Patterns of Management of Urethral Stricture Disease in the Veterans Affairs System

• Published in: Urology (Ridgewood, N.J.) Vol. 78; no. 2; pp. 454 - 458
• Main Authors: Anger, Jennifer T, Scott, Victoria C.S, Sevilla, Claudia, Wang, Mingming, Yano, Elizabeth M
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-08-2011; Elsevier
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; Humans; Male; Medical sciences; Middle Aged; Nephrology. Urinary tract diseases; Practice Patterns, Physicians; United States; United States Department of Veterans Affairs; Urethral Stricture - surgery; Urinary system involvement in other diseases. Miscellaneous; Urinary tract. Prostate gland; Urology; Veterans; Young Adult; United States; Nephrology; Urinary system disease; Clinical management; Urethral disease; Urinary tract disease; Veteran; Urethral stenosis; Urology
• ISSN: 0090-4295; 1527-9995
• DOI: 10.1016/j.urology.2010.12.081

Objectives To describe the number of urethral dilations, urethrotomies, and urethroplasties performed on men with a diagnosis of urethral stricture disease seeking care in the Veterans Affairs (VA) health care system in southern California and southern Nevada over a 5-year period. To date, few health services research studies have evaluated patterns of care for urethral stricture disease using national datasets. Methods We analyzed stricture treatment for male veterans with an ICD-9 diagnosis code for urethral stricture in the National Patient Care Database (NPCD). Encounters for urethral stricture procedures performed were identified based on the presence of Physicians Current Procedural Terminology Coding System (4th edition, CPT-4) codes for treatments performed during the fiscal years 2002-2006. Results A total of 1457 men carried a diagnosis of urethral stricture disease during the index time period. Of these, 333 men (23%) underwent 431 procedures. Of the 216 men who underwent urethral dilations, 170 (79%) underwent only 1 procedure and 26 (12%) underwent 2 procedures. Of the 79 men who underwent urethrotomy, 76 (96%) underwent 1 procedure. Sixteen men (5%) underwent a urethroplasty, 8 of whom underwent a perineal urethrostomy. Conclusions The vast majority of men treated for stricture disease underwent only 1 such procedure over a 5-year time period. Further research is required to investigate whether this is a quality-of-care issue or patients refusing intervention. It is possible that some patients may be temporized for a significant period with dilation/urethrotomy, whereas those with rapid recurrence require early urethroplasty.