Abstract: PD60-11
Sources of Funding: None

Introduction

Male urethral stricture disease is a common condition with significant quality of life and economic implications. While endoscopic treatment with incision or dilation is the most common treatment approach, the AUA guidelines (www.auanet.org/guidelines) recommend urethroplasty based on increased long-term success rates. However, the extent to which this procedure is performed relative to endoscopic treatment in real-world practice in the USA is unknown. Thus, we conducted a population-based study of patients treated for urethral stricture disease to examine management patterns and opportunities for improvement. _x000D_

Methods

We identified male patients who underwent procedures for urethral stricture disease between 2001 and June 2015 based on ICD-9 codes and administrative claims from a large, national US health insurer (Clinformatics^TM Data Mart Database, OptumInsight, Eden Prairie, MN). We assessed utilization and standardized cost of endoscopic treatments (urethrotomy and dilation) and urethroplasty. We examined patient factors associated with endoscopic treatment versus urethroplasty using multivariable logistic regression._x000D_

Results

We identified a total of 75,522 patients treated for male urethral stricture disease with 125,498 total procedures. This is the largest reported cohort of urethral stricture procedures in the literature. The majority of patients were treated with endoscopic surgery (98.8%), with only 1,515 patients undergoing urethroplasty. After adjustment, younger age (adjusted odds ratio (aOR), age ≤ 40 vs. age ≥ 60 years, 8.2; 95% CI, 7.2-9.4) and higher annual income (aOR, income ≤ $40K vs. ≥ $100,00K, 0.7; 95% CI, 0.5-0.9) were each associated with receipt of urethroplasty. Total standardized costs for endoscopic treatment was $115,724,899 compared to $3,678,066 for urethroplasty._x000D_

Conclusions

Our population-based study of insured patients demonstrated very low use of urethroplasty in real-world practice, despite recommendations for use and superior success rates. Income disparities in urethroplasty utilization is concerning and may indicate health access disparity. Strategies to increase the use of high value surgery for patients with urethral stricture disease include increasing referrals to reconstructive urologists, and knowledge and technique transfer to community urologists interested in providing this service rather than repeated, low-value endoscopic treatment._x000D_

Funding

None