Temporal Trends in the Management of Urethral Stricture Disease in Australia Over the 21st Century.

Abstract

Objective: To identify trends in the management and prevalence of urethral stricture disease in Australia over a period of two decades: METHODS: Databases related to urethral procedures between financial year (FY) 2000/01 and 2022/23 were sourced from Australian Institute of Health & Welfare and Medicare Benefits Scheme. The data include length of stay and procedure counts based on age, gender and procedure type. Nationwide subsidy burden was estimated from Service Australia data.

Results: Between FY2000/01 and 2022/23, there is a decreasing trend in urethral procedures performed. We observed a 9% increase in urethroplasty procedures and a 9% decrease in urethral dilatation procedures. Urethral procedures are commonly performed in 70-79 years old, though a rise in urethroplasty in younger patients over time was observed. The ratio of urethroplasty to endoscopic procedures has shifted from 1:13 to 1:5 in the last two decades. The estimated length of stay related to urethral procedures has reduced from 2.1 to 1.4 days. The nationwide subsidy burden between FY2002/03 and 2022/23 has increased from $23 113 to $26 825 per 100 000 persons.

Conclusion: Within the last two decades, there is a reduction in urethral procedures performed nationwide; however, among the procedures performed, we observed a rise in urethroplasty and reduction in dilatation procedures. We observed more urethral procedures performed in older males, with a notable increased uptake in urethroplasty in younger patients. This suggests that there is a shift to more sub-specialised reconstructive surgical techniques for the management of urethral stricture disease within Australia. Finally, the nationwide estimated subsidy burden has increased slightly.