The morbidity of urethral stricture disease among male Medicare beneficiaries

Background: To date, the morbidity of urethral stricture disease among American men has not been analyzed using national datasets. We sought to analyze the morbidity of urethral stricture disease by measuring the rates of urinary tract infections and urinary incontinence among men with a diagnosis of urethral stricture. Methods: We analyzed Medicare claims data for 1992, 1995, 1998, and 2001 to estimate the rate of dual diagnoses of urethral stricture with urinary tract infection and with urinary incontinence occurring in the same year among a 5% sample of beneficiaries. Male Medicare beneficiaries receiving co-incident ICD-9 codes indicating diagnoses of urethral stricture and either urinary tract infection or urinary incontinence within the same year were counted. Results: The percentage of male patients with a diagnosis of urethral stricture who also were diagnosed with a urinary tract infection was 42% in 2001, an increase from 35% in 1992. Eleven percent of male Medicare beneficiaries with urethral stricture disease in 2001 were diagnosed with urinary incontinence in the same year. This represents an increase from 8% in 1992. Conclusions: Among male Medicare beneficiaries diagnosed with urethral stricture disease in 2001, 42% were also diagnosed with a urinary tract infection, and 11% with incontinence. Although the overall incidence of stricture disease decreased over this time period, these rates of dual diagnoses increased from 1992 to 2001. Our findings shed light into the health burden of stricture disease on American men. In order to decrease the morbidity of stricture disease, early definitive management of strictures is warranted. Background Although the true incidence of urethral stricture disease in men is unknown, Medicare utilization rates for men age 65 and over were 0.9% in 2001, a decrease from 1.4% in 1992 [1]. Utilization data from the Veteran Affairs (VA) in 2003 revealed a prevalence rate of 193 per 100,000 diagnoses (0.2%) [2]. Urethral stricture disease imposes a great burden on both health and quality of life in men. Previous studies of male urethral stricture disease have shown that nearly 90% of men present with complications [2]. The majority of men with a stricture suffer from obstructive and irritative voiding symptoms, and many experience hematuria, recurrent urinary tract infections, and the need for repeated procedures such as dilation or urethrotomy [2-5]. More severe complications, including acute urinary retention, urethral carcinoma, renal failure, Fournier’s gangrene, and bladder