Smoking, ASA score predict long-term failure after urethroplasty

Men with urethral stricture disease who underwent urethroplasty may experience recurrence long after the procedure, according to a study presented at EAU 2025. 

Factors associated with urethral stricture recurrence include American Society of Anaesthesiologists (ASA) score, smoking habits, and stricture localization. 

“Urethroplasty failures still can occur many years after surgery,” said lead study author Dr Eef Adriaensen, UZ Leuven, Department of Urology, Leuven, Belgium.  

“Our prediction model provides clinicians with an easy-to-use tool to counsel their patients and could potentially be integrated into future clinical decision-making,” she added. 

A total of 291 patients were included in this retrospective single-centre analysis. Of these, nearly a third (n=91, 31.27 percent) had urethral stricture recurrence. The median follow-up for those who experienced no recurrence was 114.5 months. (EAU 2025, abstract A0324] 

Among men who had urethroplasty failure, half of them experienced recurrence within 33 months, while the rest had it within the next 10 years. 

Survival analyses revealed the following statistically significant predictors: age (p=0.003), ASA score (p=0.007), and smoking habits (p=0.035). In addition, stricture recurrence showed a significant association with stricture localization (p=0.010), length (p=0.008), preoperative urine cultures (p=0.022), and surgical technique (p=0.042). 

In multivariable Cox regression analysis, urethroplasty failure was significantly predicted by the following variables: ASA score (hazard ratio [HR], 1.98, 95 percent confidence interval [CI], 1.20–3.24; p=0.007), smoking habits (HR, 1.76, 95 percent CI, 1.12–2.78; p=0.015), and stricture localization (HR, 2.18, 95 percent CI, 1.26–3.77; p=0.005). 

“We combined those predictors in a multivariable analysis where we could conclude that, based on the individual HRs, patients with multiple predictors being present subsequently have a higher risk for recurrence compared to patients with no predictors present,” Adriaensen said. 

Prediction model 

Using these variables, Adriaensen and colleagues created an easy-to-use prediction model for recurrence-free survival to determine an individual’s recurrence-free survival rates. 

“Recurrence can occur many years after [urethroplasty], so we have to be aware of that,” she said. "We could use this model in the future as a tool for risk assessment.” 

In this retrospective single-centre trial, Adriaensen and her team examined the medical records of male patients who underwent urethroplasty between January 2003 and December 2014. They defined failure as the requirement of new instrumentation for stricture-release or proven anatomical failure with clinical repercussions, visualized by cystoscopy or cystourethrogram. 

The researchers assessed potential patient- and surgery-related predictors of long-term failure, such as age, ASA score, smoking habits, cardiovascular risk factors, aetiology, localization, length, preoperative urine culture results, and surgical technique. They also conducted summary statistics and survival analyses using Kaplan-Meier plots and Cox proportional hazards regression models. 

“We’re in need of multicentre studies to investigate additional predictors,” Adriaensen said. 

“Urethral stricture disease is an important cause of male lower urinary tract symptoms,” according to the researchers. “Urethroplasty is nowadays referred to as gold standard treatment for strictures not amenable to endoscopic treatment.”