Yilong Guo,1,* Ning Ma,2,* Jiaxiong Zhang,3 Sen Chen,2 Pingping Liu,1 Zhe Yang,2 Yangqun Li1 

1Department of Comprehensive Plastic Surgery, Plastic Surgery Hospital of Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China; 2Department of Hypospadias Plastic Surgery, Plastic Surgery Hospital of Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China; 3Department of Geriatric Medicine, Coronary Circulation Center of Xiangya Hospital, Central South University, Changsha, Hunan, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Yangqun Li, Department of Comprehensive Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 33 Badachu Road, Beijing, People’s Republic of China, Tel +86 13501210314, Email liyangqundoctor@126.com

Purpose: Anterior urethral stricture is a common clinical condition in urology with significant socioeconomic impacts and is associated with high recurrence rates of and postoperative complications. However, the long-term outcome of surgical management of urethra stricture and the associated risk factors of stricture recurrence remain limited. We conducted a 23-year single-center retrospective study to evaluate the long-term surgical outcomes of anterior urethral strictures with different clinical characteristics and to study factors that contribute to stricture recurrence.
Methods: A retrospective study was conducted on 145 male patients diagnosed with anterior urethral stricture, who underwent meatotomy, anastomotic urethroplasty (AU), penile skin flap urethroplasty (PFU), single-stage buccal mucosa grafting (SSU), or multistage buccal mucosa grafting (MSU) between April 2000 and August 2023. We defined 100 months as the cut-off time point to distinguish short-term and long-term follow-up. Early surgical complications were scored using the Clavien-Dindo classification at 3 months. Patient-Reported Outcome Measure (PROM) was applied to evaluate surgical success. Risk factors for wound complications were evaluated using univariable and multivariable analysis.
Results: The overall mean stricture length was 2.3 ± 1.8 cm (a range of 0.3– 7.0). Stricture locations were at the meatus, fossa navicularis, penile, bulbar, and multifocal in 15, 36, 79, 9, and 6. The short-term and long-term success rate for meatotomy, AU, PFU, SSU, and MSU were 70.0%/80%, 70.4%/62.5%, 77.8%/69.2%, 100%/75%, and 81.8%/66.7%, respectively. The early complications classified as Clavien grades I, II, III, IV, and V were 39, 5, 5, 0, and 0. The late complication rate in the short-term and long-term groups were 20.3% and 30.3% (p > 0.05). The satisfaction survey showed that 74.5% (108 of 145) patients were satisfied or very satisfied with the surgical result. There was no statistically significant difference in stricture-free survival among the five surgical groups (Log rank test: χ² = 3.83, p > 0.05). The binary univariate logistic regression analysis showed that stricture symptom duration (p < 0.05) and previous urethroplasty (p < 0.05) were independent predictors of surgery failure.
Conclusion: This long-term retrospective study on male anterior urethral stricture disease demonstrates that surgical management is an effective and functional treatment. However, the success rate of urethroplasty shows a declining trend with longer follow-up. Stricture symptom duration and previous urethroplasty carry a high risk of surgical failure.

Keywords: anterior urethral stricture, complication, reconstructive surgical procedures, urethra, urethroplasty