Jennifer Robles, MD, on the impact of regional disparities in HoLEP access

A recent study published in the Journal of Endourology showed that while HoLEP utilization increased from 2018 to 2022, there are still areas across the US with limited access.¹

Specifically, the investigators reported that only 34 states had at least 1 active HoLEP surgeon, which they defined as those who performed at least 10 annual HoLEP procedures. They also noted differences in patient-surgeon ratios across the US, with the worst ratios observed in the West (1050) and the Northeast (786.3) in 2018 and 2022, respectively.

In a recent interview with Urology Times®, lead study author Jennifer A. Robles, MD, MPH, highlights the impact of these regional disparities in HoLEP access on patient care. Robles is an assistant professor of urology at Vanderbilt University Medical Center and the chief of urology at the Tennessee Valley (VA) Healthcare System in Nashville, Tennessee.

Specifically, Robles underscored the significant travel burden that comes with access disparities.

She explained, “We find that the average amount of travel across the country is about 79 miles.² Comparatively, if those patients wanted to get something like a transurethral resection of the prostate, a TURP, they'd only have to travel about 5 miles. Patients that are in certain underserved regions are traveling, on average, well over 100 miles to get a HoLEP. That is a very significant burden.”

For those who aren’t able to travel these distances, Robles notes that many may be going without care altogether, or may be undergoing other procedures, which come with their own set of limitations.

REFERENCES

1. Robles J, Shin YE, Rojanasarot S, Miller NL. Niche no more? Mapping US trends and regional disparities in holmium laser enucleation of the prostate from 2018 to 2022. J Endourol. 2025.doi:10.1089/end.2025.0188

2. Robles JA, Maciolek KA, Morris K, Sato R, Miller NL. The road more traveled: geographic disparities in patient’s access to holmium laser enucleation of the prostate. J Urol. 2025;213(5S):e213. doi:10.1097/01.JU.0001109780.20015.87.11