Mp06-08 Development of the Anterior Urethral Stricture Disease Staging With Clinical Validation Using a Patient-Centered Surgical Outcome Measure

You have accessJournal of UrologyReconstruction: Urethral Reconstruction (including stricture) I (MP06)1 May 2024MP06-08 DEVELOPMENT OF THE ANTERIOR URETHRAL STRICTURE DISEASE STAGING WITH CLINICAL VALIDATION USING A PATIENT-CENTERED SURGICAL OUTCOME MEASURE Mei N.E. Tuong, Charles Schlaepfer, Alithea Zorn, Jacob Oleson, Nejd Alsikafi, Benjamin Breyer, Joshua Broghammer, Jill Buckley, Sean Elliott, Shawn Grove, Jeremy Myers, Andrew Peterson, Keith Rourke, Thomas Smith, Alex Vanni, Bryan Voelzke, Lee Zhao, and Bradley Erickson Mei N.E. TuongMei N.E. Tuong , Charles SchlaepferCharles Schlaepfer , Alithea ZornAlithea Zorn , Jacob OlesonJacob Oleson , Nejd AlsikafiNejd Alsikafi , Benjamin BreyerBenjamin Breyer , Joshua BroghammerJoshua Broghammer , Jill BuckleyJill Buckley , Sean ElliottSean Elliott , Shawn GroveShawn Grove , Jeremy MyersJeremy Myers , Andrew PetersonAndrew Peterson , Keith RourkeKeith Rourke , Thomas SmithThomas Smith , Alex VanniAlex Vanni , Bryan VoelzkeBryan Voelzke , Lee ZhaoLee Zhao , and Bradley EricksonBradley Erickson View All Author Informationhttps://doi.org/10.1097/01.JU.0001009452.79331.fd.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: We created a staging system based on the Length Segment Etiology (LSE) classification published by the Trauma and Urologic Reconstruction Network of Surgeons (TURNS) where each stage/substage represents a unique subset of anterior urethral stricture disease (aUSD), inferring location, expected repair type, and surgical outcome. METHODS: Stage development adhered to the aUSD outcomes principles from prior TURNS work on this cohort of 2,396 patients using multivariate logistic regressions and Kaplan Meier curves: 1) penile > (have a higher functional recurrence rate than) bulbar strictures; 2) longer > shorter strictures; 3) adverse pathophysiology etiology (e.g. radiation) > trauma/idiopathic etiology. A novel patient-centered surgical outcome (PCSO) score was used for stage validation, which combined functional success (defined as no secondary repair; 2=success, 0=failure), meatus location (2=orthotopic, 1=penile, 0=perineal) and number of surgeries (2=single-stage, 0=multi-stage), into a single score (Range 0 to 6). Mean PCSO scores were compared to ensure substage ordering ranked from highest (best outcomes) to lowest. RESULTS: Five stages were ultimately created, summarized as follows: Stage 1: Short bulbar strictures; Stage 2: Long bulbar strictures; Stage 3: penile strictures of favorable etiology; Stage 4: penile strictures of adverse pathology and Stage 5: pan-urethral (three-segment) strictures. Stage/substage functional success outcomes are shown in the Table 1, broken down by single-stage orthotopic meatus repair (both anastomotic and substitution/graft) (percentage overall and functional success) 2) single-stage non-orthotopic (penile/perineal) meatus repairs and 3) multi-stage orthotopic meatus repairs. Mean PCSO showed a statistically significant (p<0.001) decline by stage. CONCLUSIONS: Each stage and substage of this novel LSE Staging System was shown to provide unique information on stricture characteristics, repair, and surgical outcomes. Similar to TNM staging in cancer, the LSE staging system will improve our ability to communicate stricture complexity/severity with our patients, and more easily organize aUSD for multi-institutional outcomes studies and clinical trial recruitment purposes. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e54 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Mei N.E. Tuong More articles by this author Charles Schlaepfer More articles by this author Alithea Zorn More articles by this author Jacob Oleson More articles by this author Nejd Alsikafi More articles by this author Benjamin Breyer More articles by this author Joshua Broghammer More articles by this author Jill Buckley More articles by this author Sean Elliott More articles by this author Shawn Grove More articles by this author Jeremy Myers More articles by this author Andrew Peterson More articles by this author Keith Rourke More articles by this author Thomas Smith More articles by this author Alex Vanni More articles by this author Bryan Voelzke More articles by this author Lee Zhao More articles by this author Bradley Erickson More articles by this author Expand All Advertisement PDF downloadLoading ...