Patient-Reported Outcomes After Single-Stage Spiral Preputial Graft Urethroplasty for Panurethral Strictures: A Single-Centre Prospective Study

Patient-Reported Outcomes After Single-Stage Spiral Preputial Graft Urethroplasty for Panurethral Strictures: A Single-Centre Prospective Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Patient-Reported Outcomes After Single-Stage Spiral Preputial Graft Urethroplasty for Panurethral Strictures: A Single-Centre Prospective Study Saurabh Thakkar, Pankaj Joshi, Shreyas Bhadranavar, Jimena Navarro, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7458904/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 09 Feb, 2026 Read the published version in BMC Urology → Version 1 posted 18 You are reading this latest preprint version Abstract Background Panurethral strictures, involving the entire anterior urethra, present a significant reconstructive challenge. While buccal mucosal grafts are commonly used, limitations in graft length and donor site morbidity persist. The spiral preputial graft (SPG) offers a promising alternative, enabling long, hairless grafts without additional donor morbidity. This study prospectively evaluates patient-reported outcomes (PROs) following single-stage SPG urethroplasty for panurethral strictures. Methods A prospective observational study was conducted between January 2021 and June 2024 at a tertiary urology center. Fifty-five patients undergoing SPG urethroplasty were included. Exclusion criteria included Lichen Sclerosus, prior urethroplasty, and inadequate preputial skin. PROs were assessed preoperatively and postoperatively using the Lower Urinary Tract Symptom (LUTS) score, Visual Analogue Scale (VAS) for health status, treatment satisfaction, and quality of life (QoL) impact. Statistical significance was set at p < 0.05. Results Median LUTS scores improved significantly from 18 to 2 (p < 0.001), and mean VAS scores increased from 44.7 to 84.4 (p < 0.001). QoL improvement was reported by 83.6% of patients, with 80% expressing satisfaction. The overall success rate—defined as symptom relief without secondary intervention—was 83.7%. Conclusion Single-stage SPG urethroplasty is a technically feasible, reproducible, and effective alternative to oral grafting for panurethral strictures. It results in significant improvements in urinary symptoms, health perception, and patient satisfaction. These findings support broader adoption of the SPG technique in appropriately selected patients, with an emphasis on integrating PROs into surgical outcome assessment. Urethral Stricture Stricture Urethra Urethroplasty Spiral Preputial Graft Patient-Reported Outcomes Panurethral Stricture Quality of Life Single-Stage Repair Figures Figure 1 Figure 2 Figure 3 Figure 4 BACKGROUND Panurethral stricture disease, involving the entire anterior urethra from meatus to the bulbomembranous junction, presents a formidable challenge for reconstructive urologists due to its length, multifocal nature, and often underlying inflammatory etiology such as lichen sclerosus (LS) ( 1 , 2 ). This condition is more prevalent in South Asian settings, with LS and iatrogenic trauma (e.g., catheterization or instrumentation) being the dominant causes ( 3 , 4 ). Conventional approaches to managing panurethral stricture have evolved from multi-stage Johanson urethroplasty and fasciocutaneous flaps to one-stage dorsal onlay grafts, particularly using oral mucosa ( 4 – 9 ). Kulkarni and colleagues popularized a minimally invasive, single-stage technique involving one-sided dissection and dorsal onlay buccal mucosal graft, which demonstrated high success rates and reproducibility ( 3 , 10 ). However, buccal graft harvesting carries its own morbidity and limitations in long strictures requiring more extensive tissue ( 11 ) . To overcome this, the spiral preputial graft (SPG) has been introduced as an innovative technique that allows harvest of a long graft (up to 20 cm) from preputial skin by spiraling a circumferential strip ( 10 ). While technical feasibility has been described, there is a relative paucity of data evaluating patient-reported outcomes (PROs) following SPG urethroplasty. ( 12 ) The importance of PROs in reconstructive urology is increasingly recognized, as traditional outcome measures such as flow rates or re-intervention rates fail to capture the full patient experience ( 13 , 14 ). Validated tools such as the USS PROM have shown that urethroplasty significantly improves quality of life and symptom scores ( 11 , 14 ). However, to date, no study has prospectively evaluated patient-reported outcomes specifically following spiral preputial graft urethroplasty. This study aims to bridge that gap by prospectively evaluating LUTS improvement, patient satisfaction, and quality-of-life outcomes following single-stage SPG urethroplasty in a single-centre Indian cohort. Our hypothesis is that SPG offers not only technical success but also substantial patient-centered benefit, making it a viable alternative to oral mucosal grafting in selected patients. MATERIALS AND METHODS Study Design and Setting This was a prospective observational study conducted at a single tertiary care urology center between January 2021 and June 2024. The study was designed to evaluate patient-reported outcomes following single-stage spiral preputial graft (SPG) urethroplasty in patients with panurethral strictures. Institutional ethical clearance was obtained prior to commencement of the study, and all participants provided informed