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PD16-02 VARIABLE DEFINITIONS OF URETHRAL STRICTURE RECURRENCE AFTER VISUAL INTERNAL URETHROTOMY AND URETHROPLASTY
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THE JOURNAL OF UROLOGYâ
Vol. 195, No. 4S, Supplement, Saturday, May 7, 2016
Trauma/Reconstruction/Diversion: Urethral Reconstruction (including Stricture, Diverticulum) I Podium Saturday, May 7, 2016
10:30 AM-12:30 PM
PD16-01 UNDERSTANDING PATIENT PREFERENCES FOR SURGICAL MANAGEMENT OF URETHRAL STRICTURE DISEASE Lindsay A. Hampson*, Seattle, WA; Tracy Lin, San Francisco, CA; Leslie Wilson, San Francisci, CA; Isabel Allen, Thomas Gaither, Benjamin N. Breyer, San Francisco, CA INTRODUCTION AND OBJECTIVES: Urethral stricture disease has a substantial impact on quality of life and surgeons must understand how to best counsel patients about treatment options. We identified which treatment attributes are important to men making decisions about urethral stricture surgery and how prioritization of these attributes varies by patient characteristics. METHODS: Male patients with urethral stricture disease participated in a choice-based conjoint analysis exercise with 18 treatment scenarios. Demographic, treatment, and symptom data were collected. Mixed effects logistic regression models were used to analyze patients’ preferences and conduct subgroup analysis; a p-value of 0.05 was considered significant. RESULTS: Participants had significant preferences within all treatment attributes except recovery time, preferring higher success rate, decreased catheter duration, fewer future procedures, open reconstruction, and lower copayment (Fig1). Based on calculated relative attribute preferences, treatment success rate was the most important attribute, followed by copayment, future procedures, duration of catheterization, type of procedure, and, lastly, recovery time (Fig1). In subgroup analysis, older patients had stronger dislike for a 25% success rate and for additional procedures compared to younger patients, while lower income patients had stronger negative preferences towards higher copayments compared to higher income patients. Patients who previously underwent surgical treatment showed no differences in treatment preferences compared to those who had not. CONCLUSIONS: Treatment success rate is the most important treatment attribute, suggesting that patients should be strongly counseled about expected success rates of urethroplasty and urethrotomy. Based on subgroup analysis, doing a 00 less invasive00 urethrotomy for older patients may not be preferable given the lower success rate and higher chance of future procedures. Costs related to care are meaningful to lower income patients, even eclipsing the importance of success rates at high copayment costs. These results can help urologists’ improve patient-centered outcomes through better treatment counseling and determination of optimal management based on patients’ characteristics.
Source of Funding: National Institutes of Health NIDDK K12/ DK083021, California Urology Foundation, University of California CTSI Resident Research Award
PD16-02 VARIABLE DEFINITIONS OF URETHRAL STRICTURE RECURRENCE AFTER VISUAL INTERNAL URETHROTOMY AND URETHROPLASTY Benjamin A Sherer, M. Ryan Farrell*, Fahad Chaus, Laurence A Levine, Chicago, IL INTRODUCTION AND OBJECTIVES: Experts and international panels have called for uniformity in defining “recurrence” after urethroplasty for urethral strictures based on data prior to 2010. We evaluated how urethral stricture recurrence after both urethroplasty and visual internal urethrotomy (VIU) is being evaluated and defined in subsequent contemporary series. METHODS: We performed a systematic review of all studies reporting outcomes of either VIU or urethroplasty from 2009-2014. A PubMed/Medline search was performed using the terms urethroplasty, internal urethrotomy, and recurrence. Studies reporting number of patients treated, follow-up period, follow-up methods, and definition of stricture recurrence were included for review. RESULTS: Among 39 contemporary studies meeting inclusion criteria (Urethroplasty n¼26, VIU n¼13) definitions of recurrence fell into 5 major categories: Need for repeat procedure/instrumentation (Urethroplasty 50.0%, n¼13; VIU 15.4%, n¼2; Overall 38.5%, n¼15), inability to pass a cystoscope (16-18Fr or not specified) (Urethroplasty 26.9%, n¼7; VIU 7.7%, n¼1; Overall 20.5%, n¼8), decreased Q max on uroflowmetry (Urethroplasty 7.7%, n¼2; VIU 38.5%, n¼5; Overall 17.9%, n¼7), stricture visible on ultrasound (Urethroplasty 3.8%, n¼1; VIU 0%, n¼0; Overall 2.6%, n¼1), or a combination of aforementioned modalities (Urethroplasty 11.5%, n¼3; VIU 38.5%, n¼5; Overall 20.5%, n¼8). Of the combined modalities, 4 involved the presence of subjective symptoms. Overall, among the 39 studies, there were 18 unique definitions of stricture recurrence reported. Timing, frequency, and duration of follow-up also varied widely. CONCLUSIONS: There remains wide variability in the reporting of outcomes after treatment of urethral strictures with urethroplasty or VIU. This makes any direct or longitudinal comparison between studies difficult. There is an ongoing need to establish uniform parameters for evaluating outcomes and defining urethral stricture recurrence after surgical intervention. Source of Funding: None
