To update, simplify, and validate the UREThRAL Stricture Score (now called the U-score) for anterior urethral strictures, with the goal of using this system as a predictor of surgical complexity.

This is a retrospective review of 102 patients (test set) who underwent anterior urethroplasty at Barnes-Jewish Hospital from 2009 to 2012 and a validation set of 96 patients from Northwestern University. The U-score was based on length (1-3 points), stricture number (1-2 points), location (1-2 points), and etiology (1-2 points) for a total ranging from 4 to 9. Excision and primary anastomosis, buccal mucosal graft, and augmented anterior urethroplasty were classified as low complexity, and double buccal mucosal graft, flap, or flap-graft combo were classified as high complexity. Operative time and estimated blood loss were used as surrogates of surgical complexity.

Mean U-score for low-complexity surgeries was 5.2 and for high complexity surgeries was 7.3. Factors that were associated with high-complexity repairs included stricture etiology (trauma or idiopathic or iatrogenic vs inflammatory or hypospadias; P ≤.0001), number (1 vs >1; P = .003), location (penile vs bulbar; P <.001), and length (<2 vs 2-5 vs >5 cm; P <.001). Increasing U-score correlated with increasing surgical complexity (P ≤.0001). A linear relationship between U-score and operative time was observed (P = .0018). U-score did not correlate with estimated blood loss (P = .82). Among the validation data set, etiology (P = .0014), location (P ≤.0001), stricture length (P ≤.0001), and overall U-score (P ≤.0001) correlated with surgical complexity.

The U-score is a validated scale to describe the complexity of anterior urethral strictures that correlates with surgical time and complexity of procedure.