consent. (IRB Approval: U/23/074 ) Patient Selection Patients with panurethral stricture disease undergoing SPG urethroplasty were screened for inclusion. Inclusion Criteria: Diagnosed with panurethral stricture confirmed via urethrography or urethroscopy Undergoing single-stage SPG urethroplasty Willing and able to provide informed consent and complete follow-up questionnaires Exclusion Criteria: Patients having Lichen Sclerosus. Patients with a history of prior urethroplasty Strictures limited to bulbar or penile urethra Inadequate preputial skin Of the 64 patients who underwent the procedure, 9 were lost to follow-up, and 55 patients were included in the final analysis. Surgical Technique All procedures were performed by a trained reconstructive urology team. Under spinal anaesthesia, a midline perineal incision was made. The urethra was mobilized on one side using the Kulkarni one-sided dissection technique. A dorsal urethrotomy was performed at the 12 o’clock position, and the strictured segment of urethra was opened. A spiral preputial graft was harvested by excising a 3 cm wide strip of preputial skin circumferentially, which was then cut spirally to maintain a uniform width of approximately 1.5 cm. This technique allowed graft lengths of up to 20 cm to be obtained. The graft was placed as a dorsal onlay over the corpora cavernosa. It was quilted to the corpora cavernosa, and the urethral plate margins were anastomosed to the graft edges using interrupted 4-0 absorbable sutures, thereby reconstructing the urethra over a 14 Fr silicone catheter. The circumcision wound was closed primarily. The perineal incision was closed in layers, and a light compression dressing was applied. Outcome Measures Patients were followed up at regular intervals postoperatively. The following patient-reported outcomes (PROs) were collected preoperatively and at last follow-up: Lower Urinary Tract Symptom (LUTS) score (range 0–24): Higher scores indicated more severe symptoms Health Status Visual Analogue Scale (VAS) (0 = worst imaginable health, 100 = best): Patient-rated subjective health Treatment Satisfaction : Reported on a 3-point Likert scale (“satisfied,” “neutral,” or “unsatisfied”) Patient-perceived impact on quality of life (QoL) Data Collection and Statistical Analysis Data were recorded and analyzed using Microsoft Excel and SPSS version 31. Descriptive statistics were used to summarize continuous variables as means or medians, and categorical variables as proportions. Comparisons between pre- and postoperative scores were evaluated using appropriate parametric or non-parametric tests (paired t-test), with p < 0.05 considered statistically significant. RESULTS A total of 64 patients underwent single-stage spiral preputial graft urethroplasty between January 2021 and June 2024. Of these, 9 patients were lost to follow-up, and 55 patients were included in the final analysis. The mean age of the cohort was 55.9 years (range 15–79 years). Patient-Reported Outcomes The LUTS score significantly improved following urethroplasty, with the median score decreasing from 18 preoperatively to 2 postoperatively ( p < 0.001). Similarly, health status visual analogue scale (VAS) scores improved from a mean of 44.7 to 84.4 after surgery ( p < 0.001). Regarding quality of life (QoL): 46 patients (83.7%) reported that symptoms interfered less with their QoL. 7 patients (12.7%) reported no change. 2 patients (3.6%) experienced worsening. Success Rate The overall success rate of the procedure, defined as symptom relief and no need for secondary intervention, was 83.7%. Parameter Preoperative Postoperative p-value LUTS Score (Median 18 2 <0.001 VAS Score (Mean +/- SD) 59.36 +/- 12.25 84.4 +/- 19.6 <0.001 QoL Improved (%) 83.6 DISCUSSION In this study of 55 patients, spiral preputial graft urethroplasty (SPG) yielded an 83.7% success rate, significant improvements in LUTS (median 18 → 2), and VAS (mean 44.7 → 84.4), with over 80% of patients satisfied and reporting improved quality of life. These findings underscore the subjective and clinical efficacy of SPG in managing complex anterior urethral strictures. Traditional management of panurethral strictures often involves buccal mucosal graft (BMG) urethroplasty, which, while reliable, may be constrained by donor site morbidity and graft length, especially in long-segment repairs (15,16). The use of preputial skin, particularly via the spiral harvesting technique as described by Kulkarni et al., provides a longer graft (up to 20 cm) without additional morbidity (17). Our results support the feasibility and effectiveness of this technique, particularly in appropriately selected patients. The spiral preputial graft represents a safe, one-stage alternative to multi-stage urethroplasty in cases of panurethral stricture, particularly in patients unsuitable for oral grafts or where graft length is a limitation (15,17). Our emphasis on patient-reported outcomes aligns with modern urological practice, where surgical success is increasingly judged not just by anatomical results but by symptom relief and satisfaction (18,19). The study is limited by its single-center design, absence of a comparison group (e.g., BMG or flap-based repair), and intermediate follow-up. Further, reliance on subjective scales, although standardized, may be affected by recall bias. Sexual function outcomes were not assessed and remain a domain for future exploration Future studies should include multicenter cohorts and randomized trials comparing SPG with BMG and