Attention: Restrictions on use of AUA, AUAER, and UCF content in third party applications, including artificial intelligence technologies, such as large language models and generative AI.
You are prohibited from using or uploading content you accessed through this website into external applications, bots, software, or websites, including those using artificial intelligence technologies and infrastructure, including deep learning, machine learning and large language models and generative AI.

JU INSIGHT Affirming Long-Term Outcomes After Contemporary Urethroplasty

By: Carlos Ignacio Calvo, MD, University of Alberta, Edmonton, Canada, Pontificia Universidad Católica de Chile, Santiago; Kai Fender, BSc, University of Alberta, Edmonton, Canada; Nathan Hoy, MD, FRCSC, University of Alberta, Edmonton, Canada; Keith Rourke, BSc, MD, FRCSC, University of Alberta, Edmonton, Canada | Posted on: 18 Mar 2024

Calvo CI, Fender K, Hoy N, Rourke K. Affirming long-term outcomes after contemporary urethroplasty: the adverse impact of increasing stricture length, lichen sclerosus, radiation, and infectious strictures. J Urol. 2024;211(3):455-464.

Study Need and Importance

Urethral stricture is a relatively common condition that causes a wide spectrum of symptoms, signs, and complications with an associated reduction in patient-reported quality of life. Urethral reconstruction is broadly considered the most effective treatment and is often recommended for patients with recurrent urethral stricture. But there is a paucity of reported long-term outcomes after modern urethroplasty. This study evaluated the long-term success of contemporary urethroplasty and identified factors associated with stricture recurrence in this context.

What We Found

A total of 733 patients were identified with a minimum of 100 months of follow-up after urethroplasty. At a median follow-up of 12.3 years, 89 recurrences were observed (12%). The cumulative incidence of stricture recurrence was 6%, 10%, and 12% after 1, 5, and 10 years, respectively (Figure). From a patient-reported perspective, 89% of patients reported being satisfied with surgery. On multivariable analyses, increasing stricture length (HR 1.1, 95% CI 1.05-1.15; P < .001) and etiology (P < .001), in particular lichen sclerosus (HR 4.46, 95% CI 2.25-9.53), radiation (HR 4.25, 95% CI 1.65-10.9), and infectious strictures (HR 5.27, 95% CI 2.03-13.7), were independently associated with recurrence.

Figure. Kaplan-Meier survival curve of long-term urethroplasty success for the entire cohort (A) and stratified by at-risk etiology (B).


One of the main limitations of our study is the retrospective design despite being a diligently maintained robust cohort of patients undergoing urethroplasty with long-term follow-up. Another limitation is the lack of a validated questionnaire to assess some patient-reported outcomes. Lastly, to avoid overfit of our statistical model only a select number of predictors could be examined in the multivariable analysis.

Interpretation for Patient Care

As a unique observational cohort study, this study affirms that urethroplasty provides high rates of long-term success and patient-reported satisfaction. This objective and patient-reported information will enrich preoperative patient counseling, in particular for those patients with longer strictures, lichen sclerosus, radiation, and infectious etiologies that have a higher risk of stricture recurrence in the long-term.