The Young Academic Urologists (YAU) is a group of young clinician-scientists (aged <40 years) within the European Association of Urology (EAU) focusing on the development of clinical, educational, and research projects. In particular, due to strategic partnerships with the Guidelines Office, the Sections Office and the European School of Urology (ESU), the goals of YAU are to promote both high-quality studies to provide strong evidence for the best urological practice, and educational programmes to boost European training standards. The aim of creating a platform for close international cooperation for the future urology leaders in Europe (and beyond) is one of the YAU objectives as well. More information is available at: https://uroweb.org/young-academic-urologists-yau.

The YAU was established as part of the Young Urologists Office (YUO) in 2012, and started with nine working groups (Andrology, Bladder Cancer, Benign Prostatic Hyperplasia, Functional Urology, Paediatric Urology, Prostate Cancer, Renal Cancer, Robotics, and Urolithiasis). Over time, we have grown to 13 groups: Urothelial, Reconstructive, Urotechnology and Digital Health, Endourology and Urolithiasis, Functional Urology, Paediatric Urology, Penile and Testis Cancer, Prostate Cancer, Kidney Transplantation, Renal Cell Carcinoma, Robotic in Urology, Sexual and Reproductive Health, and very recently Infections in Urology. Each group is coordinated by a chairperson, who is actively involved in the YAU Board.

The YAU members are selected according to their academic career. The YAU groups recently expanded including members of other non-European countries. This is related to the term ‘diversity, equity and inclusion’ (DEI). Diversity refers to the individuals represented in the working force, including gender, ethnicity, religion, and disability. Equity refers to the concept of fairness and justice, e.g., equal access. As such, it is different from equality, which assumes that all people should be treated the same, whereas, with equity the final result will be equal. Lastly, inclusion means that everyone can make meaningful contributions, speak up and all voices will be heard. The YAU groups should therefore include members of different genders, countries, and cultural backgrounds.

In this research letter, our main objective was to analyse how gender and country representation within the YAU changed over time and we set goals for improvement in the future. Therefore, we collected data regarding member characteristics (gender, country) from 2012 to October 2023 and we stratified them by YAU group. Then, we analysed all papers published by the YAU and checked for gender representation in authorship, by using PubMed with the search code ‘young academic urologist’.

In the initial period (2012) members were predominantly male (74/78 [95%]), and only a few members came from outside Europe (Appendix A; Fig. A1 and Table A1). During recent years, the situation has gradually improved: currently women constitute 21% of the total number of members (40/191). We also witnessed a rise of interest from non-European members (24/191 [13%] in 2023).

Groups that deal with oncological topics have more members and thus a higher number of female representations. For example, the Renal Cell Cancer Working Group has a female representation of 29% (six of 21). The highest female representation is in the Paediatric Urology Working Group (five of 10 [50%]) and this group has two generations of female chairs.

The literature search on YAU publications yielded 396 results. After eliminating duplicates and not-YAU-related articles, we found 344 manuscripts. Considering first and last authorship (in total 688 authorships), 92 of them have female authors (13%). Among the 344 articles, 71 articles (20%) had a female first author, whereas only 21 articles (6%) had a female last author. It is noteworthy to mention that not all YAU articles were coded accurately, thus a possibility of oversight exists; however, the prevailing trend remains evident.

These numbers needs to be related to EAU membership numbers. Dr Proietti, a member of the EAU DEI task force, wrote a statement article analysing female contributions [1]: in nine European countries 63% of medical students, 48% of all residents, and 24% of all urology consultants, are female. Moreno-Fontela et al. [2] recently analysed Spanish trends and found that 50–61% of the residents were female in 2022.

Concerning congress activities within the EAU: up until 2021 women presented <20% of all posters, chaired <10% of the scientific sessions, and female faculty representation at congresses was ~12% [1]. The YAU Paediatric Working Group [3] analysed female representation on paediatric urology congresses, which also showed gradual improvement over the years. In the United States the same trends of slowly improving figures are seen [4, 5]. To improve these numbers the EAU DEI task force defined aims and objectives, and a 5–10 year plan with concrete actions. Unfortunately, to date no other work for the EAU DEI task force has emerged.

