Re-examining equity in urology

Evaluating the emergence of unintended bias against male clinicians and academics

Abstract

Introduction: Gender equity in urology has received considerable focus over the last decade, with collective efforts directed toward greater female presence, authorship, and leadership. Measurable advancement has been attained, but new data suggest the more complex reality: persistent inequalities coexist with growing perceptions of reverse bias among male urologists, thus adding new dimensions to workforce satisfaction, retention, and well-being. We aimed to synthesize peer-reviewed evidence on gender equity in urology, map progress and remaining gaps, and explore emerging perceptions of reverse bias to guide balanced, data-driven policies.

Methods: This scoping review followed the PRISMA-ScR framework and included English-language, peer-reviewed studies published between January 2009 and September 2025. Studies examining gender equity, representation, leadership, compensation, authorship, patient preferences, or clinician well-being within urology were included. A comprehensive search of PubMed, Embase, Scopus, and Web of Science was conducted, supplemented by hand-searching urology-specific journals and reference lists. Two reviewers independently screened studies and extracted data using a standardized form capturing study design, population, outcomes, and key findings. Results were synthesized narratively and organized into six domains.

Results: A total of 44 studies were included, spanning six domains: 1) workforce representation, 2) academic promotion and leadership, 3) authorship and scholarly visibility, 4) compensation and industry engagement, 5) patient preferences and clinical outcomes, and 6) perceptions of reverse bias and clinician well-being. Although female representation and authorship have increased, imbalances remain in leadership, pay, and editorial influence. Notably, tentatively emerging evidence indicates that male urologists sense diminished transparency in promotion and hiring, adding to dissatisfaction, burnout, and attrition.

Conclusions: Attainment of sustainable equity in urology will demand a measurement-first strategy based on transparent, data-driven policies. Professional societies need to spearhead the construction of equity dashboards to track workforce composition, promotion timelines, compensation trends, and authorship representation. Prospective, multi-institutional studies are needed urgently to assess both ongoing inequities and dynamic understandings of fairness so that equity initiatives fortify, not fissure, the urology workforce.