Trends in Urogynecologic and Reconstructive Pelvic Surgery among Early - Career Urologists: Analysis of ABU Case Logs from 2009 to 2020 - Beyond the Abstract
Key Findings
We observed a clear trend toward subspecialization. Urologists with URPS fellowship training were consistently more likely to perform—and on average performed higher volumes of—procedures for stress urinary incontinence, pelvic organ prolapse, and overactive bladder compared with their non-URPS peers. At the same time, the proportion of non-URPS urologists performing slings, bulking, and transvaginal prolapse repairs declined sharply. Notably, despite these trends, non-URPS urologists continue to contribute the majority of total URPS case volume.
In contrast, minimally invasive therapies for overactive bladder showed a different pattern. Although fewer non-URPS urologists performed prolapse or incontinence surgeries, they increasingly adopted intravesical Botox injections and sacral neuromodulation. These procedures have lower technical barriers, shorter learning curves, and are well-suited to outpatient settings—reflecting broader trends away from major reconstructive surgeries.
Implications for Training and Workforce Planning
Our findings highlight both opportunities and challenges. Fellowship remains essential for training in complex reconstructive surgeries. On the other hand, ensuring adequate URPS exposure during residency is critical, as non-URPS urologists still perform the majority of overall case volume and remain central to maintaining broad access to care.
Conclusion
This study underscores ongoing trends toward subspecialization in URPS. Fellowship programs will remain vital for high-complexity care, but URPS exposure during residency is equally important to meet the needs of a growing patient population.
Written by: Zhenyue Huang, MD, Fellow Physician, PGY-7 Department of Urology, Stony Brook University Hospital, Stony Brook, NY
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