Mapping Digital Transformation in Ambulatory Urology in Germany: High Familiarity versus Low Connectivity – A Nationwide Survey on the Current State, Structural Barriers, and Economic Framework

INTRODUCTION: Digital transformation of European healthcare is progressing rapidly, yet implementation in outpatient specialist care remains uneven. In Germany, office-based urologists face distinct structural, regulatory and economic challenges. We assessed digital infrastructure, tool utilization, perceived barriers and investment behaviour, including age-related differences. METHODS: We conducted a nationwide cross-sectional survey (April-July 2024) among private-practice urologists in Germany using a 35-item questionnaire structured along three dimensions of digital adoption (infrastructure, functional use, physician attitudes). Items were adapted from two previously published, peer-reviewed German urology surveys and pretested with 12 urologists prior to launch. 189 valid responses (response rate 17.4%) were analysed using descriptive statistics, chi-squared tests and pre-specified multivariable logistic regression adjusting for age, gender, practice size, years in practice and region. RESULTS: Self-reported digital familiarity was high (66.1% familiar or very familiar), yet infrastructure remained traditional: 92.6% used on-site servers and only 7.4% any cloud component. Telemedicine was rarely used (61.9% never), while 49.2% used health apps or DiGAs. Adjusted analyses confirmed that age <55 years (aOR 2.93, 95% CI 1.56-5.52, p<0.001) and shorter time in practice (aOR 0.78 per +5 years, 95% CI 0.65-0.94, p=0.009) independently predicted DiGA use and revealed that telemedicine adoption was driven primarily by practice size (aOR 1.16 per additional full-time equivalent, 95% CI 1.05-1.29, p=0.005) rather than age. Most practices planned to invest less than €30,000 over five years. CONCLUSIONS: Digitalization in outpatient urology remains primarily administrative. High familiarity does not translate into clinical transformation, and adoption is constrained by structural rather than generational barriers. Targeted funding, interoperable systems, and clear reimbursement frameworks are needed to enable clinically meaningful digital integration.