Substitution urethroplasty is a well-established treatment for male urethral strictures. While short-term outcomes have been extensively studied, long-term data, particularly beyond 10 years, remain limited. This study aimed to evaluate the long-term outcomes of substitution urethroplasty in a cohort of patients with male urethral strictures.

A retrospective review was conducted of patients who underwent substitution urethroplasty at a single Australian center from 2007 to 2017. All surgeries were performed by a single surgeon. Patient demographics, stricture characteristics, and surgical techniques were analyzed. Patients were followed-up by a telephone interview, and were assessed using the Patient Global Impression of Improvement (PGI-I) questionnaire.

Fifty-eight patients were included in the analysis and 34 (58.6%) patients responded to our telephone interview. The median age of the patients at the time of follow-up was 59 years (range 29-91 years). Median stricture length was 4 cm (range 2-18 cm). Stricture sites were located at bulbar urethra for 17 (50.0%) patients, bulbomembranous urethra for 4 (11.8%) patients, panurethra for 6 (17.6%) patients, submeatus for 3 (8.8%) patients and penile urethra for 4 (11.8%) patients. Buccal mucosa grafts (BMG) were used in 31 (91.2%) patients, flap in 2 (5.9%) and combination of BMG and flap in 1 (2.9%) patient. BMG was placed by ventral onlay in 81.3% of cases, by dorsal onlay in 6.3% of cases, and using both dorsal and ventral onlay in 4 (12.5%) patients with longer urethra stricture. At a median follow-up of 126 months (range from 84- 200 months), 79.4% of patients reported treatment success (PGI-I score ≤ 2). There was only one patient who had undergone a repeat urethroplasty procedure due to stricture recurrence.

Substitution urethroplasty is a durable and effective treatment option for male urethral strictures. Long-term outcomes are favorable, with high patient satisfaction and low rates of treatment failure.