Urological practice in the Caribbean is unique as the region comprises several island and mainland states, each with its own diverse geopolitical issues and challenges. Because of this, practice varies considerably within the region. For instance, surgeons in some territories routinely offer cutting-edge endoscopic management for kidney stones, while in other islands, open surgery is the only option due either to a lack of training, equipment, or both. Our job as surgical leaders is to somehow narrow this gap, to figure out ways of making standard of care more homogenous throughout the region.

The Caribbean Urological Association (CURA) was formed in 1999 as a unifying organization primarily within the English-speaking Caribbean, with its motto being “Advancing Urology in the Caribbean.” It has expanded significantly and has fostered camaraderie and exchange of skills and ideas among regional colleagues. CURA has maintained global links through partners like the AUA, the Société Internationale D’Urologie, and the BJU International. Our members and, by extension, our patients have benefitted tremendously from numerous workshops over the years in areas such as reconstruction, female urology, and oncology.

Many colleagues around the world are surprised to learn that we have a regional urological training program. In the Caribbean, we offer a full 5- to 6-year residency program in urology split into 2 years of core surgical training followed by 3 to 4 years of urological training. The Doctor of Medicine in Urology program commenced in Jamaica with the first graduates having completed training in 1998. Subsequently, urological residency was offered at the Trinidad campus, and the first locally trained urologist graduated in 2015. These programs have been impactful as they have supplied regional public health systems with the majority of their urologists. Additionally, several of these graduates have gone on to complete fellowships and have enhanced their local pool of skills. We have to ensure that these skills are shared at the regional level!

While practice has evolved considerably over the years with increased availability of minimally invasive surgery, these developments have largely occurred in the major territories which host training programs. Minimally invasive options for stone disease and benign prostatic hyperplasia are now routine in these territories, and laparoscopic surgery has expanded considerably. There remains no territory in the English-speaking Caribbean offering robotic surgery, but I believe this will inevitably change with the development of less-expensive robotic platforms.

Several residents have gone on to overseas fellowships and have brought skills back to these territories. Yet there still remain significant holes in urological care regionally. We need to encourage our residents to take up opportunities for further training overseas upon their exit from residency. There are several urological subspecialties which are underrepresented regionally; andrology and female urology spring to mind, and we should encourage people to pursue these fields. From personal experience, obtaining quality fellowship spots is often challenging as spots are often reserved for graduates of more recognized “first world” programs. Indeed, we should encourage our graduates to make themselves more competitive by building their resumes throughout training.

We need to develop urology in the smaller territories which are still understaffed and underequipped. CURA, as the premier urological association in the region, should be at the forefront of lobbying for change. We also need to develop regional training centers in the larger academic units with streamlined pathways where regional colleagues can pursue mini-fellowships to equip them with skills to improve care in their territories. CURA, along with our international partners, should support them as best as possible with what they need following their training.

There is a dearth of data on even common conditions around the region—many questions remain unanswered about pathology in the Caribbean, and this must change. I have always believed that we have a lot to contribute to the international literature. Collaborations regionally and with external partners are critical in order to develop the infrastructure and skill set required to conduct meaningful and high-quality research. CURA also hopes to encourage resident research through the creation of grants/scholarships.

I appeal to young graduates both from within and outside of the Caribbean region to never stop learning. Actively pursue further training and research post residency and approach urology as a calling rather than a job. Build on the efforts of those who have come before you. If you see the need for a particular urological service or procedure, dedicate your efforts to developing that service. While it may be daunting at times, there is always a way, and it will surely be worth it! I would be disappointed if the next generation of regional urologists isn’t better than we are—we would have failed as mentors.