Citation
Erickson BA, Flynn KJ, Hahn AE, Cotter K, Alsikafi NF, Breyer BN, Broghammer JA, Buckley JC, Elliott SP, Myers JB, Peterson AC, Rourke KF, Smith TG 3rd, Vanni AJ, Voelzke BB, Zhao LC; Trauma and Urologic Reconstruction Network of Surgeons (TURNS). Development and Validation of a Male Anterior Urethral Stricture Classification System. Urology. 2020 Jun 21:S0090-4295(20)30719-6. doi: 10.1016/j.urology.2020.03.072. Online ahead of print.
Abstract
To develop and validate a clinical classification system for urethral stricture disease (USD) based on the retrograde urethrogram (RUG), physical exam, and stricture-specific patient history. Three elements were chosen to be included in the classification system: 1) Length of urethral stricture (L); 2) Stricture segment/location (S); 3) Stricture Etiology (E) (LSE classification system). Each element was divided into clinically relevant sub-categories. A three-step development and validation process then ensued, culminating in an in-person Trauma and Urologic Reconstruction Network of Surgeons (TURNS) meeting, at which the final classification system was unanimously agreed upon by attendees based on interrater reliability data obtained from the classifying of 22 clinical vignettes. A final validation step involved retrospectively classifying cases in the TURNS database to determine if classification influenced surgical technique and was associated with presumed stricture etiology. The final LSE classification system was found to have an interrater reliability of 0.79 (individual components 0.76, 0.70 and 0.93 respectfully). Retrospective classification of the 2162 TURNS strictures revealed the segment (S) to be strongly associated with urethroplasty type (p = 0.0005) and stricture etiology (E) (p = 0.0005). We developed and validated a novel, easy to use, urethral stricture classification system. The system's ability to aid in directing treatments, predict treatment outcomes, and facilitate collaborative research efforts will require further study.
Key Points
- Published in Urology in 2020.
- Indexed in PubMed as PMID 32580016.
- Mapped to Urethral Stricture & Urethroplasty, Trauma & Fistula, Outcomes, Methods & Education.
- Abstract available from PubMed and rendered as static text on this page.
Clinical Relevance
This article contributes to the urethral stricture and urethroplasty literature, with emphasis on staging, reconstruction, definitions of success, and long-term functional outcomes.