OBJECTIVE:To define mild, moderate and severe symptom categories of the neurogenic bladder symptom score (NBSS) and NBSS-short form (SF), and to calculate the minimal clinically important difference (MCID) of the NBSS-SF. METHODS:We used existing datasets from the original NBSS validation study (n = 230 patients with spinal cord injury (SCI), multiple sclerosis, and spina bifida), and a large cross-sectional study of people with SCI (n = 1479) who completed the NBSS. We used the previously validated mild-moderate-severe categories of the ICIQ-UI, IPSS, and the SCI-QOL Bladder complications scale to define patients with mild, moderate or severe symptoms, and mapped these to the NBSS scores for the related NBSS domains of incontinence, storage/voiding, and consequences, respectively. We validated these NBSS score categories using four data sets, and by examining the global bladder problem rating. An anchor-based MCID of the NBSS-SF was determined. RESULTS:Using the median/interquartile range of the associated NBSS domain score of people who were in the moderate category of the ICIQ-UI, IPSS, and the SCI-QOL Bladder complications, we calculated the severity categories for the NBSS total score: 0-32 (mild), 33-48 (moderate), and 49-74 (severe). These score categories produced significantly different NBSS scores in 29/32 comparisons in four different study populations. The global bladder problem had good agreement with each domain's categorical scale. Finally, the group-level MCID of the NBSS-SF total score was calculated as an improvement of 1.8. CONCLUSIONS:We have determined interpretability ranges for the NBSS and NBSS-SF. This can help interpret patient and clinical study results.

ABSTRACT Objectives: The objectives of the study were to characterize the safety, efficacy, and recurrence rates of bladder calculi treatment in a cohort of adult patients with a history of continent lower urinary tract reconstruction. Patients and Methods: We conducted a retrospective review of adult patients with prior continent lower urinary tract reconstruction utilizing bowel who underwent surgical treatment for bladder calculi at our institution. Surgical approach was classified as endoscopic (i.e., per urethra or per catheterizable channel), percutaneous, or open. The primary outcome of interest was bladder stone recurrence, defined as any unplanned additional surgery for bladder stones. Results: We identified 64 patients who underwent 95 bladder stone surgeries. 69/95 cases (73%) involved a bladder augment and catheterizable channel, 11/95 (12%) a bladder augment only, and 11/95 (12%) a catheterizable channel only. 56/95 cases (59%) were endoscopic, 34/95 (36%) percutaneous, and 5/95 (5%) open. Over a median follow-up of 46 months (interquartile range 25–73), the overall recurrence rate was 43/95 (45%); this did not differ when stratifying by surgery type ( P = 0.52). Median time to reoperation was 25 months (15–38) and did not differ by surgery type ( P = 0.29). Conclusion: In our series, patients with bladder calculi after continent diversion could be treated surgically with minimal associated morbidity. Endoscopic and percutaneous techniques can manage the majority of calculi, with open cystolithotomy reserved for exorbitant stone burden. Recurrence rates and time to recurrence do not appear to differ by treatment modality.

The aim of our study was to evaluate and describe our multi-institutional experience with buccal mucosal graft (BMG) ureteroplasty for complex ureteral strictures. The primary outcomes analyzed were the need for re-intervention or revision surgery and the change in hydronephrosis of the affected renal unit. All patients who underwent buccal mucosal graft-onlay ureteral reconstruction and had post-surgical follow-up including upper tract imaging at five tertiary care centers were retrospectively reviewed for a 4-year period. Patient demographics, perioperative metrics, and postoperative clinical outcomes were analyzed. 40 patients (23 female, 17 male; mean age 50.2 years) had upper urinary tract reconstruction with BMG. 55

PURPOSE:To assess outcomes after colon conduit urinary diversion (CCUD) with and without concurrent colon anastomosis. MATERIALS AND METHODS:Patients who underwent CCUD were retrospectively identified at 4 institutions. Primary outcomes included 0- to 90-day high-grade complications, 30-day readmission, and late interventions. Secondary outcomes included high-grade complications and their association with concurrent colonic anastomosis, prior radiation, and hypoalbuminemia. The cohort was substratified into (1) CCUD with colonic anastomosis, (2) CCUD with colostomy, and (3) colostomy switch. Patient characteristics, perioperative variables, and outcomes were compared between groups using descriptive, univariable, and multivariable statistics. RESULTS:One hundred seventy-nine patients, median age 61 years, underwent CCUD between 1990 and 2022. Prior radiation therapy (63.7%), genitourinary surgery (54%), and abdominal surgery (72%) were common within the cohort. Outcomes included 30-day high-grade complications (28.5%), 30- to 90-day high-grade complications (14.5%), and 90-day mortality (4.5%). Ninety-day reintervention (surgical or procedural) was 30.2%. The most common late complication was need for ureteral stent or nephrostomy tube (16.8%). Preoperative albumin ≥ 3.2 was associated with reduced 30- to 90-day high-grade complications (HR 0.18). Development of high-grade complication during postoperative day 0 to 30 was associated with an increased likelihood of developing a secondary high-grade complication between postoperative day 30 and 90 (HR 2.85). CONCLUSIONS:The presence of a colonic anastomosis at the time of colon conduit urinary was not associated with worse 30-day outcomes. Hypoalbuminemia was associated with an increased likelihood of 30- to 90-day high-grade complications. Use of colon remains an important option for urinary diversion surgery when ileum is not clinically feasible.

