Would utilization of urethral stricture score (u-score) predict the outcome of patients undergoing anterior urethroplasty at Muhimbili national hospital?

Abstract

ABSTRACT Background: Urethral stricture is a common condition, with a higher incidence in developing countries(1). A large variety of surgical procedures have been developed for the treatment of anterior urethral strictures; one tool that is used to determine the type of surgery needed for different stricture patients is called the Urethral Stricture Score (U-SCORE). The U-SCORE utilizes the stricture's length, location, number (of), and aetiology to define and quantify its attributes, enabling preoperative prediction of the required surgery's complexity and treatment outcome. At MNH, there have been a large number of patients presenting with urethral strictures with different aetiologies, mostly due to a traumatic, iatrogenic, or infective nature. Urethroplasty is one of the most common operations performed at MNH. The paediatric surgery unit and the department of urology performed 65 anterior urethral stricture repairs (urethroplasty) from January 2022 to October 2022, with patients ranging in age from 5 to 97 years. In current MNH practice, there is no formal method of grading stricture complexity to guide the choice of surgical intervention and predict the urethroplasty outcome. This study aimed to assess the surgical complexity and outcome of anterior urethral stricture repair using the U-Score for MNH patients. Aim: To evaluate the surgical complexity and outcome of anterior urethral stricture repair using the U-Score for patients undergoing anterior urethroplasty at Muhimbili National Hospital. Methodology: We conducted a retrospective cross-sectional study, reviewing patient records from January 2018 to December 2022, which included patients diagnosed with anterior urethral stricture who underwent anterior urethroplasty at MNH. We extracted the length, location, number, and aetiology of the stricture from patients' records, and assessed the duration of hospital stay, surgical complexity, and postoperative complications as outcomes of interest. We calculated the U-score, performed an association between the U-score and the outcome of interest using the chi-square test, and assessed the adjusted predictor variable effect using logistic regression. Results: We retrieved 184 patient files, of which 179 (97%) met all inclusion criteria. The median age was 51 ± 19.8 years. Patients with co-morbidities were 36 (20.2%), among which 8.4% had hypertension, 6.7% had more than one comorbidity, 3.4% were seroconverted patients (AIDS), and 1.7% had diabetes mellitus. There were 165 patients with a low U-score, while 14 patients had a high U-score. However, 167 patients underwent low-complexity urethroplasty (EPA, BMG, and augmented anterior urethroplasty) with a mean U-score of 4.7, while 12 patients underwent high-complexity urethroplasty (double buccal mucosal graft, flap, and graft/flap combination) with a mean score of 7.1. Two patients with a high U-score underwent low-complexity urethroplasty. A higher U-score was predictive of higher surgical complexity (P value < 0.05). Also, high U-score was significantly associated with early postoperative complications, as there was a consistent increase in the risk of developing early postoperative complications with each additional U-score point. Conclusion: We report an association between a higher U-score and anterior urethroplasty outcomes, indicating a substantial influence of the U-score on its predictive capacity for surgical complexity and postoperative complications for patients with anterior urethral stricture. Therefore, the U-score can aid in risk stratification and perioperative counselling.