The UREThRAL stricture score: A novel method for describing
DOI:
https://doi.org/10.5489/cuaj.294Abstract
Background: Urethral stricture description is not standardized. This
makes surgical decision-making less reproducible and increases
the difficulty of objectively analyzing urethroplasty literature. We
developed a standardized system, the UREThRAL stricture score
(USS), to quantify the characteristics of anterior urethral stricture
disease based on preoperative imaging and intraoperative findings.
Methods: To develop the USS, we retrospectively analyzed 95
consecutive patients with urethral strictures who underwent open
urethroplasty by a single surgeon (SBB) at Barnes-Jewish Hospital
from 2009 to 2011. The USS is a numerical score based on five
components of anterior urethral stricture disease that help dictate
operative 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 was
categorized by increasing surgical complexity: excision/primary
anastomosis (EPA), buccal mucosal graft urethroplasty (BMG), augmented anastomotic urethroplasty (AAU), flap urethroplasty, and a
combination of flaps and/or grafts. Multinomial logistic regression
analysis was used to compare USS to surgical complexity.
Results: The mean USS for EPA, BMG, AAU, flap, and combination
flaps/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 determining
surgical treatment selection for urethral stricture disease.
The USS is a concise, easily applicable system that delineates the
clinically significant features of urethral strictures. Valuable comparison of anterior urethral stricture treatments in clinical practice
and in the urological literature could be facilitated by using this novel UREThRAL stricture score.
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