Grant funding among underrepresented minority and women urologists at academic institutions.

INTRODUCTION: Grant funding to Urology has decreased over the last decade. Documented lack of gender and race diversity at the faculty level raises concerns for funding disparities. This study sought to characterize disparities based upon race and gender in National Institutes of Health (NIH) funding data to Urologic faculty. METHODS AND MATERIALS: Data from 145 ACGME accredited Urology residency programs incorporating faculty gender and underrepresented in medicine (URiM) status was utilized. The NIH Research Portfolio Online Report Tool was queried between 1985 and 2023 for grants related to current Urology faculty. URiM status, gender, years of practice, academic rank, and Doximity residency program rank were factors in multivariable analysis. RESULTS: A total of 2,131 faculty were included. Three hundred one Urologists received 793 urologic grants for a total of $993,919,052 in funding. By race, grants were awarded to: White 72.9%, Asian 21.8%, Hispanic 3.0%, Black 2.1%. Men received 708 grants (89.3%) worth $917,083,475 total. Women received 85 grants (10.7%) worth $76,835,577 total. Likelihood of being awarded a grant was significantly associated with non-URiM status (p < 0.001) and men (p < 0.0001). On multivariable analysis, Doximity rank (p < 0.001) and academic rank (p < 0.001) were significant predictors of receiving a grant; male gender, URiM status, and years of practice were not. Academic rank was also a significant predictor of number of grants received (p = 0.04) and total funding (p = 0.04); years of practice, Doximity rank, URiM status, and gender were not. CONCLUSIONS: NIH grants were more likely awarded to higher ranked faculty from higher Doximity ranked institutions with no differences based on URiM status or gender.

Comparison of In-person FPMRS-directed Pelvic Floor Therapy Program Versus Unsupervised Pelvic Floor Exercises Following Prostatectomy.

OBJECTIVE: To compare comprehensive continence outcomes in patients receiving pelvic floor muscle training (PFMT) vs standard unsupervised home pelvic floor exercise therapy (UPFE). METHODS: As part of the UVA prostatectomy functional outcomes program, participating patients complete a 12-month PFMT program under FPMRS specialist supervision. We performed a retrospective review of prospectively collected longitudinal outcomes in patients receiving PFMT vs UPFE through 12-month follow-up. Primary study outcome was ICIQ-MLUTS SUI domain score (SDS). Secondary outcomes included daily pad use (PPD), SUI Cure (SDS=0), and quality of life score (IIQ-7). Multilevel mixed effects linear regression was used to model SDS over time. RESULTS: Analysis included 40 men. No difference in patient characteristics was seen in comparison of PFMT vs UPFE cohorts (P = NS, all comparisons). Mean predicted SDS was significantly better in the PFMT vs UPFE cohorts at 6-month (0.81 ± 0.21 vs 1.75 ± 0.34, respectively) (P = .014) and 12-month (0.72 ± 0.17 vs 1.67 ± 0.30, respectively) (P = .004) time points. At 12-month follow-up, 11 (55%) vs 4 (20%) patients reported absence of SUI in PFMT vs UPFE cohorts, respectively. Predicted probabilities of SUI cure in PFMT vs UPFE cohorts at 12months were 0.52 ± 0.14 vs 0.23 ± 0.13, respectively (P = .14). At 12-month follow-up, the mean predicted PPD and IIQ score was 0.19 ± 0.10 vs 0.79 ± 0.33 and 2.86 ± 0.86 vs 2.55 ± 1.07 in PFMT vs UPFE cohorts, respectively (P = NS). CONCLUSION: In-person, FMPRS-directed PFMT is associated with improved SUI domain scores following robotic-assisted laparoscopic prostatectomy, a finding durable through 12-month follow-up.

Academic Productivity Among Underrepresented Minority and Women Urologists at Academic Institutions.

