Smoking is known to impede post-operative wound healing due to tissue hypoxia, impaired inflammatory function, and reduced cellular proliferation. A recent systematic review demonstrated increased risk of stricture recurrence post-urethroplasty in patients with smoking history. However, it was noted that all publications included in the review failed to explicitly define smoking history as current or previous, and few distinguished stricture characteristics as a potential confounding factor. This study aims to determine the impact of current or previous history of smoking on risk of stricture recurrence and post-operative complications in adult male patients undergoing urethroplasty for urethral stricture disease.

A single surgeon, multi-institution, prospective cohort study was performed on all male patients undergoing urethroplasty from Jan 2017 – Oct 2024. Smoking status was recorded for all patients. Patients who had smoked within one-month pre-operatively were considered current smokers. Procedure, age, smoking and 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 smoking 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 (max 60 months). Most patients were non-smokers (65%), followed by ex- (23%) and current smokers (12%). The most common aetiologies were idiopathic (32%), followed by iatrogenic secondary to internal trauma (e.g. post transurethral procedure, 20%). Age, diabetic status, history of prior endoscopic treatments, history previous urethroplasties and stricture aetiology, length and segment did not differ significantly between non-, current, and ex-smokers (p>0.05). For stricture recurrence post-urethroplasty, the odds ratios (95% CI) for current and ex-smokers, compared to non-smokers, are 2.70 (1.58–5.21) and 2.27 (1.06–4.92), respectively (P<0.05). No significant difference in odds of recurrence were identified between current and ex-smokers.

Both current and ex-smokers had higher risk of stricture recurrence post-urethroplasty for urethral stricture disease compared to non-smokers.