Introduction: Women comprise 8.8% of urologists, with 55% practicing general urology. There is a perception that the female general urologist will be responsible for an outsized proportion of female urology and voiding dysfunction within her practice. Our objective is to determine the relationship between physician and patient gender and performance of voiding dysfunction procedures to allow for improved career guidance to female urologists.
Methods: General urologist American Board of Urology certification case logs from 2002-2017 were analyzed by CPT code for urodynamics (UDS; 51728, 51729), bladder chemodenervation (52287), sacral neuromodulation (SNM, 64590), transurethral resection of the prostate (TURP, 52601), laser vaporization of the prostate (PVP, 52648), simple prostatectomy (55801, 55821, 55831), male sling (53440), artificial urethral sphincter (AUS, 53445), and periurethral bulking (51715). Rates of procedure performance procedure and ratio of female to male patients were analyzed by Z-test.
Results: Overall, 447 (7.6%) female and 5,449 (92.4%) male general urologists were included. A higher proportion of female general urologists performed UDS (59% vs 50%, p<0.001), bladder chemodenervation (29% vs 15%, p<0.001), SNM (22% vs 15%, p<0.001), and periurethral bulking (34% vs 25%, <0.001) than male general urologists. However, male general urologists were more likely to perform TURP or PVP (95% vs 87%, p<0.001), male slings (12% vs 8%, p<0.005), and AUS placement (10% vs 16%, p<0.005). There was no difference in performance of simple prostatectomy by gender (p=0.48). Female general urologists performed chemodenervation and SNM on a higher proportion of female patients than male generalists, 85% vs 71% and 85% vs 76% (p<0.001). However, male general urologists were more likely to perform UDS on female patients, 44% vs 41% (p<0.001).
Conclusions: More female general urologists perform female specific voiding dysfunction procedures than their male counterparts, who are more likely to perform male voiding dysfunction procedures. Despite this, almost all urologists perform either TURP or PVP. Female general urologists were more likely to perform gender neutral procedures on women, except UDS. This may indicate differing practice patterns with male generalists referring patients to female colleagues for further procedural management or deferring procedural management altogether. In conclusion, women general urologists have a broad scope of practice within voiding dysfunction, but may want to consider further specialization if desiring a practice emphasizing AUS or male sling practice. Source of