December 6, 2025

Evaluation of urethral stricture score (USS) in predicting intraoperative complexity and postoperative outcome in anterior urethral stricture: An observational study

SVSmita VermaInstitute of Post Graduate Medical Education and Research DSDebansu SarkarInstitute of Post Graduate Medical Education and Research

Key Points

Recurrence rates correlate with higher urethral stricture scores, indicating more complex surgeries and increased postoperative complications.
The study found a mean surgery duration of 99.39 minutes, highlighting substantial time commitment based on the urethral stricture score.
Analysis of surgical techniques including optical internal urethrotomy, anastomotic urethroplasty, and buccal mucosal graft urethroplasty was undertaken during the evaluation.
Validating the urethral stricture score may enhance preoperative assessments and surgical planning for anterior urethral stricture.

Abstract

Introduction: Urethral stricture is common in men with anterior being more common. Number of surgical techniques are there for anterior urethral stricture depending upon location and extent of stricture. To compare one technique with another in terms of complexity, intra-op difficulty and recurrence, no standard scoring system is there. In order to quantify anterior urethral stricture disease, Weigand developed USS (UREThRAL Stricture Score) in 2012. This scoring system was based on preoperative imaging and intraoperative findings. This scoring system has not been accepted worldwide. The aim of this study is to evaluate the USS in predicting intraoperative complexity and postoperative outcome in anterior urethral stricture disease. Methods: This ambidirectional study included patients operated for anterior urethral stricture in our institute. USS score for each patient was calculated preoperatively. Patients underwent optical internal urethrotomy (OIU), anastomotic urethroplasty or buccal mucosal graft urethroplasty (BMG). Complexity of surgery (in terms of duration of surgery and need of blood transfusion) and postoperative outcome (post op complications and recurrence) was evaluated for association with USS score. Results: The study included 100 patients. Mean duration of surgery for overall study population was 99.39 ± 55.78 min with strong positive correlation of 0.76 ( p -value < 0.001) with USS. Subgroup analysis revealed significant association between USS and postoperative complications ( p -value 0.032) and recurrence of stricture ( p -value 0.003) in OIU patients. There was also showed that there was significant association between USS and time to recurrence in patients who underwent OIU ( p -value 0.007). Conclusion: Our study validates the USS in predicting complexity of surgery, postoperative complications and recurrence in anterior urethral stricture disease. Higher the USS, more complex is the surgery needed for anterior urethral stricture, more chances of postoperative complications and recurrence of stricture.

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