staged procedures. Incorporating both objective outcome metrics (e.g., uroflowmetry, imaging) and sexual function tools such as the IIEF or USS-PROM extensions would provide a comprehensive evaluation of urethroplasty outcomes. CONCLUSION Our findings demonstrate that this technique is not only surgically feasible and reproducible but also offers significant improvement in urinary symptoms, quality of life, and overall patient satisfaction. With a success rate of 83.7% and high levels of reported symptom relief and satisfaction, the spiral preputial graft represents a viable alternative to buccal mucosal graft or staged repairs—particularly in patients with suitable preputial tissue. Its ability to provide a long, well-vascularized, hairless graft in a single stage adds substantial value to the reconstructive armamentarium. These results emphasize the importance of incorporating patient-reported outcomes into routine urethroplasty evaluation and support the broader adoption of spiral preputial grafting in appropriately selected cases. Abbreviations BMG – Buccal Mucosal Graft LS – Lichen Sclerosus LUTS – Lower Urinary Tract Symptoms PRO – Patient-reported Outcomes SPG – Spiral Preputial Graft QoL – Quality of Life VAS – Visual Analogue Scale Declarations Ethics approval and consent to participate The study was approved by the Institutional Ethics Committee of Urokul Hospital, Pune (Urokul Hospital Institutional Ethics Committee, Reference No: IRB Approval: U/23/074). Written informed consent was obtained from all participants before inclusion in the study. Consent for publication Not applicable Availability of data and materials The datasets generated and/or analyzed during the current study are not publicly available due to patient confidentiality but are available from the corresponding author on reasonable request. Competing Interests The authors declare that they have no competing interests. Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Clinical Trial Number Not applicable Authors’ Contributions ST - Data collection, Manuscript Writing, Patient Follow-up; Data Analysis and Interpretation, Statistical Analysis PJ - Conceptualisation, Surgical Procedure, Methodology, Supervision, Manuscript Review, Final Approval SB - Data Curation, Manuscript Editing and Review JN - Literature Review, Manuscript Proofreading PB - Literature Review, Manuscript Proofreading PK - Data Collection, Data Entry, Patient Follow-up SK - Conceptualisation, Surgical Procedure, Methodology, Supervision, Manuscript Review, Final Approval Acknowledgements I would like to sincerely thank Dr. Amey Talpallikar for his valuable guidance, clinical insights, and support throughout the course of this study. We also extend our heartfelt appreciation to our co-fellows, Dr. Meritxell Costa Grau and Dr. Emmanuel Oyibo, for their collaborative spirit, encouragement, and assistance in patient care and data collection during the study period. Their contributions enriched the overall execution of this research. References Kulkarni S, Joshi P, Surana S, Hamouda A. Management of panurethral strictures. African Journal of Urology. 2016 Mar 1;22(1):33–9. Kulkarni SB, Joshi PM, Venkatesan K. Management of panurethral stricture disease in India. Journal of Urology. 2012 Sep;188(3):824–30. Goel A, Goel A, Jain A, Singh BP. Management of panurethral strictures. In: Indian Journal of Urology. 2011. p. 378–84. Singh B, Pathak H, Andankar M. Dorsolateral onlay urethroplasty for anterior urethral strictures by a unilateral urethral mobilization approach. Indian Journal of Urology. 2009 Jul 1;25(2):211–4. Kulkarni S, Barbagli G, Sansalone S, Lazzeri M. One-sided anterior urethroplasty: A new dorsal onlay graft technique. BJU Int. 2009 Oct;104(8):1150–5. Wilson SC, Stranix JT, Khurana K, Morrison SD, Levine JP, Zhao LC. Fasciocutaneous flap reinforcement of ventral onlay buccal mucosa grafts enables neophallus revision urethroplasty. Ther Adv Urol. 2016 Dec 17;8(6):331–7. Martins FE, Kulkarni SB, Joshi P, Warner J, Martins N. Management of Long-Segment and Panurethral Stricture Disease. Adv Urol. 2015;2015:1–15. Hillary CJ, Osman NI, Chapple CR. Current trends in urethral stricture management. Asian J Urol. 2014 Oct;1(1):46–54. Manne DV, Kulkarni DP. Single stage substitution urethroplasty using buccal mucosa in the management of stricture urethra in balanitis xerotica obliterans (BXO). International Journal of Medical Research and Review. 2016 Sep 30;4(9):1675–80. Kulkarni S, Kulkarni J, Surana S, Joshi PM. Management of Panurethral Stricture. Vol. 44, Urologic Clinics of North America. W.B. Saunders; 2017. p. 67–75. Jackson MJ, Chaudhury I, Mangera A, Brett A, Watkin N, Chapple CR, et al. A prospective patient-centred evaluation of urethroplasty for anterior urethral stricture using a validated patient-reported outcome measure. Eur Urol. 2013;64(5):777–82. Lucas ET, Koff WJ, Rosito TE, Berger M, Bortolini T, Silva Neto B. Assessment of satisfaction and Quality of Life using self - reported questionnaires after urethroplasty: a prospective analysis. International braz j urol. 2017 Apr;43(2):304–10. Jackson MJ, Sciberras J, Mangera A, Brett A, Watkin N, N’Dow JMO, et al. Defining a patient-reported outcome measure for urethral stricture surgery. Eur Urol. 2011 Jul;60(1):60–8. Baradaran N, Hampson LA, Edwards TC, Voelzke BB, Breyer BN. Patient-Reported Outcome Measures in Urethral Reconstruction. Vol. 19, Current Urology Reports. Current Medicine Group LLC 1; 2018. Dubey D, Kumar A, Mandhani A, Srivastava A, Kapoor R, Bhandari M. Buccal mucosal urethroplasty: a versatile technique for all urethral segments. BJU Int. 2005 Mar 10;95(4):625–9. Krishnan S V, Sakthivel DK, Velan M, Jain N, Ragavan N, Bafna S. Management of Panurethral Strictures by Preputial Graft Urethroplasty: Outcomes From a Tertiary Care Centre. Cureus. 