title: The management of bulbar urethral stricture disease before referral for definitive repair: have practice patterns changed?
abstract: OBJECTIVE
  To describe the management of patients with bulbar urethral stricture disease before referral for definitive urethroplasty and determine if practice patterns have changed with respect to endoscopic interventions.
  
  
  METHODS
  We performed an institutional review board-approved retrospective review and recorded patient demographics, stricture-related information, and all procedures performed for bulbar urethral stricture disease before initial presentation at our institution. Included procedures were: UroLume stent (AMS, Minnetonka, MN), laser urethrotomy, direct visual urethrotomy (DVIU), and dilation of urethral stricture. Patients with prior urethroplasty were excluded. We compared the differences between procedures when stratified by stricture length.
  
  
  RESULTS
  We identified 363 men who underwent urethroplasty for bulbar urethral stricture disease from January 1996 to September 2011. Of the total, 235 men (65%) had a prior DVIU, whereas 65 of these men (28%) had multiple DVIUs. One hundred ninety-nine men (55%) had a prior dilation and 155 of these men (78%) had multiple dilations. The remaining procedures consisted of laser urethrotomy (6; 2%), and UroLume stent (4; 1%). Twenty-four patients (6%) had no procedures before referral. There was no statistically significant difference between numbers of prior procedures when stratified by stricture length. From 1996 to 2010, there was no appreciable change in number of procedures before referral, with ∼ 70% of patients with ≥ 2 prior procedures.
  
  
  CONCLUSIONS
  Our institution has not seen a measurable change in practice patterns before referral from 1996 to 2010. Future studies are needed to determine if the change in referral patterns in 2011 represents a future trend.
authors.affiliation: Division of Urology, Department of Surgery, Duke University Medical Center, Durham, NC. Electronic address: Michael.Granieri@duke.edu.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Granieri
authors.affiliation: Division of Urology, Department of Surgery, Duke University Medical Center, Durham, NC.
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Peterson
mesh_terms: D006801:Humans; D008297:Male; D010818:Practice Patterns, Physicians' / Q000639:trends*; D012017:Referral and Consultation; D012189:Retrospective Studies; D014525:Urethral Stricture / Q000601:surgery*; D013521:Urologic Surgical Procedures, Male / Q000379:methods