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• W1984471684 abstract "No AccessJournal of UrologyAdult Urology: Outcomes/Epidemiology/Socioeconomics1 Jul 2004REPEAT URETHROTOMY AND DILATION FOR THE TREATMENT OF URETHRAL STRICTURE ARE NEITHER CLINICALLY EFFECTIVE NOR COST-EFFECTIVE T.J. GREENWELL, C. CASTLE, D.E. ANDRICH, J.T. MacDONALD, D.L. NICOL, and A.R. MUNDY T.J. GREENWELLT.J. GREENWELL More articles by this author , C. CASTLEC. CASTLE More articles by this author , D.E. ANDRICHD.E. ANDRICH More articles by this author , J.T. MacDONALDJ.T. MacDONALD More articles by this author , D.L. NICOLD.L. NICOL More articles by this author , and A.R. MUNDYA.R. MUNDY More articles by this author View All Author Informationhttps://doi.org/10.1097/01.ju.0000132156.76403.8fAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We developed an algorithm for the management of urethral stricture based on cost-effectiveness. Materials and Methods: United Kingdom medical and hospital costs associated with the current management of urethral stricture were calculated using private medical insurance schedules of reimbursement and clean intermittent self-catheterization supply costs. These costs were applied to 126 new patients treated endoscopically for urethral stricture in a general urological setting between January 1, 1991 and December 31, 1999. Treatment failure was defined as recurrent symptomatic stricture requiring further operative intervention following initial intervention. Mean followup available was 25 months (range 1 to 132). Results: The costs were urethrotomy/urethral dilation £2,250.00 ($3,375.00, ratio 1.00), simple 1-stage urethroplasty £5,015.00 ($7,522.50, ratio 2.23), complex 1-stage urethroplasty £5,335.00 ($8,002.50, ratio 2.37) and 2-stage urethroplasty £10,370 ($15,555.00, ratio 4.61). Of the 126 patients assessed 60 (47.6%) required more than 1 endoscopic retreatments (mean 3.13 each), 50 performed biweekly clean intermittent self-catheterization and 7 underwent urethroplasty during followup. The total cost per patient for all 126 patients for stricture treatment during followup was £6,113 ($9,170). This cost was calculated by multiplying procedure cost by the number of procedures performed. A strategy of urethrotomy or urethral dilation as first line treatment, followed by urethroplasty for recurrence yielded a total cost per patient of £5,866 ($8,799). Conclusions: A strategy of initial urethrotomy or urethral dilation followed by urethroplasty in patients with recurrent stricture proves to be the most cost-effective strategy. This financially based strategy concurs with evidence based best practice for urethral stricture management. References 1 : Urethral strictures and their surgical treatment. BJU Int2000; 86: 571. 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Link, Google Scholar From the Institute of Urology, London, United Kingdom, and Princess Alexandra Hospital (CC, DLN), Brisbane, Australia© 2004 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited ByChapman D, Bekkema J and Rourke K (2021) Urinary Symptom Nonresponse (“LUTS Failure”) after Urethroplasty: Incidence and AssociationsJournal of Urology, VOL. 206, NO. 4, (986-993), Online publication date: 1-Oct-2021.Rude T, Khurana K, Yamaguchi Y, Walter D, Makarov D and Zhao L (2017) Burden of Disease for Urethral Stricture Managed by Repeat Endoscopic Treatment vs Single Endoscopic Treatment or Urethroplasty in the Veterans Affairs PopulationUrology Practice, VOL. 5, NO. 4, (299-304), Online publication date: 1-Jul-2018.Kahokehr A, Granieri M, Webster G and Peterson A (2018) A Critical Analysis of Bulbar Urethroplasty Stricture Recurrence: Characteristics and ManagementJournal of Urology, VOL. 200, NO. 6, (1302-1307), Online publication date: 1-Dec-2018.Tong C and Simhan J (2017) Editorial CommentJournal of Urology, VOL. 199, NO. 2, (521-521), Online publication date: 1-Feb-2018.Horiguchi A, Shinchi M, Masunaga