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Updated: Aug 14, 2026
Vessel-sparing Excision and Primary Anastomosis
Published on: January 7, 2019
Second Time's a Charm? A Matched Case-Control Analysis of Revision Urethroplasty Versus Primary Urethroplasty
Ahmad AlShammari1, Alexis Filyk1, Nathan Hoy1
1Division of Urology, Department of Surgery, University of Alberta, Edmonton, Canada.
Introduction:
Revision surgery can be a viable option for patients with stricture recurrence after urethroplasty. However, comparability of outcomes to a urethroplasty naïve population remains uncertain. The objective of this study is to assess outcomes of revision urethroplasty to a surgery naïve population using a matched case-control analysis.
Methods:
Patients undergoing revision urethroplasty were case-matched to urethroplasty naïve case-controls by age, stricture length, etiology and surgical technique. Outcome measures were stricture-free survival, 90-day complications (Clavien ≥2), patient satisfaction, de novo erectile dysfunction (ED) and chordee. Stricture recurrence was defined as failure to atraumatically pass a 16Fr flexible cystoscope. Stricture-free survival was assessed using stratified Cox proportional hazards using matched pairs as a strata. Other outcomes including complications, satisfaction, de novo ED, and chordee were evaluated with the McNemar test.
Results:
Of 2068 patients undergoing urethroplasty from August 2003 to April 2024, 195 patients undergoing revision surgery were successfully matched to 195 urethroplasty naïve case-controls. Groups did not differ with respect to age (P = .7), stricture length (P = .7), etiology (P = 1.0), technique (P = 1.0), location (P = 1.0), failed endoscopic treatment (P = .3), obesity (P = .7), diabetes (P = 1.0), smoking (P = .2), or catheter status (P = .3). With a median follow-up of 138 months for those without recurrence (IQR 75-200), revision surgery was not associated with stricture recurrence (HR 1.28, 95% CI 0.70-2.34, P = .4). Stricture-free status at 1-year was 91% and 91% for revision vs urethroplasty naïve groups respectively with 5-year stricture-free estimates of 83% vs 85%. 90-day complications (12% vs 13%; P = .9), satisfaction (91% vs 87%; P = .3), ED (4.1% vs 4.6%; P = 1.0), or chordee (4.8% vs 2.7%; P = .6) did not differ between groups.
Conclusions:
Revision urethroplasty provides comparable outcomes to urethroplasty naïve patients in a case-matched population. Surgeons should not hesitate to offer revision surgery to patients failing initial urethroplasty.
