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Personal Data
Please fill in the following items:
 
Name:
male   female
Name of your institute:
Address:
Postal Code / City:
Country:
Phone number:
Fax number:
E-mail address:
Password:
Confirm password:
EAU member number:
 
What category applies to your institute: yes no
  University hospital  
  General hospital  
  Private clinic  
  Other
 
Number in staff: Urologists
  Research personnel
 
Facilities: Beds urology
 
First diagnoses per year: PROSTATE  
(number of patients) Prostate cancer  
     localised
     metastatic
  Number of radical prostatectomies  
     open
     laparoscopic
     robotic surgery
 
  BPH/LUTS  
     BPH/LUTS
     Number of TURPS
     other BPH treatments, specify 
     other BPH treatments, specify 
 
  BLADDER / GENITO-URINARY TRACT  
  Bladder cancer  
     superficial
     locally advanced
     metastatic
  Incontinence  
     stress
     urge
     mixed (stress and urge)
 
  TESTIS  
     testis cancer
     androgen deficiency
     infertility
 
  KIDNEY  
  Renal cell cancer  
     localised
     metastatic
  Number of radical nefrectomies  
     open
     laparoscopic
  Kidney transplantation
  Stones
 
  PENIS  
     penis cancer
     erectile dysfunction
 
  PEDIATRIC UROLOGY  
     pediatric urology
 
Total clinical urological trials currently running in your site
   Trials sponsored by non-profit organisation
      Specifiy non-profit organisation (eg. EORTC / EAU):  
   
   Trials sponsored by industry (eg. pharmaceutical / med. devices industry)
 
What kind of clinical indications are investigated in the trials in your site?  
 
Prostate cancerRenal cell cancer
Prostate BPH/LUTSKidney transplantation
 Kidney stones
Bladder cancer 
Bladder incontinencePenis cancer
 Penis ED / premature ejaculation
Testis cancer 
Testis androgen deficiencyPediatric Urology
Infertility 
  
Other:
 
 
Urologists in your site currently involved in urological clinical trials
 
Total patients enrolled in urological clinical trials during last:  
  3 years
  1 year
 
How would you describe your knowledge of GCP:
poor
good
excellent
 
Have you attended GCP course? yes   no
 
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