To create and validate an anterior urethral stricture disease (aUSD) staging system based on the previously validated Length (L), Urethral Segment (S), and Etiology (E, LSE) classification system.
The Trauma and Urologic Reconstruction Network of Surgeons (TURNS) prospective database was used to create and validate the staging system. A novel Urethroplasty Triad Score (UTS) was created to aid in ranking the stagings into stricture severity based on 1) functional outcomes, 2) location of urethral meatus (e.g. orthotopic, perineal) and 3) number of surgeries required for repair. Staging was secondarily validated in a non-TURNS dataset and then compared to two previously described aUSD severity scores - the U-score and the LSE score.
Five aUSD stages, with ten total substages, were ultimately created: Stage I - Short bulbar; Stage II - Long bulbar; Stage III - Penile/Fossa of favorable etiology; Stage IV - Penile/Fossa of adverse pathology; Stage V - Pan-urethral (three-segment). Mean UTS decreased (increasing severity) with each substage, with the linear trend being validated in both the separate validation cohort and within the individual TURNS surgeons. LSE staging was superior to the LSE score and U-score in predicting the need for multiple stages or a non-orthotopic meatus and was similar in predicting surgical outcomes.
Each stage and substage of this novel LSE Staging System was shown to provide unique information on stricture characteristics, repairs, and surgical outcomes. The LSE staging system will improve communication of stricture complexity/severity with our patients and organize aUSD for multi-institutional outcomes studies and clinical trial recruitment purposes.
The Journal of urology. 2024 Dec 09 [Epub ahead of print]
Bradley A Erickson, Mei N Tuong, Alithea N Zorn, Charles H Schlaepfer, Nejd F Alsikafi, Benjamin N Breyer, Joshua A Broghammer, Jill C Buckley, Sean P Elliott, Jeremy B Myers, Andrew C Peterson, Keith F Rourke, Thomas G Smith, Alex J Vanni, Bryan B Voelzke, Lee C Zhao
University of Iowa, Department of Urology, Iowa City, IA., University of Virginia, Department of Urology, Charlottesville, VA., University of Iowa, Department of Biostatistics, Iowa City, IA., Uropartners, Gurnee, IL., University of California, San Francisco, Department of Urology and Epidemiology and Biostatistics, San Francisco, CA., University of Kansas, Department of Urology., University of California, San Diego, Department of Urology, San Diego, CA., University of Minnesota, Department of Urology, Minneapolis, MN., University of Utah, Division of Urology, Salt Lake City, UT., Duke University, Division of Urology., University of Alberta, Department of Urology, Edmonton, Alberta., MD Anderson Cancer Center, Department of Urology Houston, TX., Lahey Hospital and Medical Center, Department of Urology, Burlington, MA., Spokane Urology, Spokane, WA., New York University, Department of Urology, New York, NY.