Inclusive health care entails providing equal care to all patients, including populations with uniquely challenging care. Patients with disabilities are one of these groups, and thus are often overlooked. The remarkable headway urologists have made in understanding and responding to the needs of other marginalized communities stands as a call to action to do the same for this group; we have previously demonstrated that the urology community can rise to the challenge of providing inclusive care. This article aims to discuss an approach to elucidating the state of urologic care for patients with disabilities, understanding the unique needs of this population, and mapping a path forward in working to address those needs.

Approximately 1 in 4 adults in the United States has a disability, according to CDC estimates.¹ With such a substantial presence, effort in advancing care for this population is not misplaced. The path forward spans the following 3 areas of impact: research, infrastructure, and education (Figure).

To improve our care, we must first characterize the present state of care. Currently, the literature is sparse on the topic of urologic care for people with disabilities. Our PubMed search yielded only 2 articles²,³ on the topic of prostate health for men with disabilities and 1 article on nephrolithiasis in patients with disabilities.⁴ As it stands, we encountered no papers directly studying the epidemiology, outcomes, or technical aspects of many urologic conditions in this patient group, including urothelial cancer, urinary tract infections, urinary retention, benign prostatic hyperplasia, and so on. The most studied urologic complaint in this population is urinary incontinence, presumably because it shares causes with many mobility and cognitive disabilities, most notably multiple sclerosis, spina bifida, and cerebral palsy. These numerous research gaps should catch the attention of researchers hoping to contribute to the urologic community.

Additionally, the literature lacks the inclusion of the voices of patients with disabilities themselves. Their lived experiences exemplify the profound impact barriers to care have on their overall health and quality of life. Giving a voice within urologic literature would affirm the principles of patient-centered care and forge a stronger commitment to inclusivity and equity within our scholarship and urologic care.

Health care infrastructure is another area that requires our attention to improve urologic care for patients with disabilities. Evidence may suggest urology clinics lack the equipment necessary to examine individuals with disabilities properly. A survey of subspecialty care found that only 22% of urology clinics in their sample had specialized equipment to examine a mobility-impaired patient,⁵ with some clinics not being wheelchair accessible. Urology has unique positioning challenges, including placing patients in lithotomy positions and performing the digital rectal exam, which makes accessibility and maneuverability even more important.

Regarding education, some evidence suggests that trainees may lack the training and knowledge to address the considerations involved in conducting a genitourinary exam on disabled patients. A survey of medical students from different schools found that a majority of respondents felt unprepared across a range of areas related to the care of patients with disabilities, including “accommodations for sensitive exams.”⁶ Medical schools have begun implementing curricula regarding care for this population. Urologists can advocate for urologic care to be included in this effort, eventually leading to a workforce that is prepared to care for patients with disabilities. Additionally, as we learn more about caring for this population, we can share what we learn with patients, caregivers, and primary care providers to empower them to receive better urologic care outside of the urology clinic as well.

The sparse research now suggests that this population may be in greater need of urologic care than the general population and face unique barriers. Therefore, our call to action is to dedicate time, attention, and funding to advancing urologic care for people with disabilities. This begins with understanding the patient’s needs, building the necessary infrastructure, and educating our patients and colleagues. In addition, health care facilities can ensure that these patients have access to the appropriate equipment for a comprehensive genitourinary or urologic exam. Improving the care of people with disabilities would aid in the reduction of health disparities and maintain the ethical principle of equity that underpins modern medical practice.