Development and Validation of the Length, Segment, and Etiology (LSE) Anterior Urethral Stricture Disease Staging System Using Longitudinal Urethroplasty Outcomes Data from the Trauma and Urologic Reconstruction Network of Surgeons

Abstract

Purpose: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.Materials/Methods: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.Results: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.Conclusions: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.