INTRODUCTION AND OBJECTIVES: Although urethral stricture disease (US) is a heterogeneous diagnosis with significant variability in urethral lumen diameter, it has typically been studied in a binary fashion (US present or not). We evaluated the effects of urethral strictures using a uniform, graded classification on urinary flow, patient symptoms, and management outcomes.METHODS: A prospectively maintained database of patients diagnosed with US was queried for pre-and postoperative voiding parameters. Urinary flow, post-void residual volume (PVR), and voiding symptom scores (VSS) were compared to luminal narrowing using a previously validated cystoscopic stricture staging system (Table ). Patients undergoing urethroplasty were evaluated for differences in voiding outcomes by preoperative stage and by type of procedure performed. Differences among groups were evaluated with non-parametric tests.RESULTS: Eighty-five patients were evaluated; highest stricture stage was stage 1 in 9 patients (10.6%), stage 2 in 14 (16.5%), stage 3 in 54 (63.5%), and stage 4 in 8 (9.4%). Treatment included urethral dilation in 6 (7.1%), urethrotomy in 13 (15.3%), excision and primary anastomosis (EPA) in 24 (28.2%), and buccal graft (BMG) urethroplasty in 28 (32.9%). Compared to lower stage US (stage 1 or 2), patients with stage 3 or 4 strictures had worse flow (median 6 v 10 ml/s, p¼0.048), higher VSS (7.5 v 0, p¼0.023), higher PVR (82 v 33 ml, p¼0.004), and greater postoperative improvement in flow (15 v 0 ml/s, p¼0.019). Higher preoperative stage was associated with greater postoperative flow (p¼0.028). Among patients with stage 3 strictures, those undergoing EPA and BMG urethroplasty had greater postoperative flow and improvement in flow than those undergoing urethrotomy or dilation (median improvement 19 and 20 v 3 ml/s, p¼0.001 and p¼0.006, respectively).CONCLUSIONS: Cystoscopic urethral stricture staging is a simple method to grade US to better reflect the heterogeneity of the disease and correlates well to urinary flow, post-void residual volume, and voiding symptom scores. Among patients undergoing urethroplasty, high preoperative stage is associated with greater improvement in postoperative urinary flow.
