MP32-06 PRACTICE CHANGES IN URETHRAL STRICTURE MANAGEMENT IN THE US VETERAN POPULATION AFTER THE 2016 AUA GUIDELINES

You have accessJournal of UrologyReconstruction: Urethral Reconstruction (Including Stricture) II (MP32)1 May 2024MP32-06 PRACTICE CHANGES IN URETHRAL STRICTURE MANAGEMENT IN THE US VETERAN POPULATION AFTER THE 2016 AUA GUIDELINES Nikolas Moring, Michael Tram, Darren Gemoets, Charles Welliver, and Brian Inouye Nikolas MoringNikolas Moring , Michael TramMichael Tram , Darren GemoetsDarren Gemoets , Charles WelliverCharles Welliver , and Brian InouyeBrian Inouye View All Author Informationhttps://doi.org/10.1097/01.JU.0001008816.80828.35.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Endoscopic management is often the first line treatment for urethral stricture. Until 2016, the American Urological Association (AUA) did not publish guidelines for urethral stricture treatment. The 2016 AUA guidelines aimed to change the treatment course of stricture disease from multiple endoscopic treatments to a single endoscopic treatment followed by urethroplasty if necessary. We analyzed practice patterns of Veterans Affairs (VA) urologists before and after the 2016 guidelines. METHODS: We queried the VA Corporate Data Warehouse database from 1/1/2000 to 10/18/2023 to identify Veterans with a diagnosis of urethral stricture and Veterans who underwent endoscopic treatment or urethroplasty. We assessed the number of endoscopic procedures performed and progression to urethroplasty. We compared the number of endoscopic treatments prior to urethroplasty between the pre-guidelines (2000-2015) and post-guidelines (2017-2023) periods using negative binomial regression and the time to urethroplasty after the first endoscopic treatment using a log-rank test. RESULTS: We identified 148067 patients with urethral stricture disease. We identified 84931 (57.3%) patients who underwent any treatment. Most patients (n=80669, 95.0%) did not progress to urethroplasty, receiving an average of 1.74 (SD 2.90) endoscopic treatments. There were 4262 patients who underwent urethroplasty and most had no prior endoscopic treatment (n=2735, 64.2%). Of the patients who did have endoscopic treatment prior to urethroplasty (n=1527), there was a reduction in the number of endoscopic treatments prior to urethroplasty, from an average of 2.43 (SD 2.74) to 1.34 (SD 0.70) procedures following the 2016 guidelines, which was independent of race, ethnicity, and age (p<.01). Additionally, in the post-guidelines era, the average time to urethroplasty after the first endoscopic treatment decreased from 1284.2 days to 391.6 days and was significantly shorter on Kaplan-Meier analysis (p<.01, Figure 1). CONCLUSIONS: It appears that the AUA guidelines have had the intended effect of reducing repeat endoscopic procedures prior to urethroplasty among Veterans. These findings demonstrate that Veterans are receiving guideline-adherent care. This helps minimize practice variation while enhancing patient outcomes. Download PPT Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e516 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Nikolas Moring More articles by this author Michael Tram More articles by this author Darren Gemoets More articles by this author Charles Welliver More articles by this author Brian Inouye More articles by this author Expand All Advertisement PDF downloadLoading ...