Endoscopic treatments prior to urethroplasty: trends in management of urethral stricture disease

Matthew J Moynihan,Jill Buckley,Sean P Elliott,Bradley Erickson,Alex J Vanni,Thomas Smith,Benjamin N Breyer,Lee Zhao,Nejd Alsikafi,Bryan Voelzke,Jeremy Myers

doi:10.1186/s12894-020-00638-x

Abstract

BackgroundTo determine if the number of endoscopic treatments of urethral stricture disease (USD) prior to urethroplasty has changed in the context of new AUA guidelines on management of USD. In addition to an increase in practicing reconstructive urologists and published reconstructive literature, the AUA guidelines regarding the management of male USD were presented in May 2016, advocating consideration of urethroplasty in patients with 1 prior failed endoscopic treatment.MethodsA retrospective review of a prospectively maintained, multi-institutional urethral stricture database of high volume, geographically diverse institutions was performed from 2006 to 2017. We performed a review of relevant literature and evaluated pre-urethroplasty endoscopic treatment patterns prior to and after the AUA male stricture guideline.Results2964 urethroplasties were reviewed in 10 institutions. There was both a decrease in the number of endoscopic treatments prior to urethroplasty in the pre-May 2016 compared to post-May 2016 cohorts both for overall urethroplasties (2.3 vs 1.6, P = 0.0012) and a gradual decrease in the number of pre-urethroplasty endoscopic treatments over the entire study period.ConclusionThere was a decrease in the number of endoscopic treatments of USD prior to urethroplasty in the observed period of interest. Declining endoscopic USD management is not likely to be a reflection of a solely unique influence of the guidelines as endoscopic treatment decreased over the entire study period. Further research is needed to determine if there will be a continued trend in the declining use of endoscopic treatment and elucidate the barriers to earlier urethroplasty in patients with USD.

Highlights

To determine if the number of endoscopic treatments of urethral stricture disease (USD) prior to urethroplasty has changed in the context of new American Urological Association (AUA) guidelines on management of USD
Urologists play a critical role in the evaluation and management of urethral stricture disease (USD), which accounts for nearly 1.5 million office visits per year [1]
We hypothesize that the number of endoscopic treatments prior to urethroplasty in the cohort has decreased over time and that the guideline has further decreased the use of endoscopic treatment prior to referral

Summary

Introduction

To determine if the number of endoscopic treatments of urethral stricture disease (USD) prior to urethroplasty has changed in the context of new AUA guidelines on management of USD. Urologists play a critical role in the evaluation and management of urethral stricture disease (USD), which accounts for nearly 1.5 million office visits per year [1]. The AUA male urethral stricture guideline recommends that patients should be offered urethroplasty after failed endoscopic management (Guideline 11) and for fossa navicularis, penile, bulbar strictures > 2 cm, and recurrent bulbar strictures (Guidelines 13–16) [10]. It is unclear if the new guideline has decreased the number of endoscopic treatments prior to referral for urethroplasty. We hypothesize that the number of endoscopic treatments prior to urethroplasty in the cohort has decreased over time and that the guideline has further decreased the use of endoscopic treatment prior to referral

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Results

Discussion

Conclusion