Introduction: Urethral Stricture Disease (USD) is a pathological narrowing of the urethra that often results in lower urinary tract symptoms (LUTS), urinary incontinence, urinary tract infections, and ultimately progression toward acute urinary retention. In 2016, the AUA released guidelines on urethral stricture management, focusing on the importance of an earlier transition to urethroplasty rather than repeat endoscopic procedures. This study aims to analyze the recent trends in male urethral stricture treatment from 2016-2020 to determine the impact of the AUA’s most recent guidelines on male urethral stricture management. Methods: We utilized electronic health record data stored within the TriNetX Research Network to conduct a retrospective analysis of procedures performed between 2016-2020 (a total of 78,532 procedures). Rates of direct visual internal urethrotomy (DVIU), urethral dilation, dilation + DVIU, and urethroplasty were analyzed using chi-square analysis to assess linear trends. Results: The dilation + DVIU group showed a significant increase in procedure rates between 2016-2017 (p = 1.269E-08), 2016-2018 (p = 5.08E-07), 2016-2019 (p =2.7637E-31), and 2018-2019 (p = 5.38E-13; Fig A-B). While 2019-2020 showed a decrease (p = 4.792E-06), an analysis of the overall trend from 2016-2020 demonstrated no significant difference (p = 0.07739). Urethroplasty was offered to younger patients when compared to urethral dilation/incision (Fig C) performed in older patients. Repeat dilation/incisions were performed at significantly (22%) higher rates when compared to urethroplasty (Fig D). Conclusions: Despite AUA recommendations encouraging reconstructive surgeons to offer urethroplasty instead of repeated endoscopic interventions, our results suggest no significant change in the rates of these procedures after the release of the 2016 AUA urethral stricture guidelines. The lack of clinical modification may reflect the lag-time incorporating guideline recommendations or practice barriers to implementation. SOURCE OF Funding: UCSD Academic Senate
