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"I think it would be really nice if we did have standardized guidelines on who could serve as a chaperone," says Ellen Cahill, MD.

Ellen Cahill, MD, on chaperone use for genitourinary exams

The FDA has accepted a Biologics License Application (BLA) seeking approval of nivolumab (Opdivo) co-formulated with Halozyme’s proprietary recombinant human hyaluronidase (rHuPH20), or subcutaneous nivolumab, for the treatment of patients with all previously approved solid tumor indications for nivolumab as a monotherapy, monotherapy maintenance following completion of combination therapy with nivolumab plus ipilimumab (Yervoy), or in combination with chemotherapy or cabozantinib (Cabometyx).

Nivolumab is currently approved under several indications, including in combination with ipilimumab for the first-line treatment of patients with intermediate- or poor-risk advanced renal cell carcinoma (RCC), in combination with cabozantinib for the first-line treatment of patients with advanced RCC, for the treatment of patients with advanced RCC who have received prior anti-angiogenic therapy, and in combination with cisplatin and gemcitabine for the first-line treatment of patients with unresectable or metastatic urothelial carcinoma.

The FDA is set to have a decision regarding the subcutaneous nivolumab formulation on or by December 29, 2024.

 According to a news release from Bristol Myers Squibb,

 approval of the formulation would make it the first and only subcutaneously administered PD-1 inhibitor.

“We believe subcutaneous nivolumab has the potential to make a significant difference in the lives of patients, which is reinforced by the FDA’s acceptance of our application,” said Gina Fusaro, PhD, vice president, global program lead, Bristol Myers Squibb, in the news release.

 “Opdivo is a foundational PD-1 inhibitor approved for many different types of cancer, and our continued investment in research that puts patients first remains a priority. If approved by the FDA, the subcutaneous administration of nivolumab would provide patients and their physicians with a new option that delivers the same well-known benefits as IV Opdivo but with the improved convenience of an injection administered in 3 to 5 minutes rather than a 30-to-60-minute infusion.”

The BLA submission is supported by findings from the phase 3 CheckMate-67T trial (NCT04810078), in which subcutaneous nivolumab met the study’s co-primary end points by demonstrating noninferiority to intravenous (IV) nivolumab regarding time average nivolumab serum concentration over 28 days (C

; geometric mean ratio [GMR}, 2.098; 90% CI, 2.001-2.200) and minimum serum concentration at a steady state (C

Data from the study, which were presented at the 2024 American Society of Clinical Oncology Genitourinary Cancers Symposium in San Francisco, California,

 also showed that subcutaneous nivolumab demonstrated noninferiority to IV nivolumab in the key powered secondary end point of objective response rate (ORR). Specifically, the subcutaneous arm demonstrated an ORR of 24.2% (95% CI, 19.0-30.0) per blinded independent central review (BICR), compared with 18.2% (95% CI, 13.6-23.6) in the IV arm.

The safety profile for subcutaneous nivolumab was consistent with that of the IV formulation. Among patients who received the subcutaneous formulation, 8.1% experienced injection-site reactions, with all being low-grade and transient. Deaths due to study drug toxicity occurred in 3 patients in the subcutaneous arm and 1 patient in the IV arm. Most deaths that occurred during the study were due to disease progression.

In total, the phase 3, open-label CheckMate-67T trial enrolled 495 patients with advanced or metastatic ccRCC who had received prior systemic therapy. Patients were randomly assigned 1:1 to receive 1200 mg subcutaneous nivolumab plus rHuPH20 every 4 weeks (n = 248) or to 3 mg/kg IV nivolumab every 2 weeks (n = 247) for up to 2 years of treatment or until disease progression, unacceptable toxicity, withdrawal, or death.

The co-primary pharmacokinetic end points for noninferiority testing were C

 of subcutaneous nivolumab vs IV nivolumab. The key secondary end point was ORR per BICR.

Final completion of the CheckMate-67T study is expected in January 2026.

