Severity of urethral stricture disease can be categorised by the size of urethral lumen, based on French catheter scale, and degree of urine flow obstruction. Obliterative strictures demonstrate complete occlusion of the urethra, with no contrast flow on urethrogram (i.e. 0Fr). Near-obliterative strictures demonstrate extremely limited flow on urethrogram, with an estimated lumen size of 1-3 Fr endoscopically. Strictures greater than 4Fr in diameter are considered non-obliterative. To date, no study has conducted a comparison of urethral stricture recurrence post-urethroplasty for non-, near- and completed obliterated urethral strictures. This study aimed to compare post-urethroplasty recurrence rates based on degree of urethral obliteration.

A single surgeon, multi-institution, prospective cohort study was performed on all male patients undergoing urethroplasty for urethral stricture disease from January 2017 – October 2024. Strictures were categorised into non-obliterative, near-obliterative and obliterative based on urethrogram and endoscopic findings. Patient age, diabetes history, smoking history, stricture characteristics (aetiology, segment, length), history of endoscopic interventions and previous urethroplasties were also recorded. Recurrence was determined by patient dissatisfaction with lower urinary tract symptoms, requiring secondary management (redo urethroplasty, endoscopic, intermittent self-catheterisation, supra-pubic catheter). Descriptive statistics were used to present baseline characteristics. Chi-square and Fisher’s exact test was used to delineate association between degree of obliteration 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 (max 60 months). Most strictures were non-obliterative (47%), followed by near-obliterative (41%) and obliterative (12%). Logistic regression revealed no differences in distribution of patient and stricture characteristics or prior treatments between obliterative, near- and non-obliterative strictures (p>0.05). Chi square and Fisher’s exact test found no significant difference in distribution of recurrence based on degree of stricture obliteration (p=0.833).

Obliterative and near-obliterative strictures demonstrated equal rates of stricture recurrence post-urethroplasty as non-obliterative strictures.