Anatomical, functional, and patient-reported outcomes following anterior urethroplasty. Can we predict when and why are patients with anatomical recurrences requiring reinterventions?

Despite modern advances in urethroplasty, little consensus exists on defining treatment success. The absence of reintervention was the main benchmark. However, recent efforts incorporate anatomical, functional and patient-reported criteria. Our aim is to evaluate urethroplasty outcomes using these four criteria, and to assess the progression of asymptomatic anatomical recurrences to predict the need for future treatments. An ambispective study was conducted on patients > 18 years undergoing anterior urethroplasty between 2020 and 2023. Minimum follow-up of 2 years. Techniques included anastomotic and augmentation urethroplasties. Follow-up performing urine culture, uroflowmetry, self-administered questionnaires, and endoscopic/radiological imaging. Success was defined as: anatomical (passage of a 17Ch cystoscope or normal urethrogram), functional (Qmax > 10 mL/s), asymptomatic (no urinary symptoms or infections), no need for further treatments, and overall success. 138 patients were followed for a mean of 35 months (IQR = 24.4–63.8). Success rates were: anatomical 68.8%, functional 71.7%, asymptomatic and retreatment-free 79%, and overall success 63.8%. USS-PROM and quality of life scores improved significantly with high satisfaction levels and maintained IIEF-5 scores. Among the 43 patients with anatomical recurrences, 22 were asymptomatic (51.2%) when re-stricture was identified. After 35 months, 16 out of 22 (72.7%) remained symptom-free. All symptomatic progressions, leading to further interventions, developed during the first 18 months. Anatomical and functional criteria result in lower success rates than symptoms-based or retreatment definitions. Most patients with asymptomatic anatomical strictures who do not develop symptoms in the first 18 months remain stable and do not require secondary treatments.