title: High regional variation in urethroplasty in the United States.
abstract: OBJECTIVE
  We identified clinical and regional factors associated with the use of urethroplasty vs repeat endoscopic management for urethral stricture disease.
  
  
  METHODS
  We analyzed claims for patients 18 to 65 years old in the 2007 to 2011 MarketScan® Commercial Claims and Encounters Database with a diagnosis of urethral stricture. The primary outcome was treatment with urethroplasty vs repeat endoscopic management, defined as more than 2 dilations or direct vision internal urethrotomies. The likelihood of urethroplasty vs repeat endoscopic management was determined for each major metropolitan area in the United States. Multivariate logistic regression was done to identify factors associated with urethroplasty.
  
  
  RESULTS
  We identified 41,056 patients with urethral stricture, yielding a diagnosis rate of 296/100,000 men in MarketScan. Repeat endoscopic management and urethroplasty were performed in 2,700 and 1,444 patients, respectively. Compared to patients treated with repeat endoscopic management those with urethroplasty were younger (median age 44 vs 54 years) and more likely to have a Charlson comorbidity score of 0 (84% vs 77%), have traveled out of a metropolitan area for care (34% vs 17%) and have a reconstructive urologist in the treatment metropolitan area (76% and 62%, each p <0.001). When controlling for age and Charlson comorbidity score, travel out of a metropolitan area (OR 2.7, 95% CI 2.2-3.3) and a reconstructive urologist in the treatment metropolitan area (OR 2.0, 95% CI 1.7-2.5) were associated with a greater likelihood of urethroplasty vs repeat endoscopic management.
  
  
  CONCLUSIONS
  Despite the well established benefits of urethroplasty compared to repeat endoscopic management a strong bias for repeat endoscopic management exists in many regions in the United States.
authors: Departments of Urology, Thomas Jefferson University (BDF), Philadelphia, Pennsylvania, and University of Washington, Seattle, Washington. Electronic address: bradley.figler@jefferson.edu.
authors: Bradley D
authors: BD
authors: Figler
authors: Departments of Urology, Thomas Jefferson University (BDF), Philadelphia, Pennsylvania, and University of Washington, Seattle, Washington.
authors: John L
authors: JL
authors: Gore
authors: Departments of Urology, Thomas Jefferson University (BDF), Philadelphia, Pennsylvania, and University of Washington, Seattle, Washington.
authors: Sarah K
authors: SK
authors: Holt
authors: Departments of Urology, Thomas Jefferson University (BDF), Philadelphia, Pennsylvania, and University of Washington, Seattle, Washington.
authors: Bryan B
authors: BB
authors: Voelzke
authors: Departments of Urology, Thomas Jefferson University (BDF), Philadelphia, Pennsylvania, and University of Washington, Seattle, Washington.
authors: Hunter
authors: H
authors: Wessells
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D014481:United States; D014521:Urethra / Q000601:surgery*; D014525:Urethral Stricture / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000706:statistics & numerical data; D055815:Young Adult
keywords: endoscopy; physician's practice patterns; reconstructive surgical procedures; urethra; urethral stricture