Since 2018, the partnership between AUA and the Brazilian Society of Urology has provided a rich exchange of experiences between these 2 countries, fostering motivation among young urologists within this fascinating expertise, from selection process to fellowing a reference service in another country for a couple of weeks. Globalization and technology have taken real-time scientific publications to all corners of the world, enabling a democratic spreading of knowledge beyond papers to interpersonal relationships, which became very limited in person during the COVID-19 pandemic, and could be resumed as seen at the greatest and most renowned urology congress: the 2023 AUA Annual Meeting (Figure 1). We saw that even with the hybrid formats, the plenary sessions were crowded, showing that person-to-person contact, learning, and face-to-face talks would remain the best way to exchange experiences. And it is for this very reason that programs such as scholarships are still a most appreciated and pursued way to share human experiences and perceptions.

While living in the US, I already knew I had left behind in Brazil a nearly 100% state-funded health care system: only 23% of the population is covered by private medical insurance.¹ In the US, I experienced an opposite scenario in which less than 10% of the population didn’t have private health insurance coverage, given that, in 2022, 92.1% of people, or 304.0 million, had health insurance at some point in the year in America.² This difference is highly reflected in care and access to drugs and new technologies, as technology is a great ally to the urologist in the US but still a major limitation for most Brazilians.

I was able to observe this in Sacramento at the University of California Davis under Dr Christopher Evans’ leadership, who, along with his team, thoughtfully welcomed me (Figure 2). As an ally in the daily care of urological pathologies, technology has become essential for both reducing risks to patients and improving diagnosis and treatment. When diagnosing tumors such as prostate cancer, we can count on several resources, such as genetic and imaging tests, to avoid an unnecessary biopsy. Micro-ultrasound–guided prostate biopsy has been shown to provide comparable detection rates for the diagnosis of prostate cancer with multiparametric MRI–guided prostate biopsy.³ However, even though the guidelines advocate the performance of MRI before the initial biopsy to increase the detection of Grade Group 2+ prostate cancer,⁴ access to this technology prebiopsy in the Brazilian public health system is practically impossible in most services, and it is more convenient and easier to have a urologist or a radiologist available to perform a prostate biopsy than a more accurate diagnostic approach. This shows an example of the much higher cost of technology compared to health care professional payment in emerging countries.

One of the biggest challenges for urologists in poorer countries like Brazil is the gap in access to technology, as there are bubbles of hospitals with international standard assistance and technology in the public health system, in contrast to many assistance centers that do not have simple devices such as a fluoroscope to drive and check the insertion of a ureteral catheter during the procedure. Furthermore, high technology costs will not keep up with medical fees. Therefore, a major challenge for young urologists in an increasingly competitive market will be to improve technology cost-effectiveness in the emerging world.

On one hand, among emerging technologies in Brazil I highlight the growing presence of robotic surgery. Though still confined to the private sector, we have a few public hospitals where robotics is available. Brazil has nearly 100 platforms nationwide whereas America has over 4000; thus, even if a Brazilian urologist keeps himself up to date with technological scientific literature, his access is limited for structural reasons. On the other hand, in the US the vast majority of hospitals have more than 1 platform. Nearly 100% of prostate cancer surgeries are robotic, as in the service I have the pleasure to attend in Sacramento, California. Moreover, I also highlight the high-intensity focused ultrasound technology approved by the Food and Drug Administration, with treatment indications for select cases of prostate cancer,⁵ present only in a few centers in Brazil, as the high cost of this technology greatly limits the acquisition of a device that will have few indications for use.

Being a scholar in this program was an honor to me and a great learning opportunity, and a valuable interpersonal experience, considering I could get in touch with new technologies and new colleagues’ practices, as well as a resource for new research. Ultimately, I had the opportunity to get in touch with global leaders in urology provided by the scholarship, opening new doors in my career, in my country and abroad, in medical organizations in my specialty, and even in having a wider vision within the center where I work. This experience was worthwhile, and young urologists should apply for one of these possible vacancies due to the range of opportunities that will be available, experiencing unique exchanges of experience and learning values that are much more important than updates in scientific journals.