National Trends in the Management of Urethral Stricture Disease.

Abstract

A growing body of evidence suggests that practice patterns for the management of urethral strictures are changing. We examined national trends in urethral stricture management over time using a national data set. Individuals with a new diagnosis of urethral stricture disease between 2008 and 2016 were identified within MarketScan® to determine management strategies. Repeat endoscopic management was defined as 2 or more endoscopic procedures per patient. Recommended care was defined as primary urethroplasty, a single endoscopic procedure or a single endoscopic procedure followed by urethroplasty. Linear regression and multivariate models were fit to determine trends over time. A mean of 15,621,116 beneficiaries per year were identified with a mean prevalence of urethral stricture disease of 349 strictures per 100,000 male beneficiaries. There was no significant change in urethral stricture diagnosis over time, while urethroplasty usage per stricture diagnosis increased by 43.9% (R2=0.52, p=0.003). The ratio of recommended care to repeat endoscopic care in those who underwent treatment similarly increased by 87.4% (R2=0.87, p <0.01). On multivariate analysis later year of diagnosis was associated with an increased odds of receiving recommended care while increasing age and increasing comorbidity status were associated with decreased odds. In a large national sample a significant trend toward decreased use of repeat endoscopic procedures and increased use of urethroplasty for management of urethral stricture disease was noted. These data highlight a drastic change in practice patterns over time, favoring a more definitive evidence-based approach.