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Classification systems for anterior urethral stricture disease in men: a systematic review

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Abstract

Objective

To identify and explore the various classification systems that have been proposed for anterior urethral stricture disease (AUSD) and to identify the advantages and disadvantages of each.

Methods

A comprehensive systematic review was conducted in MEDLINE, EMBASE, SCOPUS and COCHRANE databases with a search strategy created appropriately. Titles and abstracts of search results were screened by two authors and selected for full-text review. Studies exploring urethral stricture classification, clinical scoring or staging systems used in men over the age of 18 with benign anterior urethral stricture disease were included.

Results

The search identified 3113 articles, of which 10 were selected for inclusion after scrutiny. Four classification systems were identified. These include ULTRA score, urethral stricture score, cystoscopy-based staging system and Gombe Urethrographic score. These were based on various modalities, including cystoscopy, retrograde urethrogram (RUG) and sonourethrogram (SUG). From the scoring systems identified, the urethral stricture scoring system has multiple external validation studies and is predictive of operative complexity, operative time, recurrence and postoperative complications.

Conclusions

Several classification systems have been proposed for AUSD. Each has its advantages and disadvantages. The urethral stricture score has been externally validated and shown to been predictive of surgical outcomes and recurrence. There are no scores that incorporate patient-related outcome measures (PROMs). Many classification systems have yet to provide sufficient external validation. Further external validation studies are needed before the general adoption of a particular system.

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References

  1. Jackson MJ, Sciberras J, Mangera A et al (2011) Defining a patient-reported outcome measure for urethral stricture surgery. Eur Urol 60(1):60–68

    Article  Google Scholar 

  2. Popay J, Roberts H, Sowden A et al (2006) Guidance on the conduct of narrative synthesis in systematic reviews. ESRC 1:b92

    Google Scholar 

  3. Wells G, Shea B, O’Connell D et al (2000) The Newcastle-Ottawa scale (NOS) for assessing the quality of non-randomized studies in meta-analysis. Ann Int Med 12(2):1

    Google Scholar 

  4. Chen L, Hou R, Feng C et al (2017) Establishment of the ULTRA measurement rating system for anterior urethral stricture. Int urol nephrol 49(7):1201–1207

    Article  CAS  Google Scholar 

  5. Mandhani A, Chaudhury H, Kapoor R, Srivastava A, Dubey D, Kumar A (2005) Can outcome of internal urethrotomy for short segment bulbar urethral stricture be predicted? J urol 173(5):1595–1597

    Article  Google Scholar 

  6. Belsante MJ, Selph JP, Peterson AC (2015) The contemporary management of urethral strictures in men resulting from lichen sclerosus. Trans Androl Urolo 4(1):22–28

    Google Scholar 

  7. Wiegand LR, Brandes Dr SB (2012) The UREThRAL stricture score: A novel method for describing anterior urethral strictures. J Can Urol Ass 6(4):260–264

    Article  Google Scholar 

  8. Mathur R, Patil LA, Khan F (2016) Evaluating efficacy of various operative procedures done in anterior urethral stricture using urethral stricture score. Urol Ann 8(1):42–45

    Article  CAS  Google Scholar 

  9. Eswara JR, Han J, Raup VT et al (2015) Refinement and validation of the urethral stricture score in categorizing anterior urethral stricture complexity. Urol 85(2):474–477

    Article  Google Scholar 

  10. Alwaal A, Sanford TH, Harris CR, Osterberg EC, McAninch JW, Breyer BN (2016) Urethral stricture score is associated with anterior urethroplasty complexity and outcome. J urol 195(6):1817–1821

    Article  Google Scholar 

  11. Mitsui Y, Kobayashi H, Hori S, Iwai H, Nakajima K, Nagao K (2018) U-score system for predicting time to recurrence after urethral reconstruction in patients with anterior urethral stricture. Int J Urol Jpn Ass 25(12):1015–1016

    Article  Google Scholar 

  12. Purohit RS, Blaivas JG, Weinberger JM, Deibert CM (2014) A new staging system for anterior urethral strictures. Urol Prac 1(1):35–39

    Article  Google Scholar 

  13. Purohit RS, Golan R, Copeli F et al (2017) Natural History of low-stage urethral strictures. Urology 108:180–183

    Article  Google Scholar 

  14. Ahidjo A, Abdulkadir AY, Gadams IA, Saad ST (2012) Evaluation of radiographic pattern of male urethral strictures in Nigeria: a preliminary report of a proposed new scoring system for developing countries. Iran J Radiol Soc 9(1):60–62

    Article  Google Scholar 

  15. Levine LA, Strom KH, Lux MM (2007) Buccal mucosa graft urethroplasty for anterior urethral stricture repair: evaluation of the impact of stricture location and lichen sclerosus on surgical outcome. J Urol 178(5):2011–2015

    Article  Google Scholar 

  16. Kinnaird AS, Levine MA, Ambati D, Zorn JD, Rourke KF (2014) Stricture length and etiology as preoperative independent predictors of recurrence after urethroplasty: a multivariate analysis of 604 urethroplasties. J Can Urol Ass 8(5–6):e296–e300

