Clinical Efficacy of "Modified Clavien Grading Classification" for Analysis of Post Surgical Morbidity in Male Urethral Stricture Disease & Its Clinico-Pathological Profile: An Ambispective Observational Study

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Background & Aim: Male urethral stricture disease (MUSD) is a prevalent urological condition characterized by fibrotic narrowing of the urethral lumen, often resulting in recurrent urinary symptoms and complications. Surgical management remains the definitive treatment, with variable outcomes based on technique, stricture characteristics, and patient factors. Methods: This observational study included 100 patients with MUSD treated either by internal optical urethrotomy (OIU) or urethroplasty (excision and primary anastomosis or substitution) at a tertiary care centre. Clinico-demographic, intraoperative, and post-operative data were collected retrospectively (n=84) and prospectively (n=16). Morbidity was assessed using the Modified Clavien-Dindo classification, and recurrence was defined by the need for any re-intervention within 2 months postoperatively. Results: The most common aetiology was infectious (33%), followed by trauma (27%) and iatrogenic causes (21%). Weak urinary stream (74%) and acute retention (60%) were the predominant symptoms. OIU was performed in 60% of patients, with a recurrence rate of 26.7%, significantly higher than EPA (7.1%) and substitution urethroplasty (8.3%) (p=0.024). Stricture length >2 cm was a significant predictor of recurrence in the OIU group (p<0.001). Most complications were Clavien-Dindo Grade I or II, with longer hospital stays observed in urethroplasty patients. Conclusion: OIU remains a feasible short-term option but is associated with high recurrence in long or complex strictures. Urethroplasty, especially EPA, offers superior outcomes with acceptable morbidity. Surgical planning guided by stricture characteristics is essential to optimize long-term success.

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