Endoscopic Treatments Prior to Urethroplasty: Trends in Management of Urethral Stricture Disease
Matthew J. Moynihan, MD, MPH; Alex J. Vanni, MD
Lahey Clinic, Burlington, MA
BACKGROUND: Endoscopic treatment of urethral stricture disease (USD) with either direct vision internal urethrotomy (DVIU) or dilation continues to be the most common treatment of USD despite its poor success. AUA guidelines regarding the management of male USD were published in 2016, advocating a 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: We performed a retrospective review of a prospectively maintained, multi-institutional urethral stricture database of geographically diverse institutions. Patient demographics, endoscopic treatments prior to urethroplasty, operative characteristics, and peri-operative interventions were analyzed. Either DVIU or urethral dilation were considered to be endoscopic treatment. To determine if pre-urethroplasty endoscopic treatment patterns changed after the AUA guideline, the number of endoscopic treatments prior to urethroplasty were recorded and grouped into pre-2016 and 2016-current cohorts. Statistics were performed with Chi-square tests and t-tests where appropriate.
RESULTS: A total of 2,964 urethroplasties were reviewed that had sufficient data for analysis. Overall average number of endoscopic treatments prior to urethroplasty for the entire cohort was 1.97 (SD= 1.75). There was a significant difference in the average endoscopic pre-urethroplasty treatments between the pre-2016 and 2016-current cohorts (2.3 vs 1.6, P<0.0001). Endoscopic treatment prior to urethroplasty is less common in patients undergoing posterior urethral reconstruction (P<0.0001).
CONCLUSIONS: To our knowledge, 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. This change may be a direct response to recommendations in the 2016 AUA guideline on male USD, due to the continued presence of regional urethroplasty experts for referral, or part of an unrelated change in practice patterns amongst urologists. 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.
Back to 2018 Program