American Board Of Urology Research Articles

Practice Readiness? Trends in Chief Resident Case Logs vs Subsequent Case Log Data in Clinical Practice.

Limited information exists regarding the association between resident surgical case experience and subsequent case mix in practice. We compare the case log distribution residents completed during their chief year to those completed by these graduates in their first 2 years in independent practice. Resident chief year case logs from 10 institutions were analyzed across 4 categories of index procedures: (1) general urology, (2) endourology, (3) reconstructive urology, and (4) urologic oncology. Current Procedural Terminology codes for associated index procedures were used to query case log data during their first 2 years in practice collected by the American Board of Urology. Interactions were tested between the trends of chief year case logs relative to trends in practice case logs. Amongst 292 residents, a total of 104,827 cases were logged during chief year and 77,976 cases in the first 2 years as an attending. Most cases completed during chief year were in oncology followed by general urology, endourology, and reconstructive urology. As attendings, most cases completed were in general urology, followed by endourology, reconstructive urology, and oncology. Chief year case logs showed decreasing trends in the median number of case logs in reconstructive urology, endourology, and general urology, while case logs in independent practice noted increasing trends in all index procedure categories over time. Urology residents perform more cases during their chief year compared to their first 2 years of independent practice. Case types completed as chief residents vs subsequent clinical practice also differ significantly. These observations may have implications for residency training, particularly regarding curriculum design.

(286) Gender Disparities Exist in the Surgical Management of Peyronie's Disease and Urologic Prosthetics: An Evaluation of American Board of Urology (ABU) Surgical Case Logs

Abstract Introduction Urology has been predominantly male-dominated, although recent trends indicate increased female representation among urology residents, physicians and advanced-practitioner providers. While progress has been made, gender disparities persist due to societal perceptions and biases. The goal of this study was to investigate whether a provider gender gap exists in the field of reconstructive urology using American Board of Urology (ABU) case logs. Objective To examine case volume characteristics for provider gender disparities in Peyronie’s disease and urologic prosthetic surgery. Methods Retrospective review of surgical case log data from 2003 to 2023 of certified urologists was performed for 11 Current Procedural Terminology (CPT) codes for the surgical management of Peyronie’s disease (penile plication CPT 54360, plaque excision/incision with grafting CPT 54111, 54112), male urethral sling or artificial urinary sphincter (CPT 53440, 53445), and placement of penile implant (CPT 54400, 54401, 54405). Inclusion criteria included male patients who were 18 years old or older. Data collected included patient and surgeon demographics, surgical procedure, and surgeon fellowship training status. Cases were analyzed using descriptive statistics and regression testing. Results From 2003 to 2023, a total 2,852 urologists performed 15,171 Peyronie’s disease and urologic prosthetic surgical procedures. Among these procedures, 1,910 (13%) Peyronie’s disease, 8,940 (59%) penile implant, and 4,321 (28%) incontinence procedures were identified. Out of the total practicing urologists, 2,626 were male and 226 were female; the distribution of cases revealed 5 cases performed per male surgeon and 4 cases per female surgeon. Over two decades, there was a significant positive trend in the proportion of cases performed by female surgeons (p < 0.001). 169 (6%) surgeons completed fellowships in Andrology or Male Reconstruction, and performed 2,129 (14%) of total procedures. Across surgeons with Andrology or Male Reconstruction fellowship-training, there were 13 cases performed per male surgeon and 7 cases per female surgeon. Conclusions Our study confirms underrepresentation of female surgeons in the field of Peyronie's disease and prosthetic urology. Although there is a trend of increasing female representation over time, further research can be done to identify barriers to gender equality in the field. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific, Coloplast.

The birth of pediatric urology in the United States: From pioneers to subcertification

