Evaluation of Urethroplasty Outcomes in Post-traumatic Anterior Urethral Strictures Using the Ukrainian Version of the Urethral Stricture Surgery – Patient-Reported Outcome Measure (USS-PROM) questionnaire
DOI:
https://doi.org/10.11603/2414-4533.2026.3.16582Keywords:
urethral trauma, urethral stricture, urethroplasty, quality of life assessment, USS-PROM questionnaireAbstract
The aim of the work: to evaluate the results of urethroplasty in patients with post-traumatic anterior urethral strictures using the Ukrainian version of the Urethral Stricture Surgery – Patient Reported Outcome Measure (USS-PROM) questionnaire and to determine its psychometric properties.
Materials and Methods. A retrospective study was conducted at the Urology Clinic of the National Military Medical Clinical Center “Main Military Clinical Hospital” (Kyiv) between 2023 and 2025. Thirty-two patients with post-traumatic anterior urethral strictures who had preserved spontaneous voiding and completed the USS-PROM questionnaire before surgery and at 3 and 6 months after urethroplasty were included in the analysis. The etiology of strictures was as follows: gunshot injuries – 43.75 %, blunt perineal trauma – 34.35 %, and pelvic fracture urethral injury – 21.9 %. Internal consistency, reproducibility, criterion validity, and responsiveness of the questionnaire were evaluated. Statistical analysis included Cronbach’s alpha, item – total correlation, intraclass correlation coefficient (ICC), Bland – Altman analysis, Pearson correlation coefficient, and paired Student’s t-test.
Results. Cronbach’s alpha for the lower urinary tract symptoms (LUTS) scale was 0.74, while “item – scale” correlation ranged from 0.48 to 0.71. The ICC for the total score was 0.78, indicating good reproducibility. A strong negative correlation was found between the total symptom score and maximum urinary flow rate (Qmax) (R=-0.80, p<0.001). Six months after surgery, the mean total symptom score decreased from 18.0 to 4.8, the LUTS-related quality-of-life score decreased from 2.8 to 0.9, and the urinary stream score improved from 3.1 to 1.4, while the EQ-5D visual analogue scale increased from 56 to 77 (p<0.001). The technical success rate of surgery was 87.5 %.
Conclusions. The Ukrainian version of the USS-PROM demonstrates appropriate psychometric characteristics and represents a reliable and sensitive instrument for assessing urethroplasty outcomes and quality of life in patients with post-traumatic, including combat-related, anterior urethral strictures.
References
1. Cabral JD, Alkassis M, Khalafalla K, Mahdi M, Hyman MJ, Hussain S, Benson CR, Kocjancic E, Raheem OA. Contemporary Trends in the Management of Urethral Stricture Disease in the Era of the AUA Guidelines. Urology. 2025 Dec.; 206:173-9. DOI: 10.1016/j.urology.2025.07.054. DOI: https://doi.org/10.1016/j.urology.2025.07.054
2. Lumen N, Campos-Juanatey F, Greenwell T, Martins FE, Osman NI, Riechardt S, Waterloos M, Barratt R, Chan G, Esperto F, Ploumidis A, Verla W, Dimitropoulos K. European Association of Urology Guidelines on Urethral Stricture Disease (Part 1): Management of Male Urethral Stricture Disease. Eur Urol. 2021 Aug.; 80(2):190-200. DOI: 10.1016/j.eururo.2021.05.022. DOI: https://doi.org/10.1016/j.eururo.2021.05.022
3. Kobirnichenko A, Vikarchuk M, Nerovnyy V. Uretroplastyka u likuvanni struktur cholovichoyi uretry: rezulʹtaty mulʹtytsentrovoho doslidzhennya (106 vypadkiv) [Urethroplasty in the treatment of male urethral strictures: results of a multicenter study (106 cases)]. ZCH [internet]. 31, Berezenʹ 2026 [tsyt. za 02, Lypenʹ 2026]; (1):37-42. DOI: 10.30841/2786-7323.1.2026. 358689. Ukrainian. DOI: https://doi.org/10.30841/2786-7323.1.2026.358689
4. Kobirnichenko AA. Diagnosis of gunshot injuries to the male urethra in combat conditions. Literature review. CAMM. 2025 Oct.15; 32(2):23-7. DOI: 10.32751/2310-4910-2025-32-2-02. DOI: https://doi.org/10.32751/2310-4910-2025-32-2-02
5. Morey AF, Broghammer JA, Hollowell CMP, McKibben MJ, Souter L. Urotrauma Guideline 2020: AUA Guideline. J Urol. 2021 Jan.; 205(1):30-5. DOI: 10.1097/JU.0000000000001408. DOI: https://doi.org/10.1097/JU.0000000000001408
6. Verla W, Waterloos M, Lumen N. Patient-reported outcome measures after urethroplasty: current evidence and future perspectives. Curr Opin Urol. 2020; 30(4):495-501. DOI: 10.1097/MOU.0000000000000772. DOI: https://doi.org/10.1097/MOU.0000000000000772
7. Osman NI, Chapple CR, Andrich DE, et al. Outcome assessment after urethral reconstructive surgery: current concepts and future directions. Curr Opin Urol. 2021; 31(4):385-92. DOI: 10.1097/MOU.0000000000000891. DOI: https://doi.org/10.1097/MOU.0000000000000891
8. Lucas ET, Kinnaird AS, Rourke KF. Patient-reported outcome measures in anterior urethroplasty: contemporary assessment of success. Transl Androl Urol. 2021; 10(5):2325-34. DOI: 10.21037/tau-20-1164.
