title: The cost of surveillance after urethroplasty.
abstract: OBJECTIVE
  To determine variability in urethral stricture surveillance. Urethral strictures impact quality of life and exact a large economic burden. Although urethroplasty is the gold standard for durable treatment, strictures recur in 8%-18%. There are no universally accepted guidelines for posturethroplasty surveillance. We performed a literature search to evaluate variability in surveillance protocols, analyzed costs, and reviewed performance of each commonly used modality.
  
  
  METHODS
  MEDLINE search was performed using the keywords "urethroplasty," "urethral stricture," and "stricture recurrence" to ascertain commonly used surveillance strategies for stricture recurrence. We included English language articles from the past 10 years with at least 10 patients, and age >18 years. Cost data were calculated based on standard 2013 Centers for Medicare and Medicaid Services physician's fees.
  
  
  RESULTS
  Surveillance methods included retrograde urethrogram or voiding cystourethrogram, cystourethroscopy, urethral ultrasound, American Urological Association Symptom Score, and postvoid residual and urine flowmetry (UF) measurement. Most protocols call for a retrograde urethrogram or voiding cystourethrogram at the time of catheter removal. After this, UF or PVR, cystoscopy, urine culture, or a combination of UF and American Urological Association Symptom Score was performed at variable intervals. The first-year follow-up cost of anterior urethral surgery ranged from $205 to $1784. For posterior urethral surgery, follow-up cost for the first year ranged from $404 to $961.
  
  
  CONCLUSIONS
  Practice variability for surveillance of urethral stricture recurrence after urethroplasty leads to significant differences in cost.
authors.affiliation: Department of Urology, University of California, San Francisco, San Francisco, CA.
authors.forename: Uwais B
authors.initials: UB
authors.lastname: Zaid
authors.affiliation: Department of Urology, University of California, San Francisco, San Francisco, CA.
authors.forename: Mitchel
authors.initials: M
authors.lastname: Hawkins
authors.affiliation: Department of Pharmacy, University of California, San Francisco, San Francisco, CA.
authors.forename: Leslie
authors.initials: L
authors.lastname: Wilson
authors.affiliation: Department of Pharmacy, University of California, San Francisco, San Francisco, CA.
authors.forename: Jie
authors.initials: J
authors.lastname: Ting
authors.affiliation: Department of Urology, University of California, San Francisco, San Francisco, CA.
authors.forename: Catherine
authors.initials: C
authors.lastname: Harris
authors.affiliation: Department of Urology, University of California, San Francisco, San Francisco, CA.
authors.forename: Amjad
authors.initials: A
authors.lastname: Alwaal
authors.affiliation: Department of Urology, New York University, New York, NY.
authors.forename: Lee C
authors.initials: LC
authors.lastname: Zhao
authors.affiliation: Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX.
authors.forename: Allen F
authors.initials: AF
authors.lastname: Morey
authors.affiliation: Department of Urology, University of California, San Francisco, San Francisco, CA. Electronic address: bbreyer@urology.ucsf.edu.
authors.forename: Benjamin N
authors.initials: BN
authors.lastname: Breyer
mesh_terms: D003365:Costs and Cost Analysis; D006801:Humans; D008297:Male; D011159:Population Surveillance; D012008:Recurrence; D014521:Urethra / Q000601:surgery*; D014525:Urethral Stricture / Q000191:economics* / Q000601:surgery*; D013521:Urologic Surgical Procedures, Male / Q000191:economics / Q000379:methods
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