Presentation Authors: Jonathan Wingate*, Sarah Holt, Niels Johnsen, Seattle, WA
Introduction: There is a growing body of evidence that practice patterns with regards to management of urethral stricture disease are changing, with fewer repeat endoscopic procedures in favor of more definitive urethral reconstruction. We sought to examine national trends in urethral stricture management over time utilizing a national dataset.
Methods: Individuals with a new diagnosis of urethral stricture disease between 2008 and 2015 were identified within MarketScanÂ®, a database of employed individuals and their dependents with employer-sponsored health insurance in the United States. Repeat endoscopic management was defined as 2 or more endoscopic procedures per patient. Guideline-appropriate management was defined as primary urethroplasty, a single endoscopic procedure, or a single endoscopic procedure followed by urethroplasty for newly diagnosed individuals. Diagnoses and procedures were identified using both ICD and CPT codes. Linear regression models were fit to determine trends over time.
Results: A mean of 14,171,021 beneficiaries per year were identified in the dataset with a mean incidence of urethral stricture disease of 42.8 (Â± 4.9) diagnoses per 100,000 beneficiaries per year. There was no significant change in urethral stricture diagnosis per 100,000 beneficiaries per year during the study period (R2=0.24, p=0.213). Urethroplasty usage per stricture diagnosis increased by 38.2% (R2=0.72, p=0.008). Rates of repeat endoscopic intervention per beneficiary and per stricture diagnosis similarly decreased by 49.0% (R2=0.90, p < 0.001) and 51.6% (R2=0.93, p < 0.001), respectively. As a result, in those who underwent treatment, a significant increase of 185.3% in the ratio of urethroplasty to repeat endoscopic interventions was noted (R2=0.90, p < 0.001). Correspondingly, when evaluating for appropriateness of care, the ratio of guideline-appropriate to guideline-inappropriate care in those who underwent treatment increased by 71.4% during the study period (R2=0.72, p=0.007).
Conclusions: Utilizing a national sample of patients with employer-sponsored health insurance between 2008 and 2015, a significant trend towards increased utilization of urethroplasty and decreased utilization of repeat endoscopic procedures for management of urethral stricture disease is noted. These data highlight a drastic change in national practice patterns for management of urethral stricture patients, favoring more definitive management in accordance with recently published guidelines.