Preoperative American Urological Association Symptom Research Articles

V02-12 LARGE VOLUME STONE EXTRACTION FOR THE TREATMENT OF CHRONIC PROSTATITIS

You have accessJournal of UrologyCME1 May 2022V02-12 LARGE VOLUME STONE EXTRACTION FOR THE TREATMENT OF CHRONIC PROSTATITIS George Koch, and Sarah Flury George KochGeorge Koch More articles by this author , and Sarah FlurySarah Flury More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002528.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Chronic bacterial prostatitis can be a difficult condition to treat due both the variable tissue penetrance of antibiotics in the prostate, as well as the sometimes uncertain interaction between bacteria and prostatic stones. We present this video as both a demonstration of the atypical nature of this patient’s stone burden, as well as the multiple strategies employed to treat the stones. This patient presented with seven years of irritative voiding symptoms refractory to alpha-adrenergic blockers, long-term courses of antibiotics and serial prostatic message. His preoperative American Urological Association Symptom Index (AUASI) was 22 and his Quality of Life Score (QoL) was 4. MRI demonstrated a very large prostatic stone burden. METHODS: The procedure was performed using a 26 French Storz Resectoscope with both a Collins Knife electrocautery device and a 365 micron Holmium laser fiber via a laser bridge. The patient underwent unroofing of a large cavity within the prostate using the Collins Knife, and then stone fragmentation, further cavity resection, and hemostasis using the Holmium laser. Given the difficulty of removing stones with the resectoscope directly from the prostatic cavity, an Ellik evacuator was used to blow the stones into the bladder from which they were then easily drained through the sheath. RESULTS: The patient was discharged with a short course of antibiotics and a urethral catheter from the ambulatory surgery center and recovered well postoperatively. His catheter was removed on postoperative day seven and he passed a voiding trial. At his six-week follow-up appointment, he was voiding well and symptom free. His follow-up AAUSI was 14 and his QoL was 0. CONCLUSIONS: We found the use of both the Collins Knife electrocautery device and Holmium laser to be effective tools in the armamentarium to treat prostatic stones associated with chronic prostatitis. Our results demonstrate the importance of imaging and the role of nidus removal in the treatment of refractory chronic bacterial prostatitis. Source of Funding: N/A © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e114 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information George Koch More articles by this author Sarah Flury More articles by this author Expand All Advertisement PDF DownloadLoading ...

PD23-04 THE IMPACT OF PROSTATIC URETHRAL LIFT ON ALPHA-BLOCKER DISCONTINUATION

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy & New Technology IV (PD23)1 Sep 2021PD23-04 THE IMPACT OF PROSTATIC URETHRAL LIFT ON ALPHA-BLOCKER DISCONTINUATION Ankur Shah, Andrea Yeguez, Robert Zhang, and Robert Kovell Ankur ShahAnkur Shah More articles by this author , Andrea YeguezAndrea Yeguez More articles by this author , Robert ZhangRobert Zhang More articles by this author , and Robert KovellRobert Kovell More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002016.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Prostatic urethral lift (PUL) is a widely utilized minimally invasive treatment for benign prostatic hypertrophy (BPH) indicated in men with prostates less than 80 grams who desire preservation of erectile and ejaculatory function. Like many chronic conditions, men with symptomatic BPH tend to have poor medication adherence rates, estimated around 30%. While the majority of evidence demonstrates that PUL is safe and durable at 5 years, these studies primarily evaluate postoperative changes in patients’ urinary and erectile symptom scores and maximum urinary flow rates. There is sparse evidence on the impact of PUL on AB therapy. We therefore sought to evaluate whether PUL reduced the need for AB use postoperatively. We hypothesized PUL would decrease AB utilization. METHODS: We performed a retrospective analysis of 88 patients on AB therapy who underwent PUL from 2018 to 2020 at a single institution. We collected patients’ baseline demographic data and preoperative American Urological Association Symptom Score (AUASS). We also recorded the presence of diabetes mellitus, degree of bladder trabeculation, presence of urethral stricture, prior benign prostatic intervention and history of urinary retention. We then determined whether patients were on AB before and after their surgery using electronic records. Logistic regression was used to examine predictors of post-procedural discontinuation of AB. Paired student’s t-test and chi square test were utilized to compare continuous and categorical variables, respectively. RESULTS: No patients had prior prostatic surgical intervention or urethral strictures. Fifty-three percent of patients were able to discontinue AB therapy postoperatively. Patients with diabetes mellitus were more likely to require AB postoperatively (p<0.01). Age, race, AUASS, degree of bladder trabeculation, and a history of urinary retention requiring catheterization were not predictors of postoperative discontinuation of AB (Figure 1). CONCLUSIONS: PUL allowed more than half of patients undergoing surgery to discontinue use of their AB treatment. While further investigation is necessary, the findings of this study suggest PUL may be an effective alternative for men who have difficulty with or seek to avoid long-term medication use. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e421-e421 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ankur Shah More articles by this author Andrea Yeguez More articles by this author Robert Zhang More articles by this author Robert Kovell More articles by this author Expand All Advertisement Loading ...

