title: Surgical practice patterns for male urinary incontinence: analysis of case logs from certifying American urologists.
abstract: OBJECTIVE
  Several options exist for the surgical correction of male stress urinary incontinence including periurethral bulking agents, artificial urinary sphincters and the recently introduced male urethral slings. We investigated contemporary trends in the use of these treatments.
  
  
  METHODS
  Annualized case log data for incontinence surgeries from certifying and recertifying urologists were obtained from the ABU (American Board of Urology), ranging from 2004 to 2010. Chi-square tests and logistic regression models were used to evaluate the association between surgeon characteristics (type of certification, annual volume, practice type and practice location) and the use of incontinence procedures.
  
  
  RESULTS
  Among the 2,036 nonpediatric case logs examined the number of incontinence treatments reported for certification has steadily increased over time from 1,936 to 3,366 treatments per year from 2004 to 2010 (p = 0.008). Nearly a fifth of urologists reported placing at least 1 sling. The proportion of endoscopic procedures decreased from 80% of all incontinence procedures in 2004 to 60% in 2010, but they remained the exclusive incontinence procedure performed by 49% of urologists. A urologist's increased use of endoscopic treatments was associated with a decreased likelihood of performing a sling procedure (OR 0.5, p <0.0005). Artificial urinary sphincter use remained stable, accounting for 12% of procedures.
  
  
  CONCLUSIONS
  Incontinence procedures are on the rise. Urethral slings have been widely adopted and account for the largest increase among treatment modalities. Endoscopic treatments continue to be commonly performed and may represent overuse in the face of improved techniques. Further research is required to validate these trends.
authors.affiliation: Department of Surgery, Sidney Kimmel Center for Prostate and Urologic Cancers, Memorial Sloan-Kettering Cancer Center, New York, New York 10065, USA.
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Poon
authors.forename: Jonathan L
authors.initials: JL
authors.lastname: Silberstein
authors.forename: Caroline
authors.initials: C
authors.lastname: Savage
authors.forename: Alexandra C
authors.initials: AC
authors.lastname: Maschino
authors.forename: William T
authors.initials: WT
authors.lastname: Lowrance
authors.forename: Jaspreet S
authors.initials: JS
authors.lastname: Sandhu
mesh_terms: D000328:Adult; D002568:Certification; D006801:Humans; D008297:Male; D008875:Middle Aged; D010820:Physicians / Q000592:standards*; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies; D053825:Suburethral Slings; D014481:United States; D014549:Urinary Incontinence / Q000601:surgery*; D016741:Urinary Sphincter, Artificial; D013521:Urologic Surgical Procedures, Male / Q000592:standards* / Q000706:statistics & numerical data; D014572:Urology / Q000706:statistics & numerical data*