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Objective To address healthcare inequities, diversifying the physician workforce is an important step, and improved efforts to recruit Underrepresented in Medicine (URiM) students is vital. We aim to examine the current state of minority recruitment and provide solutions to increase diversity in urology residency training. Methods We conducted a retrospective analysis of self-reported race and ethnicity data for active urology trainees using the Data Resource Book by the Accreditation Council of Graduate Medical Education from 2011 to 2020. We also performed a longitudinal analysis comparing the number of urology applicants to urology trainees from 2016 to 2020 using the Electronic Residency Application Service statistics database. URiMs were designated in alignment with ACGME definitions. Categorical variables were summarized as frequencies and percentages and compared using chi-squared test between race and ethnicity. Results We identified 11,458 active urology trainees for analysis. Of these, 6638 (57.9%) identified as White, 1690 (14.7%) as Asian/Pacific Islander, 442 (3.9%) as Hispanic, 380 (3.3%) as Black, 11 (0.1%) as Native American, 608 (5.3%) as other race/ethnicity, and 1689 (14.7%) as unknown race or ethnicity. In 2011, 8.1% of trainees identified as URiM which remains the same at 8.2% in 2020. Conclusion As we strive to improve patient care and support our URiM colleagues, diversity, equity, and inclusion must be prioritized. Despite increases in students entering medical school and the expansion of urology training spots, the numbers of URiM in urologic training remain stubbornly unchanged. This work highlights an area of residency training that requires critical transformation.

PURPOSE: Increased time after spinal cord injury (SCI) is associated with a migration to bladder managements with higher morbidity such as indwelling catheter (IDC). Still it is unclear how this affects bladder-related quality of life (QoL). We hypothesized that time from injury (TFI) would be associated with changes in bladder management, symptoms, and satisfaction. MATERIALS AND METHODS: Cross-sectional analysis of time-related changes in patient-reported bladder management, symptoms, and satisfaction, using the Neurogenic Bladder Research Group SCI Registry. Outcomes included: Neurogenic Bladder Symptom Score (NBSS) and bladder-related satisfaction (NBSS-satisfaction). Multivariable regression was performed to assess associations between TFI and outcomes, adjusting for participant characteristics, injury specifics, and psychosocial aspects of health-related QoL. Participants with TFI 20 years. RESULTS: Of 1420 participants, mean age at injury was 29.7(SD13.4) years and mean TFI was 15.2(SD11.6) years. Participants grouped by TFI included 298(21%) 1–5, 340(24%) 6–10, 198(14%) 11–15, 149(10%) 16–20, and 435(31%) >20 years. As TFI increased, clean intermittent catheterization (CIC) declined (55% 1–5 vs. 45% >20 years, p20 years, p20 years from injury (−3.21[CI-1.29,−5.14,p20 years −0.85[CI-1.07,−0.63

No extensive studies have investigated current diagnosis and treatment trends of hypogonadism (HG) in adult men in the United States. Using a comprehensive commercial insurance database, we surveyed current trends in incidence, prevalence, and treatment of hypogonadism in the United States. We analyzed insurance claims data from 2008-2017 using the IBM MarketScan™ Commercial Claims and Encounters database for men ≥18. Overall, we estimated annual incidence at 16.1 cases per 100,000 person-years, with the highest incidence seen among men 35-44 years at 21.5 cases per 100,000 person-years (IRR 1.83; 95% CI 1.63, 2.06, p

In 2020, Nature Reviews Urology made a pledge to actively work towards improving diversity in our field. As we head into 2021, Black urologists make up only 2% of the US workforce in urology; this lack of representation is detrimental to the field as a whole and to the patients it serves. In this Viewpoint, which follows on from our previous article ‘Supporting Black voices in urology’, 12 medical students who have chosen to enter the field recount their experiences, describing their reasons for entering urology and why they chose particular programmes. As well as illustrating the importance of mentorship and representation, they also offer ideas on how urology programmes can better appeal to Black students, in order to encourage and support under-represented minorities into our specialty in the future., Diversity in medical fields is beneficial to both clinicians and patients, and Nature Reviews Urology is committed to improving the diversity of our specialty and supporting Black and under-represented minority urologists. In this Viewpoint, 12 medical students who are embarking on a career in urology describe their reasons for choosing the specialty, explain what they think can be done to increase the number of Black urologists, and describe what has led them to apply to specific programmes.

STUDY DESIGN Prospective, multi-centered, observational. OBJECTIVES To characterize the relationship between psychosocial aspects of health-related quality of life (HRQoL) and patient-reported bladder outcomes. SETTING Multi-institutional sites in the United States, cohort drawn from North America. METHODS We performed a cross-sectional analysis of data collected as part of the multicenter, prospective Neurogenic Bladder Research Group Spinal Cord Injury (SCI) Registry. Outcomes were: Neurogenic Bladder Symptom Score (NBSS), Neurogenic Bladder Symptom Score Satisfaction (NBSS-Satisfaction), and SCI-QoL Bladder Management Difficulties (SCI-QoL Difficulties). Adjusted multiple linear regression models were used with variables including demographic, injury characteristics, and the following psychosocial HRQoL measures; SCI-QoL Pain Interference (Pain), SCI-QoL Independence, and SCI-QoL Positive Affect and Well-being (Positive Affect). Psychosocial variables were sub-divided by tertiles for the analysis. RESULTS There were 1479 participants, 57% had paraplegia, 60% were men, and 51% managed their bladder with clean intermittent catheterization. On multivariate analysis, higher tertiles of SCI-QoL Pain were associated with worse bladder symptoms, satisfaction, and bladder management difficulties; upper tertile SCI-QoL Pain (NBSS 3.8, p

