Objective:Urethral stricture is characterized by fibrosis that decreases urine flow. Metabolic syndrome is a complex disorder that causes fibrosis in many organs. This study aimed to evaluate the relationship between metabolic syndrome and appearance of urethral stricture and effects of metabolic syndrome on the recurrence of urethral stricture in patients with primary urethral stricture who underwent direct visual internal urethrotomy.Materials and methods:One hundred thirty-two male patients who underwent direct visual internal urethrotomy between 2014 and 2021 because of primary urethral stricture were included. Location, length, and type of urethral stricture, time from diagnosis to surgery, postoperative follow-up, time from surgery to recurrence, and postoperative follow-up duration with a urethral catheter were retrospectively analyzed and association with metabolic syndrome was evaluated.Results:The mean age was 50.48 ± 17.94 years. Recurrence was found in 34.1% and metabolic syndrome in 27.3%. Postoperative follow-up duration was significantly longer in patients with recurrence than in those without (P= .033). There was no statistically significant difference in terms of metabolic syndrome and postoperative urethral catheterization between patients with and without recurrence (P= .126,P= .714, respectively). Postoperative clean intermittent self-catheterization use was found to be statistically higher in patients with recurrence than in patients without recurrence (P= .018). Postoperative urinary tract infection rate was found to be significantly higher in patients with metabolic syndrome compared to patients without metabolic ­syndrome (P= .001).Conclusion:Metabolic syndrome was not associated with recurrence. However, postoperative urinary tract infections were more common in patients with metabolic syndrome than in patients without. Clean intermittent self-catheterization used postoperatively may increase the risk of stricture.