Trends in Male and Female Urethral Endoscopic Management and Urethroplasty Using the TriNetX Database

Area of Science:

• Urology
• Surgical Practice Trends
• Health Services Research

Background:

• Provider adoption of new practice guidelines is not well understood.
• The study examines trends in urethral stricture management before and after the 2017 American Urological Association (AUA) guidelines.
• Female urethral stricture disease trends are analyzed in parallel, as no specific AUA guidelines exist.

Purpose of the Study:

• To evaluate temporal trends in urethral endoscopic management versus urethroplasty for male urethral stricture disease following the 2017 AUA guidelines.
• To assess trends in female urethral stricture management in the absence of specific AUA guidelines.
• To test the hypothesis that urethroplasty ratios are increasing and that guidelines do not cause immediate management shifts.

Main Methods:

• Data from the TriNetX database (2012-2022) were analyzed for adult males and females.
• Cohorts were defined using Current Procedural Terminology (CPT) codes for urethral endoscopic management and urethroplasty.
• Patient demographics and geographic distribution were collected alongside procedural data.

Main Results:

• Over 39,000 procedures were reviewed across 51 healthcare organizations.
• The urethroplasty-to-endoscopic management ratio increased for both males and females, reaching study highs by 2022.
• Regional variations in management ratios were observed, with the West showing the highest ratios for both sexes.

Conclusions:

• Urethroplasty utilization is increasing for both male and female urethral stricture.
• No immediate increase in urethroplasty rates was observed post-guideline release, indicating a time lag in guideline impact.
• The rise in female urethroplasty, despite lacking specific guidelines, highlights the need for ongoing provider education on urethral stricture management.