Pham MN, Ambulkar SS, Fantus RJ et al: Reproductive urologic consultation in subfertile men: predictors of establishing care and patient perceptions after abnormal semen testing. Fertil Steril 2022; 117: 489–496.

Special thanks to Drs. Rachel Passarelli and Danielle Velez Leitner at Rutgers Robert Wood Johnson Medical School.

These investigators conducted a retrospective study of abnormal semen analyses at their institution and observed that from 2002–2018, 51.9% were ordered by reproductive endocrinologists. AUA/American Society for Reproductive Medicine (ASRM) guidelines on the diagnosis of male infertility recommended reproductive urology evaluation for men with abnormal semen analyses. However, only 20.5% of the target patients were seen by reproductive urology. In surveys of these men, 77.3% did not know they had an abnormal semen analysis (SA) and only 5.6% recalled a recommendation for a reproductive urology consult.

As the authors aptly note, patients cannot seek help unless they know of a problem. This likely contributed to the low percentage of patients undergoing reproductive urology evaluation. This gap in care is highly problematic, as reproductive urology interventions may decrease the need for more invasive and expensive assisted reproductive technology. Additionally, it has been well-established that men with abnormal semen parameters are at higher risk of underlying illness. The abnormal SA may lead to the diagnosis of an underlying genetic disorder or motivate the patient to correct early metabolic disease. This can’t happen if they aren’t alerted to the problem, and it is a real missed opportunity.

Despite AUA/ASRM recommendations that men with abnormal SA are evaluated by reproductive urology, this occurs only a small percentage of the time. This article highlights the need for wider education among patients and physicians about the immediate and long-term benefits of reproductive urology evaluation in men with abnormal SA. Especially with the rapid expansion and acceptance of telemedicine, patients nationwide have greater access to specialty care but must first be made aware of the need for evaluation.

Suarez Arbelaez MC, Nassau DE, Kuchakulla M et al: Authorship gender composition in urology literature from 2015 through 2020. Urology 2022; Epub ahead of print. doi: 10.1016/j.urology.2021.11.041.

Special thanks to Drs. Rabun Jones and Rodrigo Pagani at the University of Illinois at Chicago.

Although the gender gap in urology has narrowed over the past decade, female faculty still constitute only about 14% of urological academics in the United States. The number of women in university leadership positions is even lower. Many factors are considered for promotion and tenure, including the impact factor of journals in which manuscripts are published. Unfortunately there remains a dearth of information on the association between female authorship and urology journal bibliometrics.

These investigators retrospectively reviewed urology journals to determine if impact factor, type of peer review, and journal subspeciality were related to the proportion of first and last female authors. Among 14 of the highest-impact factor urology journals yielding 65,828 articles from 2015 to 2020, only 18.6% of first and last authors were female. Higher impact factor was frustratingly significantly associated with a lower proportion of female authorship. General urology journals had significantly lower representation of female senior authors than subspecialty journals. Subspecialty journals were significantly more likely to have female authors with double-blinded peer review versus single-blinded peer review, and no such difference was found in general urology journals. While these observations were vexing, fortunately over time there was a positive trend for overall rates of female authorship.

This review characterizes the minefield that female trainees and junior attendings must navigate should they choose academic practice and highlights contributing factors to the gender gap in our field. There are limits to the study, including lack of inclusion of nonbinary gender identities, potential misclassification of author names and importantly, that the impact factor is widely recognized as a highly flawed bibliometric. However, the findings provide food for thought when evaluating peer review processes, mentorship opportunities, and academic promotions through the lens of gender equity.

Hakam N, Amend GM, Nabavizadeh B et al: Utility and outcome of angioembolization for high-grade renal trauma management in a large hospital-based trauma registry. J Urol 2022; 207: 1077-1085.

Special thanks to Drs. Andrew Lai and Rodrigo Pagani at the University of Illinois at Chicago.

National databases collect valuable information on uncommon disease entities in order to answer rare but important questions. The National Trauma Data Bank allowed these authors to compare the use of angioembolization versus surgical repair of high grade renal trauma. Previous studies were limited to single institutions with no more than 80 patients, whereas this study included nearly 500.

Surgical repair has been the standard for renal salvage in patients requiring intervention, and interestingly these investigators found a threefold increase in the percentage of blunt renal traumas managed with angioembolization. Those with high-grade renal injuries had over 85% success rates. The adjusted analysis observed that those undergoing angioembolization had 79% lower odds of requiring subsequent nephrectomy compared with those undergoing surgical repair, an association which held after matching the cohorts. Those undergoing angioembolization were not advantaged in all areas, as this group had higher rates of blood transfusions, higher proportion of hemodynamically unstable patients, and higher median pulse rates compared to the surgical repair group.

Retrospective observational studies have their limitations, especially in selection bias. Some hypothesize that higher rates of nephrectomies after initial surgical repair are due to less experience with open surgery among younger urologists, but this is speculative. Clearly this well-performed study highlights a trend towards successful minimally-invasive approaches in high-grade renal trauma.