Trends in Stricture Management Among Male Medicare Beneficiaries: Underuse of Urethroplasty?
ABSTRACT To analyze the trends in male urethral stricture management using the 1992-2001 Medicare claims data and to determine whether certain racial and ethnic groups have a disproportionate burden of urethral stricture disease.
We analyzed the Medicare claims for fiscal years 1992, 1995, 1998, and 2001. The "International Classification of Disease, 9th revision," diagnosis codes were used to identify men with urethral stricture. The demographic characteristics assessed included patient age, race, and comorbidities, as measured using the Charlson index. Treatments were identified using the Physician Current Procedural Terminology Coding System, 4th edition, procedure codes and stratified into 4 treatment types: urethral dilation, direct vision internal urethrotomy, urethral stent/steroid injection, and urethroplasty.
The overall rates of stricture diagnosis decreased from 10,088/100,000 population in 1992 to 6897 in 2001 (from 1.4% to 0.9%). The stricture prevalence was greatest among black and Hispanic men, although the urethroplasty rates were greatest among white men. Direct vision internal urethrotomy was the most common treatment, followed by urethral dilation, urethral stent/steroid injection, and urethroplasty. The urethroplasty rates remained stable, but quite low (0.6%-0.8%), during the study period.
The overall rates of stricture diagnosis decreased from 1992 to 2001. Despite the poor overall efficacy of urethrotomy and urethral dilation relative to urethroplasty and despite the known complications of stent placement in this setting, the urethroplasty rates were the lowest of all treatments. Although we could not determine the treatment success with these data, these findings suggest an underuse of the most efficacious treatment of urethral stricture disease, urethroplasty.
Full-textDOI: · Available from: Sean P Elliott, May 30, 2015
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ABSTRACT: OBJECTIVE To describe the management of patients with bulbar urethral stricture disease before referral for definitive urethroplasty and determine if practice patterns have changed with respect to endoscopic interventions. MATERIALS AND METHODS We performed an institutional review board-approved retrospective review and recorded patient demographics, stricture-related information, and all procedures performed for bulbar urethral stricture disease before initial presentation at our institution. Included procedures were: UroLume stent (AMS, Minnetonka, MN), laser urethrotomy, direct visual urethrotomy (DVIU), and dilation of urethral stricture. Patients with prior urethroplasty were excluded. We compared the differences between procedures when stratified by stricture length. RESULTS We identified 363 men who underwent urethroplasty for bulbar urethral stricture disease from January 1996 to September 2011. Of the total, 235 men (65%) had a prior DVIU, whereas 65 of these men (28%) had multiple DVIUs. One hundred ninety-nine men (55%) had a prior dilation and 155 of these men (78%) had multiple dilations. The remaining procedures consisted of laser urethrotomy (6; 2%), and UroLume stent (4; 1%). Twenty-four patients (6%) had no procedures before referral. There was no statistically significant difference between numbers of prior procedures when stratified by stricture length. From 1996 to 2010, there was no appreciable change in number of procedures before referral, with similar to 70% of patients with >= 2 prior procedures. CONCLUSION Our institution has not seen a measurable change in practice patterns before referral from 1996 to 2010. Future studies are needed to determine if the change in referral patterns in 2011 represents a future trend. (C) 2014 Elsevier Inc.Urology 08/2014; 84(4). DOI:10.1016/j.urology.2014.06.014 · 2.13 Impact Factor
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ABSTRACT: OBJECTIVE To assess the efficacy and complications of revision urethroplasty compared with urethroplasty-naive controls. MATERIALS AND METHODS A retrospective analysis was performed of 534 urethroplasties performed by a single surgeon from August 2003 to March 2011. Patient age, stricture length, location, etiology, comorbidities, and type of surgery were recorded. Statistical comparison between the revision cohort and urethroplasty-naive group were made using Fisher, chi(2), and unpaired t tests, with significance at P <.05 (2-tailed). The primary outcome was urethral patency assessed by cystoscopy. Secondary (subjective) outcome measures included erectile dysfunction, pain, urinary tract infection, or chordee at 6 months. RESULTS A total of 476 patients met inclusion criteria with completed cystoscopic follow-up. Previous urethroplasty had failed in 49 patients (10.3%). Patients undergoing revision urethroplasty were more likely to have stricture in the penile urethra (22.4%; P = .001), to have strictures exceeding 4 cm in length (71.4% vs 54.3%; P = .023), and to require tissue transfer (83.6% vs 65.1%; P = .010). Urethral patency rates did not differ significantly between naive and revision urethroplasty cohorts, with a mean follow-up of 49.9 months (94.6% vs 91.8%; P = .518). The revision group had a higher incidence of chordee (2.7% vs 14.3%; P = .001) and urinary tract infection (3.5% vs 10.2%; P = .04). The rates of erectile dysfunction, scrotal pain, lower urinary tract symptoms, and incontinence did not differ significantly between the 2 groups. CONCLUSION Revision urethroplasty is an effective treatment option for recurrent stricture after urethroplasty and is comparable to results in urethroplasty-naive patients. Patients undergoing revision urethroplasty are more likely to require tissue transfer and experience higher rates of chordee and urinary tract infection. (C) 2014 Elsevier Inc.Urology 08/2014; 84(4). DOI:10.1016/j.urology.2014.05.047 · 2.13 Impact Factor
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ABSTRACT: To identify clinical and regional factors associated with utilization of urethroplasty versus repeated endoscopic management for urethral stricture disease.The Journal of Urology 07/2014; 193(1). DOI:10.1016/j.juro.2014.07.100 · 3.75 Impact Factor