O3340: Volume of Pediatric Cases Performed by Early-Career Adult Urologists from 2004-2022

Background: The introduction of the pediatric subspecialty Certificate of Added Qualification (CAQ) in 2008 may have impacted the quantity and breadth of pediatric surgeries being performed by early-career non-pediatric (adult) urologists. We predict that the volume of pediatric urologic surgeries performed by adult urologists has decreased. This study investigates changes in the pediatric case volume of early-career adult urologists over the past several years to inform perspectives on the teaching of pediatric surgeries in residency.

Methods: We reviewed the case volumes for pediatric hydrocelectomy, hypospadias repair, and orchiopexy from six-month case logs submitted to the American Board of Urology between 2004-2022 for the Certifying Exam. Orchiopexies were subclassified by ICD code as indicated for either undescended testicle or torsion. Cases were considered pediatric if the patient’s age was less than eighteen years. A list of the total number of logs submitted each year was utilized to calculate the number of individuals who did not perform any of these procedures of interest. Descriptive statistics were calculated for the pediatric case volume of each log year and further stratified by subspecialty. Change in the average case volume per urologist over time was analyzed using a negative binomial regression model.

Results: Across all six-month logs sent between 2004-2022, about one third of urologists (1486/4999, 30%) submitted logs that included at least one of the reviewed pediatric procedures. Together, this dataset contained 19,207 pediatric cases of interest. The number of recorded pediatric cases of interest per year increased over the study period from 586 in 2004 to 1,163 in 2022. However, among adult urologists specifically, the average number of cases logged per person each year decreased (rate ratio, 0.93; 95% CI, 0.92, 0.94; p< 0.001), and the proportion of adult urologists submitting logs with none of the reviewed procedure types increased from 59.5% to 93.5% during this time. Among adult urologists, orchiopexy performed for undescended testicle contributed the greatest proportion of the reviewed pediatric case volume each year (46%-73%), and the proportion composed of orchiopexy performed for torsion steadily increased (6%-48%). The proportion of hypospadias repair and hydrocelectomy remained relatively low (1%-11%; 4%-28%).

Conclusion: Certifying Exam case logs submitted between 2004-2022 demonstrate that the number of pediatric cases performed by early-practice urologists without pediatric subspecialty training decreased, and the proportion of adult urologists logging none of the reviewed pediatric procedures substantially increased. Among the reviewed procedure types, orchiopexy contributed the greatest proportion of the case volume. These findings suggest that few early-career urologists are practicing to the full extent of their certification for pediatric urology, and that discussion is merited regarding potential changes to pediatric urology training and examination in residency.