PD04-09 DOES HEALTH LITERACY IMPACT PATIENT SATISFACTION FOLLOWING ARTIFICIAL URINARY SPHINCTER SURGERY?

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Male Incontinence: Therapy I (PD04)1 Sep 2021PD04-09 DOES HEALTH LITERACY IMPACT PATIENT SATISFACTION FOLLOWING ARTIFICIAL URINARY SPHINCTER SURGERY? Rohan Bhalla, William Furuyama, Madeleine Ball, Joshua Calvert, Benjamin Dropkin, Douglas Milam, Melissa Kaufman, and Niels Johnsen Rohan BhallaRohan Bhalla More articles by this author , William FuruyamaWilliam Furuyama More articles by this author , Madeleine BallMadeleine Ball More articles by this author , Joshua CalvertJoshua Calvert More articles by this author , Benjamin DropkinBenjamin Dropkin More articles by this author , Douglas MilamDouglas Milam More articles by this author , Melissa KaufmanMelissa Kaufman More articles by this author , and Niels JohnsenNiels Johnsen More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001968.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Health care providers often overestimate a patient’s understanding of health conditions and treatments which can impact preoperative counseling, communication between providers and patients, and ultimately widen health care disparities. We sought to determine whether a patient’s health literacy impacts satisfaction following Artificial Urinary Sphincter (AUS) placement for male urinary incontinence. METHODS: Electronic medical records of men who underwent AUS surgery between January 1st 2016 and July 31st 2020 were retrospectively reviewed. We administered a patient satisfaction phone questionnaire that measured overall satisfaction with the procedure using a Likert scale, as well as whether patients would again undergo AUS surgery. The Brief Health Literacy Screen (BHLS), a validated 3 question Likert-style questionnaire, was administered to evaluate health literacy. Ordinal logistic regression was used to determine the association between health literacy and patient satisfaction, adjusting for the following predetermined confounders: patient age, preoperative American Urological Association Symptom Index (AUASI), time from surgery to phone questionnaire, and device functionality. RESULTS: Seventy-six men who underwent AUS surgery and met inclusion criteria were identified. The median age was 70 years with an interquartile range (IQR) of 66-74 years and 88.1% were Caucasian. The median preoperative AUASI was 13 (IQR: 9-19) with a median quality of life score of 5 (IQR: 4-6). Eighty-six percent of men were either satisfied or very satisfied with their surgical procedure, and 86% of men stated that they would again undergo AUS surgery. The median BHLS score was 15 (IQR: 12-15). After adjusting for predetermined confounders, BHLS score was significantly associated with patient satisfaction (OR 1.25, 95% CI 1.02-1.56; p=0.034); however, it was not associated with likelihood to again undergo surgery (p-value = 0.403) (Table 1). CONCLUSIONS: Lower health literacy is associated with lower satisfaction scores following AUS surgery. Understanding a patient’s baseline health literacy and level of comprehension of medical treatments and expectations can aid to individualize preoperative counseling, improve subjective patient outcomes, and reduce health disparities. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e53-e53 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rohan Bhalla More articles by this author William Furuyama More articles by this author Madeleine Ball More articles by this author Joshua Calvert More articles by this author Benjamin Dropkin More articles by this author Douglas Milam More articles by this author Melissa Kaufman More articles by this author Niels Johnsen More articles by this author Expand All Advertisement Loading ...

