Comparison of success rates between urethroplasty and perineal urethrostomy in the treatment of complex urethral strictures: a meta-analysis.

Purpose: This study aimed to compare the effectiveness of urethroplasty and perineal urethrostomy (PU) in treating complex urethral strictures (CUS). CUS refers to strictures longer than 6 cm or those caused by prior surgeries, such as hypospadias or lichen sclerosus.

Methods: A systematic literature search was conducted to identify relevant studies comparing urethroplasty and PU. The studies included were cohort designs that reported surgical success rates for both procedures. A total of 6 studies were included, involving 880 patients (624 undergoing urethroplasty and 256 undergoing PU). Data analysis was performed using Review Manager 5.3 software, and heterogeneity between studies was assessed using chi-square test (Cochran's Q) and the inconsistency index (I²).

Results: The pooled analysis indicated no significant difference in the surgical success rates between the two groups (relative risk = 0.93, 95% CI: 0.84-1.03; p = 0.15). However, significant heterogeneity was observed (I² = 69%, p = 0.006), suggesting variability in the results across studies.

Conclusion: Our study shows that PU and urethroplasty have similar success rates in treating CUS. Given the quality of the studies and the identified limitations, it is not possible to draw definitive conclusions. Meanwhile, the management of CUS, especially those involving lichen sclerosus or failed hypospadias repair, should be carried out in referral centers with specialized expertise to optimize patient outcomes.