1. U.S. Food and Drug Administration accepts Bristol Myers Squibb’s application for subcutaneous nivolumab (nivolumab and hyaluronidase). News release. Bristol Myers Squibb. May 6, 2024. Accessed May 7, 2024. https://news.bms.com/news/corporate-financial/2024/U.S.-Food-and-Drug-Administration-Accepts-Bristol-Myers-Squibbs-Application-for-Subcutaneous-Nivolumab-nivolumab-and-hyaluronidase/default.aspx

2. Bristol Myers Squibb announces updated action date by the U.S. Food and Drug Administration for subcutaneous nivolumab (nivolumab and hyaluronidase). News release. Published online and accessed May 21, 2024. https://investors.bms.com/iframes/press-releases/press-release-details/2024/Bristol-Myers-Squibb-Announces-Updated-Action-Date-by-the-U.S.-Food-and-Drug-Administration-for-Subcutaneous-Nivolumab-nivolumab-and-hyaluronidase/default.aspx

3. George S, Bourlon TB, Chacon MR, et al. Subcutaneous nivolumab (NIVO SC) vs intravenous nivolumab (NIVO IV) in patients with previously treated advanced or metastatic clear cell renal cell carcinoma (ccRCC): Pharmacokinetics (PK), efficacy, and safety results from CheckMate 67T. 

4. A study of subcutaneous nivolumab versus intravenous nivolumab in participants with previously treated clear cell renal cell carcinoma that is advanced or has spread (CheckMate-67T). ClinicalTrials.gov. Last updated March 1, 2024. Accessed May 7, 2024. https://clinicaltrials.gov/study/NCT04810078

The FDA is set to have a decision regarding the subcutaneous nivolumab formulation on or by December 29, 2024. 

News

FDA accepts BLA for subcutaneous nivolumab in solid tumors

Defining mCSPC: Diagnostic Criteria, Imaging Approaches, and Patient Identification

Video content above is prompted by the following:

How do you define mCSPC and mHSPC? How are they different? (

Metastatic castration-sensitive prostate cancer (mCSPC) and metastatic hormone-sensitive prostate cancer (mHSPC) are terms used to describe prostate cancer that has spread beyond the prostate gland and still responds to hormone therapy. The distinction between mCSPC and mHSPC is subtle, often used interchangeably, but may vary based on specific clinical guidelines or contexts. Both conditions are characterized by the presence of metastases and sensitivity to androgen deprivation therapy (ADT), with treatment strategies focusing on ADT combined with other systemic therapies to improve patient outcomes.

Panelists discuss how metastatic castration-sensitive prostate cancer (mCSPC) is defined by its sensitivity to androgen deprivation therapy, while metastatic hormone-sensitive prostate cancer (mHSPC) emphasizes the cancer’s responsiveness to hormone treatment, highlighting the nuanced differences in patient management strategies.

Emerging Trends and Rising Prevalence of  mCSPC

What is the prevalence of mCSPC? What trends have emerged in recent years?

Metastatic castration-sensitive prostate cancer (mCSPC) is increasingly prevalent due to improved diagnostic techniques and an aging population. Recent trends indicate a shift towards earlier detection and treatment, with a focus on personalized therapeutic strategies. Advances in imaging and biomarker identification have contributed to better disease characterization, enabling more precise treatment approaches. Additionally, there is a growing emphasis on understanding the molecular and genetic underpinnings of mCSPC, which is driving the development of novel targeted therapies. These trends highlight the importance of continued research and innovation in managing mCSPC.

Panelists discuss how the prevalence of metastatic castration-sensitive prostate cancer (mCSPC) has been increasing, potentially influenced by changes in prostate-specific antigen screening recommendations and rising diagnoses of metastatic hormone-sensitive prostate cancer.

, discusses the study, “Exploring Female Bladder Cancer Survivorship: Patient Perspectives on Sexual Health Challenges and Resilience When Receiving Bladder Sparing Therapies,” which she presented at the 

25th Annual Fall Scientific Meeting of the Sexual Society of North America

. Helman is a fourth-year resident at Emory University School of Medicine in Atlanta, Georgia.

This transcription was AI generated and edited by human editors for clarity.

Could you describe the background/rationale for this study?

My abstract is looking at female sexual health in bladder cancer. Specifically, I wanted to look at patients who have not received a cystectomy. We’re learning more about female sexual health and how it's affected by something like cystectomy. Traditionally, a cystectomy includes an anterior exoneration, including the vaginal wall, ovaries, uterus, and other pelvic organs, and so it can be very disruptive to a woman's sexual health and function. We have a lot of good studies that tell us that, too, and for many reasons, hormonal and anatomical, it makes sense why it's so disruptive to a woman's health.