Utilization of a Peritoneal Interposition Flap to Prevent Symptomatic Lymphoceles After Robotic Radical Prostatectomy and Bilateral Pelvic Lymph Node Dissection.

Introduction: The peritoneal interposition flap (PIF) has been shown to prevent postoperative symptomatic lymphocele (SL) formation after robot-assisted radical prostatectomy (RARP) and pelvic lymph node dissection (PLND). The PIF inhibits the mobilized bladder from resealing over its lateral dissection planes, which overly the lymphadenectomy beds. This creates a window for lymphatic fluid to drain into the peritoneal cavity where it can be absorbed. Herein, we externally validate its utility in preventing postoperative SL formation and assess its effect on postoperative urinary function. Materials and Methods: We retrospectively reviewed all consecutive patients who underwent RARP with bilateral PLND by a single surgeon between July 2016 and September 2019. All patients who underwent surgery before August 8, 2018 did not receive the PIF, while those who underwent surgery after August 8, 2018 received the PIF. Our PIF technique involves fixing the peritoneum overlying the lateral dome of the bladder to the ipsilateral, anterior-lateral surface of the bladder using a barbed absorbable suture. Continuous and categorical variables were compared between the two groups using independent t-tests and chi-square tests, respectively; p < 0.05 was considered significant. Results: Of 318 total patients, 201 did not undergo the PIF and 117 underwent the PIF. With regard to postoperative complications, patients undergoing the PIF had a lower incidence of SL compared with those not undergoing the PIF (0.0% vs 6.0%, p = 0.007). There was no difference in 30-day postoperative nonlymphocele complications (Clavien >2) between both groups (p = 0.800). With regard to urinary function, there was no difference in the rate of 3-month postoperative continence (p = 0.624), preoperative American Urological Association Symptom Score (AUASS) (p = 0.898), and postoperative AUASS (p = 0.470) between both groups. Conclusion: Utilization of a PIF may minimize the risk of SL formation after RARP and PLND without increasing the risk of non-SL-related complications. This technique does not adversely affect postoperative urinary function.

Impact of Minimally Invasive Benign Prostatic Hyperplasia Therapies on 30- and 90-Day Postoperative Office Encounters

To compare the frequency of postoperative encounters in the 30-day and 90-day postoperative periods for various bladder outlet obstruction surgical therapies. All patients who underwent transurethral resection of the prostate (TURP), GreenLight laser photovaporization of the prostate (GL-PVP) (American Medical Systems Inc.), and holmium laser enucleation of the prostate (HoLEP) from January 1, 2012 to December 31, 2014 were followed for 6 months postoperatively. All postoperative encounters such as patient calls or questions, catheter exchanges or removals, and hospital-based readmissions or emergency department visits were recorded in the electronic medical record. Two hundred and ninety-one consecutive patients underwent outlet procedures during the study period: TURP (N = 199; mean age, 71 years; mean body mass index [BMI], 28.5), HoLEP (N = 60; mean age, 68 years; mean BMI, 28.1), or GL-PVP (N = 32; mean age, 72 years; mean BMI, 29.3). No statistically significant difference was observed for age, BMI, preoperative American Urological Association symptom score, or preoperative maximum flow velocity between the 3 groups. Thirty-day postoperative encounters differed significantly between the 3 surgery types (P < .001). Specifically, there were fewer encounters within 30 days of surgery for TURP compared to both HoLEP (≥1 encounter: TURP = 48.7%, HoLEP = 66.7%; P = .006) and GL-PVP (≥1 encounter: TURP = 48.7%, GL-PVP = 93.7%; P < .001). The number of encounters within 90 days postoperatively was also significantly lower for TURP patients (P < .001). TURP results in fewer postoperative encounters in both the 30-day and 90-day postoperative periods compared to HoLEP and GL-PVP. Laser prostate therapies may place increased burden on clinic staff during the 30-day and 90-day postoperative periods.

