Objective: To report a single institutional experience with urethroplasty outcomes and success rates at long-term follow up. Methods: A retrospective review was carried out of all urethroplasties performed by a single surgeon from 2000 to 2010. A total of 347 patients underwent urethroplasty during this time period, of which 227 had minimum 1-year follow-up data available. Demographic, clinical, pathological and outcome data were reviewed. Recurrence was defined by patient reported urinary symptoms or need for subsequent intervention. Statistical analyses were carried out using SPSS statistical software. Results: A total of 26% of all patients had a recurrence at a mean follow up of 62 months (range 13-147 months). The recurrence rate after anastomotic urethroplasty was 18%, as compared with 31% after substitution urethroplasty. Mean time to recurrence was 34 months (range 5-87). On univariate analysis, use of abdominal skin graft, history of prior urethroplasty, lichen sclerosus and length of follow up were statistically significant predictors of recurrence. On multivariate analysis, only history of prior urethroplasty and length of follow-up time exceeding 48 months were statistically significant predictors of recurrence. Conclusions: Urethroplasty for urethral stricture is the most durable treatment modality, regardless of surgical approach. However, there is an ongoing risk of recurrence with the passage of time. Patients should be counseled appropriately on the potential for late recurrence of stricture disease after urethroplasty.

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INTRODUCTION AND OBJECTIVES:The ability to predict which emergency department patients are likely to have a ureteral stone is useful for efficiency and cost-effectiveness in evaluation, imaging, and patient care. We performed the initial external validation of the STONE Score, a clinical prediction rule for the presence of uncomplicated ureteral stones in emergency department patients which was developed at Yale University School of Medicine.METHODS: Five-hundred thirty eight (538) consecutive patients evaluated in an urban tertiary care emergency department for the possible diagnosis of ureteral stone were retrospectively reviewed. The STONE score uses 5 factors (gender, duration of pain, race, nausea/ vomiting, erythrocytes on urine dipstick) to categorize patients into LOW, MEDIUM, and HIGH probability of having a ureteral stone. The total stone risk score is 0-13, divided into 3 groups e 0-5 ¼ LOW risk, 6-9 ¼ MOD-ERATE risk, and 10-13 ¼ high risk. Table 1 shows the scoring system.RESULTS: Of the 538 patients evaluated for suspected ureteral stone, 257 (47.8%) had a ureteral stone. Mean patient age was 45.9 years (SD 16.3) and gender prevalence was 43.9% female:56.1% male. Distribution of STONE score risk was 24.1% LOW, 48.1% MODERATE, and 27.7% HIGH. Diagnosis of ureteral stone by STONE score risk was 14% for LOW risk group, 48.3% for MODERATE risk group, and 75.8% for HIGH risk group. This distribution is very similar to internal validation at Yale University School of Medicine, where values were as follows: 8.3-9.2% for LOW risk, 51.3-51.6% for MODERATE risk, and 88.6% for HIGH risk.CONCLUSIONS: This external validation demonstrates that the STONE score accurately predicts the presence of a ureteral stone in patients who present to the ED with suspect ureteral colic. Use of the STONE score in evaluation of these patients may allow clinicians to more efficiently evaluate and triage these patients in the future.

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