Toward Standardized Outcome Reporting in Urethral Reconstruction: Development of the "Stricture-fecta" Through an International Modified Delphi Consensus
Mantica, Guglielmo Verla, Wesley Frankiewicz, Mikołaj Cocci, Andrea Chierigo, Francesco Białek, Łukasz Madec, François-Xavier Oszczudłowski, Maciej Campos-Juanatey, Felix Neuville, Paul
Mantica, Guglielmo
Verla, Wesley
Frankiewicz, Mikołaj
Cocci, Andrea
Chierigo, Francesco
Białek, Łukasz
Madec, François-Xavier
Oszczudłowski, Maciej
Campos-Juanatey, Felix
Neuville, Paul
Affiliation
IRCCS Ospedale Policlinico San Martino; University of Genova; Ghent University Hospital; The Dudley Group NHS Foundation Trust et al
Other Contributors
Publication date
2025-12-15
Subject
Collections
Research Projects
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Abstract
Treatment success after urethral reconstruction remains poorly standardized, resulting in heterogeneous outcome reporting and limited comparability across studies. To address this gap, we aimed to establish a consensus-based, reproducible definition of surgical success through the development of a novel outcome framework: the stricture-fecta. A two-round Delphi process was conducted under the auspices of the European Association of Urology (EAU) Young Academic Urologists-Trauma and Reconstructive Urology Working Party. A total of 113 international experts in urethral reconstruction were invited to assess the potential outcome criteria using a 9-point Likert scale. Consensus was defined as a rating of 7-9 by ≥70% and 1-3 by ≤15% of respondents. Eighty-seven (77%) experts completed round 1, and 65 (75%) participated in round 2. The final consensus identified three core criteria: (1) freedom from stricture retreatment; (2) no significant impact on continence or sexual function, assessed with validated instruments; and (3) patient satisfaction. The stricture-fecta represents a step toward standardized outcome reporting in urethral reconstruction, akin to the trifecta metrics in urological oncology. Its adoption may improve data quality, facilitate multicenter collaboration, and support more transparent, patient-centered evaluations of surgical success.
PATIENT SUMMARY: This study developed a clear and simple way to measure success after surgery to fix narrowing of the urethra, a condition that affects urination and quality of life. Experts agreed that success means no need for further treatment, and no negative effects on bladder control or sexual function, and that patients feel satisfied with the results. The use of this approach will help doctors compare outcomes better and improve care for patients undergoing urethral surgery.
Citation
Mantica G, Verla W, Frankiewicz M, Cocci A, Chierigo F, Białek Ł, Madec FX, Oszczudłowski M, Campos-Juanatey F, Neuville P, Rosenbaum CM, Redmond EJ, Waterloos M, Vetterlein MW; Trauma and Reconstructive Urology Working Party of the European Association of Urology Young Academic Urologists and the Stricture-fecta Delphi Consensus Panel. Toward Standardized Outcome Reporting in Urethral Reconstruction: Development of the "Stricture-fecta" Through an International Modified Delphi Consensus. Eur Urol Open Sci. 2025 Dec 15;83:120-124. doi: 10.1016/j.euros.2025.11.008
Type
Article