Trends in Urogynecologic and Reconstructive Pelvic Surgery Among Early-career Urologists: Analysis of American Board of Urology Case Logs From 2009-2020.

[OBJECTIVE] To evaluate trends in Urogynecologic and Reconstructive Pelvic Surgery (URPS) among early-career urologists, comparing URPS-trained and non-URPS urologists using American Board of Urology case logs from 2009-2020.

[MATERIALS AND METHODS] Six-month American Board of Urology case logs from 3113 early-career urologists were analyzed. Procedures included sling placement and urethral bulking for stress urinary incontinence (SUI), transvaginal prolapse repair and sacrocolpopexy for pelvic organ prolapse, and intravesical Botox injection and sacral neuromodulation for overactive bladder (OAB).

[RESULTS] URPS urologists performed higher mean case volumes for SUI (sling: 11 vs 5, P <.01; bulking: 8 vs 4, P <.01), prolapse (transvaginal: 8 vs 4, P <.001; sacrocolpopexy: 6 vs 3, P <.001), and OAB procedures (Botox: 10 vs 4.5, P <.001; sacral neuromodulation: 13.2 vs 7.9, P <.001) than non-URPS urologists. URPS training was associated with higher odds of performing these procedures (odds ratios (ORs) 8.3-25.2, 95% confidence interval (CI) [5.97-45.84] P <.01). The proportion of non-URPS urologists performing SUI and prolapse procedures declined over the years (Spearman's ρ = -0.79 to -0.94, P <.01), while the adoption of OAB procedures increased.

[CONCLUSION] Our findings revealed a gradual shift in practice patterns toward increasing subspecialization, particularly for SUI and prolapse surgeries. Interestingly, minimally invasive OAB treatments are increasingly adopted by non-URPS urologists, likely due to improvements in surgical techniques and the development of new technology.