2025 Apr 21; Kulkarni SB, Joshi PM, Basile G, Bandini M. Novel single-stage preputial spiral graft for panurethral stricture: a step-by-step description of the technique. World J Urol. 2023 Jul 14;41(9):2459–63. Alanezi T, Li B, Al-Omran L, Alshabanah L, Alkhayal NK, Verma M, et al. Surgical Outcomes Through the Patient’s Eyes: A Scoping Review of Patient-Reported Outcome Measures in Surgery. Journal of Surgical Research. 2025 Sep;313:120–30. Nolazco JI. Future of urology: Embracing patient-centered care and patient-reported outcomes. Curr Urol. 2024 Mar;18(1):23–23. Additional Declarations No competing interests reported. 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2","display":"","copyAsset":false,"role":"figure","size":841889,"visible":true,"origin":"","legend":"\u003cp\u003eUnnumbered image in the materials and methods section.\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-7458904/v1/24871bed3440f160095a1baa.png"},{"id":92530158,"identity":"5b7ba352-41be-41d5-ab5a-d5761d879f87","added_by":"auto","created_at":"2025-09-30 16:36:48","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":340351,"visible":true,"origin":"","legend":"\u003cp\u003eUnnumbered image in the Results section.\u003c/p\u003e","description":"","filename":"floatimage4.png","url":"https://assets-eu.researchsquare.com/files/rs-7458904/v1/788c4fa4de3c4bd81917330f.png"},{"id":92530156,"identity":"8e5202cf-39b2-44b8-ae9a-da01bc183149","added_by":"auto","created_at":"2025-09-30 16:36:48","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":400447,"visible":true,"origin":"","legend":"\u003cp\u003eUnnumbered image in the Results section.\u003c/p\u003e","description":"","filename":"floatimage5.png","url":"https://assets-eu.researchsquare.com/files/rs-7458904/v1/9a75ffc1d9836796fc255fda.png"},{"id":102785986,"identity":"e188b91b-70ac-46b5-9835-05e902b86fce","added_by":"auto","created_at":"2026-02-16 16:11:22","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2787056,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7458904/v1/14132325-1f4f-4f76-a3d6-12a8dc71fea1.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Patient-Reported Outcomes After Single-Stage Spiral Preputial Graft Urethroplasty for Panurethral Strictures: A Single-Centre Prospective Study","fulltext":[{"header":"BACKGROUND","content":"\u003cp\u003ePanurethral stricture disease, involving the entire anterior urethra from meatus to the bulbomembranous junction, presents a formidable challenge for reconstructive urologists due to its length, multifocal nature, and often underlying inflammatory etiology such as lichen sclerosus (LS) (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). This condition is more prevalent in South Asian settings, with LS and iatrogenic trauma (e.g., catheterization or instrumentation) being the dominant causes (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eConventional approaches to managing panurethral stricture have evolved from multi-stage Johanson urethroplasty and fasciocutaneous flaps to one-stage dorsal onlay grafts, particularly using oral mucosa (\u003cspan additionalcitationids=\"CR5 CR6 CR7 CR8\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Kulkarni and colleagues popularized a minimally invasive, single-stage technique involving one-sided dissection and dorsal onlay buccal mucosal graft, which demonstrated high success rates and reproducibility (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). However, buccal graft harvesting carries its own morbidity and limitations in long strictures requiring more extensive tissue (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e) .\u003c/p\u003e\u003cp\u003eTo overcome this, the spiral preputial graft (SPG) has been introduced as an innovative technique that allows harvest of a long graft (up to 20 cm) from preputial skin by spiraling a circumferential strip (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). While technical feasibility has been described, there is a relative paucity of data evaluating patient-reported outcomes (PROs) following SPG urethroplasty. (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eThe importance of PROs in reconstructive urology is increasingly recognized, as traditional outcome measures such as flow rates or re-intervention rates fail to capture the full patient experience (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Validated tools such as the USS PROM have shown that urethroplasty significantly improves quality of life and symptom scores (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). However, to date, no study has prospectively evaluated patient-reported outcomes specifically following spiral preputial graft urethroplasty.\u003c/p\u003e\u003cp\u003eThis study aims to bridge that gap by prospectively evaluating LUTS improvement, patient satisfaction, and quality-of-life outcomes following single-stage SPG urethroplasty in a single-centre Indian cohort. Our hypothesis is that SPG offers not only technical success but also substantial patient-centered benefit, making it a viable alternative to oral mucosal grafting in selected patients.