Socioeconomic and patient-related factors for the management of male urethral stricture disease.

Autor: Dornbier RA; Department of Urology, Loyola University Medical Center, 2160 S 1st Avenue, Fahey #54, Rm 239A, Maywood, IL, 60153, USA. Ryan.Dornbier@lumc.edu., Kirshenbaum EJ; Department of Urology, Loyola University Medical Center, 2160 S 1st Avenue, Fahey #54, Rm 239A, Maywood, IL, 60153, USA., Nelson MH; Department of Urology, Loyola University Medical Center, 2160 S 1st Avenue, Fahey #54, Rm 239A, Maywood, IL, 60153, USA., Blackwell RH; Division of Urology, Southern Illinois University School of Medicine, Springfield, IL, USA., Gupta GN; Department of Urology, Loyola University Medical Center, 2160 S 1st Avenue, Fahey #54, Rm 239A, Maywood, IL, 60153, USA., Farooq AV; Department of Urology, Loyola University Medical Center, 2160 S 1st Avenue, Fahey #54, Rm 239A, Maywood, IL, 60153, USA., Gonzalez CM; Department of Urology, Loyola University Medical Center, 2160 S 1st Avenue, Fahey #54, Rm 239A, Maywood, IL, 60153, USA.
Jazyk: angličtina
Zdroj: World journal of urology [World J Urol] 2019 Nov; Vol. 37 (11), pp. 2523-2531. Date of Electronic Publication: 2019 Feb 27.
DOI: 10.1007/s00345-019-02702-0
Abstrakt: Purpose: We sought to determine the socioeconomic and patient factors that influence the utilization of urethroplasty and location of management in the treatment of male urethral stricture disease.
Methods: A retrospective review using the Healthcare Cost and Utilization Project State Inpatient and Ambulatory Surgery and Services Databases for California and Florida was performed. Adult men with a diagnosis of urethral stricture who underwent treatment with urethroplasty or endoscopic dilation/urethrotomy between 2007 and 2011 in California and 2009 and 2014 in Florida were identified by ICD-9 or CPT codes. Patients were categorized based on whether they had a urethroplasty or serial dilations/urethrotomies. Patients were assessed for age, insurance provider, median household income by zip code, Charlson Comorbidity Index, race, prior stricture management, and location of the index procedure. A multivariable logistic regression model was fit to assess factors influencing treatment modality (urethroplasty vs endoscopic management) and location (teaching hospital vs non-teaching hospital).
Results: Twenty seven thousand, five hundred and sixty-eight patients were identified that underwent treatment for USD. 25,864 (93.8%) treated via endoscopic approaches and 1704 (6.2%) treated with urethroplasty. Factors favoring utilization of urethroplasty include younger age, lower Charlson Comorbidity score, higher zip code median income quartile, private insurance, prior endoscopic treatment, and management at a teaching hospital.
Conclusion: Socioeconomic predictors of urethroplasty utilization include higher income status and private insurance. Patient-specific factors influencing urethroplasty were younger age and fewer medical comorbidities. A primary driver of urethroplasty utilization was treatment at a teaching hospital. Older and Hispanic patients were less likely to seek care at these facilities.
Databáze: MEDLINE
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