Economic evaluation of urethroplasty vs. repeated endoscopic dilation in short bulbar urethral stricture management

Management of short bulbar urethral strictures (<2 cm) typically involves either endoscopic dilation or excision and primary anastomosis urethroplasty. While dilation is inexpensive and minimally invasive, it carries high recurrence rates. Urethroplasty is more durable but requires higher upfront resources. We conducted a decision analysis to compare the 10-year costs of both strategies.

A decision tree was constructed to model stricture recurrence and complications after either index procedure. Direct institutional costs were obtained from hospital financial data and the Quebec physician fee schedule, expressed in 2023 Canadian dollars. Ten-year cumulative costs were calculated with a 3% annual discount rate. One-way sensitivity analyses varied recurrence and complication rates across published ranges.

The average cost of urethroplasty was $7186.27 CAD compared with $441.20 CAD for dilation. Stricture recurrence was 15.5% after urethroplasty vs. 60%, 80%, and 95% after first, second, and third dilations, respectively. Over 10 years, cumulative costs were $21 714.04 CAD for urethroplasty and $25 037.45 CAD for dilation, with a break-even point at approximately 80 months. Across sensitivity analyses, urethroplasty became more expensive with varying complication rates, but remained cost-efficient across a range of recurrence rates.

Despite higher initial expenses, urethroplasty is the more cost-efficient strategy for managing short bulbar urethral strictures. Given patients' relatively young age at diagnosis, cost benefits are likely to accrue beyond 10 years, supporting urethroplasty as the preferred definitive approach after at most one dilation attempt.