\u003c/p\u003e"},{"header":"MATERIALS AND METHODS","content":"\u003cp\u003e\u003cstrong\u003eStudy Design and Setting\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis was a prospective observational study conducted at a single tertiary care urology center between January 2021 and June 2024. The study was designed to evaluate patient-reported outcomes following single-stage spiral preputial graft (SPG) urethroplasty in patients with panurethral strictures. Institutional ethical clearance was obtained prior to commencement of the study, and all participants provided informed consent. (IRB Approval: U/23/074\u003cstrong\u003e)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePatient Selection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePatients with panurethral stricture disease undergoing SPG urethroplasty were screened for inclusion.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInclusion Criteria:\u003c/strong\u003e\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003eDiagnosed with panurethral stricture confirmed via urethrography or urethroscopy\u003c/li\u003e\n \u003cli\u003eUndergoing single-stage SPG urethroplasty\u003c/li\u003e\n \u003cli\u003eWilling and able to provide informed consent and complete follow-up questionnaires\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eExclusion Criteria:\u003c/strong\u003e\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003ePatients having Lichen Sclerosus.\u003c/li\u003e\n \u003cli\u003ePatients with a history of prior urethroplasty\u003c/li\u003e\n \u003cli\u003eStrictures limited to bulbar or penile urethra\u003c/li\u003e\n \u003cli\u003eInadequate preputial skin\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eOf the 64 patients who underwent the procedure, 9 were lost to follow-up, and 55 patients were included in the final analysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSurgical Technique\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll procedures were performed by a trained reconstructive urology team.\u003c/p\u003e\n\u003cp\u003eUnder spinal anaesthesia, a midline perineal incision was made. The urethra was mobilized on one side using the Kulkarni one-sided dissection technique. A dorsal urethrotomy was performed at the 12 o\u0026rsquo;clock position, and the strictured segment of urethra was opened.\u003c/p\u003e\n\u003cp\u003eA spiral preputial graft was harvested by excising a 3 cm wide strip of preputial skin circumferentially, which was then cut spirally to maintain a uniform width of approximately 1.5 cm. This technique allowed graft lengths of up to 20 cm to be obtained.\u003c/p\u003e\n\u003cp\u003eThe graft was placed as a dorsal onlay over the corpora cavernosa. It was quilted to the corpora cavernosa, and the urethral plate margins were anastomosed to the graft edges using interrupted 4-0 absorbable sutures, thereby reconstructing the urethra over a 14 Fr silicone catheter.\u003c/p\u003e\n\u003cp\u003eThe circumcision wound was closed primarily. The perineal incision was closed in layers, and a light compression dressing was applied.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOutcome Measures\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePatients were followed up at regular intervals postoperatively. The following patient-reported outcomes (PROs) were collected preoperatively and at last follow-up:\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003e\u003cstrong\u003eLower Urinary Tract Symptom (LUTS) score\u003c/strong\u003e (range 0\u0026ndash;24): Higher scores indicated more severe symptoms\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eHealth Status Visual Analogue Scale (VAS)\u003c/strong\u003e (0 = worst imaginable health, 100 = best): Patient-rated subjective health\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eTreatment Satisfaction\u003c/strong\u003e: Reported on a 3-point Likert scale (\u0026ldquo;satisfied,\u0026rdquo; \u0026ldquo;neutral,\u0026rdquo; or \u0026ldquo;unsatisfied\u0026rdquo;)\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003ePatient-perceived impact on quality of life (QoL)\u003c/strong\u003e\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eData Collection and Statistical Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData were recorded and analyzed using Microsoft Excel and SPSS version 31. Descriptive statistics were used to summarize continuous variables as means or medians, and categorical variables as proportions. Comparisons between pre- and postoperative scores were evaluated using appropriate parametric or non-parametric tests (paired t-test), with p \u0026lt; 0.05 considered statistically significant.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eA total of 64 patients underwent single-stage spiral preputial graft urethroplasty between January 2021 and June 2024. Of these, 9 patients were lost to follow-up, and 55 patients were included in the final analysis.\u003c/p\u003e\n\u003cp\u003eThe mean age of the cohort was 55.9 years (range 15\u0026ndash;79 years).\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePatient-Reported Outcomes\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe LUTS score significantly improved following urethroplasty, with the median score decreasing from 18 preoperatively to 2 postoperatively (\u003cem\u003ep\u003c/em\u003e \u0026lt; 0.001).\u003cbr\u003eSimilarly, health status visual analogue scale (VAS) scores improved from a mean of 44.7 to 84.4 after surgery (\u003cem\u003ep\u003c/em\u003e \u0026lt; 0.001).