Introduction: Previous work has shown that relationships between urologists and industry are common. The median industry payment to urologists with industry relationships is modest. However, not much is known about the subset of urologists that receive high payment amounts from industry. Here, we characterize these payments and describe the characteristics of these high-payment urologists. Methods: We used the Open Payments database to identify all US-based urologists who received >$50,000 USD in general payments in 2021. General payments are separate from research payments. A web-based search was conducted to extract demographics including gender and subspecialty, academic metrics including h-index, and professional involvements including hospital leadership positions and academic appointments. Results: We identified 92 urologists that received over $50,000 USD in general payments. These high-payment urologists received a median payment of $82,408 USD (IQR $ 59,670 USD, $155,329 USD) and a total payment of $18.1 million USD. High-payment urologists represent 1.1% of all US urologists that received a payment in 2021 (n=8729) but received 58.2% of all industry payments made in 2021 ($31.1 million USD). Most high-payment urologists were men (91%) and specialized in urologic oncology (25%). The median h-index was 13. There was an equal distribution of high-payment urologists in academic and community practices. Of all high-payment urologists, 13% were guideline authors, 23% were editorial board members, 42% occupied leadership positions within their institution, and 58% held an academic appointment. Conclusions: A small number of urologists receive most of the payments from industry. High-payment urologists were predominantly male and specialized in urologic oncology. These individuals hold positions of influence within urology based on their academic and leadership involvements. Additional research is needed to determine the impact of these conflicts of interest on urologic practice. SOURCE OF Funding: None
