The UREThRAL stricture score: A novel method for describing

Abstract

Background: Urethral stricture description is not standardized. Thismakes surgical decision-making less reproducible and increasesthe difficulty of objectively analyzing urethroplasty literature. Wedeveloped a standardized system, the UREThRAL stricture score(USS), to quantify the characteristics of anterior urethral stricturedisease based on preoperative imaging and intraoperative findings.Methods: To develop the USS, we retrospectively analyzed 95consecutive patients with urethral strictures who underwent openurethroplasty by a single surgeon (SBB) at Barnes-Jewish Hospitalfrom 2009 to 2011. The USS is a numerical score based on fivecomponents of anterior urethral stricture disease that help dictateoperative decision-making: (1) (UR)ethral stricture (E)tiology; (2) (T)otal number of strictures; (3) (R)etention (luminal obliteration); (4)(A)natomic location; and (5) (L)ength. Stricture management wascategorized by increasing surgical complexity: excision/primaryanastomosis (EPA), buccal mucosal graft urethroplasty (BMG), augmented anastomotic urethroplasty (AAU), flap urethroplasty, and acombination of flaps and/or grafts. Multinomial logistic regressionanalysis was used to compare USS to surgical complexity.Results: The mean USS for EPA, BMG, AAU, flap, and combinationflaps/grafts was 5.78, 8.82, 9.23, 11.01, and 14.97, respectively.Increasing USS was significantly associated with surgical complexity(p < 0.0001).Interpretation: The USS describes the essential factors in determiningsurgical treatment selection for urethral stricture disease.The USS is a concise, easily applicable system that delineates theclinically significant features of urethral strictures. Valuable comparison of anterior urethral stricture treatments in clinical practiceand in the urological literature could be facilitated by using this novel UREThRAL stricture score.