Gender differences in authorship of Canadian Urological Association guidelines

Introduction: Women are underrepresented in Canadian urology, particularly within academic leadership. This study aimed to analyze gender differences and trends in Canadian Urological Association (CUA) guideline authorship. Methods: We searched the Canadian Urological Association Journal from March 2007 to August 2024 for all versions of eligible guidelines, best practice reports, and consensus statements. Two independent reviewers extracted data in duplicate. Authors appearing in multiple guidelines were counted more than once. We analyzed author characteristics by gender using the Chi-square test and assessed authorship over time using the Cochran-Armitage test for trend. Results: There were 1172 non-unique authors across 112 guidelines, of whom 750 (64%) were urologists. Women represented 15.5% of all authors and 7.5% of urologist authors. Focusing only on urologists, women were more likely to be first authors and to be included on functional, pediatric, and endourology guidelines than men. The proportion of women urologist authors, first authors, and last authors did not change significantly over time. Men and women urologists had similar rates of repeated authorship (56.7% vs. 51.7%, p=0.61), although men were more likely to appear on 5 guideline panels (23.6% vs. 6.9%, p=0.04). Conclusions: CUA guideline authorship is dominated by men, with limited progress in the participation of women over the past 18 years. CUA guideline panels help establish the standard of urologic care, and guideline authorship represents a significant academic opportunity. Further work to minimize this gender disparity is needed to ensure our guidelines better reflect the diversity of Canadian urologists, urology trainees, and patients.