MP25-19: Time Trend Analysis of the Society of Genitourinary Reconstructive Surgeons (GURS) Fellowship Case Logs: Growth in Training May Reflect Evolution of the Discipline
Introduction: The Society of Genitourinary Reconstructive Surgeons (GURS) began a formal fellowship match over a decade ago, growing from 14 to 23 programs over this time period. With the growth in the number of fellowship programs, some have voiced concern about possible dilution of operative experiences for fellows. The objective of this study is to examine trends in GURS fellowship case logs over time to determine if fellowship operative experienced has changed. Methods: Year-end surgical case logs submitted by GURS fellows from 2014-2022 were collated, analyzed and grouped into 6 categories: 1) Urethral reconstruction, 2) Male incontinence, 3) Male Sexual Health, 4) Genital reconstruction, 5) Abdominal reconstruction and 6) Female urology. Programs with more than 3 years of records were included and analyzed for time trends. Centers with more than one fellow per year were averaged. Lineal regression was used to evaluate for significant change over time. Results: Overall, 152 case logs from 25 different programs were reviewed. On linear regression, urethral reconstruction volumes demonstrated significant increase over time (R2=0.036, B=3.2, p=0.02) with a mean volume per program of 88.1 cases/year. On individual center-based analysis, 89.9% of programs remained stable while 11.1% showed a significant increase in urethroplasty. Genital reconstruction also demonstrated a significant increase (R2=0.095, B=2.3, p<0.01) with a mean of 16.4 cases/year and 33.3% of the centers showing significant growth while the rest remained stable. Abdominal reconstruction also showed an increase over time (R2=0.023, B=1.2, p=0.03) with a mean of 24.5 cases/year and 16.7% demonstrating a significant increase while the rest remained stable. Male incontinence cases remained stable (R2=0.01, B=1.02, p=0.21) at a mean number of 30.5 cases/year with 83.3% of centers remaining stable, 5.6% increasing and 11.1% decreasing. Male sexual health showed a significant increase (R2=0.03, B=2.4, p=0.03) at a mean of 32.7 cases/year with 66.7% of the centers showing no significant change, 5.6% a decline and 27.8% having growth. Female urologic reconstruction demonstrated a significant decline (R2=0.04, B=-3.08, p=0.01) with a mean of 23.2 cases/year. Conclusions: Despite an increase in the number of fellowship programs, the GURS fellow operative experience remains preserved with significant increases in urethral, genital and abdominal reconstruction over the match period. Possible explanations include: growth in reconstructive urology as a discipline, consolidation of cases to academic centers, and expansion of service lines offered by GURS surgeons (e.g., gender affirming surgery, adult congenital care). SOURCE OF Funding: None
