Association between preoperative hemoglobin, albumin, lymphocyte, and platelet (HALP) score and stricture recurrence after urethroplasty

Background: Recurrence after urethroplasty remains a challenging treatment issue, and there is a lack of validated preoperative biomarkers for risk classification. Although the hemoglobin, albumin, lymphocyte, and platelet (HALP) score serves as a composite marker of systemic inflammation and nutritional status, its association with urethroplasty results has not been explored. This study aimed to evaluate the association between the preoperative HALP score and stricture recurrence after urethroplasty. Methods: This retrospective cohort study included 91 male patients who underwent urethroplasty for urethral stricture disease at a tertiary referral center between January 2018 and December 2024. Preoperative HALP scores were calculated using routine laboratory parameters. Patients were classified into recurrence and recurrence-free groups based on postoperative follow-up. Univariable and multivariable logistic regression analyses were performed. The discriminatory performance of the HALP score was assessed using receiver operating characteristic (ROC) curve analysis. Results: During a median follow-up of 18 months, 17 patients (18.7%) experienced stricture recurrence. Patients with recurrence had significantly lower preoperative HALP scores compared with those without recurrence (34.8 vs. 48.9, p = 0.003). In multivariable logistic regression analysis adjusted for stricture length and history of prior urethral intervention, the HALP score remained independently associated with stricture recurrence (adjusted odds ratio (OR) 0.95, 95% confidence interval (CI): 0.91–0.99; p = 0.012). ROC analysis demonstrated moderate discriminatory ability of the HALP score for predicting recurrence (area under the curve (AUC) = 0.73). Conclusions: The preoperative HALP score was independently associated with stricture recurrence and may serve as a useful adjunct to conventional clinical risk factors; however, larger multicenter prospective studies are required before routine clinical implementation.

HALP score; Nutritional status; Stricture recurrence; Systemic inflammation; Urethral stricture; Urethroplasty

[1] Herout R, Flegar L, Putz J, Eisenmenger N, Huber J, Thomas C, et al. Increasing utilization of urethroplasty for male urethral stricture disease: analysis of in-hospital interventions in Germany from 2006 to 2023. International Urology and Nephrology. 2025; 57: 3559–3565.

[2] Bandini M, Basile G, Lazzeri M, Montorsi F, Valli B, Balò S, et al. Optimizing decision-making after ventral onlay buccal mucosa graft urethroplasty failure. BJU International. 2023; 131: 339–347.

[3] Barbagli G, Bandini M, Balò S, Fossati N, Montorsi F, Sansalone S, et al. Risk calculator for prediction of treatment-related urethroplasty failure in patients with penile urethral strictures. International Urology and Nephrology. 2020; 52: 1079–1085.

[4] Güler Y. Outcomes and predictive factors for re-stricture with urethroplasty methods for anterior urethra stricture. Urologia. 2023; 90: 315–321.

[5] Seth I, Lim B, Cevik J, Gracias D, Chua M, Kenney PS, et al. Impact of nutrition on skin wound healing and aesthetic outcomes: a comprehensive narrative review. JPRAS Open. 2024; 39: 291–302.

[6] Heutlinger O, Acharya N, Tedesco A, Ramesh A, Smith B, Nguyen NT, et al. Nutritional optimization of the surgical patient: a narrative review. Advances in Nutrition. 2025; 16: 100351.

[7] Moretti L, Stalfort J, Barker TH, Abebayehu D. The interplay of fibroblasts, the extracellular matrix, and inflammation in scar formation. Journal of Biological Chemistry. 2022; 298: 101530.

[8] Zhu L, Cheng J, Xiao F, Mao YY. Effects of comprehensive nutrition support on immune function, wound healing, hospital stay, and mental health in gastrointestinal surgery. World Journal of Gastrointestinal Surgery. 2024; 16: 3737–3744.

[9] Salari A, Ghahari M, Bitaraf M, Fard ES, Haddad M, Momeni SA, et al. Prognostic value of NLR, PLR, SII, and dNLR in urothelial bladder cancer following radical cystectomy. Clinical Genitourinary Cancer. 2024; 22: 102144.

[10] Bizzarri FP, Campetella M, Russo P, Palermo G, Moosavi SK, Rossi F, et al. Prognostic value of PLR, SIRI, PIV, SII, and NLR in non-muscle invasive bladder cancer: can inflammatory factors influence pathogenesis and outcomes? Cancers. 2025; 17: 2189.

[11] Tokuc E, Eksi M, Kayar R, Demir S, Topaktas R, Bastug Y, et al. Inflammation indexes and machine-learning algorithm in predicting urethroplasty success. Investigative and Clinical Urology. 2024; 65: 240–247.

[12] Farag CM, Antar R, Akosman S, Ng M, Whalen MJ. What is hemoglobin, albumin, lymphocyte, platelet (HALP) score? A comprehensive literature review of HALP’s prognostic ability in different cancer types. Oncotarget. 2023; 14: 153–172.

[13] He Y, Ma Z, Chen X, Wang J, Chen X, Deng Z, et al. Association between hemoglobin, albumin, lymphocyte, and platelet score and all-cause and cardiovascular mortality among population with diabetes: evidence from the NHANES 2003–2016. Diabetes Research and Clinical Practice. 2025; 224: 112212.

[14] Zhao P, Zhang Z, Li M, Hao J, Wang Y. Association between hemoglobin-albumin-lymphocyte-platelet score and all-cause or cardiovascular mortality in patients with diabetes or prediabetes: mediated effects of renal function. BMC Cardiovascular Disorders. 2025; 25: 331.

[15] Anderson KT, Vanni AJ, Erickson BA, Myers JB, Voelzke B, Breyer BN, et al. Defining success after anterior urethroplasty: an argument for a universal definition and surveillance protocol. The Journal of Urology. 2022; 208: 135–143.

[16] Ma W, Liu R, Li X, Yu J, Wang W. Significant association between systemic inflammation response index and prognosis in patients with urological malignancies. Frontiers in Immunology. 2025; 16: 1518647.

[17] Zheng L, Wang Z, Li Y, Ge S, Zeng Z, Gan L, et al. Prognostic significance of systemic immune inflammation index in patients with urothelial carcinoma: a systematic review and meta-analysis. Frontiers in Oncology. 2024; 14: 1469444.

[18] Urkmez A, Topaktas R, Ozsoy E, Tokuc E, Kutluhan MA, Artuk I, et al. Is neutrophil to lymphocyte ratio a predictive factor for recurrence of urethral stricture? Revista da Associação Médica Brasileira. 2019; 65: 1448–1453.

[19] Özsoy E, Kutluhan MA, Tokuç E, Artuk İ, Kayar R, Akyüz M, et al. Predictive value of systemic immune-inflammation index in recurrent urethral strictures. Urologia. 2023; 90: 510–515.

[20] Chen XL, Xue L, Wang W, Chen HN, Zhang WH, Liu K, et al. Prognostic significance of the combination of preoperative hemoglobin, albumin, lymphocyte and platelet in patients with gastric carcinoma: a retrospective cohort study. Oncotarget. 2015; 6: 41370–41382.

[21] Soydaş T, Ünal S, Uzundal H. Hemoglobin, albumin, lymphocyte, and platelet (HALP) score as a biomarker for phase differentiation in Peyronie’s disease: a retrospective cohort study. Basic and Clinical Andrology. 2025; 35: 21.