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eRegarding quality of life (QoL):\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003e46 patients (83.7%) reported that symptoms interfered less with their QoL.\u003c/li\u003e\n \u003cli\u003e7 patients (12.7%) reported no change.\u003c/li\u003e\n \u003cli\u003e2 patients (3.6%) experienced worsening.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eSuccess Rate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe overall success rate of the procedure, defined as symptom relief and no need for secondary intervention, was 83.7%.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eParameter\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003ePreoperative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003ePostoperative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eLUTS Score (Median\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eVAS Score (Mean +/- SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e59.36 +/- 12.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e84.4 +/- 19.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eQoL Improved (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e83.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eIn this study of 55 patients, spiral preputial graft urethroplasty (SPG) yielded an 83.7% success rate, significant improvements in LUTS (median 18 \u0026rarr; 2), and VAS (mean 44.7 \u0026rarr; 84.4), with over 80% of patients satisfied and reporting improved quality of life. These findings underscore the subjective and clinical efficacy of SPG in managing complex anterior urethral strictures.\u003c/p\u003e\n\u003cp\u003eTraditional management of panurethral strictures often involves buccal mucosal graft (BMG) urethroplasty, which, while reliable, may be constrained by donor site morbidity and graft length, especially in long-segment repairs (15,16). The use of preputial skin, particularly via the spiral harvesting technique as described by Kulkarni et al., provides a longer graft (up to 20 cm) without additional morbidity (17). Our results support the feasibility and effectiveness of this technique, particularly in appropriately selected patients.\u003c/p\u003e\n\u003cp\u003eThe spiral preputial graft represents a safe, one-stage alternative to multi-stage urethroplasty in cases of panurethral stricture, particularly in patients unsuitable for oral grafts or where graft length is a limitation (15,17). Our emphasis on patient-reported outcomes aligns with modern urological practice, where surgical success is increasingly judged not just by anatomical results but by symptom relief and satisfaction (18,19).\u003c/p\u003e\n\u003cp\u003eThe study is limited by its single-center design, absence of a comparison group (e.g., BMG or flap-based repair), and intermediate follow-up. Further, reliance on subjective scales, although standardized, may be affected by recall bias. Sexual function outcomes were not assessed and remain a domain for future exploration\u003c/p\u003e\n\u003cp\u003eFuture studies should include multicenter cohorts and randomized trials comparing SPG with BMG and staged procedures. Incorporating both objective outcome metrics (e.g., uroflowmetry, imaging) and sexual function tools such as the IIEF or USS-PROM extensions would provide a comprehensive evaluation of urethroplasty outcomes.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eOur findings demonstrate that this technique is not only surgically feasible and reproducible but also offers significant improvement in urinary symptoms, quality of life, and overall patient satisfaction.\u003c/p\u003e\n\u003cp\u003eWith a success rate of \u003cstrong\u003e83.7%\u003c/strong\u003e and high levels of reported symptom relief and satisfaction, the spiral preputial graft represents a \u003cstrong\u003eviable alternative\u003c/strong\u003e to buccal mucosal graft or staged repairs\u0026mdash;particularly in patients with suitable preputial tissue. Its ability to provide a long, well-vascularized, hairless graft in a single stage adds substantial value to the reconstructive armamentarium.\u003c/p\u003e\n\u003cp\u003eThese results emphasize the importance of incorporating \u003cstrong\u003epatient-reported outcomes\u003c/strong\u003e into routine urethroplasty evaluation and support the \u003cstrong\u003ebroader adoption\u003c/strong\u003e of spiral preputial grafting in appropriately selected cases.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003col\u003e\n \u003cli\u003eBMG \u0026ndash; Buccal Mucosal Graft\u003c/li\u003e\n \u003cli\u003eLS \u0026ndash; Lichen Sclerosus\u003c/li\u003e\n \u003cli\u003eLUTS \u0026ndash; Lower Urinary Tract Symptoms\u003c/li\u003e\n \u003cli\u003ePRO \u0026ndash; Patient-reported Outcomes\u003c/li\u003e\n \u003cli\u003eSPG \u0026ndash; Spiral Preputial Graft\u003c/li\u003e\n \u003cli\u003eQoL \u0026ndash; Quality of Life\u003c/li\u003e\n \u003cli\u003eVAS \u0026ndash; Visual Analogue Scale\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was approved by the Institutional Ethics Committee of Urokul Hospital, Pune (Urokul Hospital Institutional Ethics Committee, Reference No: IRB Approval: U/23/074). Written informed consent was obtained from all participants before inclusion in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eNot applicable\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and/or analyzed during the current study are not publicly available due to patient confidentiality but are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical Trial