The prevalence of urethral stricture is estimated at 0.9%. American, European and French recommendations have reduced the place of endoscopic treatments due to their poor outcomes, especially in the case of repeated procedures. Urethroplasty is the new reference treatment for urethral stricture. Our aim was to assess the evolution of national practices from 2013 to 2022.
We collected national CCAM coding data for all procedures involving urethral stricture surgery using the Scansanté internet platform produced by the Technical Agency for Information on Hospitalization, which prospectively collects all procedures coded according to CCAM coding from public, liberal and ESPIC healthcare structures.
The overall number of urethral surgical procedures has been steadily inceasing over the past 10 years. Endoscopic procedures remain largely predominant in 2022, totaling 23982, but have remained stable over the decade. Urethroplasties have been on the rise since 2019, reaching 1,600 cases in 2022 compared with 1,100 cases in 2020. Although urethrotomies currently outnumber urethroplasties by a factor of 10, this ratio has been consistently decreasing since 2016. The most significant contributor to the 10-year increase is urethroplasty by augmentation, particularly free flap techniques on the anterior urethra. Resection-anastomosis and urethrostomy techniques have remained stable.
In 2022, endoscopic treatments remain by far the majority, but urethroplasties are on the increase. A significant number of patients can benefit from initial endoscopic treatment because short bulbar localization is the most common presentation, but long-term success rates are poor compared to urethroplasty, which boasts approximately 80% success rates. Urethroplasty should no longer be considered a last-resort surgery but rather a reference technique in treating urethral stricture.
The French journal of urology. 2024 Oct 09 [Epub ahead of print]
Nicolas Couteau, Paul Neuville, Aurelie Schirmann, Amelie Bazinet, Cyrille Guillot-Tantay, Bernard Boillot, Sylvia Weis, Thierry Lebret, Francois-Xavier Madec
Urology Department, Foch Hospital, Suresnes, France., Urology Department, Lyon Sud Hospital, Lyon, France., Urology Department, Grenoble University Hospital, Grenoble, France; Department of Urology, University of Montreal, Maisonneuve-Rosemont Hospital, Montreal, Canada., Urology Department, Grenoble University Hospital, Grenoble, France., Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany., Urology Department, Foch Hospital, Suresnes, France. Electronic address: .