Toward Standardized Outcome Reporting in Urethral Reconstruction - Development of the Stricture-fecta - Brief Correspondence

Sep 29, 2026

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Treatment success after urethral reconstruction remains poorly standardized, leading to heterogeneous outcome reporting and limited comparability across studies. To close this gap, the study developed a consensus-based, reproducible surgical success framework called the stricture-fecta. A two-round international modified Delphi process invited 113 experts and used a 9-point Likert scale to define consensus thresholds. Final agreement identified three core criteria: retreatment-free status, no significant continence or sexual-function impact assessed with validated instruments, and patient satisfaction.

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EUROPEAN U ROLOGY OPEN SC IEN C E 8 3 ( 202 6 ) 120 – 1 24 available [at www.sciencedirect. com](at www.sciencedirect. com) journal [homepage: www.eu-openscience.europeanurology.com](homepage: www.eu-openscience.europeanurology.com) | Brief Correspondence
Toward Standardized Outcome Reporting in Urethral Reconstruction: Development of the ‘‘Stricture-fecta’’ Through an International Modiﬁed Delphi Consensus
Guglielmo Manticaa,b, Wesley Verlac, Mikołaj Frankiewicz d, Andrea Cocci e, Francesco Chierigof,Łukasz Białekg, Franc¸ois-Xavier Madech, Maciej Oszczudłowski g, Felix Campos-Juanateyi, Paul Neuvillej, Clemens M. Rosenbaum k, Elaine J. Redmond l, Marjan Waterloosc,m,
Malte W. Vetterleinn,*for the Trauma and Reconstructive Urology Working Party of the European Association of Urology Young Academic Urologists and the Stricture-fecta Delphi Consensus Panel
a IRCCS Ospedale Policlinico San Martino, Genova, Italy; b Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova, Italy; c Department of Urology, Ghent University Hospital, Ghent, Belgium; d Department of Urology, Medical University of Gdask, Gdask, Poland; e Department of Urology and Andrology, Careggi Hospital, University of Florence, Florence, Italy; f Department of Urology, San Paolo Hospital, Milan, Italy; g Department of Urology, Centre for Postgraduate Medical Education, Warsaw, Poland; h Service d’Urologie, Hôpital Foch, Suresnes, France; iAndrology and Reconstructive Urology Unit, Marqués de Valdecilla University Hospital, School of Medicine, Cantabria University, IDIVAL, Santander, Spain; jDepartment of Urology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Lyon, France; k Department of Urology, Asklepios Paulinen Hospital Wiesbaden, Wiesbaden, Germany; l Department of Urology, Cork University Hospital, Cork, Ireland; m Department of Urology, AZ Maria Middelares, Ghent, Belgium; n Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany | | | --- | --- | | Article info | 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
Trauma and Reconstructive Urology Working Party of the European Association of Urology Young Academic Urologists and the Stricture-fecta Delphi Consensus Panel collaborators are listed in the Acknowledgements.
*
Corresponding author. Department of Urology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany. Tel. +49 40 7410 53445; Fax: +49 40 7410 42444.
E-mail [address:](address: m.vetterlein@uke.de)[ m.vetterlein@uke.de](address: m.vetterlein@uke.de) (M.W. Vetterlein). | | Article history:
Accepted November 21, 2025
Associate Editor:
Guillaume Ploussard | | | Keywords:
Consensus
Patient-reported outcome measures
Treatment outcome Trifecta
Urethral stricture Urethroplasty | | | | | [https://doi.org/10.1016/j.euros.2025.11.008](https://doi.org/10.1

FAQs

Why is standardized outcome reporting after urethral reconstruction needed?

Treatment success definitions are not universally standardized, creating heterogeneous reporting and reducing comparability across studies. This also limits transparency, reproducibility, and objective evaluation.

How was the stricture-fecta framework developed?

A two-round international modified Delphi consensus process was conducted with 113 experts using a 9-point Likert scale. Consensus required specific response thresholds for ratings.

What are the three final criteria of surgical success in the stricture-fecta?

Surgical success requires freedom from stricture retreatment, no significant effect on continence or sexual function assessed with validated instruments, and patient satisfaction.

Sep 29, 2026

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