Study design, materials and methods
We conducted a cross-sectional survey emailed to 3000 eligible urologists, featuring an 23-question closed-ended web survey. The survey covered three domains: sociodemographics, practice patterns, and training aspirations. Practice patterns assessed patient volume, surgical procedures, confidence in unsupervised surgeries, use of indwelling catheters, and hospitalization duration. Training aspirations explored preferred areas and formats for education in LUTS-BPH. Factors influencing the adoption of technologies, including robotic or laparoscopic SP, PVP, EEP, and MISTs, were analyzed.
Results
A total of 602 participants (94.0% men; mean age 48.8 ± 11.8 years) completed the survey. The mean time since finishing residency was 18.3 ± 12.6 years, 58.9% worked at least partially in an academic center, and 72.3% resided in cities >500,000 inhabitants. Participants reported seeing 29.9 ± 26.4 LUTS-BPH patients weekly. Management strategies included watchful waiting (31.7 ± 18.3%), pharmacological treatment (48.7 ± 16.7%), and surgery (19.6 ± 12.5%). 93.0% identified transurethral resection of the prostate (TURP) as one of their two most frequently used methods, followed by open SP (37.0%), EEP (24.6%), minimally invasive SP (23.1%), PVP (9.1%), and MISTs (3.3%). The table details proficiency in BPH procedures, catheter removal times, and hospital stays. Adoption of new technologies was associated with shorter time since residency, large cities, and academic settings (p < 0.001 for all). High interest in further training was observed, especially in EEP (75.6%) and MISTs (46.7%).
Interpretation of results
In clinical practice in Brazil, the primary treatment for BPH is pharmacological therapy, followed by watchful waiting. Although the country has numerous urological centers, new technologies have not yet been widely adopted by most professionals in this surgical field. TURP and open simple prostatectomy remain the most common surgical methods. Fewer than 20% of urologists are able to perform EEP and MISTs without the assistance of a proctor, with these two techniques being the most commonly sought for training purposes. Open simple prostatectomy was associated with the longest hospital length of stay; in contrast, MISTs had an average stay of less than one day. The procedures with the longest catheter removal time were simple prostatectomy—whether performed via a conventional or minimally invasive approach—and MISTs, due to procedural characteristics specific to the techniques. The main factors associated with the adoption of new BPH treatment modalities include a shorter time since residency, being in an academic setting, and working in larger cities. The most sought-after surgical techniques are EEP and MISTs.