The Society of Basic Urologic Research (SBUR) is aware of trends related to lack of diversity and equity within the urology clinical and research workforces. The 2021 AUA Census demonstrated that only 4.4% and 2.4% of urologists were Hispanic and African American/Black, respectively.¹ Pipeline shortcomings are likely part of the problem. Black MD/PhD students were 50% more likely than White students to graduate with only an MD degree and 83% more likely to leave medical school altogether.² Additionally, in 2021 only 8% and 5% of PhDs awarded in the US in any STEM (science, technology, engineering, and mathematics) field went to Hispanic and Black scientists, respectively.³ Trends within the urology-specific clinical and research workforces suggest additional concerns. Among medical students from nearly 50% of medical institutions, LGBTQIA (lesbian, gay, bisexual, transgender, queer, intersex, and asexual) students overwhelmingly considered lack of diversity within urology and the field’s exclusivity as barriers compared to their non-LGBTQIA peers.⁴ Similarly, compared to those from higher-income households, a significant number of students who grew up in households with incomes < $40,000 cited a higher barrier to pursuing urology due to socioeconomic concerns.⁴

As a research society, we are particularly attuned to the need to diversify urology research. We recognize that the complex challenges in urology are best tackled when scientists reflecting the full breadth of diversity bring their collective perspectives to bear. We further recognize that the historical omission of diverse clinical populations, tissue samples, genetic samples, etc, in urology research has hindered the ability to make significant advancements in addressing the health of all individuals. Recently, the failure to synthesize diversity, equity, and inclusion (DEI) into biomedical research was shown to lead to higher instances of study retraction, research-related harm to marginalized communities, and insufficient evidence to drive optimal clinical and public health recommendations due to the lack of heterogeneity of research samples.⁵ Despite heightened attention, disparities for biomedical research funding exist. Among investigators receiving ≥ 3 NIH research grants between 2011 and 2020, Black women were 71% less likely than White men to be represented.⁶ Additionally, between 2010 and 2019 only 22% of NIH grants awarded to urology departments were to female principal investigators (PIs).⁷ Finally, in their review of NIH funding trends, Taffe and Gilpin estimated that approximately 120 applications from White PIs with scores between the 35th and 59th percentiles were funded vs 0 from Black PIs scoring in the same range.⁸

The SBUR takes seriously these shortcomings and commits to an agenda that advances urology science by incorporating DEI principles and practices. The Society of Women in Urology/SBUR Award for Excellence in Urological Research, established in 2006, symbolizes the joint endeavor of both societies to honor female scientists who demonstrate notable achievements in basic science research in urology. As an additional step, we started a Minority Scholar Award in 2022 with the purpose of identifying traditionally underrepresented scholars with high potential to succeed. Over the next year, we will assess scholars’ progress, pinpoint barriers and challenges, and identify areas for making the program more robust by (1) expanding funding, (2) broadening outreach to a larger pool of potential applicants, (3) improving mentoring and guidance, and (4) taking steps to retain scholars’ interest in and capacity to succeed in urology research. The program planning committee for the 2023 SBUR annual meeting took another step toward DEI by taking extra care to ensure that the meeting program was an inclusive representation of the society. This was reflected in both the selection of faculty as well as that of abstracts for oral presentations. This effort, to be continued in planning future annual meetings, was in part based on our internal reflection that presentations within the scientific program, which are typically invited, were more frequently delivered by men (Figure 1, A). While abstract submissions and poster presentations during meetings were more equitable (51% were presented by women; Figure 1, B), we nonetheless recognize the need for further improvement. Other areas requiring greater equity and inclusivity within our society and within the urology research community more broadly include those related to investigators’ career stages, age, academic status/rank, socioeconomic status, and ability status.

In order to address these needs and develop specific DEI goals across the entire continuum of diversity and equity within the SBUR, we need to better understand who we are. We are therefore taking another important step. We plan to gather more granular information about our demographics through a census of members. We will use guidance provided by the National Academies of Sciences, the NIH, and other sources^9,10 to ensure that our census questions abide by current best practices for inclusivity and sensitivity. By establishing a baseline of where we are with respect to key diversity metrics (eg, race, gender identity, sexual orientation, ability status, socioeconomic status, age, career stage, etc), we will be able to develop and execute specific strategies, assess their effectiveness, evaluate our progress in the context of other urology organizations and societies, and collaborate with others to synthesize data and synergize change within the field of urology.

To enhance the diversity and training of our members across different ages and career stages, we instituted a highly successful Trainee Affairs Symposium program in 2016, which immediately precedes each SBUR fall meeting. At the 2023 meeting, the symposium focused on training in bioinformatic approaches, career development, and grant writing. We have also awarded 31 travel scholarships to facilitate trainee participation; 9 trainees were chosen for podium presentation to enrich the diversity of our talks, a long-standing tradition for the fall meeting. In addition, to celebrate the work of our long-serving members, we established the Dr Leland W. K. Chung Mentorship Award. SBUR is also a member of the AUA’s Prostate Cancer Impact Alliance (PCIA), an alliance of 31 patient and physician advocacy organizations and industry representatives and part of the Urology Care Foundation™. A primary goal of the PCIA is to address gaps in prostate cancer advocacy, policy, awareness, education, research, and clinical care. Christina Jamieson, PhD, represents the SBUR on the PCIA, was selected to serve on the steering committee, and also serves in the health equity work group.

Finally, an area of DEI we will address within our society is the prevalence of malignant vs nonmalignant urology research at annual meetings (Figure 2). Underrepresentation of nonmalignant urology research may have broader, unwanted implications. We note that this disparity is associated with lower federal funding for nonmalignant vs malignant urology research¹¹ (whether cause or effect is unclear). Some nonmalignant urologic diseases may hit certain marginalized communities with heavier burdens, whether due to biological determinants of disease processes, treatment inequities, or both. Thus, the relative lack of attention to and funding for nonmalignant urology research may compromise public health more broadly than previously recognized.

The SBUR is deeply dedicated to establishing mechanisms that encourage every member to take responsibility for and actively strive to integrate DEI principles within the SBUR and the wider urology clinical and research communities.