Purohit-Blaivas Staging System

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The Purohit-Blaivas Staging System is a classification order to identify the degree of urethral stricture in men. The system is composed of four stages identified through the use of a 16F flexible cystocope.


Classification of the strictures were categorized as follows: Stage 0 = no stricture; Stage 1 = a stricture that easily allows scope passage; Stage 2 = passable stricture but requires gentle dilation with a 16 Fr flexible cystoscope; Stage 3 = impassable stricture with scope, but lumen visible; Stage 4 = stricture with no visible lumen.[1]

Purohit-Blaivas Staging System[2]
Stage 1 Easy passage of the scope
Stage 2 Gentle dilation required for the scope passage
Stage 3 Impossible but has a visible lumen
Stage 4 No visible lumen

Determination of stages

Usage of this staging system emerged from a study conducted by Rajveer S. Purohit, MD, MPH and Jerry G. Blaivas, MD.[3] The study was prompted by the need for a staging system of its kind. “We were prompted to develop this system recognizing the lack of a common lexicon for describing anterior urethral strictures and the absence of information on the potential for progression of strictures with a wide caliber,” said Purohit.[4] The study examined 25 men with incidental findings of early stage urethral strictures. Using a cystoscope, the examining physician analyzed the tightness of the stricture. Total analysis of the study included the assessment of 101 cystoscope videos to determine this staging system.[5] From observations of these subjects, the stages were created based on the ease of passage of the scope during examination.

Usage in the field of Urology

The staging system has been recognized as an easy-to-use, reliable system. From the study, intra-observer reliability for all observers with kappa scores ranging from 0.65 to 0.90. Inter-observer reliability for stage 3 and 4 strictures had a kappa score of 0.93 to 1.00 and 0.51 to 0.55 for stage 1 and 2 strictures.[4]


  1. Purohit MD, MPH, Rajveer S.; Blaivas MD, Jerry G.; Deibert MD, MPH, Christopher M.; Weinberger BS, James M.. "Reliability Of A New Staging System For Anterior Urethral Strictures". American Urological Association. https://www.auanet.org/university/abstract_detail.cfm?id=378&meetingID=13SAN. Retrieved 25 October 2014. 
  2. Diane K. Newman, DNP, FAAN, BCB-PMD. "SUFU WM 2014 - Evolutionary stages in urethral strictures - Session Highlights". UroToday.com. http://www.urotoday.com/bladder-cancer/69085-sufu-wm-2014-evolutionary-stages-in-urethral-strictures-session-highlights.html. Retrieved 25 October 2014. 
  3. Purohit, Rajveer; Georges, Ricardo; Benedon, Matthew; Mekel, Gabriel; Blaivas, Jerry (April 2014). "Mp13-15 Evolutionary Stages In Urethral Strictures". The Journal of Urology 191 (4): e181. Template:Citation error. http://www.jurology.com/article/S0022-5347%2814%2900942-2/fulltext. Retrieved 25 October 2014. 
  4. 4.0 4.1 Guttman Krader, Cheryl (November 21, 2013). "Stricture staging system demonstrates good reliability". The Urology Times. http://urologytimes.modernmedicine.com/urology-times/content/tags/jerry-blaivas/stricture-staging-system-demonstrates-good-reliability. Retrieved 25 October 2014. 
  5. S. Purohit, Rajveer; G. Blaivas, Jerry; M. Weinberger, James; M. Deibert, Christopher (May 2014). "A New Staging System for Anterior Urethral Strictures". Urology Practice Journal 1 (1): 35–39. Template:Citation error. http://www.urologypracticejournal.com/article/S2352-0779%2814%2900002-8/abstract. Retrieved 25 October 2014. 

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