OBJECTIVE: To characterize academic productivity for underrepresented minorities (URMs) vs non-URMs and by gender in Urology. METHODS: A database was created from 145 Urology residency programs. URM status was determined by origin of name, photo, biography, Twitter, LinkedIn, and Doximity. A PubMed query was performed for publication output. URM status, gender, post-graduate year/years of practice, and Doximity residency rank were factors in multivariable analysis. RESULTS: For residents, the median total publications was 2 [1,5] for URMs and 2 [1,5] for non-URMs (P=.54). The median first/last author publications was 1 [0,2] for URMs and 1 [0,2] for non-URMs (P=.79). The median total publications was 2 [0,4] for women and 2 [1,6] for men (P=.003). The median first/last author publications was 1 [0,2] for women and 1 [0,2] for men (P=.14). For faculty, the median total publications was 12 [3,32] for URMs and 19 [6,45] for non-URMs (P=.0002). The median first/last author publications was 4.5 [1,12] for URMs and 7 [2,20] for non-URM faculty (P=.0002). The median total publications was 11 [5,25] for women and 20 [6,49] for men (P<.0001). The median first/last author publications was 4 [1,11] for women and 8 [2,22] for men (P<.0001). On multivariable analysis, there was no difference in total publications and first/last author publications for URMs vs non-URMs. There remained a difference between genders for residents and faculty with total publications but not first/last author publications (P=.002/P=.10 residents, P=.004/P=.07 faculty). CONCLUSION: Academic productivity was not different in URMs and non-URMs for both residents and faculty. Men residents and faculty had more total publications compared to women.

Factors Influencing Underrepresented in Medicine Urologist Recruitment to Academic Institutions.

INTRODUCTION: We characterize factors associated with recruitment of underrepresented in medicine urology trainees and faculty to academic institutions given the excessive disparity between urology and other fields of medicine. METHODS: A database of urology faculty and residents in Accreditation Council for Graduate Medical Education programs was created. Demographic data were obtained from departmental websites, Twitter, LinkedIn, and Doximity. Program prestige was defined by U.S. News and World Report rankings. Program location and city size were determined using the U.S. Census data. Multivariable analysis was performed assessing the association of gender, AUA section, city size, and rankings on underrepresented in medicine recruitment. RESULTS: Of urologists in this study 8.7% were underrepresented in medicine status. More women urologists were underrepresented in medicine (31.4%) than non-underrepresented in medicine (21.3%; P < .001). Factors predictive of more underrepresented in medicine urologists were practice in South Central AUA section (OR 2.1, P = .04), and medium metro areas (OR 1.6, P < .01). Among residents, factors predictive of more underrepresented in medicine urologists were female gender (P < .001), living in medium metro areas (P = .03), and training in top 10 programs (P = .001). Underrepresented in medicine faculty were more likely to be women compared to non-underrepresented in medicine faculty (P = .05). Pearson correlation test found no association between the presence of underrepresented in medicine faculty and underrepresented in medicine residents (r = 0.20). CONCLUSIONS: Underrepresented in medicine urology residents and faculty were more likely to be women, compared to non-underrepresented in medicine residents and faculty. Underrepresented in medicine residents are more prevalent in medium metro areas and in top 10 programs. More underrepresented in medicine faculty status was not associated with more underrepresented in medicine residents.

The Impact of the Virtual Interview on Candidate Experience and Outcomes: Society of Academic Urologists National Survey of Interns Who Participated in the 2020-2021 Urology Match.

OBJECTIVE: To examine retrospective experiences with the virtual interview (VI) process among postgraduate year 1 (PGY1) urology residents who participated in the 2020-2021 American Urologic Association (AUA) Match cycle. METHODS: A 27-question survey created by a Society of Academic Urologists Taskforce on VI was distributed to PGY1 residents from 105 institutions between February 1, 2022 and March 7, 2022. The survey asked respondents to reflect on the VI process, cost concerns, and how experiences at their current program aligned with prior VI representation. RESULTS: A total of 116 PGY-1 residents completed the survey. The majority felt the VI represented the following domains well: (1) institution/program culture and strengths (74%), (2) representation of all faculty/disciplines (74%), (3) resident quality of life (62%), (4) personal fit (66%), (5) quality of surgical training and volume (63%), and (6) opportunities to meet residents (60%). Approximately 71% of respondents did not match at their home program or a program they visited in-person. Within this cohort, 13% agreed important aspects of their current program were not translated virtually, and they would not have prioritized the program had they been able to visit in-person. In total, 61% ranked programs they ordinarily might not have listed during an in-person interview season. Overall, 25% deemed financial costs a "very important" consideration during the VI process. CONCLUSION: The majority of PGY1 urology residents reported key components of their current program translated well from the VI process. This platform offers a method of overcoming conventional geographic and financial barriers associated with the in-person interview process.

