Is a sterile preoperative urine culture enough before urethroplasty? Impact of previous urinary colonization on surgical outcomes

Background: The role of preoperative urine culture in predicting outcomes after urethroplasty remains unclear. While sterile urine is generally considered a prerequisite before reconstructive surgery, the prognostic value of previous urinary bacterial colonization has not been fully investigated.
Methods: We conducted a retrospective observational study including patients who underwent urethroplasty for urethral stricture disease between January 2014 and April 2024. Clinical, microbiological, and surgical data were collected. Patients were categorized according to preoperative urine culture status and history of urinary bacterial colonization. The primary endpoint was urethroplasty recurrence during follow-up.
Results: Eighty-seven patients were included, with a mean age of 56 ± 14 years. A sterile preoperative urine culture was observed in 58.6% of cases. The overall recurrence rate was 24%. Patients with a history of urinary bacterial colonization experienced significantly higher recurrence rates despite having sterile urine cultures at the time of surgery compared with patients without prior colonization (29% vs. 17%, p = 0.03). In contrast, preoperative urine culture status alone was not significantly associated with recurrence risk.
Conclusions: A sterile preoperative urine culture appears insufficient as a standalone predictor of urethroplasty success. Previous urinary bacterial colonization may represent an independent marker of recurrence risk and should be incorporated into preoperative risk assessment strategies.