Predictors of recurrence following reconstructive urethral surgery for urethral stricture disease: A prospective observational study from a tertiary care center

Background: Urethroplasty remains the gold-standard treatment for urethral stricture disease; however, post-operative recurrence continues to pose a significant challenge. Aims and Objectives: This study aimed to evaluate clinical, anatomical, and surgical factors associated with recurrence following reconstructive urethral surgery. Materials and Methods: A prospective observational study was conducted in the Department of Urology, R. G. Kar Medical College and Hospital, Kolkata, between April 2023 and April 2026. Eighty consecutive patients undergoing reconstructive urethral surgery were enrolled. Demographic, clinical, operative, and follow-up data were prospectively collected. Recurrence was defined as maximum urinary flow rate (Qmax) <15 mL/s, anatomical stricture confirmation on retrograde urethrogram, cystoscopy to exclude detrusor underactivity, and/or requirement for secondary urethral intervention. Univariable analyses were performed. Exploratory multivariable logistic regression was attempted; however, only 18 recurrence events occurred for 12 predictors, resulting in overfitting. Results: Mean age was 46.8±13.2 years. Iatrogenic strictures (35%) and bulbar strictures (47.5%) were most common. Excision and primary anastomosis was the predominant procedure (42.5%). Recurrence occurred in 18 patients (22.5%), yielding a 77.5% success rate. Exploratory analyses suggested higher recurrence odds with balanitis xerotica obliterans, stricture length >4 cm, panurethral/posterior location, body mass index >30 kg/m2, ≥2 prior interventions, and diabetes mellitus; however, estimates were unstable due to limited events. Conclusion: Urethroplasty achieved a 77.5% success rate. Long-segment strictures, obesity, diabetes, extensive location, and multiple prior interventions may identify patients at higher recurrence risk. Larger multicentric studies are warranted to validate these associations.