title: Barriers to accessing urethroplasty.
abstract: Urethroplasty is an effective treatment for men with anterior urethral strictures, but is utilized less frequently than ineffective treatments such as internal urethrotomy. We sought to identify provider-level barriers to urethroplasty. An anonymous online survey was emailed to all Mid-Atlantic American Urological Association members. Six scenarios in which urethroplasty was the most appropriate treatment were presented. Primary outcome was recommendation for urethroplasty in ≥ three clinical scenarios. Other factors measured include practice zip code, urethroplasty training, and proximity to a urethroplasty surgeon. Multivariate logistic regression identified factors associated with increased likelihood of urethroplasty recommendation. Of 670 members emailed, 109 (16%) completed the survey. Final analysis included 88 respondents. Mean years in practice was 17.2. Most respondents received formal training in urethroplasty: 43 (49%) in residency, 5 (6%) in fellowship, and 10 (11%) in both; 48 respondents (55%) had a urethroplasty surgeon in their practice, whereas 18 (20%) had a urethroplasty surgeon within 45 minutes of his or her primary practice location. The only covariate that was associated with an increased likelihood of recommending urethroplasty in ≥ three scenarios was formal urethroplasty training. Most members (68%) reported no barriers to referring patients for urethroplasty; the most common barriers cited were long distance to urethroplasty surgeon (n 5 13, 15%) and concern about complications (n 5 8, 9%). Urethroplasty continues to be underutilized in men with anterior urethral strictures, potentially due to lack of knowledge dissemination and access to a urethroplasty surgeon. Appropriate urethroplasty utilization may increase with greater exposure to urethroplasty in training.
authors.affiliation: Department of Urology, Rowan University School of Osteopathic Medicine Stratford, NJ.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Consolo
authors.affiliation: Bladder Health and Reconstructive Urology Institute Miramar, FL.
authors.forename: Kirin K
authors.initials: KK
authors.lastname: Syed
authors.affiliation: Department of Urology, Rowan University School of Osteopathic Medicine Stratford, NJ.
authors.forename: Christopher
authors.initials: C
authors.lastname: Robison
authors.affiliation: Department of Urology, Walter Reed National Military Medical Center Bethesda, MD.
authors.forename: Jacob
authors.initials: J
authors.lastname: McFadden
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Pennsylvania Philadelphia, PA.
authors.forename: David I
authors.initials: DI
authors.lastname: Shalowitz
authors.affiliation: Department of Urology, Rowan University School of Osteopathic Medicine Stratford, NJ.
authors.forename: Gordon A
authors.initials: GA
authors.lastname: Brown
authors.affiliation: Delaware Valley Urology, LLC Voorhees, NJ.
authors.forename: David O
authors.initials: DO
authors.lastname: Sussman
authors.affiliation: Department of Urology, University of North Carolina-Chapel Hill Chapel Hill, NC.
authors.forename: Bradley D
authors.initials: BD
authors.lastname: Figler
keywords: Barriers; Physician practice patterns; Urethral stricture; Urethroplasty