According to the AUA Census in 2021, 10.9% of practicing urologists were women.¹ This number has been steadily increasing over the years. Currently, one-third of our trainees are women, which exemplifies this growth in representation.² Despite this trend toward equal gender numbers in the urology workforce, there continue to be large disparities in overall compensation, academic positions, and leadership advancement, particularly in the academic environment, for female urologists.^3-5

Women urologists are more likely to have completed fellowship training, with female pelvic medicine and reconstructive surgery and pediatric urology being the 2 most popular subspecialties for women urologists.⁶ AUA data from 2018 support these findings and demonstrated low numbers of women entering endourology fellowships.⁷

We sought to examine the perceptions and experiences of inequity that may play a role in the marginalization of women in endourology. Our study was conducted using the Culture Conducive to Women’s Academic Success (CCWAS) questionnaire, a validated instrument designed to measure how conducive the workplace is for women in academic positions. This survey was sent out to the Endourological Society LISTSERV, and responses were analyzed.

The CCWAS questionnaire is divided into 4 domains of equity: equal access, work-life balance, freedom from gender bias, and supportive leadership. All items are rated using a 5-point Likert scale. A higher score reflects a perceived favorable environment for women.

Of 1,492 surveys sent to the Endourological Society LISTSERV, 104 (7%) completed responses were received. Of the completed responses, 26.9% were women. At the time of this study, the Endourological Society did not collect gender or demographic data, and we are therefore unable to comment on how our sample’s population correlates with the general population of this organization. The LISTSERV includes a large international component, and the precise number of currently practicing urologists was unknown.

There was a statistically significant difference between male and female respondents regarding the perception of the institutional culture toward women. The male median CCWAS score was 196.0 (IQR 189.0-228.0) vs female median score of 166.5 (IQR of 127.5-210.0, P < .05), indicating that men overall perceive a more equitable work environment for women than their female colleagues. There was no statistically significant difference in CCWAS scores based on years in practice, academic vs private practice, or location of the practice. This disparity of perception was preserved across all subcategories measured including equal access, work-life balance, freedom from gender bias, and supportive leadership. These results are likely related to the interplay of other factors contributing to inequity such as the gender pay gap, insufficient parental leave policies, lack of sponsorship, and discrimination.

While survey results may not be completely representative of all endourology members, these results demonstrate male endourologists perceived a more advantageous or equitable work environment for their female colleagues. Women, however, felt their work culture to be less equitable. Informal and unconscious bias could be a factor perpetuating the difference in perceptions of the work environment between male and female urologists. These results support the hypothesis that the perception of gender equity may differ from one’s lived experiences. Awareness of such differences is necessary to progress toward meaningful interventions. This is a small yet significant step in recognizing and identifying opportunities to improve gender equity in urology.