    Article  Google Scholar 

  17. Gupta N, Dubey D, Mandhani A, Srivastava A, Kapoor R, Kumar A (2006) Urethral stricture assessment: a prospective study evaluating urethral ultrasonography and conventional radiological studies. BJU Int 98(1):149–153

    Article  Google Scholar 

  18. Ravikumar BR, Tejus C, Madappa KM, Prashant D, Dhayanand GS (2015) A comparative study of ascending urethrogram and sono-urethrogram in the evaluation of stricture urethra. Int J Urol Braz Soc Urol 41(2):388–392

    Article  CAS  Google Scholar 

  19. Horiguchi A, Shinchi M, Masunaga A, Ito K, Asano T, Azuma R (2018) Do transurethral treatments increase the complexity of urethral strictures? J urol 199(2):508–514

    Article  Google Scholar 

  20. Harraz AM, El-Assmy A, Mahmoud O et al (2015) Is there a way to predict failure after direct vision internal urethrotomy for single and short bulbar urethral strictures? Arab J Urol 13(4):277–281

    Article  Google Scholar 

  21. Tolkach Y, Herrmann T, Merseburger A et al (2016) Development of a clinical algorithm for treating urethral strictures based on a large retrospective single-center cohort. F1000Research 5:23–78

    Article  Google Scholar 

  22. Kulkarni SB, Joglekar OV, Alkandari M, Joshi PM (2018) Algorithm for the management of anterior urethral strictures. Turk J urol 44(3):195–197

    Article  Google Scholar 

  23. Holzhauer C, Roelofs AW, Kums AC, Weijerman PC, van Balken MR (2018) Is the laser mightier than the sword? A comparative study for the urethrotomy. World J Urol 36(4):663–666

    Article  Google Scholar 

  24. Krebs J, Wöllner J, Pannek J (2015) Urethral strictures in men with neurogenic lower urinary tract dysfunction using intermittent catheterization for bladder evacuation. Spinal Cord 53(4):310–313

    Article  CAS  Google Scholar 

  25. Chaitanya S, Kumar N, Satish B, Manoj B, Reddy K (2018) Codifying Anterior Urethral Strictures with UREThRAL Stricture Score. Int J Contemp Med Res 5

  26. Dinerman BF, Hauser NJ, Hu JC, Purohit RS (2017) Robotic-assisted abdomino-perineal vesicourethral anastomotic reconstruction for 45 centimeter post-prostatectomy stricture. Urol Rep 14:1–2

    Article  Google Scholar 

  27. Kalabhavi S, Jayaram S, Nagaraja NH et al (2018) Role of sonourethrogram in evaluation of anterior urethral stricture and its correlation with retrograde urethrogram and intraoperative findings-a prospective study. J Clin Diagn Res 12(8):1–4

    Google Scholar 

  28. Choudhary S, Singh P, Sundar E, Kumar S, Sahai A (2004) A comparison of sonourethrography and retrograde urethrography in evaluation of anterior urethral strictures. Clin Radiol 59(8):736–742

    Article  CAS  Google Scholar 

  29. Tao W, Bai G, Fu G, Niu X, Wang H, Wang G (2019) MR urethrography versus X-ray urethrography compared with operative findings for the evaluation of urethral strictures. Int Urol Nephrol 51(7):1137–1143

    Article  Google Scholar 

  30. El-Ghar MA, Osman Y, Elbaz E, Refiae H, El-Diasty T (2010) MR urethrogram versus combined retrograde urethrogram and sonourethrography in diagnosis of urethral stricture. Eur J Radiol 74(3):e193–198

    Article  Google Scholar 

  31. Jackson MJ, Chaudhury I, Mangera A et al (2013) A prospective patient-centred evaluation of urethroplasty for anterior urethral stricture using a validated patient-reported outcome measure. Eur Urol 64(5):777–782

    Article  Google Scholar 

  32. Baradaran N, Hampson LA, Edwards TC, Voelzke BB, Breyer BN (2018) Patient-reported outcome measures in urethral reconstruction. Curr urol Rep 19(7):12

    Article  Google Scholar 

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Funding

The authors did not receive any financial sponsorship for the review.

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Authors and Affiliations

  1. Adelaide Medical School, University of Adelaide, Adelaide, SA, 5005, Australia

    Athul John & Arman A. Kahokehr

  2. Flinders University, Adelaide, Australia

    Arman A. Kahokehr

Authors
  1. Athul John
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  2. Arman A. Kahokehr
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Contributions

AJ-Protocol development, data collection and management (screening articles), data analysis, manuscript writing/editing. AK-Protocol development, data management (screening articles), manuscript writing/editing.

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Correspondence to Athul John.

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John, A., Kahokehr, A.A. Classification systems for anterior urethral stricture disease in men: a systematic review. World J Urol 39, 761–769 (2021). https://doi.org/10.1007/s00345-020-03250-8

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  • DOI: https://doi.org/10.1007/s00345-020-03250-8

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