What's known on the subject? and What does the study add?• The incidence of specific aetiologies of urethral stricture disease has been reported from a variety of series throughout the world.• Most reported urethral stricture series are from single institutions or from a specific region of the world. We provide a multi-centred series to compare aetiologic incidence between differing regional populations. Objective• To better understand distinct regional patterns in urethral stricture aetiology and location among distinct regional populations. Patients and Methods• Data on 2589 patients who underwent urethroplasty from 2000 to 2011 were collected retrospectively from three clinical sites, including 1646 patients from Italy, 715 from India and 228 from the USA.• Data from all sites were single-surgeon series. As the data from the Italian and US cohorts were similar in aetiology, location and demographics, we combined these data to form group 1, and compared this group with men in the Indian cohort, group 2. • Age, stricture site and primary stricture aetiology were identified for each patient. Stricture site and primary aetiology were determined by the treating surgeon. Primary aetiology was defined as iatrogenic, trauma including pelvic-fracture-related urethral injury (PFUI), lichen sclerosus (LS), infectious, congenital, or unknown. Results• There were more penile strictures (27 vs 5%) and fewer posterior urethral stenoses (9 vs 34%) in group 1.• There were more iatrogenic strictures identified in group 1 (35 vs 16%). When comparing the aetiology of iatrogenic strictures alone, more strictures in group 1 were attributable to failed hypospadias repair (49 vs 16%).• More patients presented with LS (22 vs 7%) and external trauma (36 vs 16%) in group 2.• Prevalence of strictures of infectious aetiology was low (1%) with similar proportions between the two groups. Conclusions• We have shown that significant regional differences in stricture aetiology exist in a large multicentre cohort study. Group 1 had a higher proportion of penile strictures, largely owing to more iatrogenic strictures and, in particular, failed hypospadias repair. Group 2 had a higher proportion of PFUI and LS-associated urethal stricture.• Identified infection-related urethral stricture was rare in all cohorts. • Significant regional differences in stricture aetiology exist and should be considered when analysing international outcomes after urethroplasty. These data may also help the development of international disease prevention and treatment strategies.

sclerosus, hypospadias, phalloplasty, and/or prior urethroplasty were excluded from analysis. Of the remaining 197 patients, we analyzed the records of 45 patients who had a history of transurethral treatments including self-or office-dilation, urethrotomy with a cold knife or laser, and/or urethral stenting using temporary thermo-expandable stents at least once and whose urethrography results at initial stricture diagnosis and at urethroplasty were available. We considered stricture complexity increased if the number of strictures and/or stricture length on the urethrography at urethroplasty was greater than that at initial diagnosis, and/or if a false passage was newly identified.RESULTS: Thirty-nine of the patients (87%) had been subjected to urethral dilation, 32 (71%) to urethrotomy, and 13 (29%) to temporary urethral stenting, and 39 (87%) had received repeated and/or multiple kinds of transurethral treatments. Disease duration (defined as the period between the initial stricture diagnosis and urethroplasty) in patients with repeated transurethral treatments (mean 102 months) was more than four times that in patients with a single transurethral treatment (mean 24 months, p ¼ 0.006). Stricture complexity was increased in 22 (49%) and was significantly associated with a history of urethrotomy (p ¼ 0.03), urethral stenting (p ¼ 0.0002), and repeated transurethral treatments (p ¼ 0.01). Notably, twelve (92%) of 13 patients with history of urethral stenting showed increased stricture complexity, and multivariate logistic regression analysis revealed that history of urethral stenting was an independent predictor of increased stricture complexity (OR 13.7, p ¼ 0.01). Of the 22 patients with increased stricture complexity, seven (32%) were forced to change the type of urethroplasty to one more complex than the predicted repair type based on the urethrography at initial diagnosis.CONCLUSIONS: Repeated transurethral manipulation is associated with increased stricture complexity and is potentially counterproductive.

institutional study, made unique by limited inpatient admission and lack of post operative mobility restrictions. We plan to continue this current management and observe more long term results in this patient population.