HeyHippocratesStones, PSA, the prostate, torsion — a colleague who cites every call.
Clinical decision support that reasons like a urologist while you decide: size the stone, risk-stratify the PSA, climb the BPH ladder, catch the torsion — with the decision rule and exactly what would change it. Built for verified urologists.
Watch it think — in urology.
Two worked examples, reasoned the way it answers: the relevant clinical checks run, the answer is cited, the decision rule is explicit, and what is missing is flagged.
35-year-old, acute flank pain, CT shows a 5 mm distal ureteral stone, no infection or obstruction, kidney function normal — management?
A 5 mm distal ureteral stone is likely to pass spontaneously. Offer medical expulsive therapy with an alpha-blocker (tamsulosin), NSAID analgesia, hydration and a strainer, with follow-up imaging in a few weeks. Intervene — ureteroscopy or shockwave — for a stone that fails to pass, grows, or obstructs. An obstructed, infected kidney is an emergency needing urgent decompression.
Decision ruleUreteral stone ≤5 mm, no infection/obstruction → MET + analgesia and observe; failure/growth → ureteroscopy/SWL; obstruction + infection → emergent decompression.
Not established from this alone — stone size and position, infection, single kidney and renal function change the plan.
62-year-old, PSA 6.2 ng/mL, no symptoms, a normal digital rectal exam — next step?
Confirm the PSA is persistently elevated (repeat, exclude prostatitis/UTI, consider PSA density and free-to-total ratio), then move to a prostate MRI before biopsy — a suspicious PI-RADS lesion guides a targeted biopsy. Biopsy grade (ISUP grade group / Gleason) plus PSA and stage set the risk category, which drives active surveillance versus treatment. Share the decision.
Decision rulePersistently elevated PSA → MRI then targeted ± systematic biopsy; grade by ISUP/Gleason; low-risk → active surveillance; higher-risk → treat.
Not established from this alone — the confirmed PSA, MRI, biopsy grade, life expectancy and preference change the pathway.
Illustrative simulations. The physician always decides.
The answers urologists actually look up.
The exact questions your field searches for — answered in the format the knowledge base speaks: the answer, the decision rule, what's missing, and the source.
PSA and prostate cancer — screening, grading and active surveillance?
Offer PSA screening as a shared decision, broadly ages 55–69, weighing benefit against overdiagnosis. A persistently elevated PSA leads to a prostate MRI and, if suspicious, a targeted biopsy; the ISUP grade group (from the Gleason score) plus PSA and stage give the risk category. Low-risk disease (ISUP 1, low PSA, localized) is well suited to active surveillance; intermediate- and high-risk disease is treated with surgery or radiation.AUA/EAU · guideline
Decision ruleShared-decision PSA screening; elevated → MRI + targeted biopsy; low-risk (ISUP 1) → active surveillance; intermediate/high-risk → definitive treatment.
Missing data: the confirmed PSA, MRI, biopsy grade, stage and life expectancy drive the decision.
Ureteral stones — size and when to intervene?
Stone size predicts passage: most stones ≤5 mm pass spontaneously, 5–10 mm pass about half the time, and ≥10 mm rarely pass. Distal stones 5–10 mm benefit from medical expulsive therapy with an alpha-blocker. Intervene — ureteroscopy or shockwave lithotripsy — for a stone that will not pass, uncontrolled pain, or deteriorating function. An obstructing stone with infection needs emergent decompression (stent or nephrostomy).AUA/EAU · stone
Decision rule≤5 mm, no complication → observe + MET; 5–10 mm distal → MET; non-passing/large → ureteroscopy/SWL; obstruction + infection → emergent decompression.
Missing data: stone size and site, infection, a solitary kidney and renal function change management.
BPH and lower urinary tract symptoms — the medical ladder?
Grade the symptoms with the IPSS and rule out other causes (infection, cancer, neurologic). Bothersome symptoms start with lifestyle measures and an alpha-blocker (tamsulosin) for rapid relief; add a 5-alpha-reductase inhibitor for a large gland to shrink it over months; a beta-3 agonist or anticholinergic targets an overactive-bladder component. Surgery (TURP or laser) is for refractory symptoms, retention or complications.AUA · BPH
Decision ruleIPSS + workup → alpha-blocker first; large gland → add 5-ARI; OAB component → beta-3/anticholinergic; refractory/retention/complications → surgery.
Missing data: symptom severity, gland size, post-void residual and complications change the ladder.
Testicular torsion / the acute scrotum — how fast must I move?
Sudden severe testicular pain with a high-riding testis, an absent cremasteric reflex and a horizontal lie is torsion until proven otherwise — a surgical emergency. Salvage falls sharply after about six hours, so with a high clinical suspicion go straight to scrotal exploration and do not delay for ultrasound. Detorse and perform bilateral orchidopexy; ultrasound is only for genuinely equivocal cases.guideline synthesis
Decision ruleHigh suspicion of torsion → emergent exploration within ~6 h, do not delay for imaging; detorsion + bilateral orchidopexy; image only equivocal cases.
Missing data: the onset time, exam findings and pretest probability drive the decision to explore.
What it knows in urology
Your whole practice, one specialist brain — grounded in specialist-written, cited knowledge.
A generalist urology colleague across stones, prostate, BPH, uro-oncology and emergencies — cited, non-directive, always with the decision rule.
Deep specialist agents for endourology & stones, uro-oncology, functional urology and andrology — each its own specialist voice and knowledge base — plus your own uploaded materials.
Why not just use OpenEvidence or ChatGPT?
A large language model answers any clinical question with total confidence and no idea whether it is right. A search engine finds papers. HeyHippocrates reasons inside your specialty from a knowledge base a specialist in your field wrote and signed, and tells you the decision rule and what is missing.
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Questions urologists ask
It reasons in the tools you use — PSA and its derivatives, PI-RADS, the ISUP grade group and stone size — and always shows the reasoning, the decision rule and what would change it. The decision always stays your call.
Both. Residents use it to pressure-test a plan and learn the decision rule; attendings use it as a fast, cited second opinion in clinic and on call. Access is gated to verified physicians.
Endourology and stones, uro-oncology, functional urology and andrology each have their own deep specialist agent on the Pro plan, on top of the full urology scope on Basic.
No. It is physician-facing clinical decision support — a cited thinking partner. It does not diagnose, does not treat, and gives no patient-facing advice. The decision always stays with you.
Every answer is grounded only in specialist-written, cited urology knowledge — traceable to a named source — and always states the decision rule plus what data is missing, instead of a confident guess.