MP3-08 THE MANAGEMENT OF BULBAR URETHRAL STRICTURE DISEASE BEFORE REFERRAL FOR DEFINITIVE REPAIR: HAVE OUR PRACTICE PATTERNS CHANGED?

Abstract

You have accessJournal of UrologyTrauma/Reconstruction: Trauma & Reconstructive Surgery II1 Apr 2014MP3-08 THE MANAGEMENT OF BULBAR URETHRAL STRICTURE DISEASE BEFORE REFERRAL FOR DEFINITIVE REPAIR: HAVE OUR PRACTICE PATTERNS CHANGED? Michael Granieri, George Webster, Aaron Lentz, Matthew Fraser, and Andrew Peterson Michael GranieriMichael Granieri More articles by this author , George WebsterGeorge Webster More articles by this author , Aaron LentzAaron Lentz More articles by this author , Matthew FraserMatthew Fraser More articles by this author , and Andrew PetersonAndrew Peterson More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.187AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES No definitive guidelines exist for the management of bulbar urethral stricture disease (BUSD). Prior studies have argued for urethroplasty after a single failed endoscopic attempt for short (< 2cm) BUSD. We evaluated whether the number of procedures prior to referral for urethroplasty at our institution has changed since 1996. METHODS We performed an IRB approved retrospective review of our urethroplasty database. We recorded all procedures performed for BUSD prior to initial presentation. Included procedures were: Urolume stent, laser urethrotomy, direct visual urethrotomy (DVIU), self-calibration, and dilation of BUSD. Patients with prior urethroplasty were excluded. Two-tailed t test was used to compare differences in age and chi-squared test was used to compare differences among procedures by stricture length. RESULTS We identified 363 men who underwent urethroplasty by two surgeons (GDW, ACP) for BUSD from January 1996 to September 2011 with available follow up data. Table 1 demonstrates there was no difference between numbers of prior procedures when stratified by stricture length. 235 (65%) men had a prior DVIU, while 65 (28%) of these men had multiple DVIUs. 199 (55%) men had a prior dilation and 155 (78%) of these men had multiple dilations. The remaining procedures were: self-calibration (39; 11%), laser urethrotomy (6; 2%), and Urolume stent (4; 1%). 24 (6%) patients had no procedures prior to referral. Figure 1 reveals that from 1996-2010 there had been no appreciable change in number of procedures prior to referral, with ∼70% of patients with 2 or more prior procedures. However, this was abruptly reversed in 2011 with 70% of patients referred having had only 1 prior procedure and 30% referred with 2 or more. CONCLUSIONS Our institution has not seen a measurable change in practice patterns prior to referral since 1996; approximately 2/3 of patients referred for BUSD had multiple prior procedures. This is important as efficient, cost-effective care is stressed now more than ever. Table 1. Number of Prior Procedures Stratified by Stricture Length Age +/- SD 0 Procedures 1 Procedure >/=2 Procedures All Patents (n=363) 42 +/- 15 6.6% (n=24) 26.2% (n=95) 67.2% (n=244) Stricture Length < /= 2cm (n=264) 42+/-15 5.7% (n=15) 27.3 % (n=72) 66.1% (n=177) Stricture Length >2cm (n=99) 43+/-15 9.1% (n=9) 23.2% (n=23) 67.7% (n=67) p-value 0.80 0.24 0.43 0.91 © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e36-e37 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Michael Granieri More articles by this author George Webster More articles by this author Aaron Lentz More articles by this author Matthew Fraser More articles by this author Andrew Peterson More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...