Predictors of Surgical Failure in Anterior Urethral Stricture: A 15-Year Retrospective Analysis of 419 Urethroplasties.

BACKGROUND

This study aims to evaluate long-term surgical outcomes and identify predictive factors associated with urethroplasty failure in patients with anterior urethral strictures.

METHODS

A retrospective study was conducted on 419 patients who underwent urethroplasty between January 2009 and December 2024. Eleven different surgical techniques were performed based on the location, length and aetiology of strictures as well as prior interventions. Clinical data including demographics, surgical history, stricture characteristics and complications were analysed. Surgical success was defined as the absence of any further urethral intervention and maximum voiding flow rate above 15 mL/s months or years after the surgery. Statistical analysis included Cox regression, Chi-square and Kaplan-Meier survival analysis.

RESULTS

The overall surgical success rate was 74.7% (313/419 patients), with a complication rate of 10.2%. Recurrence occurred in 25.3% of cases. Univariate analysis revealed that body mass index (BMI), stricture length, number of previous direct vision internal urethrotomies (DVIUs), prior urethroplasty and panurethral strictures (>10 cm) were significantly associated with surgical failure. Multivariate analysis identified increased BMI and number of previous DVIUs as independent predictors of failure (p < 0.05).

CONCLUSIONS

History of prior interventions and BMI are key factors influencing outcomes. Early referral for definitive surgical management is recommended to avoid progression and reduce failure risk.