources of established journal articles and references. However, to supplement the urologist’s mobile library, the following apps provide easy access to key urology journals:

(App Store/Google Play) offers extensive evidence-based clinical information, including recommendations for management, opportunities to earn and track free CME/CE/CPD credits, as well as patient education materials. (Publisher: UpToDate, Inc.)

(App Store/Google Play) are two apps that contain information about pharmacology and dosing, as well as drug indications and guidelines for use, contraindications, side effects, and drug-drug interactions to enhance efficiency and safety in daily practice. The Epocrates app is free with the ability to upgrade to an 

subscription, which offers additional features, such as alternative medications, lab guides, and evidence-based disease treatment options by patient type (figure 3). New Lexicomp users will receive a 1-month free trial with the option to pay for continued access thereafter. (Publishers: athenahealth, Inc.; Lexicomp)

(App Store/Google Play) provides a systematic approach to the initial management, differential diagnosis, and treatment of common urologic emergencies, which is especially valuable for urologists in training. (Publisher: Brainydoc Ltd.)

(App Store/Google Play) allows users the opportunity to subscribe to the latest version of the Oxford Handbook of Urology. (Publisher: Indextra AB)

(App Store) serve as guides for prevention, diagnosis, and treatment of sexually transmitted diseases (STDs), in addition to identification of at-risk populations. (Publisher: Paul Chan, Centers For Disease Control and Prevention)

(App Store/Google Play) is the official drug information app from Physician Desk Reference (PDR), a longtime reference for drug prescribing information. (Publisher: PDR Network)

(App Store/Google Play) is a free app that connects physicians, nurse practitioners, physician assistants, and pharmacists. Each member has a Doximity profile, which provides access to HIPAA-secure fax and caller ID services, as well as clinical news. (Publisher: Doximity) 

(App Store/Google Play) provides 350-plus clinical calculators, risk scores, and algorithms that cover the entire spectrum of medicine (figure 4). FENa, creatinine clearance, CAPRA score, prostate volume, and PSA density are only a few calculations that are useful in daily urologic practice. (Publisher: MD Aware, LLC)

Prostate Cancer Clinical Risk Classification Tool 

(App Store) is a simple app that calculates a patient’s NCCN Risk Classification based on PSA, biopsy findings, and digital rectal examination findings. (Publisher: Genomic Health, Inc.)

Patient education and self-management tools

(App Store/Google Play) allows providers to use medical art with annotations to educate their patients about medical conditions and procedures with the assistance of personalized illustrations, presentations, and handouts (figure 5). (Publisher: Visible Health, Inc.)

(App Store) incorporates a biofeedback feature that allows male and female patients to measure how often they perform their Kegel exercises and how long they spend contracting and relaxing their pelvic muscles during each exercise. The app also allows patients to track their urinary function, such as frequency of urinary urgency, number of trips to the bathroom, number of incontinence events, and number of urinary pads used. This app is valuable for gauging response to treatment and allows for implementation of timely intervention. (Publisher: UCSF)

(App Store) allows patients to maintain a bladder diary by tracking their fluid intake and urinary output. It also contains AUA tests designed to help men assess the severity of their urinary symptoms and response to therapy. (Publisher: Ronald L. Yap, MD)

(App Store/Google Play) illustrates the anatomy and physiology of the prostate gland and the urinary bladder, as well as the pathophysiology, diagnosis, and treatment of BPH and overactive bladder. This atlas serves as animated reference for effective presentations to patients and colleagues. Limited features can be accessed for free, and the remaining content must be purchased. (Publisher: Focus Medica India Pvt. Ltd.)

More and more urologists are using these apps as an educational and reference tool in their daily practice. The apps offer the ability to continuously access information and promote the dissemination of knowledge among physicians and patients.

 is assistant professor of surgery (urology) at the Center for Reconstructive Urology and Men's Health, University of Utah, Salt Lake City, and 

 is professor of urology, Icahn School of Medicine at Mount Sinai, New York.

To help the modern urologist, we list and briefly review the best apps to get urologists at all levels of expertise through their day.

Author | Spyridon Basourakos, MD

Articles

App review: AUA apps offer clinical guidance and more

App review: Dip.io brings urinalysis to your smartphone

App review: UpToDate earns high marks for accessibility

Best apps to get urologists through their day