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National Data for the Management of Urethral Strictures Among VA patients
Benjamin W. Herrick, M.D.1, Paholo Barboglio-Romo, M.D.1, Yinong Young-Xu, PhD2, Elias S. Hyams, MD1, Vernon M. Pais, M.D.1, William Bihrle, III, M.D.1.
1Dartmouth Hitchcock Medical Center, Lebanon, NH, USA, 2White River Junction VA Medical Center, White River Junction, VT, USA.

BACKGROUND: Despite its lack of efficacy, repeat urethrotomy as a management option for urethral stricture disease remains a commonplace procedure. However, little is known about the management of urethral strictures among the US veteran population.
METHODS: Through the VA Informatics and Computer Infrastructure (VINCI) we searched the centralized national VA data sets on urethral strictures for all Veterans Affairs Medical Centers for the years 2000-2010. Using ICD-9 diagnosis codes we identified all veterans with a urethral stricture diagnosis. We further identified all patients that underwent a procedure for their urethral stricture using CPT codes, capturing both inpatient and outpatient encounters for urethral dilation, direct visual internal urethrotomy (DVIU) and urethroplasty. We report the national data for the management of urethral strictures among VA patients.
RESULTS: There were 12,353 total patients who underwent 15,305 total urethral procedures during the study period. There were a total of 10,430 DVIUs performed (68% of all stricture related procedures). Of those who underwent DVIU, 1,428/10,430 (16.5%) patients had more than one performed. For urethral dilations 3,143 (20% of all procedures) patients underwent at least one urethral dilations and 617/3,143 (20%) underwent more than one. There were 585/15,305 (4%) urethroplasties performed, 310 were inpatient.
CONCLUSIONS: These data suggest that VA-affiliated Urologists within the VA system perform few inpatient urethroplasty (310 in 10 yrs). Interestingly, there does not appear to be a gross over utilization of repeat urethrotomies. With the recent increase in war related uro-trauma, we expect these numbers to increase.


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