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Personal Data
Please fill in the following items:
Name:
--
Prof.
dr.
drs.
ir.
ing.
Mr.
M.
B.
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 cancer
Renal cell cancer
Prostate BPH/LUTS
Kidney transplantation
Kidney stones
Bladder cancer
Bladder incontinence
Penis cancer
Penis ED / premature ejaculation
Testis cancer
Testis androgen deficiency
Pediatric 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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