Defining Long-term Success after Anterior Augmentation Urethroplasty: 10-yr Patient-reported and Objective Outcomes According to the Novel Stricture-fecta Criteria

Background and objective: There is a paucity of long-term data on patient-reported outcome measures (PROMs) after urethroplasty. We aimed to evaluate PROMs and retreatment-free survival more than 10 yr after anterior augmentation urethroplasty, using the recently established stricture-fecta criteria for standardized outcome reporting. Patients and methods: We retrospectively identified 97 men who underwent anterior augmentation urethroplasty between 2010 and 2013. Stricture characteristics were classified according to the Length, Segment, and Etiology system. Follow-up was performed via structured telephone interviews, and consenting patients completed a validated online survey at a single cross-sectional time point more than 10 yr after surgery. The survey included the Urethral Stricture Surgery (USS) PROM as well as instruments for urinary incontinence (ICIQ-UI SF), erectile function (IIEF-EF), and ejaculatory function (MSHQ-Ej). Retreatment-free survival was estimated using Kaplan-Meier analysis. The endpoints investigated met the trifecta criteria of standardized urethroplasty outcome reporting (stricture-fecta). Key findings and limitations: Median follow-up in 97 patients was 136 mo (95% confidence interval 133-138). Most strictures were >2 and ≤7 cm (66%) and bulbar (64%), predominantly iatrogenic (42%) or idiopathic (38%). Single-stage repair was performed in 90%. In total, 17 patients (18%) experienced recurrence, yielding 2-, 5-, and 10-yr retreatment-free survival rates of 90%, 86%, and 84%, respectively. Median USS PROM lower urinary tract symptoms score was 5/24, median ICIQ-UI SF 0/21, median IIEF-EF 19/30 (median modified IIEF-EF 24/30), and median MSHQ-Ej 28/35, indicating low urinary symptom burden and preserved sexual function. Mean EuroQol 5-Dimension (EQ-5D) index and EuroQol Visual Analogue Scale (EQ-VAS) were 0.936 and 78. Overall, 92% of patients reported being satisfied or very satisfied with their long-term outcomes. Limitations include the cross-sectional nature of long-term follow-up and potential nonresponse bias. Intervention: Augmentation urethroplasty. Conclusions and clinical implications: This first report of PROMs beyond 10 yr after anterior urethroplasty demonstrates durable retreatment-free survival, excellent long-term urinary and sexual function, and sustained patient satisfaction, providing a robust benchmark for current and emerging treatments.