Understanding the Urology Program Directors Perspective on the Current Resident Selection Process: The Society of Academic Urologists National Survey of Urology Program Directors.

OBJECTIVE: The traditional residency selection process was altered dramatically by the SARS CoV-2 (COVID-19) pandemic. For the 2020-2021 application cycle in-person interviews were transitioned to the virtual format. What was thought to be a temporary transition has now become the new standard with continued endorsement from the Association of American Medical Colleges (AAMC) and the Society of Academic Urologists (SAU) for virtual interviews (VI). We sought to assess the perceived efficacy and satisfaction of the VI format from the urology residency program director's (PDs) perspective. DESIGN: A designated SAU Taskforce on "Optimizing the Applicant Experience in the Virtual Interview Era" developed and refined a survey composed of 69 questions on VI and was distributed to all urology program directors (PD) of member institutions of the SAU. The survey focused on candidate selection, faculty preparation, and interview day logistics. PDs were also asked to reflect on the impact of VI on their match results, recruitment of underrepresented minorities and female gender, and what their preference would be for future applications cycles. PARTICIPANTS: Urology residency PDs (84.7% response rate) between January 13, 2022 - February 10, 2022 were included in the study. RESULTS: Most programs interviewed a total of 36 to 50 applicants (80%), with an average of 10 to 20 applicants per interview day. The top 3 ranked criteria for interview selection reported by urology PDs surveyed included letters of recommendation, clerkship grades, and USMLE Step 1 score. The most common areas of formal training for faculty interviewers were diversity, equity and inclusion (55%), implicit bias (66%), and review of the SAU guidelines on illegal questions (83%). Over half (61.4%) of PDs believed that they were able to accurately represent their training program through the virtual platform, while 51% felt that VI did not afford similar assessments of applicant as in-person interviews. Two-thirds of PDs believed the VI platform improve access for all applicants to attend interviews. Focusing on the impact of the VI platform for recruitment of underrepresented minorities (URM) and female gender applicants, 15% and 24% reported improved visibility respectively for their program, and 24% and 11% reported increased ability to interview URM and female gender applicants respectively. Overall, in-person interviews were reported to be preferred by 42%, and 51% of PDs desired VIs to be included in future years. CONCLUSIONS: PDs opinion and role of the VIs into the future is variable. Despite uniform agreement of cost savings and belief that VI platform improves access for all, only half of PDs expressed interest of the VI format being continued in some form. PDs note limitation of VI in the ability to comprehensively assess applicants as well as the in-person format. Many programs have begun to incorporate vital training in the areas of diversity equity and inclusion bias, and illegal questions. There is a role for continued development and research on ways to optimize virtual interviews.

Characterization of Applicant Preference Signals, Invitations for Interviews, and Inclusion on Match Lists for Residency Positions in Urology.

Importance: Preference signals were to be implemented in over 15 specialties during the 2022-2023 residency match. Analyzing results from the implementation of signals during the American Urological Association (AUA) urology match may inform future behavior. Objective: To characterize applicant and program signal usage and results in the Society of Academic Urology and AUA databases with respect to interview invites and rank list creation. Design, Setting, and Participants: This cohort study involved all applicants and residencies in the 2021-2022 AUA match with data analysis conducted in April through July 2022. Exposures: Five signals indicating interest. Main Outcomes and Measures: Using verified match and survey data reported by applicants and programs, a logistic regression was performed on applicant factors associated with obtaining an interview-the main outcome (using inclusion on rank list as a proxy): age, gender, degree (MD or DO), dispersal of signal, US senior status, racial minority group status, Latino ethnicity, international medical graduate status, presence of a home program, AUA geographic section, and US Medical Licensing Examination Step 1 score. Applicant signal dispersal strategies were stratified by applicant and program competitiveness, as well as program behavior upon receipt of signal with respect to extending interviews and rank list ordering of applicants. Results: A total of 2659 signals were sent by 553 candidates (mean [SD] age, 27.4 [2.9] years; 179 female [32.4%], 243 racial minority candidates [61.2%]) submitting rank lists for 364 positions at 143 programs. Programs received a median (IQR) of 352 (295-411) applications and were signaled to a median of 16 (8-26) times each. In a logistic regression estimating interview status, geographic proximity (OR, 3.25; 95% CI, 2.05-5.15; P = .001) and signal status (OR, 6.04; 95% CI, 3.50-10.40; P < .001) were associated with receiving an interview. Using multiple imputation by chained equations to impute missing data and broadening the data set, male gender (OR, 0.64; 95% CI, 0.45-0.92; P = .04) and international medical graduate status (OR, 0.35; 95% CI, 0.15-0.81; P = .04) were negative variables, while MD degree (OR, 2.36; 95% CI, 1.27-4.36; P = .02) and US senior status (OR, 1.91; 95% CI, 1.13-3.23; P = .04) were positive variables. Conclusions and Relevance: This study of the usage and trends of the newly added preference signals reported the most common strategies for signal dispersal; in an analysis of factors involved in obtaining an interview, geographic similarity between applicant and program and preference signal usage were associated with successful applications.

