Patient-specific risk scoring in predicting stricture recurrence after anterior urethroplasty

Abstract

Objective This study aims to identify factors influencing anterior urethroplasty outcomes and develop a risk scoring system to predict urethral stricture recurrence (USR). Materials and methods In this retrospective study, ethical approval was obtained from the Ethics Committee of Ankara Etlik City Hospital. Data were extracted from the electronic records of male patients who underwent urethroplasty for anterior urethral stricture between January 1, 2015, and June 1, 2023. The criteria examined for recurrence are as follows: Age, Body Mass Index, comorbidities, smoking, etiology, previous endoscopic treatments, previous urethroplasty, stricture location, stricture length, stricture number, postoperative complications. After performing the Chi-square analysis, univariate and multivariate regression analyses were conducted. Logistic regression analysis was used to evaluate the multivariable effects of the risk factors, with odds ratios being calculated and standardized on a 10-point scale. Backward stepwise logistic regression was used to identify independent predictors of recurrence. To reduce the risk of overfitting, internal validation was performed using bootstrapping methods. Receiver Operating Characteristic (ROC) analysis was applied to determine the cutoff points for the risk scoring system, and the diagnostic accuracy was evaluated using Area Under the ROC Curve (AUROC). Results A total of 265 patients were included in the study, with 197 (74.3%) successfully treated without surgery in the first postoperative year. Risk factors for USR were analyzed, with significant findings including: Age > 65 years: 1 point, Presence of coronary artery disease: 1 point, Active tobacco use: 1 point, History of more than one prior endoscopic treatment: 2 points, History of prior urethroplasty: 1 point, Penile or penobulbar stricture location: 2 points, Stricture length > 2 cm: 2 points. Logistic regression identified these factors as significant predictors of USR. A risk scoring system based on these factors showed a significant correlation with recurrence, with a cutoff score of 5 points identifying high-risk patients. The diagnostic accuracy of this scoring system was 93%. Conclusion The risk score may offer clinicians a valuable tool for predicting recurrence risk, enabling tailored treatment.