I was curious, however, [to explore this in] women who are keeping their bladders, so women that either have non–muscle-invasive bladder cancer and are receiving intravesical treatment, or women that have muscle-invasive bladder cancer but have chosen to do a trimodal therapy approach with radiation, chemotherapy, and then TURBT. The reason I was curious about this is because women overall in bladder cancer have worse morbidity and mortality. This primarily relates to delay in diagnoses from what we've seen. For women who have non-muscle-invasive bladder cancer, they can often be going to the doctor continuously for [many] years to get these treatments. I wanted to know: does it have an effect on their sexual health and sexual function? What do we need to know about this in order to educate our patients or to do better as physicians? That's what inspired my project. I was inspired by the impact that a cystectomy can have on women and how much we have grown historically when it comes to treating these women.

At first we didn't offer neobladders to women, and that's because we didn't fully understand the anatomy of a urethra. A woman's urethra is a lot shorter than a male's. It was felt that their continence mechanism, so their sphincter, was at the bladder neck. So, if you did a neobladder, you couldn't safely resect what you needed to and maintain continence for a woman. However, after different studies looking at the actual anatomic and pathologic slides of a urethra, we found that the sphincter is a little bit lower, so you can safely do neobladders in women, which I thought was an interesting progression of history.

We [also] used to take out every single organ that we could in the pelvic organs for women when they're getting a cystectomy; we thought that was the right thing to do. We found out that a lot of women don't have cancer spread to their ovaries, so keeping their ovaries not only helps with fertility, but [with] other hormones that women need, and it reduced morbidity and mortality for these females. That's also why I got inspired [to do this research]. How can we look at a disease that mostly affects males, and what can we do to make the experience and the aftermath of that cancer diagnosis a little bit better for females?

What were the key findings from this study?

This study was a pilot study. We had 18 participants that we were able to get ahold of and interview. I personally called women in our database that have had non–muscle-invasive or muscle-invasive bladder cancer that have not received a cystectomy. After informed consent, we went over the interview questions with them. I wanted to make sure that it was an actual interview vs a survey design, because I wanted to hear what these women had experienced. For a lot of women, they've been dealing with this bladder cancer diagnosis for years, so I wanted to hear their feedback and listen to them. Although our n is low, we only had 18 participants, it was still extremely informative.

From there, we interviewed the patients. We gave the female sexual function index survey for those that were sexually active. Then we also [included] their baseline characteristics, demographic information, tumor characteristics, stuff like that. The data that I am going to focus on is the interview data. There's not a lot of profound statistical data that we can gather from this, because our n is so low at 18.

For the sexual function index, you need to be sexually active in order to qualify to take the survey. Of the patients that we interviewed, only 5 of them were sexually active. Which, if you think about the diagnosis of bladder cancer, it's going to be older women. The main takeaway from those 5 women is that only 1 of the women had sexual dysfunction. It's hard to say [if it was due to] her bladder cancer or other factors such as depression or anxiety. We [did] ask about [these,] but with only 1 woman having dysfunction, you can't [attribute] blame to anything.

After doing a literature review about cystectomy patients and how devastating it is for female sexual function after having a cystectomy, [my main takeaway from this study is that] it seems that women tolerate the intravesical treatments well. They don't [seem to] cause too much disruption to their sexual health. Some of the quotes that we got from women were that at first they were scared or they didn't know what to expect, but then afterwards they realized that it didn’t have as much effect as they thought it was going to, especially on their sexual function.

Some women talked about the urinary symptoms. They had increased urinary incontinence or urinary urgency, which made them a little bit embarrassed when they were having sexual intercourse. One woman said that she just pees before she starts, and that's all she needs to do. [There were] stories like that of female resilience as they're going through a cancer diagnosis, and how to navigate that to have the quality of life that they wanted.

A lot of women talked about vaginal estrogen. Even among the women that were not sexually active or those that [said] bladder cancer didn't affect them at all as far as their sexual activity, many of them touched on the benefits of vaginal estrogen on lubrication and pain. We've seen this with our non-bladder cancer patients in the perimenopausal stage as well.

Some other interesting things that women talked about were this fear of everyone being down there. One woman said that everyone's always in your business. I really felt that as someone who's had to do these procedures on women. If you have fear of it, or you maybe had a bad experience 1 time, I can see how that affects people as they're getting their treatments.

