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JU INSIGHT: Evaluating Tools for Characterizing Anterior Urethral Stricture Disease: A Comparison of the LSE System and the Urethral Stricture Score

By: Jane T. Kurtzman, MD; Rashed Kosber, BS; Preston Kerr, MD; Steven B. Brandes, MD, FACS | Posted on: 01 Nov 2022

Kurtzman JT, Kosber R, Kerr P, Brandes SB. Evaluating tools for characterizing anterior urethral stricture disease: a comparison of the LSE System and the Urethral Stricture Score. J Urol. 2022; 208(5):1083-1089.

Study Need and Importance

Reconstructive urologists are in need of an ordinal scoring system that can describe anterior urethral stricture disease (USD), as well as predict stricture recurrence risk after urethroplasty. Such a system would help in surgical planning, clinical decision making, referral patterns, and patient counseling. Our study objective was to evaluate if scores generated by 2 tools for characterizing anterior USD, the modified LSE classification system score (LSE) and the Urethral Stricture Score (U-Score), correlated with surgical complexity, operative time, and stricture recurrence risk.

Figure. Kaplan-Meier curves displaying the relationship between LSE score (LSE) (A) and Urethral Stricture Score (U-Score) (B) stratified as high versus low scores and stricture recurrence risk.

What We Found

Our analysis of 187 male patients demonstrated that both increasing U-Score and LSE linearly correlated with increasing surgical complexity (both P < .0001). Only increasing LSE correlated with increasing operative time (P = .04) and was associated with an increased risk of stricture recurrence (univariable: HR 1.2, P = .02; multivariable: HR 1.2, P = .056). Patients with a high LSE (≥7) were nearly 3 times as likely to recur versus patients with a low LSE (univariable: HR 2.7, P = .001; multivariable: HR 2.8, P = .002, see Figure).

Limitations

This was a single-surgeon study conducted in a tertiary care setting; therefore, results may not be generalizable. LSE is previously undescribed and therefore not validated. Follow-up time was relatively short. Both scoring systems lack variables that could impact recurrence risk, including postoperative infection, patient comorbidities, and prior endoscopic surgery. Cutoff values and point allocation in both systems were based on expert opinion rather than statistical modeling.

Interpretation for Patient Care

Our study demonstrates that both U-Score and LSE can help anticipate intraoperative surgical complexity. For community urologists, high scores could help determine which cases should be referred to high-volume urethral surgery centers. LSE may also help urologists anticipate the length of surgery and aid with patient counseling regarding the risk of postoperative stricture recurrence.

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