Pediatric urology is a subspecialty of urology that emerged from a culture in which children with urological disorders were cared for by general urologists and general pediatric surgeons. The development of pediatric urology as a subspecialty was years in the making, highlighted by individuals who recognized that children with urological conditions were not just "small adults," but required special experience and training. Subspecialization was initiated by persistent visionaries who recognized the need for a trained cadre of experts to provide better care for children. It took the coordinated effort of all subgroups and leaderships in pediatric urology to push these efforts over the goal line. The focus of this review is to highlight certain individuals who played major roles in this vision and to document the efforts of many to coordinate the pathways to sub-specialization. The careers of Meredith F. Campbell and Frank B. Bicknell were researched to identify their rationale and roles in developing pediatric urology as a distinct medical specialty in the United States. In addition, the minutes of the meetings of the Pediatric Urology Advisory Council (PUAC) with the American Board of Urology (ABU) were reviewed. The origins of the Society for Pediatric Urology (SPU) and the American Academy of Pediatrics Section of Urology (AAP-SOU) were researched. The contributions of each to the certification of pediatric urology as a distinct subspecialty was delineated. Campbell was Chair of Urology at the New York University (NYU) School of Medicine and wrote prolifically about pediatric urology. He published one of the first practical textbooks in pediatric urology, almost completely self-written, in 1937. Bicknell, a general urologist in Michigan on the faculty at Wayne State University School of Medicine, led the initiative to create the Society for Pediatric Urology (SPU) that first met at the 1951 annual American Urological Association (AUA) meeting in Chicago and included nine attendees. Subsequently, John Lattimer (College of Physicians and Surgeons at Columbia University) organized a well-attended meeting of urologists interested in pediatrics at the 1964 annual AAP meeting in New York City. This led to the formation of the AAP Section on Urology. Integral to the justification for the development of a subspecialty was evidence of a published corpus of content. In addition to published textbooks devoted exclusively to pediatric urology, this was further fulfilled by the AAP Section on Urology Pediatric Supplement to the Journal of Urology, first published in 1986, and later with the Journal of Pediatric Urology in 2005. The SPU and the AAP Section on Urology came together to form the Pediatric Urology Advisory Council (PUAC) in 2000, which worked with the ABU to create subspecialty certification in pediatric urology with an independent exam, first administered in 2008 to 176 applicants. The metaphor "We have stood on the shoulders of giants" is apt for pediatric urology: Meredith Campbell, Frank Bicknell, David Innes Williams (Hospital for Sick Children, London), and J. Herbert Johnston (Alder Hay Hospital, Liverpool) come to mind among the first generation of pediatric urology pioneers, and others among their colleagues also had significant impact. Clearly this is a story of persistence and attention to detail on the part of those giants and those who followed. Pediatric urology became a distinct discipline after the SPU and AAP-SOU came together to create a robust cohort of pediatric urologists who through education and negotiation were able to help the ABU and the American Board of Medical Specialties (ABMS) recognize that subspecialization would lead to better care for children with urologic disorders. This benchmark set a high bar for future subspecialization in urology and other fields.

The Journal of Urology® Home Study Course 2023 Volume 209/210.

The Journal of Urology® Home Study Course 2023 Volume 209/210.

The Journal of Urology® Home Study Course 2023 Volume 209/210.

The Journal of Urology® Home Study Course 2023 Volume 209/210.

(294) Trends and Clinical Practice Patterns of Prostatic Urethral Lift (PUL): An Analysis of the American Board of Urology Case Logs

Abstract Introduction Prior studies have shown that among benign prostatic hyperplasia (BPH) surgical treatments, PUL has a higher likelihood of preserving sexual function. As a result, the 2021 AUA guidelines on management of BPH note that PUL may be offered as a treatment option to those eligible patients who desire preservation of erectile and ejaculatory function. Objective We investigated practice trends associated with PUL utilization and hypothesized that PUL would be performed more frequently for younger patients and by urologists subspecializing in andrology (infertility and/or sexual medicine). Methods We obtained de-identified, self-reported American Board of Urology (ABU) case logs from 2015-2021. We identified 4,131 urologists who performed 48,610 surgeries with an indication for BPH per ICD codes. CPT codes distinguished PUL from transurethral incision, electrosurgical resection, laser coagulation/vaporization, laser enucleation, and thermotherapy. We identified 786 urologists who performed 7,895 PUL procedures representing 19.2% of all BPH surgeries. Additionally, 24 urologists only performed PUL, and 3,345 urologists did not perform any PUL. A logistic regression model assessed factors independently associated with performing PUL. Results The number of annual PUL performed has ranged from 101 to 2,852, comprising an increasing proportion of BPH surgeries from an initial 1.6% in 2015 to 32.5% of all BPH surgeries performed in 2020. In adjusted analyses, factors associated with higher odds of performing PUL included subspecialization in andrology (odds ratio [OR] 4.01, 95% CI 1.94-8.29); practice area population >1,000,000 (OR 1.55, 95% CI 1.01-2.38); and government (OR 4.22, 95% CI 1.83-9.74), private practice group (OR 2.68, 95% CI 1.53-4.68), and salaried hospital employment (OR 1.94, 95% CI 1.00-3.96). The operative year (OR 1.66 per year, 95% CI 1.54-1.80) and surgeon BPH surgical volume (OR 1.02 per case increase, 95% CI 1.01-1.02) were associated with increased odds of performing PUL. Endourology subspecialization was associated with lower odds of PUL (OR 0.40, 95% CI 0.2-0.8). Geographic region, surgeon age, surgeon gender, certification vs recertification status, and patient age were not associated with use of PUL. Conclusions Based on 7 years of ABU case log data, PUL is more likely to be performed by andrologists, urologists practicing in large metropolitan areas, higher volume BPH surgeons, and urologists in private practice group, government, or hospital salaried employment. Contrary to our hypothesis, lower patient age was not associated with a higher odds of undergoing PUL. The use of PUL has increased significantly and currently comprises one third of all BPH surgeries. More study is needed to determine the extent to which patient demand for ejaculation preservation is driving the rapid adoption of PUL reflected in the ABU case logs. Disclosure No

