Comment

Centralization of care for penile cancer has been underscored in the 2023 updated EAU–ASCO guidelines. Expertise consolidation enhances patient care, addressing penile cancer complexities from diagnosis to treatment. Centralization initiatives, like the European Reference Networks, and dedicated scientific societies have crucial roles in guiding centralized care pathways to ultimately improve patient outcomes.

Autonomous surgical robots have the potential to transform surgery and increase access to quality health care. Advances in artificial intelligence have produced robots mimicking human demonstrations. This application might be feasible for surgical robots but is associated with obstacles in creating robots that emulate surgeon demonstrations.

The growing global burden of genitourinary cancers is disproportionately shouldered by low- and middle-income countries. Medical journals offer an avenue for discourse among different stakeholders to strategize and identify solutions. Thus, achieving diversity in this context is crucial to put together a heterogeneous group of stakeholders with diverse personal and cultural experiences as well as distinct problem-solving approaches.

Artificial intelligence (AI) has the potential to revolutionize scientific publishing. The influence of AI could be disruptive or destructive and its influence remains to be seen, but balance between the convenience and accessibility offered by AI-driven tools and the essential skills of deep scientific inquiry and communication needs to be found.

The escalating global prevalence of urinary stone disease and its impact on public health reflects the need to synthesize ideas that can help with the development of critical research priorities. By bringing together a forum of endourologists with the support of a funding agency, the IDEA session aimed to identify important future research topics.

Oligometastatic bladder cancer, defined as a cancer with limited metastases, is a potential target for curative metastasis-directed therapy in a multidisciplinary framework. The consensus definition of oligometastatic bladder cancer is a valuable starting point for clinical trials, but challenges remain in accurately characterizing metastatic burden with current imaging modalities and determining optimal strategies to treat patients with lymph node involvement.

Prostate-specific membrane antigen-PET has become a valuable diagnostic tool. The second version of the Prostate Cancer Molecular Imaging Standardized Evaluation framework is the next step towards a standardized evaluation and reporting system from primary staging to reassessment of advanced prostate cancer.

Clinic-based uroflowmetry is limited by a short window of data collection and inefficient data transmission. Obtaining uroflowmetry data in the home setting has the potential for increased data on voiding patterns to inform clinical decision-making. However, integration of this practice depends on optimizing technology and data management.

Transgender women remain at risk of prostate cancer and warrant consideration for PSA screening. However, current PSA reference ranges and guidelines are based on data from cisgender men. As these thresholds might be inappropriate in transgender women receiving gender-affirming hormones, we recommend that these patients should undergo screening for prostate cancer at regular intervals and further evaluation for PSA >1 ng/ml or rising PSA. Furthermore patient-centred dialogues should be initiated with patients to ensure awareness of prostate cancer risk.

The gender gap among urologists is narrowing, but representation of women from under-represented in medicine (URiM) groups remains low. URiM women face the added challenge of contending with tokenism. Intentional sponsorship and coaching, as well as institutional efforts to establish an inclusive and equitable workplace culture, are imperative to abolish the lag in promotion and academic achievement of these women.

Several newly approved therapies have substantially altered the treatment paradigm for multiple genitourinary cancers. Considering the existence of numerous possible treatment approaches, understanding which treatment attributes are most valued by each patient is crucial to physicians to recommend a cancer-directed treatment.

The urological workforce in the United States is substantially affected by inequitable abortion access across the nation. Female residency applicants avoid states with restrictive laws, and women urologists residing in these states are considering leaving. The urological community needs to invest in advocacy to protect the health of their members.

Conversations around pregnancy and parenting in medicine are increasingly important, especially as the number of women in medical training increases. Common challenges are experienced by women during pregnancy, parental leave, return to work and lactation, and policy suggestions can be offered to support doctors and surgeons who want to expand their families.

Burnout is prevalent among urologists and leads to increased medical errors and decreased career satisfaction. Lack of access to mental health care and long work hours contribute to burnout in urologists; however, gender bias in the workplace, mistreatment and balancing family life responsibilities specifically predispose women urologists to burnout.

Women urologists receive less compensation than male urologists. Concerted individual and institutional action is necessary to value the impact that women urologists have on patients and on the entire field.

The field of medicine has advanced towards gender equity in medical student matriculation over the past decade, but urology has lagged substantially behind other sub-specialties regarding the percentage of both women residents and women staff. This gender gap is further increased for under-represented individuals in medicine. One of the strategies to close these gaps is to create an inclusive work environment through allyship.

The number of women entering the historically male-dominated field of urology is growing over time, but women in urology are disproportionately younger than the male counterpart and face unique challenges that require intentionally directed mentorship. In this Comment, some of these issues are discussed from the perspective of both the female mentee and mentor.

Women urologists constitute an increasing proportion of the urology workforce in the United States. Considering the projected shortage of urologists over the coming decades, women urologists will have a crucial role in the delivery of urological care. Opportunities for recruitment and retention of women in the field of urology must be highlighted.

Artificial intelligence (AI) has rapidly become one of the most important and transformative technologies of our time, with applications in virtually every field and industry. Among these applications, academic writing is one of the areas that has experienced perhaps the most rapid development and uptake of AI-based tools and methodologies. We argue that use of AI-based tools for scientific writing should widely be adopted.

Sponsorship is the active and intentional use of a person’s influence or leadership status to use political and personal capital to advance a junior colleague’s career both privately and publicly. A sponsor has a seat at the decision-making table and can access the junior colleague’s work and power, and a junior colleague can capitalize on the opportunity quickly, effectively and successfully.