Are redo urethroplasties prone to failure? Objective success rates and patient satisfac-tion in recurrent urethral stricture repair.

OBJECTIVE: To evaluate long term success rates and patient reported outcomes of redo urethroplasty (RU), a technically challenging urological procedure that may be associated with lower success rates due to increased scarring, compromised blood supply and poor surgical planes from prior surgery. MATERIALS AND METHODS: We retrospectively reviewed RU patients between 2010-2023, excluding failed hypospadias repair, and compared with a cohort of primary urethroplasty patients. Failure was defined as need for urethral intervention or imaging/cystoscopy-confirmed stricture recurrence prompted by symptoms. Primary endpoint was stricture-free survival. Secondary endpoints included patient-reported outcomes (USS-PROM), satisfaction, and subgroup analysis by stricture location. Statistical tests included T-tests, Wilcoxon signed-rank, and Fisher's exact test. RESULTS: Sixty redo urethroplasty patients (median age 48.5) were compared to 316 primary cases (median age 45, p=0.84). Median follow-up was 35 (IQR 14-81) vs. 51 (IQR 20-114) months for redo and primary cases, respectively (p=0.07). Failure rates were not significantly different: 23% in redo vs. 15% in primary cases (p=0.12). However, time to failure was significantly shorter in the redo group (median 6 vs. 17 months, p=0.01). USS-PROM questions 1-6 favored the primary group, although bother scores (Q7) were similar. Overall satisfaction was high in both groups but slightly higher after primary repair (95% vs. 87%, p=0.04). CONCLUSION: Despite greater complexity, redo urethroplasty demonstrates similar long-term success rates to primary urethroplasty. Patient-reported bother was similar, supporting redo urethroplasty as a viable option for recurrent urethral stricture after previous repair. However, recurrences occurred significantly earlier in the redo group.