MP07-09 TRENDS IN IMPLANTATION AND EXPLANTATION OF MESH FOR PELVIC ORGAN PROLAPSE AMONG FPMRS AND GENERAL UROLOGISTS

You have accessJournal of UrologyCME1 Apr 2023MP07-09 TRENDS IN IMPLANTATION AND EXPLANTATION OF MESH FOR PELVIC ORGAN PROLAPSE AMONG FPMRS AND GENERAL UROLOGISTS Mitchell G. Goldenberg, Unwanaobong Nseyo, Madeleine Burg, Evgeniy Kreydin, and David A. Ginsberg Mitchell G. GoldenbergMitchell G. Goldenberg More articles by this author , Unwanaobong NseyoUnwanaobong Nseyo More articles by this author , Madeleine BurgMadeleine Burg More articles by this author , Evgeniy KreydinEvgeniy Kreydin More articles by this author , and David A. GinsbergDavid A. Ginsberg More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003222.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The use of synthetic mesh in the treatment of pelvic floor conditions has long been scrutinized. Statements from multiple professional societies recommend that mesh for pelvic organ prolapse (POP) be performed only by those properly trained in both implantation and management of complications. We used case logs from the American Board of Urology (ABU) to understand temporal changes in the use of pelvic mesh among subspecialty trained and general urologists. METHODS: Case logs submitted to the ABU for certification and recertification in 2013 and in 2020 were reviewed. Demographic data including surgeon age, fellowship training, certification cycle, and practice type and location was analyzed. We analyzed trends in mesh insertion (both for POP and SUI) and mesh revision/removal based using common procedural terminology (CPT) codes among FPMRS and general urologists. Statistical analysis was performed using chi-squared test, binary regression, and Cronbach’s alpha. RESULTS: Over the two study years, 1877 surgeons contributed 253,326 unique procedures. A total of 1910 (1.8% of total cases) mesh implantation procedures were performed in 2013 compared to 2245 (1.5%) in 2020. Among FPMRS providers (n=154, 8.2%), the use of vaginal mesh for POP decreased from 4.6% to 1.5% (p<.001) of their total procedure volume, while transabdominal mesh for POP increased from 3.1% to 5.3%, (p<.001, see Figure 1). Similar changes were seen among generalists, among whom the rate tripled (0.1% to 0.4%, p<.001, see Figure 1b). Mesh revision/removal rates were stable (2.9%, p=.224) among FPMRS providers, but significantly decreased among general urologists in 2020 (0.2% to 0.1% p<.001). On multivariable analysis, generalists more likely to perform mesh revisions/removals were non-academic, female, and practiced in areas with a population density ≥1 million. Generalists implanting mesh were also more likely to perform revision/removal (Cronbach’s alpha=0.343, p=.015). CONCLUSIONS: Mesh-augmented POP repairs continue to be used among FPMRS and general urologists. However, these data indicate that general urologists may be referring mesh complications onto FPMRS providers, indicating that societal and FDA recommendations are perhaps not being adhered to. Source of Funding: The Catherine and Joseph Aresty Department of Urology © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e87 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mitchell G. Goldenberg More articles by this author Unwanaobong Nseyo More articles by this author Madeleine Burg More articles by this author Evgeniy Kreydin More articles by this author David A. Ginsberg More articles by this author Expand All Advertisement PDF downloadLoading ...

