Erickson Bradley A, Tuong Mei N, Zorn Alithea N, Schlaepfer Charles H, Alsikafi Nejd F, Breyer Benjamin N, Broghammer Joshua A, Buckley Jill C, Elliott Sean P, Myers Jeremy B, Peterson Andrew C, Rourke Keith F, Smith Thomas G, Vanni Alex J, Voelzke Bryan B, Zhao Lee C
Department of Urology, University of Iowa, Iowa City, Iowa.
Department of Urology, University of Virginia, Charlottesville, Virginia.
J Urol. 2025 Apr;213(4):512-523. doi: 10.1097/JU.0000000000004369. Epub 2024 Dec 9.
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.
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.
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.
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.
本研究的目的是基于先前验证的长度（L）、尿道节段（S）和病因（E；LSE）分类系统，创建并验证一种前尿道狭窄疾病（aUSD）分期系统。
利用外科医生创伤与泌尿外科重建网络（TURNS）前瞻性数据库创建并验证该分期系统。创建了一种新的尿道成形三联征评分，以帮助根据以下因素将分期按狭窄严重程度进行排序：（1）功能结果，（2）尿道口位置（如原位、会阴），以及（3）修复所需手术次数。在一个非TURNS数据集中对分期进行了二次验证，然后与之前描述的两种aUSD严重程度评分——U评分和LSE评分进行比较。
最终创建了五个aUSD分期，共10个亚分期：I期——短球部，II期——长球部，III期——病因良好的阴茎/尿道窝，IV期——病理不良的阴茎/尿道窝，V期——全尿道（三段）。随着每个亚分期的进展，尿道成形三联征平均评分降低（严重程度增加），这一线性趋势在单独的验证队列和个体TURNS中均得到验证。在预测多阶段手术需求或非原位尿道口方面，LSE分期优于LSE评分和U评分，在预测手术结果方面两者相似。
这种新的LSE分期系统的每个分期和亚分期都显示出能提供有关狭窄特征、修复和手术结果的独特信息。LSE分期系统将改善我们与患者关于狭窄复杂性/严重程度的沟通，并为多机构结果研究和临床试验招募目的对aUSD进行分类。