A, Ito K, Asano T and Azuma R (2017) Do Transurethral Treatments Increase the Complexity of Urethral Strictures?Journal of Urology, VOL. 199, NO. 2, (508-514), Online publication date: 1-Feb-2018.LaBossiere J, Cheung D and Rourke K (2015) Endoscopic Treatment of Vesicourethral Stenosis after Radical Prostatectomy: Outcomes and Predictors of SuccessJournal of Urology, VOL. 195, NO. 5, (1495-1500), Online publication date: 1-May-2016.Siegel J, Panda A, Tausch T, Meissner M, Klein A and Morey A (2015) Repeat Excision and Primary Anastomotic Urethroplasty for Salvage of Recurrent Bulbar Urethral StrictureJournal of Urology, VOL. 194, NO. 5, (1316-1322), Online publication date: 1-Nov-2015.Figler B, Gore J, Holt S, Voelzke B and Wessells H (2014) High Regional Variation in Urethroplasty in the United StatesJournal of Urology, VOL. 193, NO. 1, (179-183), Online publication date: 1-Jan-2015.Terlecki R (2014) Optimizing Outcomes of UrethroplastyJournal of Urology, VOL. 192, NO. 3, (636-637), Online publication date: 1-Sep-2014.Blaschko S, McAninch J, Myers J, Schlomer B and Breyer B (2012) Repeat Urethroplasty After Failed Urethral Reconstruction: Outcome Analysis of 130 PatientsJournal of Urology, VOL. 188, NO. 6, (2260-2264), Online publication date: 1-Dec-2012.Burks F, Salmon S, Smith A and Santucci R (2012) Urethroplasty: A Geographic Disparity in CareJournal of Urology, VOL. 187, NO. 6, (2124-2127), Online publication date: 1-Jun-2012.Hudak S, Atkinson T and Morey A (2012) Repeat Transurethral Manipulation of Bulbar Urethral Strictures is Associated With Increased Stricture Complexity and Prolonged Disease DurationJournal of Urology, VOL. 187, NO. 5, (1691-1695), Online publication date: 1-May-2012.Santucci R and Eisenberg L (2010) Urethrotomy Has a Much Lower Success Rate Than Previously ReportedJournal of Urology, VOL. 183, NO. 5, (1859-1862), Online publication date: 1-May-2010.Erickson B, Granieri M, Meeks J, Cashy J and Gonzalez C (2009) Prospective Analysis of Erectile Dysfunction After Anterior Urethroplasty: Incidence and Recovery of FunctionJournal of Urology, VOL. 183, NO. 2, (657-661), Online publication date: 1-Feb-2010.Santucci R (2009) Should We Centralize Referrals for Repair of Urethral Stricture?Journal of Urology, VOL. 182, NO. 4, (1259-1260), Online publication date: 1-Oct-2009.Morey A (2009) Urethral Stricture is Now an Open Surgical DiseaseJournal of Urology, VOL. 181, NO. 3, (953-954), Online publication date: 1-Mar-2009.Wang P, Fan M, Zhang Y, Huang C, Feng J and Xiao Y (2008) Modified Urethral Pull-Through Operation for Posterior Urethral Stricture and Long-Term OutcomeJournal of Urology, VOL. 180, NO. 6, (2479-2485), Online publication date: 1-Dec-2008.Barbagli G (2007) Editorial CommentJournal of Urology, VOL. 178, NO. 3, (1011-1011), Online publication date: 1-Sep-2007.Santucci R (2007) Editorial CommentJournal of Urology, VOL. 178, NO. 4S, (1658-1658), Online publication date: 1-Oct-2007.Santucci R, Joyce G and Wise M (2018) Male Urethral Stricture DiseaseJournal of Urology, VOL. 177, NO. 5, (1667-1674), Online publication date: 1-May-2007.Bullock T and Brandes S (2018) Adult Anterior Urethral Strictures: A National Practice Patterns Survey of Board Certified Urologists in the United StatesJournal of Urology, VOL. 177, NO. 2, (685-690), Online publication date: 1-Feb-2007. Volume 172Issue 1July 2004Page: 275-277 Advertisement Copyright & Permissions© 2004 by American Urological Association, Inc.Keywordsurethral strictureurethracost-benefit analysisurinary catheterizationballoon dilatationMetricsAuthor Information T.J. GREENWELL More articles by this author C. CASTLE More articles by this author D.E. ANDRICH More articles by this author J.T. MacDONALD More articles by this author D.L. NICOL More articles by this author A.R. MUNDY More articles by this author Expand All Advertisement PDF DownloadLoading ..." @default.
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