Skip to main content Skip to main navigation menu Skip to site footer

Efficacy of revision urethroplasty in the treatment of recurrent urethral strictures at a tertiary hospital (Kenyatta National Hospital–KNH), in Nairobi Kenya: 2015-2018


Background: Urethral strictures cause malfunction of the urethra. Urethroplasty is a cost-effective treatment option. Its success rate is greater than 90% where excision and primary anastomosis(EPA)is performed and 80-85% following substitution urethroplasty. Definitive treatment for recurrent urethral strictures after urethroplasty is not defined. Repeat urethroplasty is a viable option with unknown efficacy.

Method: Retrospective analysis of patients who underwent revision urethroplasty for unsuccessful urethroplasty at KNH from 2015 to 2018 was performed. Patients’ age, demographic data, stricture length, location, aetiology, comorbidities and type of urethroplasty was evaluated from records with complete data. Male patients aged 13 to 80years were evaluated. Comparison of urethroplasty outcome between two patient cohorts was made: Fresh urethroplasty patients versus failed urethroplasty who underwent revision so as to determine efficacy of the later. Principal outcome measure was urethral patency, while Subsidiary outcome measures were associated complications. Outcomes were compared using statistical package SPSS version 23.0.

Result: 235 patients who met inclusion criteria underwent urethroplasty, 71.5% (n=168) had a successful outcome, while28.5% (n=67) failed and were subjected to revision urethroplasty. Another 58% were successful upon revision but experienced significant morbidity. Majority of urethral strictures were bulbomembranous. Trauma was the leading cause of urethral strictures followed by idiopathic strictures. EPA was the commonest surgery while Tissue transfer featured prominently in revision urethroplasty. A significant correlation was evident between stricture length, prior surgery, and procedure choice and urethroplasty outcome.

Conclusion: Revision urethroplasty is feasible after failed urethroplasty but less efficacious. Stricture length, number of prior surgeries and procedure choice affected outcome.EPA and Tissue Transfer techniques are essential surgical armamentarium in revision setting.


