Faculty Bibliography

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/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/CONCLUSIONS: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.

PURPOSE/OBJECTIVE:Overactive bladder (OAB) is a prevalent condition that can have a significant impact on quality of life. Sacral neuromodulation (SNM) is proven as an effective treatment option for OAB patients. Rechargeable devices have gained popularity in recent years. However, there is a paucity of data investigating revision rates for rechargeable SNM devices and associated impacting factors. MATERIALS AND METHODS/METHODS:We conducted a retrospective cohort study to investigate the revision rates of SNM devices in patients diagnosed with OAB. Patients who underwent implantation of rechargeable or non-rechargeable SNM devices at our institution between January 2019 and June 2023 were included. Revision events, reasons for revisions, and patient demographics were analyzed and compared between the device groups. RESULTS:The study included 246 patients. One hundred fifty received rechargeable SNM devices and 96 received non-rechargeable devices. Revision rates were significantly different between the two groups, with 34% of patients in the rechargeable device group requiring revisions compared to 13.5% in the non-rechargeable group (p < 0.001). The most common reasons for revision in the rechargeable group included difficulty charging (35.3%) and reduction of symptom improvement (23.5%). Having a rechargeable device resulted in a significantly higher probability of requiring a revision over time compared to non-rechargeable (p < 0.001). CONCLUSION/CONCLUSIONS:Our study demonstrated that patients who received rechargeable SNM devices were more likely to require revision. Factors such as device malfunction or difficulties connecting to the device may contribute to the higher revision rates. Further studies are needed to elucidate factors affecting revision rates in SNM devices.