title: Contemporary practice patterns of endoscopic surgical management for benign prostatic hyperplasia among urologists in the United States.
abstract: OBJECTIVE
  We describe contemporary trends in endoscopic surgical management for benign prostatic hyperplasia. We examined case logs submitted by urologists for American Board of Urology certification or recertification. We compared electrosurgical transurethral resection of the prostate vs laser vaporization or laser enucleation and determined the impact of surgeon age on practice patterns.
  
  
  METHODS
  We analyzed case logs from 2004 to 2010 for trends and used logistic regression models to assess the impact of surgeon age on endoscopic surgery use.
  
  
  RESULTS
  A total of 3,955 urologists included at least 1 endoscopic surgical management in the case logs, while 2,334 (59%) exclusively performed electrosurgical transurethral resection of the prostate and 309 (8%) exclusively performed laser vaporization or laser enucleation. We observed a large increase in the number and proportion of laser procedures from 11% in 2004 to 44% in 2010. Although there was no difference in median age between urologists who performed exclusively electrosurgical transurethral resection and those who performed laser procedures, the latter had a substantially higher case volume. Older urologists were significantly less likely to perform laser vaporization or enucleation when undergoing the second recertification (OR 0.56/10 years of age, 95% CI 0.36-0.87, p = 0.009), but not the initial certification.
  
  
  CONCLUSIONS
  There was a substantial increase in laser vaporization or laser enucleation procedures performed by urologists who underwent board certification or recertification in 2004 to 2010. However, of those undergoing the second recertification older age was significantly associated with a lower likelihood of performing laser procedures. These data provide estimates of current practice patterns and further our understanding of evolving surgical treatment for benign prostatic hyperplasia.
authors.affiliation: Department of Surgery, Urology Division, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah 84112, USA. will.lowrance@hci.utah.edu
authors.forename: William T
authors.initials: WT
authors.lastname: Lowrance
authors.forename: Andrew
authors.initials: A
authors.lastname: Southwick
authors.forename: Alexandra C
authors.initials: AC
authors.lastname: Maschino
authors.forename: Jaspreet S
authors.initials: JS
authors.lastname: Sandhu
mesh_terms: D000328:Adult; D000367:Age Factors; D004724:Endoscopy / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D053685:Laser Therapy / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D011470:Prostatic Hyperplasia / Q000601:surgery*; D020728:Transurethral Resection of Prostate / Q000706:statistics & numerical data*; D014481:United States; D013521:Urologic Surgical Procedures, Male / Q000706:statistics & numerical data; D014572:Urology