Toward Standardized Outcome Reporting in Urethral Reconstruction: Development of the “Stricture-fecta” Through an International Modified Delphi Consensus
Guglielmo Mantica, Wesley Verla, Mikołaj Frankiewicz, Andrea Cocci, Francesco Chierigo, Łukasz Białek, François-Xavier Madec, Maciej Oszczudłowski, Félix Campos‐Juanatey, P. Neuville, Clemens M. Rosenbaum, Elaine J. Redmond, Marjan Waterloos, Malte W. Vetterlein, Mark Joseph Abalajon, Hilgard Ackermann, Kuncoro Adi, Sascha Ahyai, Paul Anderson, Marco Bandini, Adam S. Baumgarten, Javier Belinky, Elisa Berdondini, Andrew Cohen, Jessica DeLong, Miroslav L. Djordjević, Sean P. Elliott, Francesco Esperto, Marco Falcone, Margit Fisch, L. Freton, Tamsin Greenwell, Uri Gur, Judith C. Hagedorn, Lindsay A. Hampson, Akio Horiguchi, Brian M. Inouye, Luis Kluth, Sanjay Kulkarni, Luis Martínez‐Piñeiro, Francisco E. Martins, Saskia Morgenstern, Dmitriy Nikolavsky, Nicolás Ortiz, Danelo Du Plessis, Mirko Preto, David Ralph, Javier Romero-Otero, Keith Rourke, Alexander T. Rozanski, Jukka Sairanen, Paksi Satyagraha, Ofer Z. Shenfeld, Alchiede Simonato, Alexander J. Skokan, Michał Skrzypczyk, Pieter Spies, André van der Merwe, Henriette Veiby Holm, Ramón Virasoro, Nick Watkin, Hadley Wood, Amir Zarrabi, Lee C. Zhao, Valentin Zumstein
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.