TOPLINE

Revision urethroplasty following failed surgery demonstrated stricture-free survival comparable to that after primary surgery in matched patients, with 1-year success rates of 91% and 5-year rates of more than 80% in both groups.

METHODOLOGY

• Researchers conducted a retrospective matched case-control analysis at a single reconstructive urology center using data from a prospective database of urethroplasties performed between 2003 and 2024.
• Nearly 195 adult male patients who underwent repeat urethroplasty for recurrence after an initial open urethral reconstruction were matched with 195 urethroplasty-naive control patients on the basis of age, stricture length, etiology, and surgical technique. The median age in both groups was 49 years.
• Surgical techniques included buccal mucosal grafts (56%), staged urethroplasty (23%), anastomotic repair (12%), fasciocutaneous flaps (6%), and combined tissue transfer (2%).
• The primary outcome was stricture-free survival, with recurrence defined as failure to atraumatically pass a 16-French flexible cystoscope during follow-up evaluation.
• Secondary outcomes were 90-day complications, patient-reported satisfaction assessed at up to 6 months postoperatively, and de novo erectile dysfunction.

TAKEAWAY

• Revision urethroplasty was not associated with an increased risk for stricture recurrence compared with primary surgery.
• Stricture-free survival at 1 year was 91% for both groups; 5-year survival was 83% vs 85% in the revision group vs the naive group; 10-year survival was 81% vs 82%.
• Complications occurred in 12% vs 13% of revision cases vs primary surgery cases and were mostly related to urinary tract infection or wound complications.
• Patient satisfaction did not differ significantly between groups, with 91% vs 87% of patients reporting satisfaction. De novo erectile dysfunction occurred in 4.1% vs 4.6% of patients, while chordee was observed in 4.8% vs 2.7%, respectively.

IN PRACTICE

“[The study’s] matched design provides compelling evidence that revision urethroplasty can achieve durable success comparable to primary repair when performed in appropriately selected patients…this finding is particularly important for patient counseling as it supports offering revision urethroplasty as a definitive treatment rather than defaulting to palliative endoscopic management or perineal urethrostomy based solely on prior surgical history,” the authors of the study wrote.

SOURCE

The study was led by Ahmad AlShammari of the Department of Surgery at the University of Alberta in Edmonton, Alberta, Canada. It was published online on August 12, 2026, in The Journal of Urology.

LIMITATIONS

Some factors, such as unmatched patient exclusions, surgeon experience, and level of spongiofibrosis, were not fully considered in the analysis. Patient-reported outcomes were measured using tools that were not validated.

DISCLOSURES

No funding was provided for this research. The authors disclosed no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.