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

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 healt...

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Bibliographic Details
Published in:Urology (Ridgewood, N.J.) N.J.), 2011-08, Vol.78 (2), p.454-458
Main Authors: Anger, Jennifer T, Scott, Victoria C.S, Sevilla, Claudia, Wang, Mingming, Yano, Elizabeth M
Format: Article
Language:English
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
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Summary: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.
ISSN:0090-4295
1527-9995
DOI:10.1016/j.urology.2010.12.081