Logo image
Back
MP06-08 DEVELOPMENT OF THE ANTERIOR URETHRAL STRICTURE DISEASE STAGING WITH CLINICAL VALIDATION USING A PATIENT-CENTERED SURGICAL OUTCOME MEASURE
Abstract   Peer reviewed

MP06-08 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, …
The Journal of urology, Vol.211(5S)
05/2024
DOI: 10.1097/01.JU.0001009452.79331.fd.08
url
https://escholarship.org/content/qt0350m5f0/qt0350m5f0.pdf?t=sj8lmeView
Open Access

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

Details

Metrics

12 Record Views
Logo image