The reconstructive urology work force: present and future

Indirect measures that determine the number of reconstructive urologists in the US seem to indicate a general shortage in the number of these specially trained surgeons. This shortage may worsen in the future, as the US population continues to age and the number of urologists relative to the general population growth continues to fall. The lack of reconstructive urology expertise seems to drive an inappropriate number of urethrotomies performed in the US, most troubling in those with previous failed urethotomies in whom the subsequent urethrotomy failure rate approaches 100%. Recently increases in the number of fellowship training programs and an increased number of residency centers nationwide that graduate urologists with good basic knowledge of urethroplasty will partly ameliorate this shortage, but wide geographic regions remain without any urologic reconstruction experts.