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Belzutifan was recently approved for the management of Von Hippel–Lindau disease (VHL). Given the morbidity of recurrent treatment, systemic therapy to reduce or eliminate the need for surgery has been long-awaited. Herein, we sought to gain insight about future utilization by surveying VHL  experts in the United States. A survey developed by members of the VHL Alliance (VHLA) Clinical Advisory Council was distributed to kidney cancer providers at VHLA and National Comprehensive Cancer Network (NCCN) centers. Surveys were administered on a secure web-based platform. A total of 60 respondents from 29 institutions participated. Urologists (50%) and medical oncologists (43%) represented the majority of participants. The majority (98%) of respondents anticipated that belzutifan’s approval would signifi-cantly change the current treatment landscape. Most reported that therapy should be continuous (76%). There was a difference in willingness to prescribe belzutifan by specialty (38% of urologists vs 91% of medical oncologists (P = 0.02). In individuals with renal tumors <3 cm, 36% would still recommend surveillance, while 36% would initiate belzutifan to prevent growth. In those with multifocal renal lesions and growth of a solitary tumor on belzutifan, 50% would proceed with only treatment of that site. In conclusion, VHL kidney cancer specialists anticipate a paradigm shift with the approval of belzutifan. Provider roles may change with movement away from surgical management. Opinions on treatment indications, such as when to initiate therapy and how to best salvage, vary widely and collaborative efforts among experts may assist in the development of  clinical guidelines.

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INTRODUCTION AND OBJECTIVE: Historically, urology has had a lack of racial/ethnic diversity in its workforce. In 2019, only 2.0% of practicing urologists were Black and 3.9% Hispanic. Few empirical studies describe trends in urologists who are Under-Represented in Medicine (URM). We aimed to describe the historical trends and current state of racial/ethnic representation within the urology workforce compared to the national population.METHODS: Using data from the U.S. Census Bureau and the Association of American Medical Colleges, trends in racial/ethnic distribution for 2007-2019 were described for the educational "pipeline" for academic urologists, defined as starting with the U.S. population, leading to medical school application and graduation, then residency application, matching and graduation, and ending with urology faculty appointment. A comparative cohort analysis was done for the 2018-2019 academic year for differences in racial/ethnic distribution across cohorts by binomial tests.RESULTS: From 2010-2019, the U.S. Black and Latinx populations increased from 13 to 13.4% and 16 to 18.5% respectively. During that same time, the proportion of Black (3-4%) and Latinx (3-5%) urology residents remained unchanged, despite the increase in total number of residents (N[1043 to 1331). In 2019, there were step-wise decreases in proportion of Black and Latinx members represented at each stage of the educational pipeline, p<0.0001.CONCLUSIONS: The proportion of URM urologists was stagnant and did not match the national increase in racial/ethnic diversity during 2010-2019. This may be due to the loss of potential URM urologists at each educational stage. Our findings highlight possible strategies to diversify the urology workforce: diversifying the pool of undergraduates qualified to apply for medical school, targeted support for URM medical students, adequate preparation of URM urology applicants, appraising the equitability of application policies and promoting inclusion for URM faculty retention.