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Urological resident exposure to transurethral surgical options for BPH management in 2012-2013: A pan-Canadian survey.

Since its first description by McCarty in 1932, transurethral resection of the prostate (TURP) has been the unopposed standard in surgical treatment of benign prostatic hyperplasia (BPH). The most common indication for BPH surgical treatment is bothersome lower urinary tract symptoms (LUTS) associated with prostatic obstruction refractory to conservative or medical therapy. Since the introduction of pharmacological treatment, the rate of TURP has been in decline.1 TURP remains the dominant form of surgery for BPH in Canada.2 The fundamental importance of this surgery explains why the Royal College of Physicians and Surgeons of Canada (RCPSC)3 classifies TURP as a “List A” surgical procedure, wherein “the fully trained resident must be competent to individually perform” the procedure. In recent years many minimally invasive surgical therapies (MIST) for BPH have been developed. Among them holmium laser enucleation of the prostate (HoLEP), GreenLight photoselective vaporization of the prostate (PVP) and the Olympus Plasma Button are being increasingly used in BPH in the United States (in 2008, TURP accounted for 30% of all BPH procedures).4 In Canada, a similar trend can be observed, characterized by a continuous increase in the use of MISTs albeit at a slower pace; in 2011, TURP still represented more than 90% of all BPH procedures in the country.2 Most urology residency training programs are based in tertiary care centres and are typically designed to offer exposure to major surgical cases. In this context, and with the increasingly heavy demands of a residency training program, it is possible that BPH surgeries can become relegated as “minor” surgeries with proper exposure lagging behind. However, the reality is that urologists perform fewer major cases, focusing instead on less invasive procedures, such as BPH surgeries. Moreover, the advancements in BPH surgical management, including MISTs, raise an educational conundrum for Canadian urological training programs. With TURPs being performed less, are residents sufficiently exposed to attain competency for their future practice? With the emerging MISTs, is there a need, or an advantage, to train future urologists in these novel technologies? If yes, which modalities? In this context, we evaluate the perceptions of Canadian urology residents on current surgical management of BPH in their training centres in the 2012-2013 academic year. Furthermore, we assess whether they felt they received sufficient exposure to the various BPH surgeries and whether they felt adequately prepared for their future urological practice. Finally, we capture their opinions on various novel BPH MISTs.