MP19-07 PRACTICE PATTERNS OF UROLOGISTS SEEKING BOARD CERTIFICATION IN FEMALE PELVIC MEDICINE AND RECONSTRUCTIVE SURGERY

You have accessJournal of UrologyCME1 Apr 2023MP19-07 PRACTICE PATTERNS OF UROLOGISTS SEEKING BOARD CERTIFICATION IN FEMALE PELVIC MEDICINE AND RECONSTRUCTIVE SURGERY Samuel W. Plaska, Patricia Maymi-Castrodad, Alyssa Gracely, Giulia I. Lane, and J. Quentin Clemens Samuel W. PlaskaSamuel W. Plaska More articles by this author , Patricia Maymi-CastrodadPatricia Maymi-Castrodad More articles by this author , Alyssa GracelyAlyssa Gracely More articles by this author , Giulia I. LaneGiulia I. Lane More articles by this author , and J. Quentin ClemensJ. Quentin Clemens More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003244.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To identify opportunities to improve surgical access to Female Pelvic Medicine and Reconstructive Surgery (FPMRS) certified urologists through review of clinical practice logs. METHODS: FPMRS clinical practice logs were obtained from the American Board of Urology from 2013-21. We grouped encounters into FPMRS diagnostic groups and calculated the proportion of clinic visits to corresponding procedures. We performed multilevel logistic regression to evaluate variability between surgeons while accounting for surgeon gender, age, certification status, year and patient age. RESULTS: 370 FPMRS urologists submitted 383,424 clinic and 323,929 procedural encounters, of which 49% constituted FPMRS-related diagnoses. Of these urinary incontinence (UI, 30%), overactive bladder (OAB; 26%), and urinary tract infections (14%) were most common. Diagnoses with the highest proportion of procedural visits (%) included pelvic organ prolapse (POP; 30%), UI (39%), and fistulas (50%), while interstitial cystitis (0%), neurogenic bladder (0%), and benign prostatic hyperplasia (4%) had the fewest associated procedures (Figure 1). Multilevel regression found that 15% of variance (intraclass correlation, ICC) in the proportion of FPMRS clinic visits to procedures was explained by clustering at the physician level and that increasing surgeon age was associated with a deceased proportion of clinic visits (Odds Ratio (OR): 0.99p=0.01).When evaluating diagnostic sub-groups, results were similar, with clustering under physicians explaining 14-19% of variance in clinic vs. procedural proportion depending on the diagnostic group. Increasing patient age was associated with increased clinic visits (fewer procedures) for OAB (OR=1.00 p<0.001), UI (OR=1.00 p<0.001), and POP (OR=1.01 p<0.001). Female physicians had 20% increased odds of having a clinic visit per procedure compared to male counterparts for UI (OR=1.25 p<0.001) and POP (OR=1.23 p=0.01). CONCLUSIONS: A large portion of FPMRS-urologists practice is non-operative and not sub-specialty related. Efforts that increase access to FPMRS-trained urologists may benefit from methods to triage non-operative management to physician extenders and focus practices on FPMRS care. Source of Funding: Medtronic Fellowship Educational Grant - AWD016079 © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e266 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Samuel W. Plaska More articles by this author Patricia Maymi-Castrodad More articles by this author Alyssa Gracely More articles by this author Giulia I. Lane More articles by this author J. Quentin Clemens More articles by this author Expand All Advertisement PDF downloadLoading ...

Current Practice Patterns in the Surgical Management of Benign Prostatic Hyperplasia

ObjectiveTo use American Board of Urology (ABU) case log data to elucidate practice patterns for benign prostatic hyperplasia (BPH) surgery. Several surgical modalities have been introduced in recent decades causing significant practice variation. Materials and MethodsWe retrospectively analyzed ABU case logs from 2008-2021 to assess trends in BPH surgery. We created logistic regression models to identify surgeon-sided factors associated with utilization of each surgical modality. ResultsWe identified 6,632 urologists who logged 73,884 surgeries for BPH. Transurethral resection of the prostate (TURP) was the most commonly performed BPH surgery in all but 1 year, and odds of performing a TURP increased year-over-year (OR 1.055, 95% CI [1.013,1.098], P = .010). The use of holmium laser enucleation of the prostate (HoLEP) did not change over time. HoLEP was more likely to be performed by urologists with higher BPH surgical volume (OR 1.017, CI [1.013, 1.021], P < .001) and with endourology subspecialization (OR 2.410, CI [1.45, 4.01], P = .001). Prostatic urethral lift (PUL) utilization increased significantly since its introduction in 2015 (OR 1.663, CI [1.540, 1.796], P < .001). PUL currently comprises over one third of all BPH surgeries logged. ConclusionIn the face of newer technologies, TURP remains the most common surgery for BPH in the United States. PUL has been rapidly adopted while HoLEP comprises a consistent minority of cases. Surgeon age, patient age, and urologist subspecialization were associated with use of certain BPH surgical approaches.

The Journal of Urology® Home Study Course 2023 Volume 209/210.

The Journal of Urology® Home Study Course 2023 Volume 209/210.

