Wright Jonathan L, Wessells Hunter, Nathens Avery B, Hollingworth Will
Department of Urology, Harborview Medical Center, University of Washington Medical Center, Seattle, Washington, USA.
Urology. 2006 May;67(5):889-93. doi: 10.1016/j.urology.2005.11.003.
Direct vision internal urethrotomy (DVIU) and urethroplasty are the primary methods of managing urethral stricture disease. Using decision analysis, we determine the cost-effectiveness of different management strategies for short, bulbar urethral strictures 1 to 2 cm in length.
A decision tree was constructed, with the number of planned possible DVIUs before attempting urethroplasty defined for each primary branch point. Success rates were obtained from published reports. Costs were estimated from a societal perspective and included the costs of the procedures and office visits and lost wages from convalescence. Sensitivity analyses were conducted, varying the success rates of the procedures and cost estimates.
The most cost-effective approach was one DVIU before urethroplasty. The incremental cost of performing a second DVIU before attempting urethroplasty was $141,962 for each additional successfully voiding patient. In the sensitivity analysis, urethroplasty as the primary therapy was cost-effective only when the expected success rate of the first DVIU was less than 35%.
The most cost-effective strategy for the management of short, bulbar urethral strictures is to reserve urethroplasty for patients in whom a single endoscopic attempt fails. For longer strictures for which the success rate of DVIU is expected to be less than 35%, urethroplasty as primary therapy is cost-effective. Future prospective, multicenter studies of DVIU and urethroplasty outcomes would help enhance the accuracy of our model.
直视下内尿道切开术（DVIU）和尿道成形术是治疗尿道狭窄疾病的主要方法。通过决策分析，我们确定了针对长度为1至2厘米的短段球部尿道狭窄的不同治疗策略的成本效益。
构建了一个决策树，为每个主要分支点定义了在尝试尿道成形术之前计划进行的DVIU次数。成功率来自已发表的报告。从社会角度估算成本，包括手术、门诊就诊费用以及康复期间的工资损失。进行了敏感性分析，改变了手术成功率和成本估算。
最具成本效益的方法是在尿道成形术之前进行一次DVIU。在尝试尿道成形术之前进行第二次DVIU的增量成本为每位额外成功排尿的患者141,962美元。在敏感性分析中，仅当第一次DVIU的预期成功率低于35%时，尿道成形术作为主要治疗方法才具有成本效益。
治疗短段球部尿道狭窄最具成本效益的策略是，对于单次内镜治疗失败的患者保留尿道成形术。对于预期DVIU成功率低于35%的较长狭窄，尿道成形术作为主要治疗方法具有成本效益。未来关于DVIU和尿道成形术结果的前瞻性、多中心研究将有助于提高我们模型的准确性。
