ArticleWorld journal of urology2025
Practice changes in urethral stricture management in the US veteran population after the 2016 AUA guidelines.
Article in World journal of urology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionThe 2016 AUA guidelines aimed to change urethral stricture management from multiple endoscopic treatments to a single endoscopic treatment followed by urethroplasty if necessary. We analyzed treatment patterns of Veterans with urethral stricture disease before and after the 2016 guidelines.
methodsWe queried the VA Corporate Data Warehouse from January 1, 2000 to October 18, 2023 to identify Veterans with a urethral stricture diagnosis and Veterans who underwent endoscopic treatment or urethroplasty. We assessed the number of endoscopic procedures 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 time to urethroplasty after the first endoscopic treatment using a log-rank test.
resultsWe identified 148,067 male veterans for analysis. 84,931 (57.3%) patients underwent any treatment. Most patients (n = 80,669, 95.0%) did not undergo urethroplasty, receiving an average of 1.74 ± 2.90 endoscopic treatments and a median of 1 (IQR 1). There were 4,262 patients who underwent urethroplasty. Among urethroplasty patients, most had no prior endoscopic treatment (n = 2,735, 64.2%). Among patients who had endoscopic treatment prior to urethroplasty (n = 1,527), the number of endoscopic treatments prior to urethroplasty decreased from 2.43 ± 2.74 to 1.34 ± 0.70 following the guidelines (p < .01). The median time to urethroplasty after the first endoscopic treatment decreased from 657 to 250 days (p < .01).
conclusionIt appears that the 2016 AUA guidelines were associated with a reduction of repeat endoscopic procedures and time to urethroplasty among Veterans. These findings demonstrate that Veterans are receiving guideline-adherent care.
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