National Trends in the Management of Urethral Stricture Disease: A 14-Year Survey of the Nationwide Inpatient Sample

Introduction Urethral strictures are common in general urology practice and can initially be treated with urethral dilation or incision. Unfortunately, many patients require retreatment. Urethroplasty provides a more durable effect but may be underused. We examined national trends in the management of urethral stricture disease. Methods Using the NIS (Nationwide Inpatient Sample) database from 1998 to 2011 we identified patients with a primary or secondary admitting ICD-9 diagnosis code of 598.X (urethral stricture) and excluded patients with urethral cancer, urethritis, urethral stone, abscess or epispadias. Inpatient procedure codes were used to classify 2 treatment groups, including 1) urethral dilation/incision and 2) urethral reconstruction. Linear regression was performed to determine the change in the utilization rate of incision/dilation and urethral reconstruction per 1,000 urethral strictures with time. Results A total of 240,108 procedures were identified for 471,596 urethral stricture diagnoses upon hospital admission, including 217,869 (90.7%) for incision/dilation and 22,239 (9.3%) for urethral reconstruction/urethrostomy. Mean utilization of incision/dilation per 1,000 strictures decreased slightly by 10.74 per year (1%) (p ≤0.001). Mean utilization of urethral reconstruction increased slightly by 1.65 per year (0.17%) (p = 0.0062). For every 1 increase in urethral reconstruction there were 12 fewer urethral dilations per 1,000 urethral strictures per year. Conclusions Urethral dilation/incision continues to be the foremost management of urethral stricture disease with known high recurrence and failure rates. Patients should be referred for urethral reconstruction to optimize treatment outcomes.