Socioeconomic and patient-related factors for the management of male urethral stricture disease
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We sought to determine the socioeconomic and patient factors that influence the utilization of urethroplasty and location of management in the treatment of male urethral stricture disease.
A retrospective review using the Healthcare Cost and Utilization Project State Inpatient and Ambulatory Surgery and Services Databases for California and Florida was performed. Adult men with a diagnosis of urethral stricture who underwent treatment with urethroplasty or endoscopic dilation/urethrotomy between 2007 and 2011 in California and 2009 and 2014 in Florida were identified by ICD-9 or CPT codes. Patients were categorized based on whether they had a urethroplasty or serial dilations/urethrotomies. Patients were assessed for age, insurance provider, median household income by zip code, Charlson Comorbidity Index, race, prior stricture management, and location of the index procedure. A multivariable logistic regression model was fit to assess factors influencing treatment modality (urethroplasty vs endoscopic management) and location (teaching hospital vs non-teaching hospital).
Twenty seven thousand, five hundred and sixty-eight patients were identified that underwent treatment for USD. 25,864 (93.8%) treated via endoscopic approaches and 1704 (6.2%) treated with urethroplasty. Factors favoring utilization of urethroplasty include younger age, lower Charlson Comorbidity score, higher zip code median income quartile, private insurance, prior endoscopic treatment, and management at a teaching hospital.
Socioeconomic predictors of urethroplasty utilization include higher income status and private insurance. Patient-specific factors influencing urethroplasty were younger age and fewer medical comorbidities. A primary driver of urethroplasty utilization was treatment at a teaching hospital. Older and Hispanic patients were less likely to seek care at these facilities.
KeywordsUrethral stricture disease Urethroplasty Socioeconomics Specialized centers
RA Dornbier: project development, data collection and analysis, manuscript writing. EJ Kirshenbaum: project development, data collection and analysis, manuscript editing. MH Nelson: data collection and analysis. RH Blackwell: project development, manuscript editing. GN Gupta: data analysis, manuscript editing. AV Farooq: project development, data analysis, manuscript editing. CM Gonzalez: data analysis, manuscript editing
This study was funded with institutional and departmental funding.
Compliance with ethical standards
Conflict of interest
CM Gonzalez: fellowship support from Boston Scientific and Coloplast. AV Farooq: fellowship support from Boston Scientific and Coloplast. All other authors declare that they have no conflicts of interest.
Statement of human rights
For this type of study formal consent is not required. This study was institutional review board exempt given the low risk of patient identification using a large, de-identified database. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee nd with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Informed consent was not obtained for this study, given its retrospective nature and use of a large, de-identified database. The risk of patient identification was low.
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