AB165. Referral patterns for urethral reconstruction surgery in Ireland—implications for service planning and provision

Background: Urethral reconstruction is a complex sub-specialty procedure, performed in a limited number of units in Ireland. The additional caseload comprised by provision of a national sub-specialty service places significant pressures on delivery of normal day-to-day services. We report the referral patterns of patients to the urethral reconstruction service in the Mater Misericordiae University Hospital (MMUH) over a 14-year period.

Methods: All patients undergoing urethroplasty in MMUH between 2005 and 2019 were identified from the hospital electronic operative record system. Medical records were reviewed and patient home address and referral source recorded. Referral origins were then grouped by Community Healthcare Organisation (CHO) and HSE Hospital Group.

Results: A total of 279 patients underwent urethroplasty at MMUH under the care of a single surgeon between 2005 and 2018. Referrals were received from patients living 25 counties in Ireland. 15.4% of patients’ home address at time of referral was within the local CHO (CHO 9 – Dublin North). Where patients were referred from other hospitals, 14.96% came from the primary hospital grouping (Ireland East), with 78.14% from other hospital groups and 6.9% from private hospitals. The overall workload relating to these patients is in fact significantly larger, as many also undergo preliminary investigations and procedures such as urethrography and urethral dilation/urethrotomy.

Conclusions: Provision of sub-specialty care places a significant demand on a service, with the majority of patients being referred from alternative catchment areas. We advocate the need for national frameworks and networks to facilitate provision of these services, without placing undue burden on day to day working.

Keywords: Urethral reconstruction; service planning; sub-speciality care