To determine the frequency of complications related to urethral stricture and identify clinical factors associated with them.

Of 1851 patients with a suspected diagnosis of urethral stricture referred to a single urologist from 2005 to 2016 were retrospectively reviewed. Clinical variables included complications directly related to urethral stricture at the time of patient presentation, associated signs/symptoms, patient age, stricture length, location, and etiology. Complications considered significant were acute urinary retention or difficult catheterization requiring emergent urologic intervention or renal failure, urosepsis, or urethral abscess directly related to stricture. Patients without complete data were excluded from study. The occurrence of complications was compared in relation to patient age, symptoms, stricture length, location, and etiology using binary logistic regression.

Of 1023 patients meeting inclusion criteria, mean age was 48.0 years and mean stricture length was 5.0 cm (1-18). Of 40.6% (415) of patients experienced at least one complication directly related to urethral stricture including acute urinary retention (32.6%), difficult catheterization (16.0%), urethral abscess/urosepsis (5.0%), or renal failure (3.1%). On multivariate analysis, stricture length (cm) (odds ratio [OR] 1.1; 95% confidence interval [CI] 1.1-1.2, P = .01), lack of reported lower urinary tract symptoms (OR 3.8, 95%CI 1.9-7.3, P <.0001), posterior stenosis (OR 3.0, 95%CI 1.3-6.8, P = .01), and trauma-related strictures (OR 1.6, 95% CI 1.1-2.4, P = .02) were associated with complications. Lastly, 7.0% of patients experienced complications deemed to be life-threatening.

Urethral stricture is frequently a morbid condition. Patients with longer strictures, posterior stenoses, absence of preceding lower urinary tract symptoms and traumatic strictures are at highest risk for complications related to urethral stricture and should likely be directed toward more definitive treatment.