Skip to main content

Evaluation of the effect of urethroplasty for anterior urethral strictures by a validated disease-specific patient-reported outcome measure



To better understand our urethroplasty outcome, we translated the English version of a urethral stricture surgery patient-reported outcome measure (USS-PROM) into Japanese and used it to evaluate the effect of urethroplasty for anterior urethral strictures.


The PROM quantifies lower urinary tract symptoms (LUTS) and health-related quality of life (EQ-5D), and it evaluates overall satisfaction by asking patients to choose “very satisfied”, “satisfied”, “unsatisfied”, or “very unsatisfied”. 93 Japanese-speaking male patients with anterior urethral stricture who underwent urethroplasty completed it before (baseline) and 6 months after urethroplasty. The psychometric criteria evaluated in the present study were the PROM’s internal consistency, test–retest reliability, criterion validity, and responsiveness.


Qmax was negatively correlated with the LUTS-total scores (r = − 0.61). Cronbach’s alpha was 0.80 and the test–retest intraclass correlation coefficient for the LUTS-total score was 0.82. 83 patients (89.2%) achieved stricture-free, which was defined as no re-stricture on cystoscopy and no need for additional treatment. The mean total LUTS-score improved from 12.4 at baseline to 3.7 postoperatively (p < 0.0001). The mean EQ-5D visual analogue scores and EQ-5D index improved from 61.2 and 0.76, respectively, at baseline to 77.9 and 0.89 postoperatively (p < 0.0001, p < 0.0001). 55 patients (59.1%) were “very satisfied” with the outcome of their urethroplasty and 33 (35.5%) were “satisfied”.


The Japanese version of the USS-PROM has adequate psychometric properties. Urethroplasty improved not only objective data but also voiding symptoms and health-related QOL, and it resulted in a high rate of patient satisfaction.

This is a preview of subscription content, access via your institution.

Fig. 1


  1. Latini JM, McAninch JW, Brandes SB, Chung JY, Rosenstein D (2014) SIU/ICUD consultation on urethral strictures: epidemiology, etiology, anatomy, and nomenclature of urethral stenoses, strictures, and pelvic fracture urethral disruption injuries. Urology 83(3 Suppl):S1–S7.

    Article  PubMed  Google Scholar 

  2. Wessells H, Angermeier KW, Elliott S, Gonzalez CM, Kirkby E, Kodama R, Peterson AC, Reston J, Rourke K, Stoffel JT, Vanni AJ, Voelzke B, Zhao L, Santucci RA (2016) Male urethral stricture: AUA guideline. J Urol 197(1):182–190.

    Article  PubMed  Google Scholar 

  3. Morey AF, Watkin N, Shenfeld O, Eltahawy E, Giudice C (2014) SIU/ICUD consultation on urethral strictures: anterior urethra–primary anastomosis. Urology 83(3 Suppl):S23–S26.

    Article  PubMed  Google Scholar 

  4. Chapple C, Andrich D, Atala A, Barbagli G, Cavalcanti A, Kulkarni S, Mangera A, Nakajima Y (2014) SIU/ICUD consultation on urethral strictures: the management of anterior urethral stricture disease using substitution urethroplasty. Urology 83(3 Suppl):S31–S47.

    Article  PubMed  Google Scholar 

  5. Jackson MJ, Sciberras J, Mangera A, Brett A, Watkin N, N’Dow JMO, Chapple CR, Andrich DE, Pickard RS, Mundy AR (2011) Defining a patient-reported outcome measure for urethral stricture surgery. Eur Urol 60:60–68.

    Article  PubMed  Google Scholar 

  6. Barbagli G, Romano G, Sansalone S, Lazzeri M (2011) Italian validation of the English PROM-USS-Q questionnaire in patients undergoing anterior urethroplasty. Urologia 78(2):98–107.

    Article  PubMed  Google Scholar 

  7. Kluth LA, Dahlem R, Becker A, Schmid M, Soave A, Rosenbaum C, Ludwig TA, Christ N, Rink M, Reiss P, Engel O, Riechardt S, Chun FK, Fisch M, Ahyai SA (2016) Psychometric validation of a German language version of a PROM for urethral stricture surgery and preliminary testing of supplementary ED and UI constructs. World J Urol 34(3):369–375.

