Urethral strictures are a significant and common complication that can occur after hypospadias repair, often necessitating surgical intervention. The most widely employed techniques for addressing these strictures are one-stage and two-stage urethroplasty. However, the debate on which approach is superior remains ongoing. This systematic review and meta-analysis aim to provide valuable insights by comparing the success and complication rates of both techniques in adults who experience urethral strictures following hypospadias repair.

A systematic search was carried out in PubMed, Scopus, Cochrane, and ScienceDirect in accordance with PRISMA guidelines. The analysis included studies that compared one-stage and two-stage urethroplasty. Success rates and complication rates were evaluated, and the quality of the studies was assessed using the Newcastle-Ottawa Scale (NOS). A meta-analysis was conducted employing a random-effects model.

Five studies were included, with a total of 149 patients. Two-stage urethroplasty had a slightly higher success rate (90.4%) than one-stage urethroplasty (87.1–100%). Complication rates were similar (14% for two-stage vs. 12% for one-stage). One-stage urethroplasty was associated with a higher risk of fistulas, while two-stage repairs had more graft-related complications. Meta-analysis showed no significant difference in overall complication risk (RR: 0.93, 95% CI: 0.33–2.61, I² = 0%).

Both one-stage and two-stage urethroplasty are effective options, with selection depending on stricture complexity, patient preference, and surgeon expertise. Two-stage urethroplasty is preferable for longer strictures (>6 cm), while one-stage urethroplasty is suitable for shorter strictures (<4 cm). Further prospective studies are needed to refine guidelines.