Ventral Inlay Labia Minora Graft Urethroplasty for the Management of Female Urethral Strictures

To evaluate the functional outcomes of ventral inlay labia minora graft urethroplasty (VILGU) for the management of female urethral strictures. Data of 7 consecutive women treated with VILGU between 2011 and 2013 were reviewed. Two patients had cystostomy tubes at repair, and 5 had undergone previous urethral dilations and urethrotomies. Clinical evaluation included assessment of the effect of voiding symptoms with American Urological Association (AUA) symptom score, uroflowmetry, voiding cystourethrography, and intraoperative urethrocystoscopy using a 6.5F pediatric ureterorenoscope. Preoperative AUA symptom score and peak urinary flow rate were compared with postoperative values. Cure was defined as the absence of any restenosis requiring additional intervention with subjective patient satisfaction at the last follow-up. Mean stricture length was 1.5 cm (range, 1-2.5), and mean operative time was 95 minutes (range, 70-110). With a mean follow-up of 18.2 months (range, 3-30), cure was achieved in 6 (86%) women. At the last follow-up, mean maximum urine flow (mL/s) increased from 3.9 ± 3.1 preoperatively to 22.7 ± 8.3 postoperatively (P <.001), and mean AUA symptom score decreased from 25.3 ± 5.2 preoperatively to 6.9 ± 3.7 postoperatively (P = .001). No fistulae developed after surgery. "De-novo" stress urinary incontinence was not evident in any case. VILGU effectively provides better urinary flow and significantly improves patient satisfaction in patients with female urethral stricture disease.

Experience With More Than 1,000 Holmium Laser Prostate Enucleations for Benign Prostatic Hyperplasia

Holmium laser prostate enucleation is a contemporary treatment for benign prostatic hyperplasia. We report our experience with more than 1,000 procedures. From June 1998 to March 2009 we performed 1,065 holmium laser prostate enucleations. After receiving institutional review board approval we retrospectively reviewed the database. Reported short-term, intermediate term and long-term results are 0 to 6, 6 to 12 and greater than 12 months, respectively. Bladder stones were present in 50 patients (4.7%) and 87 of the 717 (12.1%) with laboratory studies available had renal insufficiency. Preoperative urinary retention was present in 411 cases (38.7%). Significant preoperative stress and urge incontinence was noted in 8 and 16 patients, respectively. Mean transrectal ultrasound prostate volume was 99.3 gm (range 9 to 391). Mean preoperative American Urological Association symptom score was 20.3 (range 1 to 35) and maximum urinary flow was 8.4 cc per second (range 1.1 to 39.3). Intraoperative or postoperative complications occurred in 24 cases (2.3%). Mean followup was 287 days (range 6 to 3,571). At short-term, intermediate term and long-term followup the mean symptom score was 8.7, 5.9 and 5.3, and maximum urinary flow was 17.9, 19.5 and 22.7 cc per second, respectively. At the most recent followup 3 patients (0.3%) were in urinary retention. One patient with maximum urinary flow 20 cc per second required a second procedure for bleeding prostatic regrowth. Urethral stricture was noted in 9 (0.9%), 11 (1.3%), 4 (1.3%) and 0 patients, and bladder neck contracture was found in 0, 7 (0.8%), 4 (1.3%) and 5 (6.0%) at short-term, intermediate term, long-term and greater than 5-year followup, respectively. At the most recent followup significant stress and urge incontinence was noted in 9 and 6 patients, respectively. Holmium laser prostate enucleation is safe and effective for benign prostatic hyperplasia. The complication rate is low, and incontinence and the need for ancillary procedures are rare for holmium laser prostate enucleation with durable long-term results.

Experience With More Than 1,000 Holmium Laser Prostate Enucleations for Benign Prostatic Hyperplasia

