Over the past few decades, the Kingdom of Saudi Arabia (KSA) has made notable advancements in its health care infrastructure, where 60% of health care services is primarily owned and operated by the Ministry of Health, while the remaining 40% is managed by semipublic or private services.¹ As the global population grows and ages, the demand for urologic care increases. This article discusses the status of urology practice in the KSA, emphasizing its structure, level of development and implementation, and current challenges.

The Saudi Board of Urology (SBU) Training Program, established in the KSA more than 30 years ago, provides a structured curriculum to produce proficient and qualified urologists capable of independently caring for patients. The program adheres to the national standards set by the Saudi Commission for Health Specialties (SCFHS). There are 35 accredited, well-equipped training centers in 18 cities in the KSA, belonging to the Ministry of Health, public, military, academic or private hospitals.² According to the SCFHS, in January 2023 there were 1629 registered urologists.

To attract young individuals to the field, a well-structured residency program with expert mentors is essential. Modern computer-based learning technologies can support knowledge acquisition through frequent self-assessment and individualized learning. Additionally, such technology provides a cost-effective strategy for integrating staff development and individualized training programs into clinical practice expectations. The SCFHS and the SBU are undergoing significant restructuring to ensure the standardization and quality of training across the KSA, especially by increasing training centers to match the growth of medical schools and the number of residents annually accepted for training. The incorporation of the new roles defined under the Canadian Medical Education Directions for Specialists sets the standard for all programs according to SCFHS rules and regulations.²

Postgraduate subspecialty education includes fellowship programs within KSA and scholarships for accredited training programs in Asia, Europe, and North America. The first accredited local fellowship program, established 20 years ago, was in the field of pediatric urology. Currently, there are nationally accredited subspecialty programs for pediatric urology, endourology, andrology, voiding dysfunction, and reconstructive urology. The availability of well-trained general urologists is vital, but fellowship training is crucial for providing comprehensive care for patients, considering the high volume of patients, the diversity and complexity of disease processes, and the high demand for subspecialized urologists.

The Saudi Urological Association (SUA) plays a crucial role in providing updated scientific activities, continuing medical education, and hands-on courses and workshops through its 35 past annual meetings, and other meetings throughout the year in different cities around the KSA in collaboration with regional and international societies and experts.

The Health Sector Transformation Program, aligned with Saudi Arabia’s Vision 2030, aims to improve the health care system by enhancing access to dedicated health care and ensuring a healthy and productive life for all individuals. This transformation has led to significant changes in urology practice, including the adoption of new technologies such as robotic technology, with 24 surgical robots installed mainly in governmental hospitals, making the KSA a technology leader in the Middle East.³ Urologists in the KSA consistently keep up to date with and are eager to incorporate the latest technologies into their practices. Thus, Saudi Arabia is the central hub and primary market for medical and pharmaceutical companies seeking to launch new products in the region.

Interestingly, the overall urological research quality has improved dramatically in the last decade. The official publication of the SUA, Urology Annals, was established 15 years ago and has provided an enormous boost for urology research in KSA. The shift toward conducting multicenter prospective clinical research reflects the exchange of knowledge and the collaboration of different centers to achieve a higher level of evidence-based medicine and contributes unique data to the global urological literature. Collaboration between the SUA and Urology Annals has led to the publication of different national guidelines for different urologic conditions, such as uro-oncology, urolithiasis, and robotic surgery. These guidelines are tailored to local practices and local patient demands. There are an increasing number of certified fellowship-trained surgeons returning home to the KSA, and they are collaborating with mentors across the world, sharing clinical updates, experience, and research achievements.

Despite these advancements, the Saudi health care system faces challenges such as an aging population, an increase in chronic diseases, and a shortage of health care professionals. Consequently, the Saudi government is expanding its health care infrastructure, improving its service quality, and promoting the use of technology, including artificial intelligence. The integration of artificial intelligence is expected to enhance efficiency, reduce costs, and improve the quality of care across the country.⁴ Another challenge is the low percentage of women practicing urology in the KSA.⁵ Additionally, most of those who are practicing choose the subspecialty of female urology and pelvic reconstruction, followed by pediatric urology, while they are least likely to select andrology and male infertility. It seems important to increase the number of women applying to urology programs and improve women’s leadership and mentorship programs.

Saudi urologists need to stay connected with their colleagues worldwide to ensure international collaboration and a satisfactory perception of the educational environment in the KSA. International collaboration among urologists allows for the exchange of knowledge, expertise, and best practices, helping Saudi urologists keep abreast of advancements in the field, especially for complex or rare conditions. Research collaboration helps advance diagnosis, treatment, and patient care. Training and education exchange programs provide individuals with access to different environments and renowned experts, improving practitioners’ skills and knowledge. Moreover, collaborations with international and regional urological organizations and centers of excellence increase the standards of urological care and enhance the reputation of the KSA’s health care system. International collaboration among urologists may further expand access to urological care in low-resource settings and improve subspecialty care in centers of excellence. Moreover, urologists must be able to address common urologic emergencies and issues, irrespective of their subspecialization and differentiation between large private and academic practices and have the flexibility to rapidly adapt to changing technology.