THE JOURNAL OF UROLOGYâ
Vol. 195, No. 4S, Supplement, Saturday, May 7, 2016
Trauma/Reconstruction/Diversion: Urethral Reconstruction (including Stricture, Diverticulum) I Podium Saturday, May 7, 2016
10:30 AM-12:30 PM
PD16-01 UNDERSTANDING PATIENT PREFERENCES FOR SURGICAL MANAGEMENT OF URETHRAL STRICTURE DISEASE Lindsay A. Hampson*, Seattle, WA; Tracy Lin, San Francisco, CA; Leslie Wilson, San Francisci, CA; Isabel Allen, Thomas Gaither, Benjamin N. Breyer, San Francisco, CA INTRODUCTION AND OBJECTIVES: Urethral stricture disease has a substantial impact on quality of life and surgeons must understand how to best counsel patients about treatment options. We identified which treatment attributes are important to men making decisions about urethral stricture surgery and how prioritization of these attributes varies by patient characteristics. METHODS: Male patients with urethral stricture disease participated in a choice-based conjoint analysis exercise with 18 treatment scenarios. Demographic, treatment, and symptom data were collected. Mixed effects logistic regression models were used to analyze patients’ preferences and conduct subgroup analysis; a p-value of 0.05 was considered significant. RESULTS: Participants had significant preferences within all treatment attributes except recovery time, preferring higher success rate, decreased catheter duration, fewer future procedures, open reconstruction, and lower copayment (Fig1). Based on calculated relative attribute preferences, treatment success rate was the most important attribute, followed by copayment, future procedures, duration of catheterization, type of procedure, and, lastly, recovery time (Fig1). In subgroup analysis, older patients had stronger dislike for a 25% success rate and for additional procedures compared to younger patients, while lower income patients had stronger negative preferences towards higher copayments compared to higher income patients. Patients who previously underwent surgical treatment showed no differences in treatment preferences compared to those who had not. CONCLUSIONS: Treatment success rate is the most important treatment attribute, suggesting that patients should be strongly counseled about expected success rates of urethroplasty and urethrotomy. Based on subgroup analysis, doing a 00 less invasive00 urethrotomy for older patients may not be preferable given the lower success rate and higher chance of future procedures. Costs related to care are meaningful to lower income patients, even eclipsing the importance of success rates at high copayment costs. These results can help urologists’ improve patient-centered outcomes through better treatment counseling and determination of optimal management based on patients’ characteristics.
Source of Funding: National Institutes of Health NIDDK K12/ DK083021, California Urology Foundation, University of California CTSI Resident Research Award
PD16-02 VARIABLE DEFINITIONS OF URETHRAL STRICTURE RECURRENCE AFTER VISUAL INTERNAL URETHROTOMY AND URETHROPLASTY Benjamin A Sherer, M. Ryan Farrell*, Fahad Chaus, Laurence A Levine, Chicago, IL INTRODUCTION AND OBJECTIVES: Experts and international panels have called for uniformity in defining “recurrence” after urethroplasty for urethral strictures based on data prior to 2010. We evaluated how urethral stricture recurrence after both urethroplasty and visual internal urethrotomy (VIU) is being evaluated and defined in subsequent contemporary series. METHODS: We performed a systematic review of all studies reporting outcomes of either VIU or urethroplasty from 2009-2014. A PubMed/Medline search was performed using the terms urethroplasty, internal urethrotomy, and recurrence. Studies reporting number of patients treated, follow-up period, follow-up methods, and definition of stricture recurrence were included for review. RESULTS: Among 39 contemporary studies meeting inclusion criteria (Urethroplasty n¼26, VIU n¼13) definitions of recurrence fell into 5 major categories: Need for repeat procedure/instrumentation (Urethroplasty 50.0%, n¼13; VIU 15.4%, n¼2; Overall 38.5%, n¼15), inability to pass a cystoscope (16-18Fr or not specified) (Urethroplasty 26.9%, n¼7; VIU 7.7%, n¼1; Overall 20.5%, n¼8), decreased Q max on uroflowmetry (Urethroplasty 7.7%, n¼2; VIU 38.5%, n¼5; Overall 17.9%, n¼7), stricture visible on ultrasound (Urethroplasty 3.8%, n¼1; VIU 0%, n¼0; Overall 2.6%, n¼1), or a combination of aforementioned modalities (Urethroplasty 11.5%, n¼3; VIU 38.5%, n¼5; Overall 20.5%, n¼8). Of the combined modalities, 4 involved the presence of subjective symptoms. Overall, among the 39 studies, there were 18 unique definitions of stricture recurrence reported. Timing, frequency, and duration of follow-up also varied widely. CONCLUSIONS: There remains wide variability in the reporting of outcomes after treatment of urethral strictures with urethroplasty or VIU. This makes any direct or longitudinal comparison between studies difficult. There is an ongoing need to establish uniform parameters for evaluating outcomes and defining urethral stricture recurrence after surgical intervention. Source of Funding: None