Background:The pathophysiology of anterior urethral stricture disease (aUSD) is unknown (idiopathic) in the majority of men. Testosterone is required for the in utero development of the male urethra and has been shown to aid in urethral healing. Thus, the purpose of this study was to understand the relationship between circulating sex hormones and aUSD. Methods:This study included 154 males with aUSD undergoing urethroplasty who were enrolled in a prospective, multicenter study evaluating the relationship between inflammation and urethral strictures. This study represents a secondary analysis on serum, measuring circulating levels of total testosterone (TT), free testosterone (fT), estradiol (Es), progesterone (Pr), and cortisol (Co). The control group consisted of males (n=9) lacking urologic pathology undergoing vasectomy. Within the stricture cohort, we looked at differences in sex hormone levels by stricture features and inflammation. T-tests and one-way analysis of variance were used to compare means. Univariate logistic regression was used to assess significant differences followed by multivariable logistic regression to adjust for confounders. Results:fT was lower in the stricture cohort versus control cohort (1.08 vs. 2.13 pg/dL, P=0.05). Adjusting for confounding factors including age, there was a significant decrease in the odds of stricture with increasing fT levels (adjusted odds ratio: 0.33, P=0.02), with a 1-unit increase in fT being associated with a 67% decrease in the adjusted odds of aUSD. Among the stricture cohort, longer strictures were associated with lower fT (P=0.01). Other circulating hormones, including TT, were not statistically different between cohorts or related to aUSD inflammation. Conclusions:We show an association between lower fT, aUSD, and aUSD severity. Bioavailable testosterone is necessary for male urethral development and has anti-inflammatory and anti-fibrotic properties. We hypothesize that fT may contribute to aUSD development by impairing healing to sub-clinical trauma.

OBJECTIVE:To create and validate a disease-specific patient-reported outcome measure derived from the patient voice for men with a urethral stricture disease. METHODS:We previously performed and published a qualitative assessments to construct a disease-specific patient-reported outcome measure for urethral stricture disease. Psychometric evaluations were done on the developed final form using both the preoperative and postoperative data. We assess instrument internal consistency, validity, sensitivity to change, and test-retest reliability. RESULTS:Three dimensions were suggested by the parallel analysis. All items loaded on one general factor and two group factors. Based on a review of clinical meaning, the remaining 10 items relating to urinary or sexual functions were retained in the final form with each item having 5 possible responses. The density plot for the Urethral Stricture Symptom and Impact Measure (USSIM) total score revealed a significant skew toward improved function following surgery. Cronbach's alpha among the 10 items was 0.8 (95% 0.75-0.84) for the preoperative cohort and 0.82 (95% CI: 0.78-0.86) for the postoperative cohort, indicating good internal consistency. Overall, the final USSIM is adequate to discriminate patients who did better or worse following surgery. The intraclass correlation coefficient for USSIM score was 0.74 indicating moderate to good test-retest reliability. CONCLUSION:The USSIM possesses strong measurement properties that are representative for use in men with a urethral stricture. We propose use of this instrument in the preoperative and postoperative setting.

PURPOSE:Ideal treatment of lichen sclerosus (LS)-induced penile urethral strictures (PUS) remains elusive. The objective of this study was to compare multi-institutional outcomes of single-stage urethroplasty (SSU) with oral mucosal graft, staged urethroplasty, and perineal urethrostomy (PU) for treatment of LS-induced PUS. MATERIALS AND METHODS:Multi-institutional analysis was performed at 9 centers on men undergoing SSU, staged urethroplasty, or PU for LS-induced PUS. Meatal strictures (<2 cm), bulbar urethral involvement, and panurethral strictures (>10 cm) were excluded. The primary outcome was recurrence-free status on follow-up assessment. Secondary outcomes included 90-day complications (Clavien ≥2), erectile dysfunction, chordee, and urethrocutaneous fistula. RESULTS:Two hundred thirty-one patients were included with a median stricture length of 5 cm and median follow-up of 53 months among those without stricture recurrence. One-, 5-, and 10-year stricture-free estimates were 90%, 80%, and 75%, respectively. Fifty-five percent (127/231) underwent SSU with oral mucosal graft, 19% (44) staged urethroplasty, and 26% (60) PU. On log-rank, there was no identifiable difference in stricture recurrence between techniques (P = .6) with 5-year stricture-free estimates of 82%, 76%, and 75%, respectively. On χ2, there was no significant difference in 90-day complications (7.1% vs 16% vs 8.3%; P = .2), erectile dysfunction (7.1% vs 4.5% vs 3.3%; P = .6), chordee (5.5% vs 6.8% vs 1.7%; P = .4), or urethrocutaneous fistula (2.4% vs 6.8% vs 0%; P = .09). On Cox regression, only obesity (BMI ≥35) was associated with stricture recurrence (HR, 2.31, 95% CI, 1.28-4.17; P = .006). CONCLUSIONS:Favorable comparative outcomes confirm SSU as a highly feasible treatment for LS-induced PUS in properly selected patients, especially when considering fewer surgeries required and preservation of an orthotopic meatus.