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Since 2017, the TrueNTH Global Registry (TNGR) has aimed to drive improvement in patient outcomes for individuals with localized prostate cancer by collating data from healthcare institutions across 13 countries. As TNGR matures, a systematic evaluation of existing processes and documents is necessary to evaluate whether the registry is operating as intended. The main supporting documents: protocol and data dictionary, were comprehensively reviewed in a series of meetings over a 10-month period by an international working group. In parallel, individual consultations with local institutions regarding a benchmarking quality-of-care report were conducted. Four consensus areas for improvement emerged: updating operational definitions, appraisal of the recruitment process, refinement of data elements, and improvement of data quality and reporting. Recommendations presented were drawn from our collective experience and accumulated knowledge in operating an international registry. These can be readily generalized to other health-related reporting programs beyond clinical registries.

INTRODUCTION AND OBJECTIVE: Erectile Dysfunction (ED) affects about 52% of men between ages 40 and 70 and is an important marker of cardiovascular and metabolic disease. Streamlining the diagnosis of ED can have significant public health implications. Despite the high prevalence of ED, the number of men seeking treatment continues to lag. We aimed to compare the demographics and characteristics of men presenting with ED in 2 outpatient urology settings: an academic-based subspecialty clinic (SC) and an underserved community-based clinic (CC).METHODS: With IRB approval, new patient consultations from 10/2015 through 10/2020 were extracted from electronic records at SC and CC. Patients with <1 year follow-up or age <18 were excluded. All initial consultations with ICD-10 codes for ED were identified. Descriptive statistics and univariate analysis for demographic and clinical attributes were conducted and compared using chi-square analysis.RESULTS: Results are summarized in Table 1. 3067 men were seen at SC and 913 at CC. Based on the incidence and prevalence ED and the respective zip codes covered by these two clinics, a significantly lower number of men presented with ED during this time period. Notably, 98.9% of patients at SC were referred by another provider, whereas 93.1% of patients at CC were self-referred. Patients seen for ED at CC were more likely to be a minority racial/ethnic background, aged 41-59, have government insurance, be self-referred, have a metabolic disease, and live within the county served by the CC, but less likely to have other cardiac diseases. All differences between sites were statistically significant (p <0.0001).CONCLUSIONS: The clinic that is overwhelmingly comprised of demographic minorities depends on self-referral despite historical barriers to health care advocacy. The challenge for urologists, referring physicians, and policymakers is to understand the social determinants that limit primary care referral for ED and to educate stakeholders that early diagnosis of ED is intrinsic to systems-based high quality care.

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.