MP01-07 FACTORS ASSOCIATED WITH USE OF PROSTATIC URETHRAL LIFT (PUL)

You have accessJournal of UrologyCME1 May 2022MP01-07 FACTORS ASSOCIATED WITH USE OF PROSTATIC URETHRAL LIFT (PUL) Samantha L. Thorogood, Tenny R. Zhang, Christina Sze, Gina DeMeo, Mary O. Strasser, Richard K. Lee, Bilal Chughtai, Alexis Te, and Jim C. Hu Samantha L. ThorogoodSamantha L. Thorogood More articles by this author , Tenny R. ZhangTenny R. Zhang More articles by this author , Christina SzeChristina Sze More articles by this author , Gina DeMeoGina DeMeo More articles by this author , Mary O. StrasserMary O. Strasser More articles by this author , Richard K. LeeRichard K. Lee More articles by this author , Bilal ChughtaiBilal Chughtai More articles by this author , Alexis TeAlexis Te More articles by this author , and Jim C. HuJim C. Hu More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002513.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: PUL vs. other benign prostatic hyperplasia (BPH) surgical approaches improves preservation of antegrade ejaculation and shortens both operative time and postoperative catheterization. We investigated trends associated with its use. METHODS: We obtained de-identified, self-reported American Board of Urology (ABU) case logs from 2015-2021. We identified 4,131 urologists who performed 48,610 surgeries with an indication for BPH per ICD coding. CPT codes distinguished BPH surgical approaches. We identified 786 urologists who performed 7,895 PUL: 24 urologists only performed PUL, and 3,345 urologists did not perform any PUL. A logistic regression model assessed factors independently associated with PUL use. RESULTS: Annual PUL surgeon volume ranged from 101 to 2,852 cases; PUL comprised 1.6% of BPH surgeries in 2015 and increased to 32.5% in 2020. In adjusted analyses (Table 1), factors associated with higher odds of performing PUL included subspecialization in andrology (odds ratio [OR] 4.01, 95% CI 1.94-8.29); practice area population >1,000,000 (OR 1.55, 95% CI 1.01-2.38); and government (OR 4.22, 95% CI 1.83-9.74), private practice group (OR 2.68, 95% CI 1.53-4.68), and salaried hospital employment (OR 1.94, 95% CI 1.00-3.96). The operative year (OR 1.66 per year, 95% CI 1.54-1.80) and surgeon BPH surgical volume (OR 1.02 per case increase, 95% CI 1.01-1.02) were associated with increased odds of performing PUL. Endourology subspecialization was associated with lower odds of PUL (OR 0.40, 95% CI 0.2-0.8). Geographic region, surgeon age, surgeon gender, certification vs recertification status, and patient age were not associated with PUL use. CONCLUSIONS: PUL utilization varies based on subspecialization, practice area, practice type, and BPH surgeon volume. Use of PUL has increased significantly and currently comprises one third of all BPH surgeries. More study is needed to determine durability of PUL outcomes particularly given its current widespread use and increasing adoption. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e3 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Samantha L. Thorogood More articles by this author Tenny R. Zhang More articles by this author Christina Sze More articles by this author Gina DeMeo More articles by this author Mary O. Strasser More articles by this author Richard K. Lee More articles by this author Bilal Chughtai More articles by this author Alexis Te More articles by this author Jim C. Hu More articles by this author Expand All Advertisement PDF DownloadLoading ...

MP04-09 TRENDS IN HOLMIUM LASER ENUCLEATION OF THE PROSTATE FOR TREATMENT OF BENIGN PROSTATIC HYPERPLASIA

You have accessJournal of UrologyCME1 May 2022MP04-09 TRENDS IN HOLMIUM LASER ENUCLEATION OF THE PROSTATE FOR TREATMENT OF BENIGN PROSTATIC HYPERPLASIA Tenny R. Zhang, Mary O. Strasser, Samantha L. Thorogood, Christina Sze, Bilal Chughtai, Alexis Te, Richard K. Lee, and Jim C. Hu Tenny R. ZhangTenny R. Zhang More articles by this author , Mary O. StrasserMary O. Strasser More articles by this author , Samantha L. ThorogoodSamantha L. Thorogood More articles by this author , Christina SzeChristina Sze More articles by this author , Bilal ChughtaiBilal Chughtai More articles by this author , Alexis TeAlexis Te More articles by this author , Richard K. LeeRichard K. Lee More articles by this author , and Jim C. HuJim C. Hu More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002521.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Compared to traditional treatment options for benign prostatic hyperplasia (BPH), holmium laser enucleation of the prostate (HoLEP) has demonstrated improved outcomes in hemostasis, urinary symptoms, and immediate complication rates. We investigated practice patterns associated with the use of HoLEP. METHODS: We obtained de-identified, self-reported American Board of Urology (ABU) certification/recertification case log data from 2008-2021. We identified 6,632 urologists who performed 73,884 surgeries with an indication for BPH. Current Procedural Terminology (CPT) codes distinguished HoLEP, transurethral resection of prostate (TURP), laser TURP, simple prostatectomy, prostatic urethral lift, transurethral incision of the prostate, and microwave and radiofrequency ablation. We identified 548 urologists (8.3%) who performed 7,386 HoLEP surgeries. Forty-three urologists (0.7%) performed HOLEP exclusively (no other BPH surgical approaches). A logistic regression model was used to determine factors independently associated with using HoLEP. RESULTS: The annual number of HoLEP procedures performed ranged from 3 to 1276, comprising 0.06% to 17.3% of total BPH surgeries annually. Highest HoLEP volumes were logged in 2019, representing 17.3% of total BPH cases. In adjusted analyses (table) factors associated with lower odds of performing HoLEP include surgeon age (odds ratio [OR] 0.93); government (OR 0.06), private practice group (OR 0.44), managed care (OR 0.14), salaried hospital (OR 0.38) vs. academic employment; and Mid-Atlantic (OR 0.28) and New England (0.45) regions vs. South Central (referent). Factors associated with higher odds of performing HoLEP include higher BPH surgical volume (OR 1.02) and endourology (OR 2.41) vs. general urology subspecialty. CONCLUSIONS: HoLEP is more likely to be performed by younger urologists, urologists in academic practice, endourology subspecialists, and those with higher BPH volume. HoLEP was less likely to be performed in Mid-Atlantic and New England regions. Additional studies are needed to elucidate practice pattern variations. Despite evidence demonstrating improved perioperative outcomes compared to competing BPH surgical approaches, HoLEP dissemination over time has been limited, possibly due to prolonged learning curve. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e60 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Tenny R. Zhang More articles by this author Mary O. Strasser More articles by this author Samantha L. Thorogood More articles by this author Christina Sze More articles by this author Bilal Chughtai More articles by this author Alexis Te More articles by this author Richard K. Lee More articles by this author Jim C. Hu More articles by this author Expand All Advertisement PDF DownloadLoading ...