In recent years there have been more studies dedicated to Peyronie's disease (PD). However, prevalence and incidence are likely underestimated, with limited information on regional variation in the rate of diagnosis. In this study, we sought to estimate age and regional variation of the annual incidence and prevalence of PD in the United States. We reviewed data from the IBM MarketScan™ Claims and Encounters database between 2008-2017 for men ≥18 years. Inclusion required ≥1 medical claim with PD, identified by ICD-9 and ICD-10 codes or ≥1 claim for intralesional injection for PD, identified by Current Procedure Terminology (CPT) code. Overall average annual incidence was estimated at 20.9 cases per 100,000, with the highest rate of 41.6 cases per 100,000 observed in men 55-64 years (RR = 8.2; p < 0.0001). Geographically, the highest incidence rate was observed in the South (23.9 cases per 100,000 men; RR = 1.30; p < 0.0001). Across all ages, overall prevalence of PD showed a general upward trend, from 0.052% in 2008 to 0.096% in 2017. Our findings suggest men in the southern U.S. are diagnosed more with PD compared to other regions. Identification of associated factors may allow for a more proactive approach to diagnosis and management.

With a growing focus on mental health, it is imperative that healthcare providers seek to understand how psychiatric comorbidities affect sexual health. The purpose of this review is to identify and fill knowledge gaps in our understanding of the relationship between psychiatric comorbidities, their treatments, and sexual health, expanding on management approaches that are geared toward optimizing patient outcomes. Following increased interest in sexual medicine and growing research on sexuality, we have deepened our understanding of sexual health. Affective disorders and their treatments are linked to sexual dysfunction, which manifest differently in men and women as well as in individuals with concurrent psychiatric disorders. Merging current knowledge on sexual health with neuroscientific findings on affective disorders may provide a better approach to assessing and treating specific sexual complaints. Failure to investigate a patient’s psychiatric background negatively influences treatment goals. Clinicians who seek to improve overall patient health must endeavor to consider patient characteristics such as gender differences and concurrent comorbid psychiatric conditions with regard to effectiveness of treatment and side effect profiles. A better understanding of sexual function and psychiatric disorders in terms of neuroimaging and neurobiology may assist healthcare providers in choosing treatment options that are best suited to specific patient concerns.

To estimate the association between an erectile dysfunction (ED) diagnosis and other chronic health conditions, as well as, the association between receiving ED treatment and these conditions.Data was reviewed from the IBM MarketScan Claims and Encounters database between 2008-2017 for men ≥18 years. Of this cohort, common chronic health conditions were identified and the associations of receiving ED treatment and having a chronic health condition was then analyzed.We identified 954 512 (38.3%) of the 2 489 069 men ≥18 years with at least one recorded diagnosis of ED, who also had at least one chronic health condition. Eighteen conditions were observed to be positively associated with ED, while eleven conditions were negatively associated. Depression (OR 2.875: 95% CI 2.866, 2.884; P.001) had the strongest association, while ischemic heart disease (IHD) had the weakest (OR 0.76: 95% CI 0.755, 0.773; P.001).Our study found that a diagnosis of ED was strongly associated with concomitant diagnoses of depression, hypertension, diabetes and several autoimmune diseases. Receiving treatment for ED varied between chronic health conditions.

Treatments for Peyronie’s Disease (PD) include oral medications, intralesional injections, and surgery. Collagenase Clostridium histolyticum (CCh) is the only FDA-approved treatment for PD. We sought to examine current trends in treatment of PD across the United States. Using data in the MarketScan Database, we conducted a retrospective study of men with PD in the United States. Cases were identified by ICD-9 and 10 codes, and treatments were identified using NDC and CPT codes. Treatment rates were analyzed using a linear regression model, and a Cox proportional hazard function test was performed for time-to-treatment analysis. About 27.8% of men with PD were treated within a year of diagnosis. The annual treatment rate increased from 23.2 to 35.4%, and intralesional injection was the most used treatment. Over the study period, the percentage of men receiving treatment with oral medication increased from 0.66 to 20.5%, while the use of intralesional injection and surgery decreased. Increased odds of treatment were observed in men 45–54 years (odds ratio [OR] 1.35; 95% confidence interval [CI], 1.21–1.50; p = 0) and in the southern region (OR 1.48; 95% CI, 1.39–1.56; p = 0). Trends in treatment of PD have changed over time. Intralesional injection remains the most used treatment option for men with PD.

INTRODUCTION AND OBJECTIVE:Females with spinal cord injury (SCI) have been collectively analyzed along with males with SCI, despite the fact that women have fundamentally different genitourinary an...