Several causes of inequal gender distribution can be pointed out: lack of awareness, limited mentorship opportunities, harassment, disparity regarding promotion opportunities due to e.g., maternity leave, unequal care tasks for women leaving less time left for research compared to men, etc. [4, 5]. This latter may be relevant for the specific case of the YAU working groups: in order to enter YAU the applicant will need to pass a selection, which requires multiple articles in the field of interest. This principle might sometimes benefit male gender.

Additionally, ‘imposter syndrome’ may play a role. This term, introduced by Clance in 1978, describes a persistent internalised fear of being exposed as frauds. Those individuals experiencing this phenomenon do not believe they deserve their success or luck, regardless of external evidence of their skills. There is scarce literature on imposter syndrome in urologists. According to a large survey done by Jefferson et al. [6] younger and female urologists experience impostor syndrome more severely and it is also independently associated with burnout.

With the current understanding of the situation, consideration should be given to enhancing DEI within the YAU working groups. Therefore, a ‘Strengths, Weaknesses, Opportunities, and Threats’ (SWOT) analysis is described in Box 1. The DEI criteria are currently being defined and will be published on the YAU website. DEI should be included in the mission of the YAU working groups, including regular evaluation and using it for selecting new members and chairpersons.

Overall, there is a positive trend in female representation within the YAU working groups; however, numbers are still behind those observed in residency programmes. Several suggestions have been stated. We hope that these efforts raise awareness within the YAU, thus paving the way for further improve in DEI. Our analysis can also encourage other groups to interrogate themselves and improve gender and diversity distributions among their members and board.

青年学术泌尿科医生 （YAU） 是欧洲泌尿外科协会 （EAU） 内的一群年轻临床科学家（年龄 <40 岁），专注于临床、教育和研究项目的开发。特别是，由于与指南办公室、科室和欧洲泌尿外科学院 （ESU） 的战略合作伙伴关系，YAU 的目标是促进高质量的研究，为最佳泌尿外科实践提供强有力的证据，以及提高欧洲培训标准的教育计划。为欧洲（及其他地区）的未来泌尿外科领导者创建一个密切国际合作的平台也是 YAU 的目标之一。有关更多信息，请访问：https://uroweb.org/young-academic-urologists-yau。

YAU 于 2012 年作为青年泌尿外科医师办公室 （YUO） 的一部分成立，最初有九个工作组（男科、膀胱癌、良性前列腺增生、功能性泌尿外科、小儿泌尿外科、前列腺癌、肾癌、机器人技术和尿石症）。随着时间的推移，我们已经发展到 13 个组：尿路上皮、重建、泌尿技术和数字健康、腔内泌尿外科和尿石症、功能性泌尿外科、小儿泌尿外科、和睾丸癌、前列腺癌、肾移植、肾细胞癌、泌尿外科机器人、性和生殖健康，以及最近的泌尿外科感染。每个小组都由一名主席协调，他积极参与 YAU 董事会。

YAU 成员是根据他们的学术经历选出的。YAU 小组最近扩大了范围，包括其他非欧洲国家的成员。这与“多元化、公平和包容性”（DEI） 一词有关。多样性是指员工队伍中代表的个人，包括性别、种族、宗教和残疾。公平是指公平和公正的概念，例如平等机会。因此，它与平等不同，平等假设所有人都应该受到平等对待，而公平则最终结果将是平等的。最后，包容性意味着每个人都可以做出有意义的贡献，畅所欲言，所有的声音都会被听到。因此，YAU 群体应包括不同性别、国家和文化背景的成员。

在这封研究信中，我们的主要目标是分析 YAU 中的性别和国家代表性如何随着时间的推移而变化，并设定了未来的改进目标。因此，我们收集了 2012 年至 2023 年 10 月的成员特征（性别、国家）数据，并按 YAU 组进行分层。然后，我们分析了 YAU 发表的所有论文，并使用 PubMed 和搜索代码“young academic urologist”来检查作者的性别代表性。

