Volume 20 Issue 7, July 2023

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.

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.

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.

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.

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.

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.

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.

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.

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.

Non-invasive liquid biopsies such as plasma circulating tumour DNA (ctDNA) and urinary tumour DNA (utDNA) are promising tools for urothelial carcinoma diagnosis and management. In this Review, the authors provide an overview of the different liquid biopsy technologies available, and discuss the current state as well as future perspectives of ctDNA and utDNA application in urothelial carcinoma clinical care.

In this Review, Nolla and colleagues discuss the use of patient-reported outcome measures (PROMs) to assess health-related quality of life in six immunotherapy versus sunitinib clinical trials for advanced renal cell carcinoma and, following this discussion, make recommendations for future PROM use in clinical trials.

In this Review, Reyes et al. provide an overview of the embryology and genetics of typical sex development, before discussing the clinical manifestations, genetic causes and phenotypic complexity of differences in sex development.