  1. Jasionowska S, Brunckhorst O, Ahmed K. Redo-urethroplasty for the management of recurrent Urethral strictures in males: a systematic review. World J Urol. 2019;379:1801-1815. DOI. 10 1007/s00345-019-02709-7
  2. Hudak SJ, Morey AF. Reconstruction of failed urethroplasty. Advanced male urethral and Genital reconstructive surgery. New York: Springer; 2015. p. 373-385.
  3. Levine MA, Kinnaird AS, Rourke KF. Revision urethroplasty success is comparable to primary urethroplasty: A comparative analysis. J Urol. 2016;84(4):2014; 928-933. DOI. 10 1016/j urology .2014.05.047.
  4. Andrich DE, Dunglison N, Greenwell TJ, Mundy AR. The Long Term results of urethroplasty. J. Urol. 2003;170(1):90-92. DOI. 10 1097/01.iu 0000069820 81726 00.
  5. Breyer BN, Mc Aninch JW, Whitson JM, et al. Multivariate analysis of risk factors for long-term urethroplasty outcome. J Urol. 2010;183:613-617. DOI. 1016/j juro.2009.10 018.
  6. Roehrborn CG, McConnell JD. Analysis of factors contributing to success or failure of 1-stage urethroplasty for urethral stricture disease. J Urol. 1994;151(4):869-74. DOI. 10 1016/s0022-5347(17)35109-1.
  7. Culty T, Boccon-Gibod L. Anastomotic urethroplasty for posttraumatic urethral stricture: previous urethral manipulation has a negative impact on the final outcome. J Urol. 2007;177(4):1374-7. DOI. 10 1016/j juro 2006.11.092.
  8. Vetterlein MW, Stahlberg J, Zumstein V, Engel O’ Dahlem R, Fisch M, Rosenbaum CM, Kluth LA . The Impact of Surgical Sequence on Stricture Recurrence after Anterior 1-stage Buccal Mucosal Graft Urethroplasty: Comparative Effectiveness of Initial, repeat and secondary Procedures. J Urol. 2018;200(6):1308-1314. DOI. 10 1016/j juro 2018.06.067.
  9. Morey AF, Duckett CP, McAninch JW. Failed anterior urethroplasty: Guidelines for reconstruction. J Urol 1997;158(4):1383-1387. DOI. 10 1016/s0022-5347(01)64221-6.
  10. Koraitim MM. Failed posterior urethroplasty: lessons learned. J Urol. 2003;62(4):719-22. DOI. org/10.1016/S0090-4295 (03)00573-9.
  11. Spilotros M, Sihra N, Malde S, Pakzad MH, Hamid R, Ockrim JL, Greenwell TJ. Buccal mucosa graft urethroplasty in men-risk factors for recurrence and complications: a third referral center experience in anterior urethroplasty using buccal mucosa graft. Transl Androl Urol. 2017;6(3):510-516. DOI. 10.21037/ tau. 2017.03.69.
  12. Erickson BA, Breyer BN, McAninch JW. The use of Uroflowmetry to diagnose recurrent stricture after urethral reconstruction surgery. J Urol. 2010;184(4):1386-1390. DOI. 10.1016/j.juro.2010.06.015.
  13. Morey AF, McAninch JW, Duckett CP, Rogers RS. American Urological Association symptom Index in the assessment of urethroplasty outcomes. J. Urol. 1998;159(4):1192-1194. DOI. 10 1016/S0022-5347(01)63552-3.
  14. Rosenbaum CM, Schmid M, Ludwig TA, Kluth LA, Dahlem R, Fisch M, Ahyai S. Redobuccal mucosa graft urethroplasty: Successrate, oral morbidity and functional outcome. BJU Int. 2002;118(5):797-803. DOI. 10 1111/bju.13528.
  15. Mugalo E, Bwombwongo S, Ayuo P. Aetiology of urethral strictures at Moi Teaching and Referral Hospital. Annals Afr Surg. 2013;10(1):10-14.
  16. Stein DM, Thum DJ, Barbagli G, Kulkarni B, Sansalone S, Pardeshi A, Gonzalez CM. A geographical analysis of male urethral stricture aetiology and location. BJUI Int. 2013;112(6):830-8. DOI. 10 1111/j.1464-410X.2012.11600.x.
  17. Blaschko SD, McAninch JW, Myers JB, Schlomer BJ, Breyer BN. Repeat urethroplasty after failed urethral reconstruction: outcome analysis of 130 patients. J Urol. 2012;188:2260-2264. DOI. 10. 1016/j. juro.2012.07.101.
  18. Joseph JV, Andrich DE, Leach CJ, Mundy AR. Urethroplasty for refractory anterior urethral stricture. J Urol. 2002;167(1):127-129. DOI. 101016/ S0022-5347(05)65396-7.
  19. O’Riordan A, Narahari R, Kumar V, Pickard R. Outcome of dorsal buccal graft urethroplasty for recurrent bulbar urethral strictures. BJU Int. 2008;102:1148-1151. DOI. 10.1111/j.1464-410X.2008.07763.x.
  20. Barbagli G, Palminteri E, Lazzeri M, et al. Long-term outcome of urethroplasty after failed urethrotomy versus primary repair. J Urol. 2001;165(6):1918-9. DOI. 1016/S0022-5347(05)66242-8.
  21. Woods DN, Andrich DE, Greenwell TJ,Mundy AR.Standing the test of time: the long-term results of urethroplasty. World J Urol. 2006;24:250-254. DOI. org/10.1007/s00345-006-0057-3
  22. Sinha RJ, Singh V, Sankhwar SN. Does tobacco consumption influence outcome of oral mucosa graft urethroplasty?. Urol J. 2010;7(1):45-50.
  23. Dogra PN, Saini AK, Seth A. Erectile dysfunction after anterior urethroplasty: A prospective analysis of incidence and probability of recovery-single center experience. J Urol. 2011;78(1):78-81. DOI. 10.1016/j. urology.2011.01.019.
  24. Erickson BA, Granieri MA, Meeks JJ, Cashy JP, Gonzalez CM. Prospective analysis of erectile dysfunction after anterior urethroplasty: Incidence and recovery of function. J Urol. 2010;183(2):657-61. DOI. 10.1016/j.juro.2009.10.017.
  25. Han JS, Liu J, Hofer MD, Fuchs A, Chi A, Stein D, Dielubanza E, Ballek N, Gonzalez CM. Risk of urethral stricture recurrence increases overtime after urethroplasty. Int J Urol. 2015;22(7):695-9. DOI. 10.1111/iju.12781.

How to Cite

Otele, W. H., Miima, S., Owilla, F., & Monda, S. (2020). Efficacy of revision urethroplasty in the treatment of recurrent urethral strictures at a tertiary hospital (Kenyatta National Hospital–KNH), in Nairobi Kenya: 2015-2018. Bali Medical Journal, 9(1), 67–76.