A patient asked me years ago whether technology was helping prostate and urinary problems at the pace it should be. I gave a short and fairly proud answer at the time. Urology has always been early to new technology, I said, and I listed lasers, shock wave, microwave, nerve stimulators, radiofrequency ablation and robotics as proof.
I still believe the first part. But I have been doing this since 1995, and I have now watched enough technology arrive with fanfare and leave without a sound that the honest answer is more interesting than the one I gave.
What actually changed how patients do
Robotic surgery. In 2013 this was still displacing open surgery and the argument was live. That argument is over. Nearly every radical prostatectomy in the country is done robotically now. Less blood loss, shorter catheter time, faster recovery. The catch, which took years to admit out loud, is that the robot does not make a mediocre surgeon good. Volume and judgment still decide outcomes. The tool got better and the variation between surgeons did not go away.
Ureteroscopy and the holmium laser. This one gets no press and deserves a great deal. Small flexible scopes and a laser that breaks stones reliably meant we could go get almost any stone, anywhere in the kidney, without an incision. If you want a single thing that changed daily urology more than anything else in my career, it is this, and most patients have never heard of it.
MRI of the prostate, and PSMA PET. For most of my career, an elevated PSA meant sampling the prostate blindly and hoping. Now we look before we biopsy, aim at what we see, and skip the biopsy entirely in some men. PSMA PET does the same thing for staging, finding disease that older scans missed.
Minimally invasive BPH treatment. For a long time the choice was a daily pill or a real operation, and a lot of men picked neither and lived with their symptoms. UroLift, Rezum, Aquablation, prostatic artery embolization and HoLEP filled in that middle. Not every one suits every prostate, but the gap that used to swallow men is mostly closed.
What did not pan out
Transurethral microwave therapy. I named it in 2013 as evidence of how forward thinking we were. It is essentially gone.
Prostatic stents. Same story. A clever idea that did not hold up.
Proton beam for prostate cancer. Still available, still expensive, still without convincing evidence that it beats standard radiation for this disease. Twenty years of waiting for the data to arrive.
HIFU and cryotherapy, at least as whole gland treatments. Both found a narrower home as focal therapy, which is a reasonable landing spot, but neither became what was predicted.
I do not think any of that was wasted. That is roughly what medical progress looks like from the inside. You try things, some hold up, most do not, and the ones that fail are usually failures of evidence rather than of imagination. What bothers me is not that these things did not work. It is how confidently they were sold while we were still finding out.
The best change was not a technology at all
If you asked me to name the single development that has done the most good for my patients over thirty years, I would not name a device.
It is active surveillance. The recognition that a great many low risk prostate cancers should be watched rather than treated, and that finding a cancer does not oblige you to operate on it. No new machine. No FDA clearance. Just better evidence and the discipline to act on it.
That was harder to adopt than any technology on this page, because it asked surgeons to do less. It is also the change I would defend first.
So, to the original question
Is technology moving at the pace it should? Faster than the evidence, most of the time. The devices arrive before the studies do, and patients hear about them in that order too.
I still love working in a specialty that reaches for new tools early. I have just learned to ask how long a thing has been around and who paid for the study, before I get enthusiastic about it in front of a patient.