Diabetes impairs wound healing due to vascular dysfunction, impaired tissue oxygenation and delayed inflammatory processes. Optimal wound healing is essential for positive outcomes following reconstructive surgery, such as urethroplasties for urethral stricture disease. However, current evidence regarding the impact of diabetes on stricture recurrence post-urethroplasty remains equivocal. Studies have reported conflicting results regarding diabetes as an independent risk factor for stricture recurrence. This study aimed to assess the impact of diabetes on stricture recurrence post-urethroplasty.

A single surgeon, multi-institution, prospective cohort study was performed on all male patients undergoing urethroplasty for diverse stricture aetiology from January 2017 – October 2024. Age, smoking status, diabetic status, stricture length, stricture aetiology, prior endoscopic treatment, previous urethroplasties and recurrence were recorded for all patients. Recurrence was determined by patient dissatisfaction with lower urinary tract symptoms, requiring secondary management. Descriptive statistics were used to present baseline characteristics. Multiple logistic regression models were used to delineate the association between diabetic status and recurrence.

In total, 188 patients (with 216 presentations) were included. Mean (SD) age was 56 (17) years. Various techniques were applied. Most were buccal mucosal graft urethroplasty (83.8%), followed by anastomotic (9.5%), Johanson staged (4.4%) and preputial skin flap (2.3%). Success rate, defined as patient satisfaction requiring no further intervention, was 89.6%. Mean follow-up was 21 months, maximum 60 months. Most patients were non-diabetic (n=193, 89%), with just over one-tenth having diabetes (n=23, 11%). All diabetics had type 2 diabetes mellitus. Diabetics were significantly older, with a mean age of 64 years versus 55 years amongst non-diabetics (p = 0.017). Smoking status, history of prior endoscopic treatments, history previous urethroplasties and stricture aetiology, length and segment did not differ significantly between diabetics and non-diabetics (p>0.05). For stricture recurrence post-urethroplasty, the odds ratios (95% CI) for diabetics compared with non-diabetics was 1.21 (0.42–3.48). This was not statistically significant (p=0.36).

Although diabetics have increased odds of stricture recurrence post-urethroplasty, this was not statistically significant. Diabetic control pre-urethroplasty may be a more accurate predictor of post-urethroplasty stricture recurrence in diabetic patients.