MP88-13 MALE SLING AND ARTIFICIAL URETHRAL SPHINCTER FOR INCONTINENCE AMONGST CERTIFYING AMERICAN UROLOGISTS

Abstract

INTRODUCTION AND OBJECTIVES: We examined surgical case volume characteristics among certifying urologists performing male sling and AUS to evaluate practice patterns in the care of male stress urinary incontinence (SUI). METHODS: Six month case log data of certifying urologists (2003 to 2013) was obtained from the American Board of Urology (ABU). Cases specifying a CPT code for male sling, AUS, and removal or revision in male patients 18 years were analyzed for surgeonspecific variables. RESULTS: Among 1615 urologists (568 certifying and 1047 recertifying) logging at least one male incontinence procedure, 2109 (48% of all procedures) male sling and 2284 (52%) AUS cases were identified. Mean age of patients undergoing AUS was 74.9 years, compared to 67.3 years in sling patients (p<0.001). Median number of male slings performed was two (range 1-40), with 32.7% placing male slings exclusively. Increase in overall number of incontinence procedures from 2004 to 2014 was greater than the growth in number of urologists applying for certification. Sling and AUS revisions remained relatively stable at a mean of 2.5% and 14% of cases, respectively. The rate of male sling increased from 32.7% of incontinence surgeries in 2004 to 45.5% in 2013 (p<0.001) with a peak in 2011, when placement of a sling was 1.6 times more frequently performed than AUS (sling 62.2%, AUS 37.8%). Academically-affiliated urologists are 1.5 times more likely to perform AUS than male sling for SUI, whereas the proportion of procedures were equal amongst non-academic affiliated urologists (p<0.001). A small group of urologists (27 surgeons, 3.4%) accounted for 22% (464 cases) of all male slings placed. This same cohort of surgeons logged 10.2% (234 cases) of all AUS procedures. Surgical management of male SUI varies widely across states, with slings performed between 21-70%. The states with the highest volume of slings (CA, TX, FL) were also high volume for AUS, accounting for 26.6% of slings and 30.2% of AUS. Five states reported no male slings during this period (DE, ND, NM, VT, WY). CONCLUSIONS: The number of male incontinence procedures has increased over time, with a growing proportion of male slings. Most slings and AUS cases are performed by high-volume surgeons. Regional disparity exists for male slings, with several states reporting no male slings over ten years of certification. Source of Funding: none