One woman who it really affected said, "You get afraid of having sexual intercourse. You don't want to disrupt what's going on there. Your partner is nervous too. Everything is too close going down there." Another woman said, "It did at the beginning, and then it was okay. It was a shock when you have cancer, no symptoms. That made me not want to have sex, though. But after the surgeries, I take some breaks. I need some time." That was a common theme as well is that [after] women have their cystoscopies for surveillance of their bladder cancer, they usually took a day or 2 off of any kind of sexual activity afterwards, just for their own reasons. They couldn't really describe it; they just wanted a break. They felt that their partners were really receptive of that as well.

For the other cohort of patients, the ones that were not sexually active, it was [pretty] black and white. We'd ask, "Are you sexually active currently? Do you wish to be in the future? Do you have any interest in this?" For the women that weren't sexually active, they said, "Bladder cancer does not affect my sexual activity. I'm just not sexually active for X, Y, and Z." Maybe they lost their partner, maybe they're dealing with some health issues. They felt like it was a non-issue for them; out of all things in their life, bladder cancer was not the reason that they were not sexually active.

What future work is planned based on these findings?

We would love to continue to increase the number of women that we're able to interview. We have a large database at Emory, but finding female patients is less common, and female patients that have non–muscle-invasive [disease] and that are sexually active are [even] less common. Our goal is to continue to increase the number of women we can interview.

To expand on that, [we want to determine] what to do with the information. I personally would like to focus on patient education. There have been a couple studies in the literature already of patients that were unaware of the effects of bladder cancer, specifically cystectomy. I think now we can expand that to intravesical treatments and endoscopic treatments. They were just unaware of any of the effects that would happen to them. Even after the oncologist does a great job talking to them about what to expect afterwards, it's still just so much information. To have a woman-specific education material [saying] "This is what's going to happen to your vagina," with pictures [would be helpful]. People are starting to do [this] here at Emory, which is [great].

Increasing awareness for our providers is [also] a huge thing that we still need to work on. There was a study that looked at how many providers counseled men on sexual dysfunction after cystectomy, and how many counseled women on sexual dysfunction after cystectomy. [They found] significant differences between pre- and post-op counseling of these patients.

Additionally, we have started to include vaginal estrogen therapy as part of our post-operative protocol for a lot of these patients. We have that worked into our EPIC flow. I think that's an [great] thing to come of this study so that patients are at least offered it. I also think it would be incredibly important to increase the awareness and number of referrals to sexual therapists for patients and their partners after they have any of these surgeries or a bladder cancer diagnosis. One of the questions we asked in the interview is, "is your partner still interested in sexual intercourse?" For some women, their partners are too sick or have passed away. But for the women that are engaged with their partner about this issue, it was so reassuring and relieving to hear how supportive their partners are and how they work through the nuances of having bladder cancer and sexual health. I think having more sexual therapists for our partners and our patients [as well as] more education for both would be a huge future step for this.

What is the overall take-home message for urologists based on this study?

The overall take-home message for urologists is to continue to get to know your patient and ask them what their priorities and what their baseline sexual function is. From previous studies, we've seen that many women really value provider-initiated preoperative counseling on their sexual health, as well as printed out materials that they could read afterwards. Many women, even though they were told all these risks, didn't fully understand the magnitude of what was going to happen after surgery. Asking a patient if they are sexually active, if that's something that they value, or if that's something that they see themselves valuing in the future is a great way to understand their baseline and understand their priorities.

Is there anything else you wanted to add?

I was really excited by this study. I wanted to do something that we didn't know a lot of information about. Although it's a low number of women that we have currently, I think it's a huge step and can be truly transformative to our field in recognizing and understanding the importance of female sexual health in the context of bladder cancer care. There's an intricate relationship between these 2 domains, not only because they're physically so close together, but [because] it's a very personal experience to go through cancer. We can empower our female patients and [empower] health care providers to deliver more personalized and holistic care to our patients if they understand more about that patient's priorities and what they really hope for the future and their survivorship. As more and more therapies are coming out and as we're getting new technology, cancer survivorship is becoming even more important. Allowing these women to have a fulfilling life after cancer is one of the best things we can do as physicians.

The study explores female bladder cancer survivorship, focusing on sexual health challenges and resilience in patients undergoing bladder-sparing therapies. It highlights the impact of non-cystectomy treatments on sexual function, revealing that many women tolerate intravesical treatments well, with minimal disruption to sexual health. The study emphasizes the importance of patient education and provider awareness regarding sexual health post-treatment. Future work aims to expand the participant pool and enhance educational resources for patients and providers, ultimately improving the quality of life for female bladder cancer survivors.