Complex Foley Catheter Placement After Radical Prostatectomy.

OBJECTIVE: To describe a method for replacement of a dislodged critical urethral foley catheter following a robotic- assisted laparoscopic radical prostatectomy. BACKGROUND: Following robotic-assisted laparoscopic radical prostatectomy (RALP), a bladder drainage via catheter is necessary to allow for proper healing of the urethrovesical anastomosis. In most cases, this is done using a transurethral foley catheter.1,2 Early traumatic loss of the urethral catheter following RALP is consider a urologic emergency and can lead to vesicourethral anastomotic urine leak, ileus, infection or abscess, and future anastomotic stenosis.3 Replacing the urethral catheter in this situation can be difficult even in experienced hands and often requires imaging assistance. METHOD: A 53-year-old male with Grade Group 4 (Gleason 4 + 4) prostate cancer underwent an uncomplicated RALP. During his post-operative course, his urethral foley catheter fell out or was traumatically removed three times resulting in disruption of the posterior anastomosis. To replace the urethral catheter and prevent it from being dislodged again, a transabdominal approach under ultrasound and cystoscopic guidance was employed to replace the catheter into the bladder and secure it trans abdominally using a single G-tube safety Pexy T fastener. CONCLUSION: This case reports describes a technique used to replace and secure a urethral foley catheter in a patient who suffered from a posterior anastomotic disruption following repeated loss and traumatic removal of his urethral foley catheter during his RALP post-operative course. While replacement of a dislodged urethral foley catheter following a RALP can be challenging, the catheter can safely be placed and secured trans abdominally in these rare but serious situations where the conventional catheter secure devices and patient education alone are not sufficient to prevent removal.

The Fate of the Unmatched Urology Applicant.

OBJECTIVE: To determine the outcomes and eventual career paths for unmatched applicants by evaluating a historical cohort of unmatched applicants in the Urology Match. METHODS: The 2008-2014 AUA Match lists were obtained from the Society of Academic Urologists and 730 unique applicants were identified with at least one unmatched result. Additional information such as preliminary training and eventual specialty choice were obtained from publicly available sources. Comparative analysis with univariable and multivariable analysis was performed between eventual urologists and those who chose alternative career paths. RESULTS: Overall, 43.5% (318/730) of unmatched urology applicants subsequently continued their interest in Urology and 77.4% (246/317) of initially unsuccessful applicants eventually became urologists. Males (80.9%, P = .01), Doctor of Osteopathy (DO) degree (62.5%, P = <.001), and those undergoing a research year compared to a preliminary surgery year (85.2% vs 72.0% respectively, P = .047) had an increased likelihood of successfully becoming a urologist. The most common alternative specialty choices were Internal Medicine (13.8%), General Surgery (12.9%) and Anesthesiology (11.9%). CONCLUSION: Urology is a competitive surgical sub-specialty. Surprisingly, approximately 3 in 4 unmatched urology applicants who continue their interest in urology will eventually obtain a residency position. However, only 33.7% of initially unmatched students ultimately became urologists. Unmatched applicants have several viable pathways to obtain a urological residency position. Male gender, a DO degree, and a research year are associated with successfully obtaining a urology residency position.

Novel online comprehensive pelvic floor therapy program following prostatectomy.