9. Benson CR, Li G, Brandes ER, et al. Validation and clinical utility of patient-reported outcome measures following urethral reconstruction. Urology. 2022; 164:170-76. DOI: 10.1016/j.urology.2022.02.021. DOI: https://doi.org/10.1016/j.urology.2022.02.021
10. Campos-Juanatey F, Lumen N, Osman NI, et al. Patient-reported outcomes after anterior urethroplasty: recommendations from the EAU Urethral Stricture Guidelines Panel. Eur Urol Focus. 2023; 9(5):1208-16. DOI:10.1016/j.euf.2022.12.006. DOI: https://doi.org/10.1016/j.euf.2022.12.006
11. Riechardt S, Waterloos M, Verla W, Lumen N. Health-related quality of life after urethroplasty: contemporary evidence and patient-centred outcomes. World J Urol. 2024; 42:214. DOI: 10.1007/s00345-024-04812-9.
12. Kałużny A, Frankiewicz M, Krukowski J, Zdun-Ryżewska A, Trawicka A, Matuszewski M. Evaluation of outcomes of Urethral Stricture Surgery: psychometric validation of a Polish language version of the Patient-Reported Outcome Measure for urethral stricture surgery. Cent European J Urol. 2019; 72(2):198-203. DOI: 10.5173/ceju.2019.1901. DOI: https://doi.org/10.5173/ceju.2019.1901
13. Horiguchi A, Shinchi M, Ojima K, Masunaga A, Ito K, Asano T, Takahashi E, Kimura F, Azuma R. Evaluation of the effect of urethroplasty for anterior urethral strictures by a validated disease-specific patient-reported outcome measure. World J Urol. 2019 Apr.; 37(4):601-6. DOI: 10.1007/s00345-018-2540-z. DOI: https://doi.org/10.1007/s00345-018-2540-z
14. Jorge KB, Viana GS, Jost RT, Rabolini EB, de Oliveira RT, Gorgen ARH, Tavares PM, Rosito TE. Brazilian Portuguese validation of the patient-reported outcome measure for urethral stricture surgery (USS-PROM) questionnaire. Int Braz J Urol. 2024 May-Jun.; 50(3):261-76. DOI: 10.1590/S1677-5538.IBJU.2023.0602. DOI: https://doi.org/10.1590/s1677-5538.ibju.2023.0602
15. Tayyebi Azar A, Fallah-Karkan M, Hosseini MA, Kazemzadeh Azad B, Heidarzadeh A, Hosseini J. Persian version of Patient-Reported Outcome Measure for Urethral Stricture Surgery (USS-PROM) Questionnaire, Validation and Adaptation Study. Urol J. 2020 Jan. 26; 17(1):61-7. DOI: 10.22037/uj.v0i0.4937.
16. El Kaddouri H, Roumeguere T, Pinar U, Akakpo W, Madec FX, Marcelli F, Da Silva Maia R, Nguyen M, Tosco L, Beirnaert J. French language validation of the USS-PROM questionnaire assessing clinical outcomes and patient satisfaction after urethroplasty. Fr J Urol. 2026 Jan.; 36(1):103001. DOI: 10.1016/j.fjurol.2025.103001. DOI: https://doi.org/10.1016/j.fjurol.2025.103001
17. European Association of Urology. EAU Guidelines on Non-neurogenic Male Lower Urinary Tract Symptoms (LUTS), including Benign Prostatic Obstruction. Arnhem, The Netherlands: EAU Guidelines Office; 2024.
18. EuroQol Research Foundation. EQ-5D-5L User Guide. Basic information on how to use the EQ-5D-5L instrument. Version 4.0. Rotterdam: EuroQol Research Foundation; 2023.
19. Devlin NJ, Shah KK, Feng Y, Mulhern B, van Hout B. Valuing health-related quality of life: An EQ-5D-5L value set for England. Health Econ. 2018; 27(1):7-22. DOI: 10.1002/hec.3564. DOI: https://doi.org/10.1002/hec.3564
20. Rourke KF, Jordan GH. Primary urethral reconstruction: contemporary outcomes and long-term durability. Transl Androl Urol. 2020; 9(Suppl 2):S177-S186. DOI:10.21037/tau.2019.09.33. DOI: https://doi.org/10.21037/tau.2019.09.33
21. Benson CR, Li G, Brandes ER, et al. Risk factors for recurrence after anterior urethroplasty: a multi-institutional analysis. J Urol. 2021; 206(5):1172-79. DOI: 10.1097/JU.0000000000001903. DOI: https://doi.org/10.1097/JU.0000000000001903
22. Furr JR, Wisenbaugh ES, Gelman J. Surveillance after urethroplasty: contemporary strategies for detection of stricture recurrence. Curr Opin Urol. 2022; 32(6):593-99. DOI: 10.1097/MOU.0000000000001050. DOI: https://doi.org/10.1097/MOU.0000000000001050
23. Viers BR, Pagliara TJ, Elliott SP. Sexual function after anterior urethroplasty: contemporary evidence and patient counselling. Transl Androl Urol. 2020; 9(Suppl 2):S187-S197. DOI: 10.21037/tau.2019.09.30. DOI: https://doi.org/10.21037/tau.2019.09.30
24. Lucas ET, Kinnaird AS, Rourke KF. Sexual outcomes following anterior urethroplasty: a systematic review of current evidence. World J Urol. 2021; 39(10):3811-20. DOI: 10.1007/s00345-021-03654-5.
25. Kaluzny A, Gibas A, Matuszewski M. Ejaculatory Disorders in Men With Urethral Stricture and Impact of Urethroplasty on the Ejaculatory Function: A Systematic Review. J Sex Med. 2018 Jul.; 15(7):974-81. DOI: 10.1016/j.jsxm.2018.05.005. DOI: https://doi.org/10.1016/j.jsxm.2018.05.005
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