Number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eST - Data collection, Manuscript Writing, Patient Follow-up; Data Analysis and Interpretation, Statistical Analysis\u003c/p\u003e\n\u003cp\u003ePJ - Conceptualisation, Surgical Procedure, Methodology, Supervision, Manuscript Review, Final Approval\u003c/p\u003e\n\u003cp\u003eSB - Data Curation, Manuscript Editing and Review\u003c/p\u003e\n\u003cp\u003eJN - Literature Review, Manuscript Proofreading\u003c/p\u003e\n\u003cp\u003ePB - Literature Review, Manuscript Proofreading\u003c/p\u003e\n\u003cp\u003ePK - Data Collection, Data Entry, Patient Follow-up\u003c/p\u003e\n\u003cp\u003eSK - Conceptualisation, Surgical Procedure, Methodology, Supervision, Manuscript Review, Final Approval\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eI would like to sincerely thank Dr. Amey Talpallikar for his valuable guidance, clinical insights, and support throughout the course of this study. We also extend our heartfelt appreciation to our co-fellows, Dr. Meritxell Costa Grau and Dr. Emmanuel Oyibo, for their collaborative spirit, encouragement, and assistance in patient care and data collection during the study period. Their contributions enriched the overall execution of this research.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eKulkarni S, Joshi P, Surana S, Hamouda A. Management of panurethral strictures. African Journal of Urology. 2016 Mar 1;22(1):33\u0026ndash;9. \u003c/li\u003e\n\u003cli\u003eKulkarni SB, Joshi PM, Venkatesan K. Management of panurethral stricture disease in India. Journal of Urology. 2012 Sep;188(3):824\u0026ndash;30. \u003c/li\u003e\n\u003cli\u003eGoel A, Goel A, Jain A, Singh BP. Management of panurethral strictures. In: Indian Journal of Urology. 2011. p. 378\u0026ndash;84. \u003c/li\u003e\n\u003cli\u003eSingh B, Pathak H, Andankar M. Dorsolateral onlay urethroplasty for anterior urethral strictures by a unilateral urethral mobilization approach. Indian Journal of Urology. 2009 Jul 1;25(2):211\u0026ndash;4. \u003c/li\u003e\n\u003cli\u003eKulkarni S, Barbagli G, Sansalone S, Lazzeri M. One-sided anterior urethroplasty: A new dorsal onlay graft technique. BJU Int. 2009 Oct;104(8):1150\u0026ndash;5. \u003c/li\u003e\n\u003cli\u003eWilson SC, Stranix JT, Khurana K, Morrison SD, Levine JP, Zhao LC. Fasciocutaneous flap reinforcement of ventral onlay buccal mucosa grafts enables neophallus revision urethroplasty. Ther Adv Urol. 2016 Dec 17;8(6):331\u0026ndash;7. \u003c/li\u003e\n\u003cli\u003eMartins FE, Kulkarni SB, Joshi P, Warner J, Martins N. Management of Long-Segment and Panurethral Stricture Disease. Adv Urol. 2015;2015:1\u0026ndash;15. \u003c/li\u003e\n\u003cli\u003eHillary CJ, Osman NI, Chapple CR. Current trends in urethral stricture management. Asian J Urol. 2014 Oct;1(1):46\u0026ndash;54. \u003c/li\u003e\n\u003cli\u003eManne DV, Kulkarni DP. Single stage substitution urethroplasty using buccal mucosa in the management of stricture urethra in balanitis xerotica obliterans (BXO). International Journal of Medical Research and Review. 2016 Sep 30;4(9):1675\u0026ndash;80. \u003c/li\u003e\n\u003cli\u003eKulkarni S, Kulkarni J, Surana S, Joshi PM. Management of Panurethral Stricture. Vol. 44, Urologic Clinics of North America. W.B. Saunders; 2017. p. 67\u0026ndash;75. \u003c/li\u003e\n\u003cli\u003eJackson MJ, Chaudhury I, Mangera A, Brett A, Watkin N, Chapple CR, et al. A prospective patient-centred evaluation of urethroplasty for anterior urethral stricture using a validated patient-reported outcome measure. Eur Urol. 2013;64(5):777\u0026ndash;82. \u003c/li\u003e\n\u003cli\u003eLucas ET, Koff WJ, Rosito TE, Berger M, Bortolini T, Silva Neto B. Assessment of satisfaction and Quality of Life using self - reported questionnaires after urethroplasty: a prospective analysis. International braz j urol. 2017 Apr;43(2):304\u0026ndash;10. \u003c/li\u003e\n\u003cli\u003eJackson MJ, Sciberras J, Mangera A, Brett A, Watkin N, N\u0026rsquo;Dow JMO, et al. Defining a patient-reported outcome measure for urethral stricture surgery. Eur Urol. 2011 Jul;60(1):60\u0026ndash;8. \u003c/li\u003e\n\u003cli\u003eBaradaran N, Hampson LA, Edwards TC, Voelzke BB, Breyer BN. Patient-Reported Outcome Measures in Urethral Reconstruction. Vol. 19, Current Urology Reports. Current Medicine Group LLC 1; 2018. \u003c/li\u003e\n\u003cli\u003eDubey D, Kumar A, Mandhani A, Srivastava A, Kapoor R, Bhandari M. Buccal mucosal urethroplasty: a versatile technique for all urethral segments. BJU Int. 2005 Mar 10;95(4):625\u0026ndash;9. \u003c/li\u003e\n\u003cli\u003eKrishnan S V, Sakthivel DK, Velan M, Jain N, Ragavan N, Bafna S. Management of Panurethral Strictures by Preputial Graft Urethroplasty: Outcomes From a Tertiary Care Centre. Cureus. 2025 Apr 21; \u003c/li\u003e\n\u003cli\u003eKulkarni SB, Joshi PM, Basile G, Bandini M. Novel single-stage preputial spiral graft for panurethral stricture: a step-by-step description of the technique. World J Urol. 2023 Jul 14;41(9):2459\u0026ndash;63. \u003c/li\u003e\n\u003cli\u003eAlanezi T, Li B, Al-Omran L, Alshabanah L, Alkhayal NK, Verma M, et al. Surgical Outcomes Through the Patient\u0026rsquo;s Eyes: A Scoping Review of Patient-Reported Outcome Measures in Surgery. Journal of Surgical Research. 2025 Sep;313:120\u0026ndash;30. \u003c/li\u003e\n\u003cli\u003eNolazco JI. Future of urology: Embracing patient-centered care and patient-reported outcomes. Curr Urol. 2024 Mar;18(1):23\u0026ndash;23. