272 Socioeconomic Factors Influence the Utilization of Urethroplasty in the Treatment of Male Urethral Stricture Disease

Male urethral stricture disease is a commonly encountered urologic condition. Treatment options include endoscopic approaches versus urethroplasty. Previously identified provider-level barriers to urethroplasty utilization include access to a reconstructive surgeon, geographic disparities in care, and provider concerns regarding complications. We sought to determine patient related and socioeconomic factors influencing urethroplasty utilization compared to endoscopic management. 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 urethroplasty or endoscopic dilation/urethrotomy between 2007-2011 for California and 2009-2014 for Florida were identified by ICD-9 or CPT codes. Patients were assessed for age, insurance provider, median household income, Charlson comorbidity index, race, and number of endoscopic procedures. A stepwise multivariate analysis model was fit to assess factors influencing treatment modality (urethroplasty vs. endoscopic management). 27,641 patients were identified who underwent treatment for urethral stricture disease. 1,692 underwent urethroplasty (6.1%). Factors favoring utilization of urethroplasty include younger age, lower Charlson comorbidity score, higher income quartile, and increased number of endoscopic treatments (Figure 1). Hispanics were more likely to undergo endoscopic management compared to Caucasians.