MP35-02 IS URETHROPLASTY REALLY MORE COST-EFFECTIVE THAN URETHRAL DILATATION FOR PRIMARY BULBAR URETHRAL STRICTURES?

Abstract

INTRODUCTION AND OBJECTIVE: Urethroplasty is the gold-standard curative treatment for bulbar urethral strictures. Nevertheless many are still managed by urethrotomy/dilatation. This study evaluates the cost-effectiveness of urethroplasty compared to urethral dilatation within the framework of the UK NHS funding system. METHODS: All untreated bulbar strictures managed by urethroplasty or urethral dilatation between January and December 2013 were included. Our prospective outcomes database was retrospectively searched to identify patient and stricture characteristics, treatment outcome and management of failures. Cost of urethroplasty was £2964. Dilatation done as a day case procedure in the operating theatre cost £934. (Dilatation as an outpatient costs £194 for dilatation alone or £317 including cystoscopy). All patients were followed up for 5 years. Cost of treatment per patient over the entire period from the initial procedure to date was calculated. RESULTS: 38 patients with untreated bulbar strictures were managed by dilatation (GroupA) and 62 by urethroplasty (GroupB – anastomotic n=6; non-transecting anastomotic n=28; buccal graft augmentation n=28). 11(29%) patients in groupA and 58(93.5%) in GroupB required no further intervention during follow-up. 16 patients in GroupA required 29 further dilatations between them (mean 1.8each) costing £2627 per patient. 15 patients went on to have a urethroplasty, 11 after the first dilatation. Between them these 15 had 19 dilatations costing £4147per patient. Cost of managing a patient after a single failed dilatation (by further dilatation or urethroplasty) was £3583 (£2304 if outpatient dilatation). Total cost per patient of managing bulbar strictures by urethral dilatation as inpatient was £2816 (£1728 as outpatient incl cystoscopy). 4 patients in GroupB developed recurrent strictures. One underwent redo-urethroplasty. The other 3 underwent 7 dilatations between them. Total cost of managing strictures by urethroplasty was £3117per patient. CONCLUSIONS: Overall costs per patient of managing bulbar strictures in hospital by urethral dilatation and primary urethroplasty are comparable (£2816 vs £3117). However, if the first dilatation fails, any further management, particularly urethroplasty, becomes less cost-effective than immediate urethroplasty. If, however, inpatient urethroplasty is compared with outpatient dilatation then dilatation becomes considerably more cost-effective over that 5 year period. Patient and stricture selection are therefore extremely important before embarking on a treatment strategy for bulbar strictures. Source of Funding: None