The Urological Society for American Veterans (USAV) has 3 missions: (1) promote the highest standards of urological care for American veterans, (2) advocate for the well-being of federal urological practitioners to enhance their ability to deliver the highest quality of urological care to American veterans, and (3) affiliate and collaborate with the Society of Government Service Urologists (SGSU) in its missions to represent and support active and reserve urologists of the US armed forces. These missions are enhanced by recognizing the diversity of the veteran and active-duty military population and the team of physicians, advanced practice providers, and nurses who provide their urologic care. The focus of the USAV has been to host a society meeting in conjunction with the AUA Annual Meeting. This meeting provides a veteran-focused forum for all urologists and affiliated providers with an interest in veterans’ urologic issues to meet, collaborate, and learn about issues relevant to the urologic care of veterans. The USAV also runs a popular session at the Kimbrough Urologic Seminar (the annual meeting of the SGSU). We use these opportunities to highlight inclusive care for all veterans and focus on urologic issues that frequently occur in the veteran population.

The Department of Veterans Affairs (VA) serves an increasingly diverse population of veterans. Women represented 9.3% of the total enrollee population in 2021.¹ Nearly half (48.5%) of the VA population was ≥ 65 years old, and 29.9% were between ages 45 and 64.¹ The population was largely White (nearly 80%) with 14% Black veterans.¹ While the VA population is largely older, White men, these demographics are changing. Among veterans under 65 years old, the proportion of White patients decreased into the 60% range and the proportion of Hispanic patients increased from around 6% to between 10% and 15%.¹ Recognizing the changing demographics of the veteran population has motivated us to provide educational programming to help providers meet veterans’ urologic health care needs.

In addition to recognizing the demographic diversity of the VA population, it is important for VA providers to understand the unique culture of the veteran population and the unique health challenges that face veterans, which can vary by era and theater of service. Military culture can include values of discipline, teamwork, and selfless duty, respect for hierarchy, and obedience to command not found in other populations.² There are a host of health issues, which, while not exclusive to veterans, do occur at a higher frequency in the veteran population than in other groups. These include mental health issues, including depression and higher rates of suicide among veterans, substance use disorders, post-traumatic stress disorder, traumatic brain injury, and chronic pain.² Military sexual trauma disproportionately, but not exclusively, affects women veterans. Hazardous exposures to Agent Orange, contaminated water, radiation, burn pit smoke, and asbestos are often unique considerations for veteran patients.² Agent Orange exposure is considered a risk for the development of prostate and bladder cancer, and these diseases are regularly highlighted in our programming.

Through programming at our USAV society meeting at the AUA Annual Meeting and in our session at the SGSU, we have sought to address the issues of providing health care to an increasingly diverse veteran population. We have also focused on unique health care and urologic issues facing veterans. This has been accomplished through inviting a diverse range of speakers to participate in our sessions and attempting to maintain a diverse executive board.

At the most recent Kimbrough Urologic Seminar held in January 2024, a highlight of the USAV session was a lecture by Tracy Downs, MD, professor of urology and chief diversity and community engagement officer at the University of Virginia and chair of the AUA Task Force on Diversity, Equity, and Inclusion. Dr Downs led off with a clinical example to illustrate the differences in equitable care and equal care, and how equal care could lead to unequal outcomes for different patients. Dr Downs’s lecture highlighted the increasing diversity of the urology workforce, especially with increasing numbers of women going into urology. Dr Downs showed the increasing costs of inequitable care, which are expected to reach $1 trillion by 2040. Dr Downs also discussed clinical urologic issues related to diversity, including cancer screening in transgender patients and potential issues arising from using the Sexual Health Inventory for Men, which may not be applicable to same-sex couples.

Women represent the fastest growing group in the veteran population, comprising 4% of veterans in 2000, but projected to be 18% of veterans by 2040.³ To help VA urologists take care of this expanding cohort of patients, we invited Rachel Rubin, MD, from Georgetown University and the Washington, District of Columbia, VA to our 2022 meeting to deliver a lecture titled “Addressing the Needs of Female Vets at the VA.” Dr Rubin included tips on developing a Women’s Health program within the VA and how to develop a welcoming environment for women. She had numerous practical tips for taking care of women’s urologic health, including the value of topical estrogen treatment. This year’s USAV society meeting at the AUA (Sunday, May 5, 10:00 AM-2:30 PM, Grand Hyatt, San Antonio, Texas, Ballroom C) will feature a panel discussion on “Genitourinary Care for Transgender Veterans: Current Practices and Future Directions,” moderated by Jaime Cavallo, Yale University and West Haven Veterans Affairs Medical Center.

USAV has sought to address diversity, equity, and inclusion through educational programming that aims to better equip VA, active-duty military, and other federally employed urologists to deliver equitable health care to the veteran population. In the VA this care can include not only focusing on issues facing women and racial minorities, but it can also mean focusing on providing equitable health care for issues such as post-traumatic stress disorder and military sexual trauma, which may disproportionately affect veterans.