Update from the American Urological Association's Residents and fellows committee.

The American Urological Association’s (AUA) Residents and Fellows committee, since its inception in 2002, represents the voice of trainee members of the AUA. Over the past few years, the committee has been investigating issues surrounding parental leave among US residents. Through the help of the AUA our committee developed a survey [1]. We found that 1 in 4 residents have children and 80% of those residents had a child during residency. We also found that 78% of residents took <2 weeks off after the birth of their child. Currently, there is no national American Board of Urology (ABU) policy for trainees [2, 3]. Our committee has had the opportunity to interface with the ABU to express concerns surrounding the lack of parental leave policy for trainees. Over the past year, the ABU has worked with the numerous stakeholders to develop a standardised parental leave policy that will be put into place this July. Residents will be allowed to take 6 weeks of parental leave without affecting vacation or sick leave and without an extension of training. Additionally, residents will be allowed an additional 2–4 weeks of leave depending on their year of training. This policy effectively will provide 8–10 weeks of parental leave. Our committee has offered full support for ABU’s pending policy and appreciation for their acknowledgement of parental leave as an issue critical to trainees. Most recently, over the past year our committee also worked to support residents during the COVID-19 pandemic. Urology residents were faced with uncertainty on a daily basis during the pandemic with decreased inpatient, outpatient, and surgical volumes [4]. Additionally, didactics were disrupted and residents were redeployed to COVID units. Collaborative efforts for urology resident education emerged across the country. One of the first initiatives was the UCSF Urology COViD (Urology Collaborative Online Virtual Didactics) lecture series [5]. Similarly, residents from the New York Section of the AUA created the Educational Multi-institutional Program for Instructing Residents (EMPIRE) lecture series [6]. These lectures provided critical didactic education that was suddenly absent from residency training. Topics spanned the breadth of urology and experts across the country volunteered to be presenters. The virtual educational series did more than just replace missing didactics, they presented a novel opportunity for a more interconnected national resident education program. These virtual education series derived their success from several factors. First, they met a widespread demand for easily accessible educational opportunities during the pandemic. Second, using teleconference platforms, the lectures maintained a sense of interactivity through live question and answer sessions and audience surveys. Alternatively, recordings of these sessions provided flexibility for learning. Third, by addressing a wide variety of topics, learners could tailor their experience around their interests. And finally, informal ‘mentoring sessions’ with each speaker before the lectures provided timely insights and career advice for residents and students. The creation of a digital library of urology lectures and the collaboration necessary to rise to these challenging times will likely have long-lasting effects. The challenge of the COVID-19 pandemic created an opportunity for an entirely interconnected urology resident cohort. Will urology residents be inspired to pursue fellowship after increased exposure to subspecialists? Could this serve as the foundation to create a national resident mentorship program? Despite the challenges of the COVID-19 pandemic the work of the AUA Residents and Fellows Committee has continued and our constituency is more connected than ever. The authors have no relevant interests to disclose.

Medical Professionalism Is Like Pornography: You Know it When You See it.

