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. 2025 Apr;213(4):512-523.
doi: 10.1097/JU.0000000000004369. Epub 2024 Dec 9.

Development and Validation of the Length, Segment, and Etiology Anterior Urethral Stricture Disease Staging System Using Longitudinal Urethroplasty Outcomes Data From the Trauma and Urologic Reconstructive Network of Surgeons

Bradley A Erickson  1 , Mei N Tuong  2 , Alithea N Zorn  3 , Charles H Schlaepfer  1 , Nejd F Alsikafi  4 , Benjamin N Breyer  5 , Joshua A Broghammer  6 , Jill C Buckley  7 , Sean P Elliott  8 , Jeremy B Myers  9 , Andrew C Peterson  10 , Keith F Rourke  11 , Thomas G Smith 3rd  1 , Alex J Vanni  12 , Bryan B Voelzke  13 , Lee C Zhao  14
Affiliations

Development and Validation of the Length, Segment, and Etiology Anterior Urethral Stricture Disease Staging System Using Longitudinal Urethroplasty Outcomes Data From the Trauma and Urologic Reconstructive Network of Surgeons

Bradley A Erickson et al. J Urol. 2025 Apr.

Abstract

Purpose: The purpose of this study was 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 and methods: The Trauma and Urologic Reconstructive Network of Surgeons (TURNS) prospective database was used to create and validate the staging system. A novel Urethroplasty Triad Score was created to aid in ranking the stagings into stricture severity based on (1) functional outcomes, (2) location of urethral meatus (eg, orthotopic, perineal), and (3) number of surgeries required for repair. Staging was secondarily validated in a non-TURNS dataset and then compared with 2 previously described aUSD severity scores-the U-score and the LSE score.

Results: Five aUSD stages, with 10 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, and stage V-pan-urethral (3-segment). Mean Urethroplasty Triad Score decreased (increasing severity) with each substage, with the linear trend being validated in both the separate validation cohort and within the individual TURNS. LSE staging was superior to the LSE score and U-score in predicting the need for multiple stages or a nonorthotopic 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.

Keywords: anterior urethral stricture disease; disease staging; surgical outcomes; urethroplasty.

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Comment in

  • Editorial Comment.
    Johnsen NV. Johnsen NV. J Urol. 2025 Apr;213(4):521. doi: 10.1097/JU.0000000000004390. Epub 2025 Jan 21. J Urol. 2025. PMID: 39836876 No abstract available.
  • Editorial Comment.
    Elyaguov J. Elyaguov J. J Urol. 2025 Apr;213(4):521-522. doi: 10.1097/JU.0000000000004391. Epub 2025 Jan 21. J Urol. 2025. PMID: 39836894 No abstract available.

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