Urethroplasty and endoscopic interventions (urethral dilation, urethrotomy) are both used for treatment of male urethral stricture disease. Treatment choice is dependent on patient age, comorbidities, previous treatments and preference, as well as stricture characteristics. The impact of prior attempts at endoscopic intervention on recurrent urethral stricture disease is unclear. Previous literature found no association between prior endoscopic intervention and post-urethroplasty stricture recurrence. However, a recent study reported associations between stricture recurrence and ≥3 prior endoscopic treatments or clean intermittent self-catheterisation (CISC). To corroborate these findings, this study aimed to assess the impact of prior endoscopic interventions on post-urethroplasty stricture recurrence.

A single surgeon, multi-institution, prospective cohort study was performed on all male patients undergoing urethroplasty from January 2017 – October 2024. Previous CISC and endoscopic interventions were recorded for all patients. Procedure, age, diabetic and smoking history, previous urethroplasties and stricture aetiology, location and length were recorded. 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 and Fisher’s exact test were used to compare patient and stricture characteristics, based on CISC and endoscopic intervention history.

In total, 188 patients (with 216 presentations) were included. Mean (SD) age was 56 (17) years. Success rate, defined as patient satisfaction requiring no further intervention, was 89.6%. Mean follow-up was 21 months, maximum 60 months. Most patients had previous urethral dilations (67%), half had previous urethrotomies (46%) and one-third had performed CISC prior (32%). Age, smoking status, diabetic status, history previous urethroplasties and stricture cahracteristics did not differ significantly between patients with or without history of urethral dilation, urethrotomy or CISC (p>0.05). The distribution of stricture recurrence post-urethroplasty did not differ based on history of CISC or urethral dilation (p=0.097, p=0.484 respectively). A significant difference in distribution of stricture recurrence based on previous urethrotomy status was found (p=0.036). The odds ratio (95% CI) of stricture recurrence post-urethroplasty for patients with previous urethrotomies compared to those without was 2.13 (1.06–4.28).

Patients with previous urethrotomies were associated with increased stricture recurrence post-urethroplasty for urethral stricture disease. Previous urethral dilation and CISC does not increase rates of stricture recurrence.