Development and Validation of A Male Anterior Urethral Stricture Classification System

Erickson, Beth; Flynn, Kevin J.; Hahn, Amy; Cotter, Katherine; Alsikafi, Nejd F.; Breyer, Benjamin N.; Broghammer, Joshua A.; Buckley, Jill C.; Elliott, Sean P.; Myers, Jeremy B.; Peterson, Andrew C.; Rourke, Keith; Smith, Thomas G.; Vanni, Alex J.; Voelzke, Bryan B.; Zhao, Lee C.

doi:10.1016/j.urology.2020.03.072

Cited by 24 publications

(28 citation statements)

References 27 publications

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“…We categorized our cohort based on the new TURNS LSE classification system for anterior urethral strictures. 7 We evaluated patients with penile strictures not extending into the bulb, and also excluded those limited to the fossa navicularis/ meatus as well as those arising from hypospadias (S2b and S2c and excluding E5, Fig. 3).…”

Section: Discussionmentioning

confidence: 99%

“…The TURNS group has recently published a novel classification system for categorizing anterior urethral strictures. 7 These are subdivided into three parameters based on stricture LSE. The aim was to better standardize the nomenclature of the various disease processes and more precisely study each permutation of urethral stricture disease.…”

Section: Introductionmentioning

confidence: 99%

“…The TURNS group has recently published a novel classification system for categorizing anterior urethral strictures 7 . These are subdivided into three parameters based on stricture LSE.…”

Section: Introductionmentioning

confidence: 99%

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Multi‐institutional review of non‐hypospadiac penile urethral stricture management and outcomes

et al. 2022

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Penile urethral stricture disease not associated with hypospadias is rare, and there is a wide range of commonly used surgical repair techniques for this disease. We sought to compile a multi-institutional database of patients who had surgical correction of strictures in the penile urethra not limited to the meatus, and who had no history of hypospadias, for analysis using the Trauma and Urologic Reconstructive Network of Surgeons length, urethral segment and etiology classification system. Methods: A retrospective database from 13 institutions was compiled of patients who had undergone surgical correction of Trauma and Urologic Reconstructive Network of Surgeons length, urethral segment and etiology urethral stricture segments S2b/S2c and excluding E5, with a minimum follow-up time of 4 months. Failure was defined as cystoscopically confirmed recurrence of a stricture measuring less than 16-Fr. Results: We analyzed 222 patients with a median age of 57 years and a follow-up of 49 months. The overall surgical success rate was 80.2%. On multivariate analysis, the two variables identified that were predictive of surgical success were stricture length ≤2 cm as well as use of a buccal mucosa graft as compared to use of a fasciocutaneous flap, which had success rates of 83% and 52%, respectively (P = 0.0004). No statistically significant differences were found based on incisional approach or surgical technique, nor were outcomes different based on etiology or preoperative patient demographics. Conclusions: Surgical repair of penile urethral strictures of non-hypospadiac origin have a favorable overall success rate, at 80.2%. Regardless of incisional approach or surgical technique, all operations appear to have similar outcomes other than repairs using fasciocutaneous flap, which were statistically less successful than those using buccal mucosa graft.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Multi‐institutional review of non‐hypospadiac penile urethral stricture management and outcomes

et al. 2022

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“…Lastly, we evaluated the estimated probabilities of success according to a new validated anterior urethral stricture classification system. 9 Specifically, success estimates were compared according to stricture length (L; ≤2 cm, 2–7 cm, ≥7 cm), location (S; penile urethra, bulbar urethra and panurethral stricture involvement) and etiology (E; external trauma, idiopathic, iatrogenic—internal trauma [ie transurethral resection of the prostate], iatrogenic—radiation induced and infectious/inflammatory/lichen sclerosis [LS]). The goal was to determine whether success estimates by each definition decreased with higher LSE stages.…”

Section: Methodsmentioning

confidence: 99%

Defining Success after Anterior Urethroplasty: An Argument for a Universal Definition and Surveillance Protocol

et al. 2022

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Purpose:A successful urethroplasty has been defined in different ways across studies. This variety in the literature makes it difficult to compare success rates and techniques across studies. We aim to evaluate the success of anterior urethroplasty based on different definitions of success in a single cohort.Materials and Methods:Data were collected from a multi-institutional, prospectively maintained database. We included men undergoing first-time, single-stage, anterior urethroplasty between 2006 and 2020. Exclusion criteria included lack of followup, hypospadias, extended meatotomy, perineal urethrostomy, posterior urethroplasty and staged repairs. We compared 5 different ways to define a “failed” urethroplasty: 1) stricture retreatment, 2) anatomical recurrence on cystoscopy, 3) peak flow rate <15 ml/second, 4) weak stream on questionnaire and 5) failure by any of these measures. Kaplan-Meier survival curves were generated for each of the definitions. We also compared outcomes by stricture length, location and etiology.Results:A total of 712 men met inclusion criteria, including completion of all types of followup. The 1- and 5-year estimated probabilities of success were “retreatment,” 94% and 75%; “cystoscopy,” 88% and 71%; “uroflow,” 84% and 58%; “questionnaire,” 67% and 37%; and “any failure,” 57% and 23%. This pattern was inconsistent across stricture length, location and etiology.Conclusions:The estimated probability of success after first-time, anterior urethroplasty is highly dependent on the way success is defined. The variability in definitions in the literature has limited our ability to compare urethroplasty outcomes across studies.

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“…However, we absolutely agree that using internationally acknowledged staging systems might facilitate multi-institutional comparisons, first and foremost to evaluate the efficacy of different surgical techniques in discrete stricture cohorts. A great example is the recently developed LSE classification system based on stricture length (L), segment (S), and etiology (E) [4], which particularly accounts for a stricture in the segment of prior hypospadias repair and allows for organizing "[…] a heterogeneous condition […] that will improve our ability to study the disease process" [4].…”

Section: Dear Editormentioning

confidence: 99%

Nomenclature and treatment of secondary urethral strictures following primary hypospadias repair: weighing up academic principles and clinical pragmatism

et al. 2020

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Development and Validation of A Male Anterior Urethral Stricture Classification System

Cited by 24 publications

References 27 publications

Multi‐institutional review of non‐hypospadiac penile urethral stricture management and outcomes

Multi‐institutional review of non‐hypospadiac penile urethral stricture management and outcomes

Defining Success after Anterior Urethroplasty: An Argument for a Universal Definition and Surveillance Protocol

Nomenclature and treatment of secondary urethral strictures following primary hypospadias repair: weighing up academic principles and clinical pragmatism

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