Second Time's a Charm? A Matched Case-Control Analysis of Revision Urethroplasty versus Primary Urethroplasty.

Authors

Ahmad AlShammari, Alexis Filyk, Nathan Hoy, Keith Rourke

Published in

The Journal of urology. Pages 101097JU0000000000005246. Aug 12, 2026. Epub Aug 12, 2026.

Abstract

Revision surgery can be a viable option for patients with stricture recurrence after urethroplasty. However, comparability of outcomes to a urethroplasty naïve population remains uncertain. The objective of this study is to assess outcomes of revision urethroplasty to a surgery naïve population using a matched case-control analysis.
Patients undergoing revision urethroplasty were case-matched to urethroplasty naïve case-controls by age, stricture length, etiology and surgical technique. Outcome measures were stricture-free survival, 90-day complications (Clavien ≥2), patient satisfaction, de novo erectile dysfunction (ED) and chordee. Stricture recurrence was defined as failure to atraumatically pass a 16Fr flexible cystoscope. Stricture-free survival was assessed using stratified Cox proportional hazards using matched pairs as a strata. Other outcomes including complications, satisfaction, de novo ED, and chordee were evaluated with the McNemar test.
Of 2068 patients undergoing urethroplasty from August 2003-April 2024, 195 patients undergoing revision surgery were successfully matched to 195 urethroplasty naïve case-controls. Groups did not differ with respect to age (p=0.7), stricture length (p=0.7), etiology (p=1.0), technique (p=1.0), location (p=1.0), failed endoscopic treatment (p=0.3), obesity (p=0.7), diabetes (p=1.0), smoking (p=0.2), or catheter status (p=0.3). With a median follow-up of 138 months for those without recurrence (IQR 75-200), revision surgery was not associated with stricture recurrence (Hazard ratio 1.28, 95%C.I. 0.70-2.34, p=0.4). Stricture-free status at 1-year was 91% and 91% for revision versus urethroplasty naïve groups respectively with 5-year stricture-free estimates of 83% versus 85%. 90-day complications (12% vs. 13%; p=0.9), satisfaction (91% vs. 87%; p=0.3), ED (4.1% vs. 4.6%; p=1.0), or chordee (4.8% vs. 2.7%; p=0.6) did not differ between groups.
Revision urethroplasty provides comparable outcomes to urethroplasty naïve patients in a case-matched population. Surgeons should not hesitate to offer revision surgery to patients failing initial urethroplasty.

PMID:
42585587
Bibliographic data and abstract were imported from PubMed on 13 Aug 2026.

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