Category: BPH/LUTS: Electrosurgery, Lasers & Other Technology
Introduction & Objective : Management of urologic disease has evolved over time. We sought to determine the changing practice of urologic procedures performed, as well as trends for likelihood of outward referrals for management of benign prostatic hyperplasia (BPH) procedures among practicing urologists in the United States (US).
As part of the American Urological Association (AUA) Leadership Program study, ‘Trends in Urologic Referral Patterns (TURP),’ we performed a two-part analysis. We queried case logs of certifying and re-certifying urologists submitted to the American Board of Urology (ABU). We also surveyed board-certified urologists and AUA members regarding subjective trends in self-management versus referral over the past five years for a panel of surgical procedures. A Likert scale was used for likelihood of referral and respondents were also solicited for their opinions regarding principal drivers for change.
Results : We analyzed 7,836 case logs from 7,062 urologists from 2005 to 2015. A total of 574,848 procedures were logged based on 164 unique procedure or CPT codes. Among the ten most common CPT codes were three endoscopic interventions for the management of BPH, transurethral resection of prostate (TURP), laser prostatectomy, and transurethral microwave therapy (TUMT). An increase in laser therapy for BPH paralleled a decrease in TURP, with subsequent TURP volume rebounding after 2009. Volume of TUMT has been steadily decreasing since 2008. The survey was sent to 7,512 US board certified practicing urologists and current AUA members and was completed by 959 respondents (13% response rate). Practicing urologists collectively reported a net decrease in outward referrals for endoscopic surgical management of BPH. However, for simple prostatectomy, there was a 1.7-fold increase in likelihood of outward referral.
Conclusions : The ‘TURP’ study was the first of its kind to evaluate frequency of intraspecialty referrals within urology and this project further expands on that evaluation as it relates to BPH. Endoscopic treatments for BPH are among the most common procedures performed. Furthermore, urologists are less likely to refer transurethral BPH procedures and are referring all other queried operations to other providers.
Amy Pearlman– Fellow, Wake Forest Baptist Health, Winston-Salem, North Carolina
Ethan Matz– Resident, Wake Forest Baptist Health, Winston-Salem, North Carolina
Brant Inman– Associate Professor of Urologic Oncology; Vice Chief of Urology, Duke University Medical Center, Durham, North Carolina
Ryan Terlecki– Wake Forest Baptist Health, Winston-Salem, North Carolina
Nicole Miller– Associate Professor of Urology, Vanderbilt University Medical Center, Nashville, Tennessee
Jennifer Robles– Urology Fellow, Vanderbilt University Medical Center, Nashville, Tennessee
Associate Professor of Urologic Oncology; Vice Chief of Urology
Duke University Medical Center
Durham, North Carolina
Associate Professor of Urology
Vanderbilt University Medical Center
Vanderbilt University Medical Center
Jennifer Robles, M.D. completed a Urologic Surgery residency at Washington University in Saint Louis in 2016 and is currently an Endourology and Laparoscopic/Robotic Surgery Fellow at Vanderbilt University. She is also a VA Quality Scholar and is completing a fellowship in Quality Improvement, including a Master's in Public Health. Her interests are in surgical quality improvement, particularly using implementation science and clinical informatics to improve the efficiency and quality of surgical care delivery.