Holmium laser prostate enucleation is a contemporary treatment for benign prostatic hyperplasia. We report our experience with more than 1,000 procedures. From June 1998 to March 2009 we performed 1,065 holmium laser prostate enucleations. After receiving institutional review board approval we retrospectively reviewed the database. Reported short-term, intermediate term and long-term results are 0 to 6, 6 to 12 and greater than 12 months, respectively. Bladder stones were present in 50 patients (4.7%) and 87 of the 717 (12.1%) with laboratory studies available had renal insufficiency. Preoperative urinary retention was present in 411 cases (38.7%). Significant preoperative stress and urge incontinence was noted in 8 and 16 patients, respectively. Mean transrectal ultrasound prostate volume was 99.3 gm (range 9 to 391). Mean preoperative American Urological Association symptom score was 20.3 (range 1 to 35) and maximum urinary flow was 8.4 cc per second (range 1.1 to 39.3). Intraoperative or postoperative complications occurred in 24 cases (2.3%). Mean followup was 287 days (range 6 to 3,571). At short-term, intermediate term and long-term followup the mean symptom score was 8.7, 5.9 and 5.3, and maximum urinary flow was 17.9, 19.5 and 22.7 cc per second, respectively. At the most recent followup 3 patients (0.3%) were in urinary retention. One patient with maximum urinary flow 20 cc per second required a second procedure for bleeding prostatic regrowth. Urethral stricture was noted in 9 (0.9%), 11 (1.3%), 4 (1.3%) and 0 patients, and bladder neck contracture was found in 0, 7 (0.8%), 4 (1.3%) and 5 (6.0%) at short-term, intermediate term, long-term and greater than 5-year followup, respectively. At the most recent followup significant stress and urge incontinence was noted in 9 and 6 patients, respectively. Holmium laser prostate enucleation is safe and effective for benign prostatic hyperplasia. The complication rate is low, and incontinence and the need for ancillary procedures are rare for holmium laser prostate enucleation with durable long-term results.

HOLMIUM LASER ENUCLEATION FOR PROSTATE ADENOMA GREATER THAN 100 GM.: : COMPARISON TO OPEN PROSTATECTOMY

Options for treatment of large (greater than 100 gm.) prostatic adenomas have until now been limited to open surgery or transurethral resection by skilled resectionists. Considerable blood loss, morbidity, extended hospital stay and prolonged recovery occur with open surgery for large prostatic adenomas. Endoscopic surgery for benign prostatic hyperplasia has evolved during the last decade to offer the patient and surgeon significant advantages of transurethral removal of prostatic adenomas. Holmium laser enucleation of the prostate with transurethral tissue morcellation provides significant reductions in morbidity, bleeding and hospital stay for patients with large prostate adenomas. A retrospective review of data on 10 cases of holmium laser enucleation and 10 open prostatectomies for greater than 100 gm. prostatic adenomas was performed from 1998 to 1999 at our institution. Patient demographics, indication for surgery, preoperative and postoperative American Urological Association (AUA) symptom scores, operating time, serum hemoglobin, resected prostatic weight, pathological diagnosis, length of stay and complications were compared. Patient age, indications for surgery (retention, failed medical therapy, high post-void residual, bladder calculi, bladder diverticula and azotemia) and preoperative AUA symptom scores were similar in both groups. Postoperative AUA symptom scores were significantly decreased (p <0.004) in both groups. Operating times were not significantly different. Serum sodium was unchanged by holmium laser enucleation (not significant), and postoperative hemoglobin was not significantly reduced in the holmium laser enucleation group but decreased significantly in the open prostatectomy group (mean decrease 2.9 +/- 0.7 gm., p = 0.0003). Resected weight was greater in the holmium laser enucleation group (151 versus 106 gm., p = 0.07). Length of stay was significantly shorter in the holmium laser enucleation group (2.1 versus 6.1 days, p <0.001). Complications in the holmium laser enucleation group included stress urinary incontinence in 4 cases, prostatic perforation in 1 and urinary retention in 1. No patient treated with holmium laser enucleation was discharged home with an indwelling catheter. Complications in the open prostatectomy group included bladder neck contractures in 2 cases, stress incontinence in 1 and urge incontinence in 1. All patients treated with open prostatectomy were discharged home with an indwelling catheter. Holmium laser enucleation is an effective, safe procedure for large prostatic adenomas with significantly lower morbidity, catheterization duration and length of stay. Performing holmium laser enucleation for large adenomas requires experience. Stress incontinence was seen frequently with laser but was short-term and self-limited. Holmium laser enucleation is a new procedure, and as experience and expertise increase, it may become an attractive alternative to open prostatectomy for patients with large prostate adenomas.

