Clinical Application Research Of Posterior Urethral Stenosis Score

Objective: To develop a posterior urethral stenosis score(PU-score)system,with the goal of using this scoring system as a preliminary predictor of surgical complexity and outcome of posterior urethral stenosis.Materials and Methods: Early in 2011 to 2015,we investigated 286 domestic urologists on awareness and treatment model posterior urethral obstructive disease.We retrospectively reviewed records of all patients diagnosed with posterior urethral stenosis or bladder neck obstruction treated at our institution from 2013 to 2015.Patients with incomplete clinical data or imaging exams,those who did not receive operation,those treated with staged operation or perineal urethrostomy,those lost to follow-up or follow-up shorter than 6 months were excluded.Clinical characters were collected including age,etiology,location,length,urethral fistula,false passage,concomitant anterior urethral stricture and treatment history.We classified surgical complexity into low complexity and high complexity according to clinical experiences.All clinical characters were analyzed according to surgical complexity,screening out the meaningful scoring factors.Different scores were assigned to every factor.We calculated the score of all patients and analyzed its association with surgical complexity,intraoperative blood loss,stenosis recurrence,erectile dysfunction and urinary incontinence.Results: Our pre-survey showed that the number of patients with posterior urethral obstruction in various regions of the country is limited,the choice of treatment is very different and the outcomes of various methods had a greater difference.In the later research,292 patients were included.There were 146 patients who underwent low complexity urethral surgery with a mean score of 5.1 points,while 146 underwent high complexity urethroplasty with a mean score of 6.6 points.The PU-score is based on five components,namely etiology(1 or 2 points),location(1 to 3 points),length(1 to 3 points),urethral fistula(1 or 2 points)and false passage(1 point).We could observe significant differences between low and high surgical complexity(p =0.000).Higher PU-score was predictive of higher surgical complexity(p=0.000),more intraoperative blood loss(p=0.000),lower successful rate(p=0.007)and lower pre(p=0.003)or postoperative erectile function(p=0.003).However,no association was observed between PU-score and urinary incontinence.Conclusion: The PU-score is a novel method predicting complexity and outcome of posterior urethral stenosis and bladder obstruction.It is worth our effort in the future to further improve and promote.