Guglielmo Mantica, Wesley Verla, Mikołaj Frankiewicz, Andrea Cocci, Francesco Chierigo, Łukasz Białek, François-Xavier Madec, Maciej Oszczudłowski, Felix Campos-Juanatey, Paul Neuville, Clemens M. Rosenbaum, Elaine J. Redmond, Marjan Waterloos, Malte W. Vetterlein, Mark Joseph Abalajon, Hilgard Ackermann, Kuncoro Adi, Sascha A. Ahyai, Paul Anderson, Marco Bandini, Adam Baumgarten, Javier Belinky, Elisa Berdondini, Andrew Cohen, Jessica DeLong, Miroslav Djordjevic, Sean P. Elliott, Francesco Esperto, Marco Falcone, Margit Fisch, Lucas Freton, Tamsin J. Greenwell, Uri Gur, Judith Hagedorn, Lindsay A. Hampson, Akio Horiguchi, Brian M. Inouye, Luis A. Kluth, Sanjay B. Kulkarni, Luis Martínez-Piñeiro, Francisco E. Martins, Saskia C. Morgenstern, Dmitriy Nikolavsky, Nicolas M. Ortiz, Danelo E. du Plessis, Mirko Preto, David Ralph, Javier Romero-Otero, Keith Rourke, Alexander Rozanski, Jukka Sairanen, Paksi Satyagraha, Ofer Shenfeld, Alchiede Simonato, Alexander J. Skokan, Michał A. Skrzypczyk, Pieter Spies, André van der Merwe, Henriette Veiby Holm, Ramon Virasoro, Nick Watkin, Hadley Wood, Amir Zarrabi, Lee C. Zhao, Valentin Zumstein
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. © 2025 The Author(s)
IRCCS Ospedale Policlinico San Martino, Genova, Italy; Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova, Italy; Department of Urology, Ghent University Hospital, Ghent, Belgium; Department of Urology, Medical University of Gdańsk, Gdańsk, Poland; Department of Urology and Andrology, Careggi Hospital, University of Florence, Florence, Italy; Department of Urology, San Paolo Hospital, Milan, Italy; Department of Urology, Centre for Postgraduate Medical Education, Warsaw, Poland; Service d'Urologie, Hôpital Foch, Suresnes, France; Andrology and Reconstructive Urology Unit, Marqués de Valdecilla University Hospital, School of Medicine, Cantabria University, IDIVAL, Santander, Spain; Department of Urology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Lyon, France; Department of Urology, Asklepios Paulinen Hospital Wiesbaden, Wiesbaden, Germany; Department of Urology, Cork University Hospital, Cork, Ireland; Department of Urology, AZ Maria Middelares, Ghent, Belgium; Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; East Avenue Medical Center, Quezon City, Philippines; Private Sector, Ackermann Urology Incorporated, Cape Town, South Africa; Department of Urology, Hasan Sadikin General Hospital, Bandung, Indonesia; Department of Urology, Medical University of Graz, Graz, Austria; Department of Urology, Russell's Hall Hospital, Dudley, United Kingdom; Division of Experimental Oncology / Unit of Urology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy; Department of Urology, University of Alabama at Birmingham Medical Center, Birmingham, AL, United States; Department of Urology, Hospital General de Agudos Carlos G. Durand, Buenos Aires, Argentina; Department of Reconstructive Surgery, Clinica Sedes Sapientiae, Turin and Nigrisoli Hospital, Bologna, Italy; Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, United States; CommonSpirit Urology, Durango, CO, United States; Department of Urology and Surgery, University of Belgrade School of Medicine, Belgrade, Serbia; Department of Urology, University of Minnesota, Minneapolis, MN, United States; Department of Urology, Campus Bio-Medico University, Rome, Italy; Department of Urology, A.O.U. “Città della Salute e della Scienza” - Molinette Hospital, University of Turin, Turin, Italy; Department of Urology, University of Rennes, Rennes, France; Department of Urology, University College London Hospital, London, United Kingdom; Department of Urology, Meir Medical Center, Kfar Sava, Israel; Department of Urology, University of Washington, Seattle, WA, United States; Department of Urology, University of California, San Francisco, San Francisco, CA, United States; Center for Trauma, Burn and Tactical Medicine, National Defense Medical College Hospital, Saitama, Japan; Department of Urology, Albany Medical Center, Albany, NY, United States; Department of Urology, Kulkarni Reconstructive Urology Center, Pune, India; Department of Urology, La Paz University Hospital and IdiPAZ, Madrid, Spain; Department of Urology, University of Lisbon, School of Medicine, Santa Maria Hospital, Lisbon, Portugal; Department of Urology, Agaplesion Markus Hospital, Frankfurt, Germany; Department of Urology, SUNY Upstate Medical University, Syracuse, NY, United States; Department of Urology, University of Virginia, Charlottesville, VA, United States; Department of Surgery, Division of Urology, Faculty of Medicine and Health Sciences, Tygerberg Hospital, Stellenbosch University, Cape Town, South Africa; Department of Urology, University Hospital HM Puerta del Sur, Madrid, Spain; Division of Urology, Department of Surgery, University of Alberta, Edmonton, AB, Canada; Department of Urology, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States; Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Department of Urology, Faculty of Medicine, Universitas Brawijaya, Saiful Anwar General Hospital, Malang, Indonesia; Department of Reconstructive and Functional Urology, Shaare Zedek Medical Center, Jerusalem, Israel; Department of Urology, Azienda Ospedaliera Universitaria Policlinico (AOUP) “Paolo Giaccone”, Palermo, Italy; Department of Urology, Section of Reconstructive Urology and Neurourology, Oslo University Hospital, Oslo, Norway; Division of Urology, University of Colorado, Aurora, CO, United States; Department of Urology, St George's University Hospitals NHS Foundation Trust, London, United Kingdom; Department of Urology, Cleveland Clinic Foundation, Glickman Urological & Kidney Institute, Cleveland, OH, United States; Mercy Hospital, Dunedin, New Zealand; Department of Urology, NYU Langone Health, New York, NY, United States; Faculty of Medicine, University of Zürich, Zürich, Switzerland