    Article  PubMed  Google Scholar 

  8. Verla W, Waterloos M, Lumen N (2017) Urethroplasty and quality of life: psychometric validation of a Dutch version of the urethral stricture surgery patient reported outcome measures. Urol Int 99(4):460–466.

    Article  PubMed  Google Scholar 

  9. Donovan JL, Abrams P, Peters TJ, Kay HE, Reynard J, Chapple C, De La Rosette JJ, Kondo A (1996) The ICS-’BPH’ study: the psychometric validity and reliability of the ICSmale questionnaire. Br J Urol 77(4):554–562

    Article  CAS  PubMed  Google Scholar 

  10. Donovan JL, Peters TJ, Abrams P, Brookes ST, Rosette JJ, Schafer W (2000) Scoring the short form ICSmaleSF questionnaire. Int Cont Soc J Urol 164(6):1948–1955

    CAS  Google Scholar 

  11. Peeling WB (1989) Diagnostic assessment of benign prostatic hyperplasia. Prostate 15(Suppl 2):51–68

    Article  Google Scholar 

  12. Hamashima C, Yoshida K (2001) A study of the reliability of health state valuations in the Japanese EuroQol instrument. Environ Health Prev Med 6(3):189–191.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Tsuchiya A, Ikeda S, Ikegami N, Nishimura S, Sakai I, Fukuda T, Hamashima C, Hisashige A, Tamura M (2002) Estimating an EQ-5D population value set: the case of Japan. Health Econ 11(4):341–353.

    Article  PubMed  Google Scholar 

  14. Meeks JJ, Erickson BA, Granieri MA, Gonzalez CM (2009) Stricture recurrence after urethroplasty: a systematic review. J Urol 182(4):1266–1270.

    Article  PubMed  Google Scholar 

  15. Blaschko SD, Sanford MT, Cinman NM, McAninch JW, Breyer BN (2013) De novo erectile dysfunction after anterior urethroplasty: a systematic review and meta-analysis. BJU Int 112(5):655–663.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Bertrand LA, Voelzke BB, Elliott SP, Myers JB, Breyer BN, Vanni AJ, McClung CD, Tam CA, Warren GJ, Erickson BA, Trauma and Urologic Reconstruction Network of Surgeons (2016) Measuring and predicting patient dissatisfaction after anterior urethroplasty using patient reported outcomes measures. J Urol 196(2):453–461.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Hampson LA, Elliott SP, Erickson BA, Vanni AJ, Myers JB, McClung C, Breyer BN, Smith TG 3rd, Hagedorn JC, Voelzke BB, Turns F (2016) Multicenter analysis of urinary urgency and urge incontinence in patients with anterior urethral stricture disease before and after urethroplasty. J Urol 196(6):1700–1705.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Osterberg EC, Schulster M, Blaivas JG, Maganty A, Lee DJ, Purohit RS (2016) Urethroplasty improves overactive bladder symptoms in men with anterior urethral strictures. Urology 93:208–212.

    Article  PubMed  Google Scholar 

  19. Maciejewski CC, Haines T, Rourke KF (2017) Chordee and penile shortening rather than voiding function are associated with patient dissatisfaction after urethroplasty. Urology 103:234–239.

    Article  PubMed  Google Scholar 

Download references


This study was supported by a grant for scientific research from the Ministry of Education, Science, Sports and Culture (16H05467). We have no financial interests to disclose.

Author information

Authors and Affiliations



AH: data collection, project development, data analysis, and manuscript writing. MS: data collection/analysis. KO, AM, KI, TA, ET, and FK: data collection. RA: data collection, project development, and manuscript editing.

Corresponding author

Correspondence to Akio Horiguchi.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

For this type of study, formal consent is not required.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Horiguchi, A., Shinchi, M., Ojima, K. et al. Evaluation of the effect of urethroplasty for anterior urethral strictures by a validated disease-specific patient-reported outcome measure. World J Urol 37, 601–606 (2019).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


  • Urethroplasty
  • Quality of life
  • Patient-reported outcome
  • Validation