ARTIFICIAL URINARY SPHINCTER FOR POST-PROSTATECTOMY INCONTINENCE: IMPACT OF PRIOR COLLAGEN INJECTION ON COST AND CLINICAL OUTCOME

We retrospectively reviewed our experience with the artificial urinary sphincter in men with post-prostatectomy incontinence to determine the impact of prior collagen injection therapy on surgical outcome and overall cost of treatment. The records and preoperative urodynamic studies of 30 men with post-prostatectomy incontinence who underwent artificial urinary sphincter placement were reviewed. Of these patients 23 (76.6%) had undergone prior collagen injection (collagen group) and 7 had not (noncollagen group). Preoperative and postoperative severity of incontinence was assessed with the American Urological Association quality of life index (scale 0 to 6) and number of pads used daily. Using a Valsalva leak point pressure of less than 60 cm. water as a predictor of failure with collagen injection, we calculated the potential savings had these patients foregone collagen injection and chosen artificial urinary sphincter primarily. Of the 30 patients 24 (80%) were incontinent following radical retropubic prostatectomy and 6 (20%) after transurethral resection. Intrinsic sphincter deficiency was the sole etiology of incontinence in most patients (83.3%) and 5 (16.7%) had concomitant detrusor instability. Six patients alternated the use of pads with the use of clamps or a condom catheter to aid in controlling leakage. Mean number of collagen treatment sessions for the injection group was 2.9 (range 1 to 7). There was a significant difference in mean time from prostatectomy to artificial urinary sphincter between the noncollagen (25.3 months) and collagen (35.8 months) groups (p = 0.04). There were no other statistically significant differences between the groups, including mean age (66.2 years, range 45 to 83), mean followup (26.2 months), mean preoperative pads daily (5.8+/-3.4), median preoperative quality of life index (6, range 3 to 6), median preoperative American Urological Association symptom score (13, range 3 to 35) and mean preoperative Valsalva leak point pressure (42.7+/-21.4 cm. water). For all patients in the study the mean postoperative pads daily was 0.8, mean quality of life index 1 and surgical complication rate 13.3%. There were no statistically significant differences between the collagen and noncollagen groups in any of these parameters. Among the collagen group 17 patients (73.9%) had a Valsalva leak point pressure less than 60 cm. water. Considering the mean additional period of incontinence (time between prostatectomy and artificial urinary sphincter) to be 12.9 months and the additional treatment costs (including pads daily and mean number of collagen syringes per patient), the direct costs of treatment for the collagen group were 85.6% higher than those for patients who chose artificial urinary sphincter primarily. Prior collagen therapy did not adversely influence the surgical complication rate or compromise effectiveness of the artificial urinary sphincter. However, patients with Valsalva leak point pressure less than 60 cm. water have lower rates of success with collagen injection therapy and could benefit from a more successful, timely and cost-effective treatment of incontinence by choosing the artificial urinary sphincter as primary therapy.

AMERICAN UROLOGICAL ASSOCIATION SYMPTOM INDEX IN THE ASSESSMENT OF URETHROPLASTY OUTCOMES

Purpose In men undergoing urethroplasty we used the American Urological Association (AUA) symptom index to assess the magnitude of symptoms and determine the validity of this index as an outcome assessment tool. Materials and Methods The AUA symptom index was completed by individual interview of 50 men a mean of 41 years old who underwent urethral reconstruction. Symptom scores were then correlated with radiographic retrograde urethrograms and urinary flow rates to determine whether changes in the score were consistent with these other clinical indicators of success or failure. Results Mean preoperative AUA symptom index score in all evaluable patients was 26.9 (maximum 35), indicating severely bothersome voiding symptoms. In patients with radiographic evidence of successful urethral reconstruction the average postoperative score was 5.1 (p <0.0001). In those with recurrent stricture after urethroplasty scores were essentially unchanged but after successful repeat urethroplasty the mean symptom index score decreased to 3.4 (p <0.0001). A statistically significant inverse correlation (r = −0.712, p <0.0001) was found between AUA symptom index scores and maximum urinary flow rates. Conclusions Patients with urethral strictures who are selected for formal urethroplasty have severe obstructive and irritative voiding symptoms. Results of the AUA symptom index correlate closely with conventional measures of urethroplasty outcome, such as radiographic retrograde urethrography and urinary flow studies. The AUA symptom index appears to have clinical validity as an adjunctive outcome assessment tool after urethroplasty.