“Allowing these women to have a fulfilling life after cancer is one of the best things we can do as physicians,” says Talia A. Helman, MD. 

Navigating bladder cancer: Talia Helman, MD, on female survivorship and sexual health 

 discusses her recent publication, “The past, present and future of women in the Unites States urological workforce”.

 Mehta is an assistant professor of urology and the director of male reproductive health at Emory University School of Medicine in Atlanta, Georgia.

Could you provide some background on this paper?

This particular manuscript is actually 1 of a series of manuscripts that are going to be published on the state of women in urology. Our manuscripts are focused on the women in the urologic work force as they currently stand, what our hopes are for the future, as well as discussing some strategies on how we maintain the current work force and attract more women urologists to the work force in subsequent years.

What does female representation in urology look like today?

Depending on the survey results that you look at, whether it's the AUA [American Urological Association] membership survey or some of the Medscape surveys that have come out recently, the current proportion of women urologists in the overall urologic work force is around 11% to 12%. This is already an increase over the last AUA census that measured this number, which is wonderful to see. Hopefully this is a trend that will continue to increase.

We still remain underrepresented as women in the urology work force, however, when you take into account the fact that our patients are nearly 50% women. We are caring for a variety of patients who do not look like the physicians who are providing care to them. That gender discordance is very important in making sure that we are providing appropriate care to our patients.

What are some of the future projections for the urologic work force, and what impact will women in urology have on that?

Even though the current proportion of practicing women urologists is around 11%, the proportion of trainees that are actively in urologic training programs across the country is much higher, somewhere between 25% and 30%, which is really promising and gives us a glimpse into what the future of urology will be 10 to 15 years from now when these trainees are established in practice. There's certainly going to be an increase in the number of women entering urology practice.

If we look at the current distribution of where women practice within urology, they tend to be more likely to be fellowship trained, so to have subspecialty expertise. They tend to be more likely to practice in academic training centers, so where they themselves are having an impact on the training of the future generation of urologists, and often providing very advanced subspecialty cutting edge care for their patients. They are engaged in research; they're engaged in device design and optimization. So, they're really at the forefront of our field.

It's our hope that this trajectory will continue as more and more women enter the field. It's going to be really important for us to be mindful of the strategies that we implement, not only to bring more women into the field, but also to retain and support the women that are already here within urology. The priorities for the women who are in training or the women who are in practice or even mid-career are very different. We need to be able to speak to all of those different priorities at those different stages in training or practice.

What are some strategies for recruitment and retention of women in the urologic work force?

Recruitment into urology is a challenge. [With] the way the current medical school curriculum exists across medical schools in the United States, many schools do not have a formalized introduction to the field of urology for their medical students. Students will complete 4 years of medical school, sometimes with just 1 or 2 hours dedicated to urologic education. Many students will never actually complete a clinical rotation in urology. So, it's not unusual for students to go through medical training having very little knowledge of what the field of urology encompasses. That's the first thing to change. And I think the AUA as an organization can take an instrumental role in that.

Of the folks that do find out about urology and are fortunate to be able to rotate in our departments, for them to choose urology as a career depends heavily on how they see their faculty practicing, how much they see their faculty and the trainees enjoying their field [and] their patients and deriving satisfaction from the practices that they have. To the extent that we can offer flexibility in the breadth of urology and the type of practice patterns that as a field we support, I think that can be very helpful.

For many of our women trainees, they are going through training at a time that's also the peak years for their reproductive planning, and I think that's always a concern. We know that women surgeons are at increased risk for a diagnosis of infertility and for fertility-associated complications, even if they do not struggle with infertility. That can be daunting. It is a big ask of a trainee to have them sign up for a field that is demanding in terms of training, but also demanding in terms of non-professional commitments that they would otherwise make to their family life and their personal life.

It's important for us as a field to be able to recognize that and to support our trainees, whether it's through the introduction of parental leave policies that many schools are doing [and] that the [Accreditation Council for Graduate Medical Education] has also mandated and now that the [American Board of Urology] is trying to mirror. That's one thing. But to also think outside of the box, to be able to support lactation for those female trainees who may have young children at home that they're trying to breastfeed to be able to support participation at academic meetings. And AUA, again, has made great strides in this in being able to offer babysitting and child support services at the meeting. That has been a tremendous help for some of our trainees. Sometimes, the need for a flexible work schedule, or a shortened work week, or unconventional work week that allows for work on campus, as well as remote work is helpful. COVID has forced us to think about that, to some extent, so many institutions and practices have been able to implement that. That needs to be on the forefront for us as well.

