Long-term outcome of urethroplasty after failed urethrotomy versus primaryrepair

Purpose: A urethral stricture recurring after repeat urethrotomy challenges even a skilled urologist. To address the question of whether to repeat ure throtomy or perform open reconstructive surgery, we retrospectively review a series of 93 patients comparing these who underwent primary repair versus those who had undergone urethrotomy and underwent secondary treatment. Materials and Methods: From 1975 to 1998, 93 males between age 13 and 78 ye ars (mean 39) underwent surgical treatment for bulbar urethral stricture. I n 46 (49%) of the patients urethroplasty was performed as primary repair, a nd in 47 (51%) after previously failed urethrotomy. The strictures were loc alized in the bulbous urethra without involvement of penile or membranous t racts. The etiology was ischemic in 37 patients, traumatic in 23, unknown i n 17 and inflammatory in 16. To simplify evaluation of the results, the cli nical outcome was considered either a success or a failure at the time any postoperative procedure was needed, including dilation. Results: In our 93 patients primary urethroplasty had a final success rate of 85%, and after failed urethrotomy 87%. Previously failed urethrotomy did not influence the long-term outcome of urethroplasty. The long-term result s of different urethroplasty techniques had a final success rate ranging fr om 77% to 96%. Conclusions: We conclude that failed urethrotomy does not condition the lon g-term result of surgical repair. With extended followup, the success rate of urethroplasty decreases with time but it is in fact still higher than th at of urethrotomy.