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Trends in Reconstructive and Prosthetic Urologic Procedures Among Medicare Beneficiaries, 2013-2023
Emma Harwood, MD, Lily C. Wang, MD, PhD, Graham T. VerLee, MD.
Maine Medical Center, Portland, ME, USA.
BACKGROUND: Reconstructive and prosthetic urologic procedures treat urinary incontinence, urethral stricture disease, and erectile dysfunction, but national utilization patterns and regional variation remain incompletely characterized. We evaluated temporal trends and regional differences among Medicare beneficiaries.
METHODS: We analyzed the Centers for Medicare & Medicaid Services Physician and Other Practitioners Public Use File from 2013 to 2023. Procedures were identified using CPT codes for urethral reconstruction (53410, 53415, 53425, 53430), artificial urinary sphincter insertion (53445), and penile prosthesis implantation (54400, 54405, 54410). Annual procedural volumes were calculated, and regional variation was assessed using U.S. Census region and division definitions. Analyses were limited to urologists.
RESULTS: From 2013 to 2023, 25,465 procedures were identified. Penile prosthesis accounted for 79.7%, followed by artificial urinary sphincter (15.9%) and urethral reconstruction (4.4%). Artificial urinary sphincter utilization increased from 377 to 532 procedures (+41.1%). Growth varied by region, with increases in the Midwest (59.6%), West (43.7%), and Northeast (12.9%), and a decline in the South (16.8%). New England accounted for 597 procedures (2.3%) and showed higher proportions of urethral reconstruction (24.8% vs 4.4%) and artificial urinary sphincter use (22.3% vs 15.9%), with lower penile prosthesis utilization (52.9% vs 79.7%).
CONCLUSIONS: Reconstructive and prosthetic urologic care varies regionally. Greater use of reconstructive procedures in New England suggests access to definitive care may depend on referral patterns and subspecialty expertise.
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