Addressing professionalism is a key role of Certification Boards, but how best to do this is not clear. This article describes a 360° approach to monitoring and enhancing professionalism taken by the American Board of Urology (ABU). In addition to monitoring full and active medical licenses, ABU has identified ethical issues specific to Urology, includes a position article on ethics in Urology on its Web site, and requires a completion of modules on ethics. As a part of its 10-year cycle, the Board requires peer evaluations from other urologists in the community. Finally, and most importantly, ABU uses a portfolio practice log to evaluate the candidates' use of procedures appropriate to their stated subspecialty area of expertise, evaluation of potential overuse or inappropriate use of procedures and a narrative that details any major complications associated with their procedures.

National Characteristics of Surgeons Performing Vasectomy: Increasing Specialization and a Persistent Gender Gap

ObjectiveTo describe trends in the characteristics of urologic surgeons performing vasectomy over time. MethodsWe performed a retrospective, cross-sectional study examining surgeon characteristics for case logs from the American Board of Urology between 2004 and 2013. We used generalized estimating equations with a log link and negative binomial distribution to examine demographic differences (gender, rural location, and surgeon volume) in the number of vasectomies surgeons performed over time. ResultsBetween 2004 and 2013, 5316 urologists had case logs collected within the 7-month certification window. The majority of these surgeons self-identified as general urologists (82.8%), and a small proportion identified as andrology and infertility specialists (1.7%). Across all years, the median number of vasectomies performed per certifying surgeon during the study period was 14 (interquartile range 6-26). The majority of vasectomies were performed by high-volume surgeons (≥ 26 vasectomies) ranging from 49.2% to 66.9% annually, whereas the proportion performed by low-volume (≤ 5 vasectomies) surgeons ranged from 3.3% to 6.6% annually. Male surgeons performed vasectomies 2.20 times more frequently than female surgeons (95% confidence interval 1.93-2.49; P <.0001) across the study period with no evidence to suggest this gap changed over time (gender-year interaction 1.01 [95% confidence interval: 0.97-1.06; p = .576]). ConclusionWhile the majority of urologists performing vasectomy identify as general urologists, there appears to be a focus on vasectomy practice among a small number of high-volume surgeons. Furthermore, while the number of female surgeons performing vasectomies increased, a gender gap persists in the proportion of vasectomies performed by females.

Renal Thermal Ablation Trends of American Urologists.

Objective: To define current trends in the utilization of renal thermal ablation by urologists in the United States. Material and Methods: A six-month case log data for renal procedures submitted by certifying and recertifying American urologists from 2003 to 2018 were obtained from the American Board of Urology and stratified by current procedural terminology code. The utilization of thermal ablative techniques was examined with respect to overall trends, surgeon, and practice characteristics associated with its use. Results: Six thousand two hundred eleven unique urologists performed 54,075 renal procedures, including 1916 (3.5%) thermal ablations, 630 (1.2%) renal biopsies, 17,361 (32.1%) partial nephrectomies, 20,403 (37.8%) radical nephrectomies, and 7957 (14.7%) nephroureterectomies. Eight hundred twenty-five (13.3%) unique urologists performed renal ablations, including 1344 (70.2%), 418 (21.8%), and 154 (8.0%) laparoscopic, percutaneous, and open ablation procedures, respectively. The annual volume of ablation was highest in 2008, followed by 2010 and 2009. On multivariate modeling of those performing renal interventions, the first decade of practice, self-declared endourologist, urologist who completed an endourology fellowship, urologist who practices in the Mid Atlantic, North Central, South Central, and South Eastern United States (compared with New England) were more likely to perform thermal ablation for renal masses. Urologists who perform renal biopsies and partial nephrectomies are also more likely to perform ablation of renal masses. Conclusions: Thermal ablation accounted for a small percentage of renal interventions performed by urologists in the last 1.5 decades with definable associations to practice characteristics. Renal ablation was most commonly performed laparoscopically, with declining use in recent years.

Identifying Current Trends in the Urologic Oncology Workforce: Does Completion of Fellowship Significantly Change Future Practice?

PurposeTo assess fellowship impact on subsequent practice type and case-mix, we compared urologists who completed a urologic oncology fellowship (OF) to urologists who did not complete a fellowship (NF). Materials and MethodsAnnualized case log data were obtained from the American Board of Urology from 2004 to 2016, including initial certification (C1) and re-certifications 1 (R1) and 2 (R2). We evaluated trends in major urologic oncology case volume using relevant Current Procedural Terminology codes. Surgeon-specific data, including fellowship training, practice type, and practice area population, were analyzed using chi-squared and 2-sample t-tests. ResultsOF (N=338) were more likely than NF (N=7,785) to practice in larger population areas (p<0.001), and practice in academics (p<0.001). OF performed nearly three times as many major oncology cases as NF at each certification cycle (C1: 29.7 vs 12.5, R1: 32.3 vs 13.5, R2: 30.5 vs 11.5; p<0.001 for all), and maintained case volumes over time. OF performed significantly more major cases in kidney, bladder, and prostate cancer across all certification time points than NF, and continued to perform these cases at similar frequency at all certification cycles. Moreover, during the time period studied, OF performed an increasing percentage of overall major oncologic cases (from 8.9% in 2004 to 13.3% by 2016). ConclusionsCompletion of urologic oncology fellowship is associated with performing and maintaining a high volume of major oncology cases over recertification cycles, with academic practice, and with practicing in large population centers. This information may be useful to urology residents considering OF opportunities.

