Management Trends of Urethral Stricture Disease: A Two-decade (2000-2024) Comparison Between Veteran and Civilian...

To evaluate trends in the prevalence of urethral stricture disease (USD) and treatment approaches within the veteran and civilian populations over the past two decades, with an emphasis on the impact of the American Urological Association (AUA) 2016 recommendations.

We accessed the medical records of 476,715 randomly selected male veterans from 2000 to 2024 using the VA Informatics and Computing Infrastructure (VINCI). Patients were identified through ICD-9 and ICD-10 codes, with urethroplasty as the primary endpoint (CPT code 53400). Additional treatments were also analyzed, including Direct Vision Internal Urethrotomy (DVIU) (CPT 52276) and Urethral Dilation (UD) (CPT 53600). Similarly, a retrospective analysis of procedures performed in the general population was conducted using electronic health record data from the TriNetX Research Network. Treatment trends were stratified by diagnosis year, comparing 2000-2016 and 2017-2024.

A total of 63,810 veterans were diagnosed with USD: 47,007 (73.7%) from 2000-2016 and 16,803 (26.3%) from 2017-2024. Of these, 211 underwent urethroplasty, with a higher percentage in the earlier period (0.4%) compared to the later period (0.2%). Nonsurgical treatments (DVIU and UD) remained consistent across age groups. Urethroplasty patients were younger (median age 62) than those treated nonsurgically. In the general population (TriNetX data), DVIU and dilation rates declined, while urethroplasty rates remained consistent across both periods.

Suboptimal incorporation of urethroplasty management for USD is observed in both veteran and civilian populations. Our results suggest no significant improvement in the rates of Urethroplasty after the release of the 2016 AUA urethral stricture guidelines.