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-urology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"buro","sideBox":"Learn more about [BMC Urology](http://bmcurol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/buro/default.aspx","title":"BMC Urology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Urethral Stricture, Stricture Urethra, Urethroplasty, Spiral Preputial Graft, Patient-Reported Outcomes, Panurethral Stricture, Quality of Life, Single-Stage Repair","lastPublishedDoi":"10.21203/rs.3.rs-7458904/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7458904/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003ePanurethral strictures, involving the entire anterior urethra, present a significant reconstructive challenge. While buccal mucosal grafts are commonly used, limitations in graft length and donor site morbidity persist. The spiral preputial graft (SPG) offers a promising alternative, enabling long, hairless grafts without additional donor morbidity. This study prospectively evaluates patient-reported outcomes (PROs) following single-stage SPG urethroplasty for panurethral strictures.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA prospective observational study was conducted between January 2021 and June 2024 at a tertiary urology center. Fifty-five patients undergoing SPG urethroplasty were included. Exclusion criteria included Lichen Sclerosus, prior urethroplasty, and inadequate preputial skin. PROs were assessed preoperatively and postoperatively using the Lower Urinary Tract Symptom (LUTS) score, Visual Analogue Scale (VAS) for health status, treatment satisfaction, and quality of life (QoL) impact. Statistical significance was set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eMedian LUTS scores improved significantly from 18 to 2 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and mean VAS scores increased from 44.7 to 84.4 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). QoL improvement was reported by 83.6% of patients, with 80% expressing satisfaction. The overall success rate\u0026mdash;defined as symptom relief without secondary intervention\u0026mdash;was 83.7%.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eSingle-stage SPG urethroplasty is a technically feasible, reproducible, and effective alternative to oral grafting for panurethral strictures. It results in significant improvements in urinary symptoms, health perception, and patient satisfaction. These findings support broader adoption of the SPG technique in appropriately selected patients, with an emphasis on integrating PROs into surgical outcome assessment.\u003c/p\u003e","manuscriptTitle":"Patient-Reported Outcomes After Single-Stage Spiral Preputial Graft Urethroplasty for Panurethral Strictures: A Single-Centre Prospective Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-30 16:28:43","doi":"10.21203/rs.3.rs-7458904/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-10-21T11:07:53+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-21T05:58:29+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-20T13:21:41+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-17T09:14:45+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"153776139952303366152236477191668604027","date":"2025-10-09T08:56:09+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-08T09:43:15+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"157480783369030688988018312566511494983","date":"2025-10-08T09:32:38+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"38913545741485191223363688423253741216","date":"2025-10-06T20:49:30+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"237642771658924442233853578057092869296","date":"2025-10-03T07:49:53+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"208662671277210232450404112540267768855","date":"2025-09-25T20:40:38+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-25T13:22:13+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"231877173902239306944882188113499531028","date":"2025-09-24T10:21:50+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"124219265362937875832774607813077714374","date":"2025-09-20T16:17:31+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-18T18:06:45+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-18T18:05:17+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-09-09T19:43:39+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-06T09:03:57+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Urology","date":"2025-09-06T09:01:15+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-urology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"buro","sideBox":"Learn more about [BMC Urology](http://bmcurol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/buro/default.aspx","title":"BMC Urology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"842bce83-8d5c-4fae-9081-132bb0d6992b","owner":[],"postedDate":"September 30th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-02-16T16:07:46+00:00","versionOfRecord":{"articleIdentity":"rs-7458904","link":"https://doi.org/10.1186/s12894-026-02070-z","journal":{"identity":"bmc-urology","isVorOnly":false,"title":"BMC Urology"},"publishedOn":"2026-02-09 15:57:25","publishedOnDateReadable":"February 9th, 2026"},"versionCreatedAt":"2025-09-30 16:28:43","video":"","vorDoi":"10.1186/s12894-026-02070-z","vorDoiUrl":"https://doi.org/10.1186/s12894-026-02070-z","workflowStages":[]},"version":"v1","identity":"rs-7458904","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7458904","identity":"rs-7458904","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}