The Non-neurogenic Overactive Bladder: an Update

The objective of this study was to review the most recent literature to evaluate and analyse new information regarding the evaluation and treatment trends that is available. The aetiology and pathophysiology for the non-neurogenic or idiopathic overactive bladder (OAB) remains unclear. Recent functional MRI studies of the brain indicate an age-related decrease in neurological control of continence of urine. Microbiomes in the urogenital tract have also been implicated in the aetiology of the OAB. The diagnosis and initial management should be based on a thorough history, examination and basic investigations to exclude treatable causes such as urinary tract infection (UTI) and malignant conditions. The first line of therapy is conservative with behavioural and pelvic floor muscle retraining and the addition of an information leaflet can add to a better outcome. However, there are still too few studies to evaluate the effect on urgency urinary incontinence (UUI). Electrical stimulation combined with pelvic floor muscle training (PFMT) treatment versus PFMT treatment alone is twice more likely to improve UUI. There is a recent trend towards mirabegron as the preferred choice of first-line pharmacotherapy versus anticholinergic treatment for OAB to avoid anticholinergic side effects. For the refractory cases, phase III trials with level 1 evidence make licencing of the use of 100 U of botulinum for the idiopathic OAB now possible. American Board of Urology (ABU)-certified urologists in the USA perform sacral neuromodulation (SNS) more commonly and very rarely augmentation cystoplasty. The pathophysiology of the OAB remains unclear and further ongoing research is required. New trends of treatment are recognised for both conservative pharmacotherapy and refractory OAB.

Trends and Clinical Practice Patterns of Sacral Neuromodulation for Overactive Bladder.

The aim of this study was to investigate surgical practice patterns of American urologists treating refractory overactive bladder (OAB) over the past decade. Refractory OAB remains a management challenge to urologists. When multiple medical therapies have failed, treatment options may include sacral neuromodulation (SNM) or surgery such as augmentation cystoplasty (AC). Data on SNM and AC performed between 2003 and 2012 by certifying and recertifying urologists were obtained in the form of annualized case logs from the American Board of Urology (ABU). Associations between surgeon characteristics (type of certification, annual volume, practice type, and location) and these procedures were evaluated. Over the past decade, 756 of 6355 urologists certified with the ABU performed SNM or AC for the treatment of refractory OAB. Forty-five (6%) of these surgeons completed fellowships in female urology and 71 surgeons (9%) completed another type of fellowship program. Surgeons recertifying with ABU performed 76% of all SNM procedures. Although SNM and AC have increased from 64 to 2086 between 2003 and 2012, however, this is mainly driven by the increase of SNM from 48 to 2068 cases. Rates of AC have remained stable with 14 to 38 cases reported annually. However, they have declined relative to the total, from 25% in 2003 to less than 1% in 2012. Sacral neuromodulation has increased dramatically over the past decade in surgeons certified with the ABU. This is in contrast to AC, which while remaining stable in number of procedures.

Changes in practice patterns in male infertility cases in the United States: the trend toward subspecialization

To assess changes in the practice patterns of urologists performing male infertility procedures (vasal reconstruction, sperm retrieval, varicocelectomy) from 2004 to 2015 in the United States. Examination of self-reported procedural volumes from urologists undergoing certification and recertification using case log data provided by the American Board of Urology. The study period was stratified into early (2004-2007) and recent (2012-2015) time periods. Not applicable. None. None. Temporal variations in male infertility practice patterns among different urologic subspecialties between the early and recent time periods. The overall proportion of total male infertility procedures performed by andrologists significantly increased between the early and recent groups (23% to 26%). This growth was driven by a significant increase in the proportion of varicocele repairs being performed by andrologists between the early and recent periods (19% to 25%). Most notably, an assessment of total number of male infertility procedures performed by newly certifying urologists showed that there was a significant increase in the overall proportion of all male infertility procedures being performed by recently trained andrologists (24% to 35%). This significant increase was seen individually among all three types of male infertility procedures. With the increased trend in urologists obtaining fellowship training, male infertility surgical volume is beginning to shift from general urologists to subspecialized andrologists.