Presentation Authors: Andrew J Cohen*, San Francisco , CA, Danil Makarov, New York, NY, Matthew Cooperberg, San Francisco , CA, Raymond Fang, Linthicum, MD, Benjamin N. Breyer, San Francisco , CA
Introduction: Repeated endoscopic management of urethral strictures has poor long-term success. Recent AUA guidelines on urethral stricture disease encourage early urethroplasty. Contemporary patterns of urethral stricture disease management and the affect of the AUA guidelines on them are poorly understood. We hypothesized that practices with greater numbers of urethral stricture patients would be likely to perform frequent DVIU.
Methods: We queried the AQUA database using a combination of Current Procedural Terminology (CPT) codes and International Statistical Classification of Diseases (ICD) 9/10 codes to identify patients with urethral stricture and how they were managed. We calculated total patient volume at the practice level as well as frequency of direct vision internal urethrotomy (DVIU) and urethroplasty.
Results: We identified 77,742 unique patients diagnosed with urethral stricture in AQUA since 2014. Caucasians accounted for 75.4% of patients. The patients were cared for by 1343 providers at 171 practices. There was wide variation in utilization of DVIU (Figure 1) at both the practice-level and the provider level, where we noted a 20-fold variation. On average, practices performed 0.54 urethroplasties vs. 7.8 DVIU procedures. There was a positive correlation between a greater practice utilization of DVIU and increased urethroplasty volumes (correlation coefficient +0.80).
Conclusions: DVIU is utilized significantly more frequently than urethroplasty. There is wide variation in the utilization of DVIU across practices and providers. Future research should determine whether this variation is guideline concordant or driven by variation in case mix. On the other hand, this care may be guideline discordant and driven by a lack of knowledge or by specific patient or physician preferences.
Source of Funding: Institutional Funds