title: Refinement and validation of the urethral stricture score in categorizing anterior urethral stricture complexity.
abstract: OBJECTIVE
  To update, simplify, and validate the UREThRAL Stricture Score (now called the U-score) for anterior urethral strictures, with the goal of using this system as a predictor of surgical complexity.
  
  
  METHODS
  This is a retrospective review of 102 patients (test set) who underwent anterior urethroplasty at Barnes-Jewish Hospital from 2009 to 2012 and a validation set of 96 patients from Northwestern University. The U-score was based on length (1-3 points), stricture number (1-2 points), location (1-2 points), and etiology (1-2 points) for a total ranging from 4 to 9. Excision and primary anastomosis, buccal mucosal graft, and augmented anterior urethroplasty were classified as low complexity, and double buccal mucosal graft, flap, or flap-graft combo were classified as high complexity. Operative time and estimated blood loss were used as surrogates of surgical complexity.
  
  
  RESULTS
  Mean U-score for low-complexity surgeries was 5.2 and for high complexity surgeries was 7.3. Factors that were associated with high-complexity repairs included stricture etiology (trauma or idiopathic or iatrogenic vs inflammatory or hypospadias; P ≤.0001), number (1 vs. >1; P = .003), location (penile vs. bulbar; P <.001), and length (<2 vs. 2-5 vs. >5 cm; P <.001). Increasing U-score correlated with increasing surgical complexity (P ≤.0001). A linear relationship between U-score and operative time was observed (P = .0018). U-score did not correlate with estimated blood loss (P = .82). Among the validation data set, etiology (P = .0014), location (P ≤.0001), stricture length (P ≤.0001), and overall U-score (P ≤.0001) correlated with surgical complexity.
  
  
  CONCLUSIONS
  The U-score is a validated scale to describe the complexity of anterior urethral strictures that correlates with surgical time and complexity of procedure.
authors.affiliation: Division of Urology, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. Electronic address: jeswara@partners.org.
authors.forename: Jairam R
authors.initials: JR
authors.lastname: Eswara
authors.affiliation: Department of Urology, Northwestern University School of Medicine, Chicago, IL.
authors.forename: Justin
authors.initials: J
authors.lastname: Han
authors.affiliation: Division of Urologic Surgery, Department of Surgery, Barnes-Jewish Hospital, Washington University School of Medicine.
authors.forename: Valary T
authors.initials: VT
authors.lastname: Raup
authors.affiliation: Department of Urology, Northwestern University School of Medicine, Chicago, IL.
authors.forename: Elodi
authors.initials: E
authors.lastname: Dielubanza
authors.affiliation: Department of Urology, Northwestern University School of Medicine, Chicago, IL.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Gonzalez
authors.affiliation: Division of Urologic Surgery, Department of Surgery, Barnes-Jewish Hospital, Washington University School of Medicine.
authors.forename: Joel M
authors.initials: JM
authors.lastname: Vetter
authors.affiliation: Division of Urologic Surgery, Department of Surgery, Barnes-Jewish Hospital, Washington University School of Medicine.
authors.forename: Steven B
authors.initials: SB
authors.lastname: Brandes
mesh_terms: D000328:Adult; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014525:Urethral Stricture / Q000473:pathology* / Q000601:surgery; D013521:Urologic Surgical Procedures, Male / Q000379:methods