Four experts will debate the merits of invasive testing when monitoring patients for recurrence following surgical treatment of urethral stricture during a Monday morning Controversies in Urology session on Reconstruction. The 30-minute debate begins at 8:30 am during the Prime Time plenary session in the Esplanade Ballroom at Moscone South.
Moderator Sean Elliott, MD, MS, FACS, the Cloverfields Professor and Vice Chair of Urology at the University of Minnesota, said evaluating outcomes after urethral stricture surgery is similar to a urologists’ debate about prostate cancer screening.
“How aggressive do you want to be in finding a recurrence early after urethral stricture surgery? I think attendees will hear the debaters arguing against invasive testing say that, unlike prostate cancer, urethral stricture is a quality of life disease. This is not a life or death disease,” Dr. Elliott said.
Bradley Erickson, MD, MS, FACS, associate professor at the University of Iowa, and Benjamin Breyer, MD, MAS, FACS, associate professor of Urology and Epidemiology & Biostatistics at the University of California, San Francisco, will make the case against invasive testing. They will question whether it can demonstrate that managing recurrences early improves a man’s satisfaction with urethral stricture surgery.
“If there are quality of life issues with the surgery, can’t the man tell you when he’s symptomatic enough that he needs re-treatment?” Dr. Elliott asked. “Because, unlike prostate cancer, we don’t know if treating a minor recurrence of his stricture makes any difference in his long-term happiness.”
Jill Buckley, MD, associate professor at the University of California, San Diego, and Keith Rourke, MD, FRCSC, professor of Urology at the University of Alberta in Edmonton, Canada, will argue that early detection of urethral stricture recurrence has benefits for the patient and the profession.
“Drs. Buckley and Rourke will likely make the case that detecting recurrences early allows clinicians to begin to manage them early, before they progress,” Dr. Elliott said. “They will argue that early detection gives you some lead time, and that lead time will help you achieve better outcomes in the long term.”
Additionally, invasive testing following urethral stricture surgery may have implications for advancing the practice.
“If you rely solely on patient reported outcomes to determine the success rates for urethral stricture procedures, the data will show a very high success rate,” Dr. Elliott said. “If you measure patients’ flow rates, it will be almost as high of a success rate. If you measure their recurrence rate with invasive testing, the success rate is going to be lower. It’s a more sensitive test.”
Dr. Elliott said Drs. Buckley and Rourke will argue that, in order to advance the field of urethral stricture surgery, comparison data are needed to determine which procedures have better outcomes, and more sensitive tests are needed to get that data.
“If every procedure has a 95 percent success based on patient reported outcome measures, how can you really compare two surgeries? Everything looks grand,” Dr. Elliott said. “Using invasive testing may provide a better understanding of the outcomes of our urethral stricture surgeries.”
Dr. Elliott said he hopes Monday’s debate attracts a large crowd because all urologists deal with urethral strictures, even if not all perform urethroplasty.
“We all need to know the best way to evaluate outcomes after urethral stricture surgery,” he said.