In light of the recent Canadian Urological Association (CUA) and other urological association (America Urological Association, European Association of Urology) recommendations for the treatment of benign prostate hyperplasia (BPH) with lower urinary tract symptoms (LUTS), open simple prostatectomy (OSP) remains the recommended approach for large prostates with measured volumes over 80 cc. 1 We sought to assess the current state of OSP and other BPH surgical training across Canadian urology residency programs and the use of guideline-recommended imagery prior to BPH surgery.
A survey was distributed among Canadian urology program directors in June 2019. We identified the various surgical modalities available for the treatment of BPH offered by each program and obtained the annual number of OSP performed at each academic residency program. Additionally, we evaluated if preoperative transrectal ultrasound (TRUS) of the prostate was routinely performed to obtain the prostate volume during patient counselling as recommended by 2018 CUA guidelines.
All 13 program directors from the Canadian urology programs responded to our survey. OSP and monopolar transurethral resection of the prostate (TURP) remain the most common across programs and are practiced in all centers. Greenlight photo-vaporization, bipolar TURP, holmium laser enucleation of the prostate and robot-assisted simple prostatectomy were practiced in 76.8%, 69.2%, 23.1%, and 23.1% of centers, respectively. The mean number of OSP per academic training program was 4.7 cases annually. Moreover, only five (38%) academic centers routinely performed a preoperative TRUS to evaluate prostate volume for BPH counselling.
Although recognized and referenced as the BPH gold standard for the treatment of prostates over 80 cc, Canadian urology trainees' annual OSP exposure remains extremely limited. Considering the degree of importance given (category A) to the direct observation (of a minimum of five) of this intervention during residency training in the new Royal College's practice guidelines, it may be unrealistic to reach these national standards considering the annual case OSP volumes in Canadian academic urology faculties.
Canadian Urological Association journal = Journal de l'Association des urologues du Canada. 2020 Jan 20 [Epub ahead of print]
Patrice Levasseur-Fortin, Kyle W Law, David-Dan Nguyen, Ahmed Zakaria, Vincent Misrai, Dean Elterman, Naeem Bhojani, Enrique Rijo, Kevin C Zorn
Faculty of Medicine, Université de Montréal, Montreal, QC, Canada., Faculty of Medicine, McGill University, Montreal, QC, Canada., Division of Urology, Centre hospitalier de l'Université de Montréal, Université de Montréal, Montreal, QC, Canada., Department of Urology, Clinique Pasteur, Toulouse, France., Division of Urology, University of Toronto, Toronto, ON, Canada., Department of Urology, Hospital Quiron Barcelona, Barcelona, Spain.