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Background: Urethral strictures and bladder neck contractures (BNCs) can be significantly morbid for patients and may require intervention for effective urinary drainage. We hypothesized patients with abnormal scarring disorders, such as keloids or hypertrophic scars, are at elevated risks of urethroplasty failure as well as postprocedural urethral strictures and BNCs. Methods: We queried the TriNetX database to determine the risk of urethroplasty failure for patients with abnormal scarring disorders compared to controls. We also investigated the risk of developing urethral strictures and BNCs for patients undergoing various endourology procedures. Results are reported in terms of risk ratio (RR) with 95% confidence interval (CI). Statistical significance was considered when the CI did not include 1.0. Propensity score matching was performed to limit confounding. Notably, TriNetX rounds values < 10 to 10 for patient anonymity (denoted by *). Results: Urethroplasty patients with scarring pathology needed a second procedure more than twice as often (36.2% vs. <17.2%*, RR = 2.1, 95%CI 1.1-4.1). Following cystoscopy, there was no difference in urethral stricture rates for patients with scarring disorders (2.7% vs. 2.6%, RR = 1.1, 95%CI 0.85-1.3). These patients also showed similar rates of BNCs (7.5% vs. 5.3%, RR = 1.4, 95%CI 0.84-2.3) and urethral strictures (5.9% vs. 5.3%, RR = 1.1, 95%CI 0.68-1.8) after transurethral bladder outlet procedures. Conclusions: Patients with scarring disorders showed much higher urethroplasty failure rates. They experienced similar rates of urethral strictures and BNC formation after endoscopic procedures. These novel findings underscore the importance of recognizing abnormal scarring conditions during preoperative assessments, guiding clinicians in counseling patients and tailoring operative interventions.

Background: How quickly providers adapt to new practice guidelines is not well known. The objective of this study was to evaluate temporal trends in the performance of urethral endoscopic management and urethroplasty surrounding the release of the American Urological Association (AUA) Male Urethral Stricture Guidelines in 2017. We also evaluate in parallel trends in female urethral stricture disease, where AUA guidelines are not present. We hypothesized that the ratio of urethroplasty versus urethral endoscopic management in both males and females is increasing and that guidelines do not result in immediate changes in management trends., Methods: Endoscopic management and urethroplasty data were collected from the TriNetX database on adult males and females five years before (starting 1 January 2012) and after (ending 31 December 2022) the 2017 AUA guidelines. Cohorts were built using Current Procedural Terminology (CPT) codes and grouped into urethral endoscopic management (Males: CPT 52275, 52281, 52282, 53600, 53601, 53620, 53621; Females: CPT 52270, 53660, 53661, 53665) or urethroplasty (Males: CPT 53000, 53010, 53400, 53410, 53415, 53420, 53450, 53460; Females: CPT 53430). Data on patient age, race, and geographic distribution were also collected., Results: In total, 27,623 (Males: 25,039; Females: 2584) endoscopic managements and 11,771 (Males: 11,105; Females: 666) urethroplasties were reviewed across 51 Health Care Organizations. The mean age of endoscopic management and urethroplasty patients was 67.1 and 55.7, respectively ( p < 0.01). The urethroplasty-to-endoscopic management ratio decreased for males between 2012 and 2013 and then steadily increased until 2017. The ratio steadily increased for females from 2012 to 2017. The urethroplasty-to-endoscopic management ratio showed a slight decline from 2017 to 2020 across both males and females before rising again through 2022 to a study high (Males: 0.62; Females: 0.63). Regional differences were identified, with the West having the highest urethroplasty-to-endoscopic management ratios for both males and females, the Northeast having the lowest urethroplasty-to-endoscopic management ratio for males, and the Midwest having the lowest ratio for females., Conclusions: The utilization of urethroplasty for males and females is increasing. An immediate benefit on post-guideline urethroplasty rates was not observed, and the utilization of female urethroplasty increased despite the absence of AUA guidelines. These illustrate that the impact of guideline dissemination takes time and supports the need for continued provider outreach and education on urethral stricture disease and management.

Background: We queried a global database to understand re-intervention rates following urethroplasty with the goal of evaluating whether they align with previously published data., Methods: Using the TriNetX database and Common Procedural Terminology (CPT) and International Classification of Diseases-10 (ICD) codes, we identified adult male patients with urethral stricture disease (ICD N35) who underwent one-stage anterior (CPT 53410) or posterior urethroplasty (CPT 53415), with or without (substitution urethroplasty) a tissue flap (CPT 15740) or buccal graft (CPT 15240 or 15241). We set urethroplasty as the index event and used descriptive statistics to report the incidence of secondary procedures (using CPT codes) within 10 years after the index event., Results: There were 6606 patients who underwent urethroplasty within the last 20 years, with 14.3% of patients undergoing a second procedure after index event. Upon subgroup analysis, reintervention rates were 14.5% for anterior urethroplasty vs. 12.4% of patients with an anterior substitution urethroplasty (RR 1.7, p = 0.09) and 13.3% for posterior urethroplasty vs. 8.2% for patients with a posterior substitution urethroplasty (RR 1.6, p < 0.01)., Conclusions: Most patients will not need any form of re-intervention following urethroplasty. These data align with previously described recurrence rates, which may help urologists counsel patients considering urethroplasty.