Significant Management Variability of Urethral stricture Disease in United States: Data from the AUA Quality (AQUA) Registry

To determine the degree of contemporary practice variation for the treatment of urethral stricture disease (USD) given repeated endoscopic management yields poor long-term success. The AUA Quality (AQUA) Registry collects data from participating urologists across practice settings by direct interfac...

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Published in:Urology (Ridgewood, N.J.) N.J.), 2020-12, Vol.146, p.265-270
Main Authors: Cohen, Andrew J., Agochukwu-Mmonu, Nnenaya, Makarov, Danil V., Meeks, William, Murphy, John, Fang, Raymond, Cooperberg, Matthew R., Breyer, Benjamin N.
Format: Article
Language:English
Subjects:
Adult
Age Factors
Aged
Aged, 80 and over
Disease Management
Endoscopy - statistics & numerical data
Humans
Male
Medical Overuse - statistics & numerical data
Middle Aged
Practice Patterns, Physicians' - statistics & numerical data
Reconstructive Surgical Procedures - statistics & numerical data
Registries
Reoperation - statistics & numerical data
United States
Urethra - surgery
Urethral Stricture - therapy
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container_title Urology (Ridgewood, N.J.)
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creator Cohen, Andrew J.
Agochukwu-Mmonu, Nnenaya
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description To determine the degree of contemporary practice variation for the treatment of urethral stricture disease (USD) given repeated endoscopic management yields poor long-term success. The AUA Quality (AQUA) Registry collects data from participating urologists across practice settings by direct interface with local electronic health record systems. We identified procedures used for USD using Current Procedural Terminology (CPT) and International Statistical Classification of Diseases (ICD-9/-10) codes. We assessed the association between patient and provider factors and repeated endoscopic treatment using generalized linear models. Provider details were derived from AUA Census. We identified 20,640 male patients with USD treated surgically in AQUA from 2014-2018. The patients were cared for by 1343 providers at 171 practices, 95% of these community-based. Among patients with USD who had treatment, 20,101(97.9%) underwent endoscopic management. 6218(31%) underwent repeated endoscopic treatment during the study period. Urethroplasty was performed in 539(2.6%) patients.  Median patient age at first procedure for endoscopic surgery vs. urethroplasty was 73 vs. 39 years old, respectively (p
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The AUA Quality (AQUA) Registry collects data from participating urologists across practice settings by direct interface with local electronic health record systems. We identified procedures used for USD using Current Procedural Terminology (CPT) and International Statistical Classification of Diseases (ICD-9/-10) codes. We assessed the association between patient and provider factors and repeated endoscopic treatment using generalized linear models. Provider details were derived from AUA Census. We identified 20,640 male patients with USD treated surgically in AQUA from 2014-2018. The patients were cared for by 1343 providers at 171 practices, 95% of these community-based. Among patients with USD who had treatment, 20,101(97.9%) underwent endoscopic management. 6218(31%) underwent repeated endoscopic treatment during the study period. Urethroplasty was performed in 539(2.6%) patients.  Median patient age at first procedure for endoscopic surgery vs. urethroplasty was 73 vs. 39 years old, respectively (p&lt;0.001). At the practice level, significant variation in rates of repeated endoscopic management was noted. Patients of older age (OR=1.08, 95%CI: 1.06-1.11 for ages ≥80) and patients with a bladder cancer diagnosis (OR=1.17, 95%CI: 1.15-1.20) had higher odds of receiving repeated endoscopic management. Increasing practitioner age was also associated with increased odds of repeated endoscopic management. (OR=1.13, 95%CI: 1.11- 1.16, for practitioners ≥64). Repeated endoscopic management for USD is overused. 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Urethroplasty was performed in 539(2.6%) patients.  Median patient age at first procedure for endoscopic surgery vs. urethroplasty was 73 vs. 39 years old, respectively (p&lt;0.001). At the practice level, significant variation in rates of repeated endoscopic management was noted. Patients of older age (OR=1.08, 95%CI: 1.06-1.11 for ages ≥80) and patients with a bladder cancer diagnosis (OR=1.17, 95%CI: 1.15-1.20) had higher odds of receiving repeated endoscopic management. Increasing practitioner age was also associated with increased odds of repeated endoscopic management. (OR=1.13, 95%CI: 1.11- 1.16, for practitioners ≥64). Repeated endoscopic management for USD is overused. The utilization of endoscopic management is variable across practices and frequently guideline-discordant, presenting an opportunity for quality improvement.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>32777368</pmid><doi>10.1016/j.urology.2020.07.053</doi><tpages>6</tpages></addata></record>
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subjects Adult
Age Factors
Aged
Aged, 80 and over
Disease Management
Endoscopy - statistics & numerical data
Humans
Male
Medical Overuse - statistics & numerical data
Middle Aged
Practice Patterns, Physicians' - statistics & numerical data
Reconstructive Surgical Procedures - statistics & numerical data
Registries
Reoperation - statistics & numerical data
United States
Urethra - surgery
Urethral Stricture - therapy
title Significant Management Variability of Urethral stricture Disease in United States: Data from the AUA Quality (AQUA) Registry
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