Analysis of the factors involved in the failure of urethroplasty in men

Editorial Comment from Dr Rourke to Risk of urethral stricture recurrence increases over time after urethroplasty

“…The factors most often associated with stricture recurrence (in descending order) are prior procedures (urethroplasty or endoscopic), stricture length, smoking and lichen sclerosus. [2][3][4] These risk factors, however, are found in less than half of the studies on the subject. Other occasionally identified factors include diabetes, the use of penile skin grafts, surgical technique (anastomotic urethroplasty), hypospadias, poor oral hygiene and surgeon experience.…”

“…[3][4][5] Lifelong follow up is necessary after substitution urethroplasty, because stricture recurrences can increase with time and occur even after 15 years as a result of the contracture of grafts or flaps.…”

“…Santucci et al reported a long-term (mean of 70 months postoperatively) outcome of anastomotic urethroplasty for 168 bulbar urethral strictures with a high recurrence-free rate (95%) and recurrences in just eight patients (the mean time to recurrence was 15 months). 4 Notably, six out of eight patients (75%) experienced recurrences within 12 months, and only one experienced a late recurrence (at 80 months postoperatively). 4 The recurrence rate according to Andrich et al also appears to be stable at 5, 10 and 15 years after anastomotic urethroplasty.…”

“…4 Notably, six out of eight patients (75%) experienced recurrences within 12 months, and only one experienced a late recurrence (at 80 months postoperatively). 4 The recurrence rate according to Andrich et al also appears to be stable at 5, 10 and 15 years after anastomotic urethroplasty. 5 In accordance with the authors' findings, I suppose these differences might be due to the number of patients who did not participate in follow-up examinations and could have experienced recurrences.…”

“…It is evident from the literature that anastomotic urethroplasty is highly successful and has sustained durable results. 4 I understand that scar formation at anastomotic sites stabilizes within 12 months after anastomotic urethroplasty, and that stricture recurrence after 12 months is rare. Santucci et al reported a long-term (mean of 70 months postoperatively) outcome of anastomotic urethroplasty for 168 bulbar urethral strictures with a high recurrence-free rate (95%) and recurrences in just eight patients (the mean time to recurrence was 15 months).…”