Background: Although pelvic floor muscle training (PFMT) is widely shown to improve post-prostatectomy incontinence (PPI), numerous barriers impede access to formal PFMT and include the limited availability of specialized therapists and financial or scheduling barriers. To address these barriers, we developed a novel online program delivering comprehensive long-term PFMT, pelvic floor education (PFE), and dietary/behavioral modification education. This study is a prospective interim analysis of online PFMT/PFE (oPFMT/PFE), with focus on feasibility, satisfaction, and continence outcomes. Methods: Patients anticipating robotic-assisted laparoscopic prostatectomy (RALP) were recruited (6/2021-9/2022) for oPFMT/PFE. oPFMT/PFE comprises a 12-month program of 3 phases, including multiple exercises with varied contraction types and duration, and comprehensive dietary and behavioral technique education. Incontinence and quality of life (QOL) outcomes are assessed at 3 weeks, 3, 6, and 12 months following RALP using validated International Consultation on Incontinence Questionnaire Male Lower Urinary Tract Symptoms (ICIQ-MLUTS) and Incontinence Impact Questionnaire (IIQ-7) questionnaires and additional items assessing satisfaction, improvement, and daily pad use. Primary study outcomes included ICIQ-MLUTS stress urinary incontinence (SUI) domain score (SDS) and SUI cure [ICIQ SUI domain score (SDS) =0]. Interim 6-month analysis was performed using mixed effects linear regression and mixed effects Poisson regression. Results: Analysis included 21 men (64±6 years). At 6-month follow-up, men undergoing oPFMT/PFE showed significant improvement in SDS compared to the 3-week time point [mean ± standard error (SE) =1.05±0.24 vs. 0.45±0.17, P=0.011], but still experienced higher scores than at baseline (P=0.017). Six-month patient-reported improvement averaged 7.42±0.74 (10-point Likert scale). All (100%) of 19 respondents (2 missing data) found the program easy to use, educational, and would recommend it to others, with 89% expressing satisfaction with the program. During patient interview at 6-month follow-up, no men reported inability to access the program online or any adverse events. Finally, IIQ-7 score improved significantly from the 3-week timepoint (4.47±1.10) at both time points (3-month 1.14±0.44, P<0.001 and 6-month 1.10±0.37, P<0.001), and neither 3- nor 6-month scores differed from baseline (P=0.808 and P=0.444, respectively). Conclusions: Our novel oPFMT/PFE yields significant improvements to validated urinary incontinence (UI) and QOL measures, providing a valuable and accessible treatment option for PPI.

The role of surgery for locally advanced urothelial cancers.

PURPOSE OF REVIEW: Extirpative surgery can play an important role in the management strategies for locally advanced urothelial carcinoma. The current review is intended to relay current information reported in the literature over the past 12 months regarding the usage of surgical resection in advanced urothelial cancers of the bladder and upper tracts, document operative outcomes, and oncologic efficacy. RECENT FINDINGS: Multimodal therapy is key to long-term overall survival for advanced urothelial carcinoma. Radical cystectomy with bilateral pelvic lymph node dissection can be performed after an observable response to chemotherapy or immunotherapy for cT4 or cN2 and higher node-positive disease of the bladder. Moreover, radical cystectomy after trimodal therapy similarly yields durable local response. For upper tract disease, nephroureterectomy with regional lymphadenectomy is the primary surgical modality used often in conjunction with perioperative cisplatin-based chemotherapy. SUMMARY: Surgical resection as a monotherapy is not curative in patients with locally advanced urothelial carcinoma. However, its use in combination with systemic agents can potentiate durable long-term survival in a subset of patients. Future studies investigating patient-reported outcomes among those receiving consolidative surgery for locally advanced disease are warranted to guide clinical recommendations.

Preference Signaling Pilot in the Urology Match: Outcomes and Perceptions.

OBJECTIVE: To assess the perceptions and outcomes of the A preference signaling (PS) pilot implemented by the Society of Academic Urology in the 2021-2022 Urology Match cycle. METHODS: Five non-weighted signals were provided to each applicant, and signals were delivered to programs by the American Urological Association to provide an applicant-centered formal and equitable process to express genuine interest in residency programs. Applicant and program perception and behavior was assessed through surveys. Signal distribution, mean, range, and interview offer rates for overall, signaled, and non-signaled programs were calculated. RESULTS: In the 2021-2022 Urology Match cycle, 566 applicants completed signaling; 2829 total signals were sent to programs with 97% applicant and 100% program participation. Each program received a mean number of 19 signals (range of 1-62), and 25% of programs received 49% of all signals. The overall interview-offer rate for the cohort was 12.5% (6019 interviews held/47,989 applications received); the signaled interview rate was 51% (1443/2829), and the non-signaled interview rate was 10% (4576/45,160) with an approximate 4-fold increase in rate of interview for signaled programs compared to non-signaled programs. There was moderate to high levels of satisfaction from applicants and programs on the overall process. 48% of programs incorporated PS into initial application review. CONCLUSION: Preference signaling was demonstrated to be feasible and successful in providing a novel applicant-directed, formal, equitable, and credible structured process for applicants to express genuine interest in programs. Additionally, programs were able to incorporate PS into their interview selection and recruitment process.