And then lastly, I would say that in addition to the clinical roles that many women urologists play, many of them are also tasked with administrative roles that have little recognition associated with them. They can be a time commitment and a time sink without any benefit, either related to academic promotion or pay increases. That's something we need to be very mindful of to make sure that those administrative tasks are being assigned equally to all urologists in the practice or the department, not disproportionately to the women. On that topic, I'll also say that pay equity in terms of gender equity has been an important problem for all of medicine, and urology is no exception to that. Transparent reimbursement policies [and] making sure that we are informing our physicians of how they are making money compared with their peers fosters that collegial work environment where women feel that they have pay transparency and the opportunity to have pay equity. That's really important.

Your paper also mentioned this idea of the “leaky pipeline” for women urologists. Could you highlight this concept in more depth?

We were trying to illustrate the idea that although more women are entering the field of urology and staying within academia disproportionately compared with private practice, they do not quite get that same boost in terms of career advancement that some of their male colleagues do in the world of academic medicine. For example, women are less likely to be promoted, both overall and certainly less likely to be promoted at the same rate as some of their male colleagues. They are less likely to hold leadership positions, whether that be program director positions, or chair positions, or division directors, or other leadership roles at their institutions. This can be very disheartening for qualified individuals who have been through the same training [and have] the same experience, and do not get those same opportunities for career advancement. It can certainly put physicians at risk for leaving that academic setting, just given the increased frustration with their lack of professional advancement, and it may even place some women at risk for leaving the field of urology altogether, which would be a shame.

Seeing women in positions of leadership is essential to be able to attract more women into urology. I never appreciated that as a trainee myself, at least when I was applying into urology, but definitely appreciated it more when I was towards the end of my training. And I certainly appreciate it now, as I try to mentor other women trainees to enter this field. If we do not see people that look like us in positions of leadership, that is not a field that we're going to want to enter.

Is there anything else that you’d like to add?

I would just say that, as a follow up to the initial comment I made, this paper is certainly a standalone paper on this topic, but it is really an essential part of that entire series on the state of women in urology, so I would encourage the readers to look at all of the papers together to have a comprehensive view on how we can do better.

1. Nam CS, Luckenbaugh AN, Mehta A. The past, present and future of women in the United States urological workforce. 

The representation of women in the urological workforce is currently around 11-12%, with a promising increase in female trainees. Despite this, women remain underrepresented, especially in leadership roles, which can lead to career dissatisfaction and attrition. Strategies to recruit and retain women include improving exposure to urology in medical education, supporting work-life balance, and ensuring pay equity. Addressing the "leaky pipeline" is crucial, as women often face barriers to career advancement. Increasing female leadership visibility is essential for attracting more women to the field.

"We are caring for a variety of patients who do not look like the physicians who are providing care to them," says Akanksha Mehta, MD, MS. 

Dr. Mehta discusses the state of women in urology

 discusses the “leaky pipeline” for female urologists, which she and her colleagues outline in their recent publication, “The past, present and future of women in the Unites States urological workforce”. Mehta is an assistant professor of urology and the director of male reproductive health at Emory University School of Medicine in Atlanta, Georgia.

I also want to add that seeing women in positions of leadership is essential to be able to attract more women into urology. I never appreciated that as a trainee myself, at least when I was applying into urology, but definitely appreciated it more when I was towards the end of my training. And I certainly appreciate it now, as I try to mentor other women trainees to enter this field. If we do not see people that look like us in positions of leadership, that is not a field that we're going to want to enter.

This transcription has been edited for clarity.

The interview with Dr. Akanksha Mehta highlights the challenges faced by female urologists in academic medicine, despite increasing numbers entering the field. Women in urology often encounter barriers to career advancement, such as lower promotion rates and fewer leadership roles compared to male counterparts. This disparity can lead to frustration and attrition from academia or the field entirely. Dr. Mehta emphasizes the importance of female leadership in attracting more women to urology and the need for mentorship to support female trainees in pursuing and advancing within this specialty.

"If we do not see people that look like us in positions of leadership, that is not a field that we're going to want to enter," says Akanksha Mehta, MD, MS. 

Ellen Cahill, MD

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