Are redo urethroplasties prone to failure? Objective success rates and patient satisfac-tion in recurrent urethral stricture repair.

OBJECTIVE

To evaluate long term success rates and patient reported outcomes of redo urethroplasty (RU), a technically challenging urological procedure that may be associated with lower success rates due to increased scarring, compromised blood supply and poor surgical planes from prior surgery.

MATERIALS AND

METHODS

We retrospectively reviewed RU patients between 2010-2023, excluding failed hypospadias repair, and compared with a cohort of primary urethroplasty patients. Failure was defined as need for urethral intervention or imaging/cystoscopy-confirmed stricture recurrence prompted by symptoms. Primary endpoint was stricture-free survival. Secondary endpoints included patient-reported outcomes (USS-PROM), satisfaction, and subgroup analysis by stricture location. Statistical tests included T-tests, Wilcoxon signed-rank, and Fisher's exact test.

RESULTS

Sixty redo urethroplasty patients (median age 48.5) were compared to 316 primary cases (median age 45, p=0.84). Median follow-up was 35 (IQR 14-81) vs. 51 (IQR 20-114) months for redo and primary cases, respectively (p=0.07). Failure rates were not significantly different: 23% in redo vs. 15% in primary cases (p=0.12). However, time to failure was significantly shorter in the redo group (median 6 vs. 17 months, p=0.01). USS-PROM questions 1-6 favored the primary group, although bother scores (Q7) were similar. Overall satisfaction was high in both groups but slightly higher after primary repair (95% vs. 87%, p=0.04).

CONCLUSION

Despite greater complexity, redo urethroplasty demonstrates similar long-term success rates to primary urethroplasty. Patient-reported bother was similar, supporting redo urethroplasty as a viable option for recurrent urethral stricture after previous repair. However, recurrences occurred significantly earlier in the redo group.