在初始阶段（2012 年），成员主要是男性 （74/78 [95%]），只有少数成员来自欧洲以外（附录 A;无花果。A1 和表 A1）。近年来，情况逐渐改善：目前女性占会员总数的 21% （40/191）。我们还看到非欧洲成员的兴趣有所上升（2023 年为 24/191 [13%]）。

处理肿瘤学主题的小组有更多的成员，因此女性代表的数量也更多。例如，肾细胞癌工作组的女性代表为 29%（21 人中的 6 人）。女性代表最高的是儿科泌尿外科工作组（10 人中有 5 人 [50%]），该小组有两代女性主席。

对 YAU 出版物的文献检索产生了 396 个结果。在剔除重复和非 YAU 相关的文章后，我们找到了 344 篇手稿。考虑到第一作者和最后一作者（总共 688 个作者），其中 92 个有女性作者 （13%）。在这 344 篇文章中，71 篇文章 （20%） 有女性第一作者，而只有 21 篇文章 （6%） 有女性第一作者。值得一提的是，并非所有 YAU 文章都编码准确，因此存在疏忽的可能性;然而，普遍趋势仍然很明显。

这些号码需要与 EAU 会员号码相关联。EAU DEI 工作组成员 Proietti 博士撰写了一篇声明文章，分析了女性的贡献 [1]：在 9 个欧洲国家，63% 的医学生、48% 的住院医师和 24% 的泌尿外科顾问是女性。Moreno-Fontela 等人 [2] 最近分析了西班牙的趋势，发现 2022 年有 50-61% 的居民是女性。

关于 EAU 内部的会议活动：截至 2021 年，女性展示了 <20% 的所有海报，主持了 <10% 的科学会议，女性教师在大会上的代表占 ~12% [1]。YAU 儿科工作组 [3] 分析了女性在儿科泌尿外科大会上的代表性，多年来也显示出逐渐改善。在美国，也出现了同样缓慢改善的趋势 [4， 5]。为了提高这些数字，EAU DEI 工作组确定了目标和目标，并制定了 5-10 年计划并采取具体行动。不幸的是，迄今为止，EAU DEI 工作组还没有出现其他工作。

可以指出性别分布不平等的几个原因：缺乏意识、有限的指导机会、骚扰、由于产假等原因导致的晋升机会差异、女性的护理任务不平等，与男性相比，留给研究的时间更少等 [4， 5]。后者可能与 YAU 工作组的具体情况有关：为了进入 YAU，申请人需要通过选拔，这需要在感兴趣的领域发表多篇文章。这个原则有时可能对男性有益。

此外，“冒名顶替综合症”可能也起作用。这个词由 Clance 于 1978 年提出，描述了一种持续的内在恐惧，即害怕被揭露为欺诈行为。那些经历过这种现象的人不相信他们值得成功或运气，无论他们的技能是否有外部证据。关于泌尿科医生冒名顶替综合症的文献很少。根据 Jefferson 等人 [6] 进行的一项大型调查，年轻和女性泌尿科医生的冒名顶替综合征更严重，并且它也与倦怠独立相关。

根据目前对情况的了解，应考虑在 YAU 工作组内加强 DEI。因此，方框 1 描述了“优势、劣势、机会和威胁”（SWOT） 分析。DEI 标准目前正在定义中，并将在 YAU 网站上发布。DEI 应纳入 YAU 工作组的使命，包括定期评估并将其用于选择新成员和主席。

总体而言，女性在 YAU 工作组中的代表性呈积极趋势;然而，数字仍然落后于住院医师计划中观察到的数字。已经提出了几项建议。我们希望这些努力能提高 YAU 内部的意识，从而为进一步改进 DEI 铺平道路。我们的分析还可以鼓励其他团体审视自己，并改善其成员和董事会之间的性别和多样性分布。