Psychometric and Linguistic External Validation of the Urethral Stricture Symptom and Impact Measure and Its Association With Treatment Satisfaction and Decision Regret After Anterior Urethroplasty.

PURPOSE: The Urethral Stricture Symptom and Impact Measure (USSIM) is a patient-derived patient-reported outcome measure (PROM) for men undergoing urethroplasty, but external and linguistic validation is lacking. We aimed to validate the USSIM in an independent cohort and further examine its association with treatment satisfaction and decisional regret.

MATERIALS AND

METHODS

From September 2023 to September 2024, 151 male patients undergoing anterior urethroplasty were prospectively enrolled; 100 completed both baseline and 3- to 9-month postoperative PROMs. The 12-item USSIM was translated into German following the International Consultation on Incontinence Questionnaire validation methodology and was administered together with the Urethral Stricture Surgery Patient-Reported Outcome Measure lower urinary tract symptoms score, Male Sexual Health Questionnaire ejaculation scale, International Consultation on Incontinence Questionnaire satisfaction outcome score, and the Decision Regret Scale. Psychometric evaluation followed the COSMIN (Consensus-Based Standards for the Selection of Health Measurement Instruments) initiative, assessing reliability, validity, and responsiveness.

RESULTS

Of 100 patients with preoperative and postoperative PROMs available, most patients underwent single-stage urethroplasty (94%), with bulbar (75%) or penile (25%) strictures, predominantly idiopathic (40%) or iatrogenic (31%), and median stricture length of 30 mm (IQR 20-40). Postoperative assessment occurred at a median of 6 months (IQR 4-7). Internal consistency of the 10-item postoperative scale was good (Cronbach α = 0.869). Test-retest reliability was high (intraclass correlation coefficient = 0.88). Changes in USSIM voiding scores strongly correlated with Urethral Stricture Surgery Patient-Reported Outcome Measure lower urinary tract symptoms score improvements (Spearman rank correlation coefficient [rs] = 0.72, P < .001), weakly with Male Sexual Health Questionnaire ejaculation scale changes (rs = -0.25, P = .015), moderately with treatment satisfaction (rs = -0.37, P < .001), and moderately with decision regret (rs = 0.32, P = .001). Total USSIM scores (reference range: 10-50) decreased significantly postoperatively (median change -10; P < .001), demonstrating high responsiveness.

CONCLUSIONS

This first external psychometric and linguistic validation confirms that the USSIM is a reliable, valid, and responsive instrument for assessing urinary and sexual outcomes after anterior urethroplasty. It provides a standardized, patient-centered tool for postoperative follow-up and comparative research.