Renal Thermal Ablation Trends of American Urologists

Objective: To define current trends in the utilization of renal thermal ablation by urologists in the United States. Material and Methods: A six-month case log data for renal procedures submitted by certifying and recertifying American urologists from 2003 to 2018 were obtained from the American Board of Urology and stratified by current procedural terminology code. The utilization of thermal ablative techniques was examined with respect to overall trends, surgeon, and practice characteristics associated with its use. Results: Six thousand two hundred eleven unique urologists performed 54,075 renal procedures, including 1916 (3.5%) thermal ablations, 630 (1.2%) renal biopsies, 17,361 (32.1%) partial nephrectomies, 20,403 (37.8%) radical nephrectomies, and 7957 (14.7%) nephroureterectomies. Eight hundred twenty-five (13.3%) unique urologists performed renal ablations, including 1344 (70.2%), 418 (21.8%), and 154 (8.0%) laparoscopic, percutaneous, and open ablation procedures, respectively. The annual volume of ablation was highest in 2008, followed by 2010 and 2009. On multivariate modeling of those performing renal interventions, the first decade of practice, self-declared endourologist, urologist who completed an endourology fellowship, urologist who practices in the Mid Atlantic, North Central, South Central, and South Eastern United States (compared with New England) were more likely to perform thermal ablation for renal masses. Urologists who perform renal biopsies and partial nephrectomies are also more likely to perform ablation of renal masses. Conclusions: Thermal ablation accounted for a small percentage of renal interventions performed by urologists in the last 1.5 decades with definable associations to practice characteristics. Renal ablation was most commonly performed laparoscopically, with declining use in recent years.