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Changes to an established general urologist's practice demographics after offering holmium laser enucleation of the prostate as a surgical treatment for benign prostatic hyperplasia
Ankur Ushir Choksi, MD, Christopher S. Hayden, MD, Daniel Segal, MD, Soum D. Lokeshwar, MD, MBA, Daniel S. Kellner, MD.
Yale School of Medicine, New Haven, CT, USA.

Background:Holmium laser enucleation of the prostate (HoLEP) is recognized as a size-independent surgical option for the endoscopic management of benign prostatic hyperplasia (BPH). For providers that are motivated to offer HoLEP, understanding the anticipated changes to their practice is significant. In this study, we analyzed the changes to a general urologist's patient demographics and practice patterns after the addition of HoLEP to their surgical repertoire. Methods:We retrospectively reviewed the electronic health record to analyze for changes in a general urologist's patient population following introduction of HoLEP. Records were reviewed 30 months before and after introduction of HoLEP. We assessed for differences in age, gender, zip code of primary residence and clinical volume. Pearson chi-squared test of independence and student's t-test were used for statistical analysis. Results:A total of 4390 unique patients were seen in clinic during the five year period of which, 2052 were seen before and 2338 were seen after the introduction of HoLEP. BPH related clinic visits increased from 893 (43.52%) to 1555 (66.51%). The mean crow fly distance of zip code of residence for patients with BPH to treatment center remained statistically unchanged (pre-HoLEP: 32.52 152.42 miles (IQR: 6.01 16.91), post-HoLEP: 29.65 141.79 miles (IQR: 6.01 16.91), p = 0.9896) (Figure 1). Surgical volume increased from 380 to 1041 cases with a concordant increase in other BPH related surgeries, with an inflection point at the time of HoLEP introduction (Figure 2). Conclusion: There was an increase in both clinical and surgical volume to an established general urologist's practice after offering HoLEP as a surgical treatment for BPH. A majority of these patients were being treated from within the initial catchment area, which may be in part due to under-treatment of large prostate glands.

VariablePre - HoLEPPost HoLEP
Number of Clinic Patients20522338
Number of BPH Clinic Patients893 (43.5%)1555 (66.5%)
Number of Male Patients1856 (90.4%)2252 (96.3%)
< 49 years343131
50 64 years504494
65 74 years615866
75 84 years415632
85+ years166204
Surgical Volume by Case Type
Transurethral Resection of Prostate6387
Transurethral Incision of Prostate1420
Enucleation of the Prostate25539
Ureteroscopy/Laser Lithotripsy/Stent130164
Robotic Radical Prostatectomy6420

Table 1: Summary of patient demographics and surgical case volume

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