PURPOSE 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/METHODS The Trauma and Urologic Reconstruction Network of Surgeons (TURNS) prospective database was used to create and validate the staging system. A novel Urethroplasty Triad Score (UTS) was created to aid in ranking the stagings into stricture severity based on 1) functional outcomes, 2) location of urethral meatus (e.g. orthotopic, perineal) and 3) number of surgeries required for repair. Staging was secondarily validated in a non-TURNS dataset and then compared to two previously described aUSD severity scores - the U-score and the LSE score. RESULTS Five aUSD stages, with ten 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; Stage V - Pan-urethral (three-segment). Mean UTS decreased (increasing severity) with each substage, with the linear trend being validated in both the separate validation cohort and within the individual TURNS surgeons. LSE staging was superior to the LSE score and U-score in predicting the need for multiple stages or a non-orthotopic 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.

中文翻译：

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使用来自外科医生创伤和泌尿外科重建网络的纵向尿道成形术结果数据开发和验证长度、节段和病因学 （LSE） 前尿道狭窄疾病分期系统。


目的 根据先前验证的长度 （L）、尿道节段 （S） 和病因学 （E， LSE） 分类系统创建和验证前尿道狭窄疾病 （aUSD） 分期系统。材料/方法 使用外科医生创伤和泌尿外科重建网络 （TURNS） 前瞻性数据库来创建和验证分期系统。创建了一个新的尿道成形术三联征评分 （UTS），以帮助根据 1） 功能结果，2） 尿道口的位置（例如 原位、会阴）和 3） 修复所需的手术次数。在非 TURNS 数据集中对分期进行了二次验证，然后与之前描述的两个 aUSD 严重性评分 - U 评分和 LSE 评分进行了比较。结果 最终创建了 5 个 aUSD 阶段，总共有 10 个子阶段： 第一阶段 - 短延髓;II 期 - 长延髓;III 期 - 病因良好的/颅窝;IV 期 - 不良病理的/颅窝;V 期 - 全尿道（三段）。平均 UTS 随着每个子阶段的减少（严重程度增加），线性趋势在单独的验证队列和单个 TURNS 外科医生中得到验证。LSE 分期在预测需要多个分期或非原位尿道口方面优于 LSE 评分和 U 评分，并且在预测手术结果方面相似。结论 这种新型 LSE 分期系统的每个阶段和子阶段都被证明提供了有关狭窄特征、修复和手术结果的独特信息。LSE 分期系统将改善与患者关于狭窄复杂性/严重程度的沟通，并组织 aUSD 用于多机构结果研究和临床试验招募目的。