Jennifer Robles, MD, on trends and regional disparities in HoLEP utilization

Data published in the Journal of Endourology point to a significant increase in HoLEP utilization from 2018 to 2022, though regional disparities in access to HoLEP surgeons still persist.¹

This analysis builds off prior work published in 2020 which showed that rates of HoLEP only accounted for about 4% of all benign prostatic hyperplasia (BPH) procedures in the US in 2014.²

In a recent interview with Urology Times®, lead author Jennifer A. Robles, MD, MPH, describes the rationale for conducting the follow-up study and highlights key findings on contemporary HoLEP trends. 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.

Data showed that from 2018 to 2022, HoLEP utilization increased by 52%. Further, the number of HoLEP surgeons increased from 386 in 2018 to 451 in 2022, representing a rise of 16%. The number of active surgeons (defined as those who performed at least 10 annual HoLEP procedures) also increased from 106 to 151, representing a rise of 43%.

Robles noted, “I think those trends overall show that people are not only just trying HoLEP, but they're sticking with it.”

The investigators also found that the number of states with at least 1 active HoLEP surgeon rose over the time period assessed—from 32 to 34—although 33% of states still had no active surgeons.

The authors also reported geographical disparities in surgeon distribution, noting, “The West (1050) and Northeast (786.3) had the highest BPH patient-to-surgeon ratios in 2018 and 2022, respectively, while the South had the best ratio and the most surgeons.”

According to the authors, this finding "indicates a need for facilitating the dissemination of expertise to ensure equitable access to HoLEP."

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 J, Pais V, Miller N. Mind the gaps: Adoption and underutilization of holmium laser enucleation of the prostate in the United States from 2008 to 2014. J Endourol. 2020;34(7):770-776. doi:10.1089/end.2019.0603