Presentation Authors: Matthew Moynihan*, Burlington, MA, Jeremy Myers, Salt Lake City, UT, Sean Elliott, Minneapolis, MN, Bradley Erickson, Iowa City, IA, Thomas Smith, Houston, TX, Jill Buckley, San Diego, CA, Lee Zhao, New York City, NY, Bryan Voelzke, Seattle, WA, Nejd Alsikafi, Gurnee, IL, Benjamin Breyer, San Francisco, CA, Alex Vanni, Burlington, MA
Introduction: Endoscopic treatment of urethral stricture disease (USD) continues to be the most common treatment of USD despite its poor success compared to urethroplasty. 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. The aim of our study is to determine if the number of endoscopic treatments of USD prior to urethroplasty has decreased since the implementation of the AUA guideline.
Methods: A retrospective review of a prospectively maintained, multi-institutional urethral stricture database of high volume, geographically diverse institutions was performed. We evaluated pre-urethroplasty endoscopic treatment patterns prior to and after the AUA male stricture guideline.
Results: 2,964 urethroplasties were reviewed in 10 institutions. The overall average number of endoscopic treatments prior to urethroplasty for the entire cohort was 2.15 (SD= 4.887). There was 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 anterior urethroplasties specifically (2.6 vs 1.9, P=0.0026).
Conclusions: This is the first study to demonstrate a decrease in the number of endoscopic treatments of USD prior to urethroplasty since development of the AUA stricture guideline. 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.