Impact of the Virtual Interview Format on Urology Residency Interviews: A Survey of Program Directors.

INTRODUCTION: Our objective is to assess the impact of the virtual interview (VI) format on urology residency interviews during the COVID-19 pandemic from the perspectives of program directors (PDs). METHODS: An anonymous survey was sent to PDs of American Council for Graduate Medical Education-accredited urology residency programs. Questions were designed to evaluate how VIs affected programs' assessment of applicants, interview logistics, and overall perspectives regarding in-person and virtual interviews. RESULTS: A total of 42 PDs (31%) responded to our survey. VIs negatively affected programs' ability to assess applicants' fit with their residency program (71%), commitment to urology along with their ability to function as a resident (67%), and personality and communication skills (71%) when compared to in-person interviews. Fifty percent of PDs reported that they relied more heavily on objective metrics when ranking applicants, compared to prior years. VIs were more economical than in-person interviews for all participating programs, with each program saving an average of $3,135 in interview-related costs. Additionally, 33% of PDs reported that VIs were less time-consuming when compared to in-person interviews, with 26% of PDs reporting that they were able to interview more applicants. Only 19% of PDs reported that VIs were better than in-person interviews. Given the option, 60% of PDs intend on hosting both virtual and in-person interviews moving forward, while 9% and 31% of programs intend to exclusively host virtual and in-person interviews, respectively. CONCLUSIONS: PDs perceived VIs to be less reliable than in-person interviews for subjective evaluation of applicants; however, many PDs still desire to integrate VIs in future application cycles.

Assessing Contemporary Trends in Female Speakership within Urologic Oncology.

OBJECTIVE: To evaluate multidisciplinary female representation at urologic oncology conferences, we reviewed speakership trends at contemporary Society of Urologic Oncology (SUO) and American Society of Clinical Oncology Genitourinary Symposium (GU-ASCO) annual meetings. METHODS: Meeting programs from SUO and GU-ASCO from 2015 to 2019 were analyzed. Biographical information was determined by querying institutional websites and social/professional media platforms. Statistical analyses were performed to assess for differences and relationships between male and female authorship based on gender, specialty, professional, and educational factors. RESULTS: We identified 1102 speakers at genitourinary oncology conferences. Overall, 222 (20%) were female. There was no significant difference between female speakership rates at SUO and GU-ASCO. The overall proportion of female speakers increased over time, but not when analyzing each individual subspecialty conference separately. Several professional and educational differences were noted between genders. Female speakers were more likely to be medical oncologists (P <.001), have more recent years of graduation (2001 vs 1996, P <.001), hold an additional advanced degree (OR 2.09, P = .005), and speak in sessions where other women served as chair (OR 1.42, P = .044). Conversely, female speakers had lower odds of delivering a plenary or keynote address (OR 0.28, P = .015). CONCLUSION: We identified a significantly positive trend towards increased female representation within contemporary genitourinary conferences over time; these trends did not remain significant when analyzing each meeting separately. Several important disparities between men and women speakers were identified. Our data suggests that inclusion of women in planning committees may help reduce gender bias and promote diversity within urologic oncology.

Women in Leadership in Urology: The Case for Increasing Diversity and Equity.

There is a persistent male gender predominance in urology, especially with respect to female representation in leadership. We review the current status of women in urology leadership, discuss challenges women face in leadership positions, present the case for adopting inclusive practices that increase diversity and gender equity in urology leadership, and review the potential benefits of such an expansion. We discuss practical strategies to grow the role of women in urologic leadership, including increasing mentorship, modifying academic promotion criteria, and addressing implicit bias, while presenting a roadmap toward achieving equity and diversity at the highest ranks of urologic leadership.