Urethroplasty is the gold standard for definitive treatment of urethral stricture disease. The current estimated recurrence rate reported in the literature is 10–20%, who require further interventions. There is minimal literature from the Australian population. Understanding the predictors of recurrence is crucial for optimising patient outcomes. This study aims to characterise urethral stricture disease and recurrence after urethroplasty in a GURS trained urethroplasty surgeon.

A high volume, multi-institution series of male urethroplasty patients was collected retrospectively between October 2017 and June 2024 for a single GURS-trained reconstructive surgeon in Sydney, Australia. Demographic, perioperative and recurrence data were collected. The primary outcome was urethral stricture recurrence, defined as the need for subsequent intervention.

Of 111 male urethroplasty patients, the mean age was 52 yo (18–82). The most frequency stricture location was the bulbar urethra in over half of cases (57%), with peno-bulbar long strictures being the next most common (14%). The most common aetiology was idiopathic accounting for 40% of cases, closely followed by iatrogenic (37%). Other causes included trauma, hypospadias, lichen sclerosis and infection. The average stricture length was 32 mm. The most common urethroplasty technique was buccal mucosal graft (BMG) dorsal onlay urethroplasty (58%), then excision and primary anastomosis (EPA) (24%), Non transecting (Heineke Mikulicz) urethroplasty (6%), two-stage BMG urethroplasty (5%), bladder neck reconstruction (5%), one-stage BMG urethroplasty (3%). Suprapubic catheter was inserted in 41% urethroplasty cases intraoperatively. In this case series there was a recurrence rate of 19.8% (n = 22) with a median follow up of 9.4 months, consistent with international literature. The average time to recurrence was 9.4 months. Half were managed with optical dilatation and the other half S-shaped dilatation. The proximal end of the BMG graft site was a more common site for stricture recurrence.

In this Australian high-volume urethroplasty series from a GURS-trained reconstructive surgeon, we have demonstrated equivalent stricture recurrence rates to international literature. Further long-term data are required to assess stricture recurrence over time. Assessment of predictive factors are required to select those at risk of recurrence.