Background: Internal urethrotomy is commonly used as the first treatment for urethral strictures but has a high recurrence rate. Open urethroplasty comes with best long-term results and decreases the risk of needing any further interventions. Until now, there are no recommendations based on evidence that compare the outcome of recurrent urethral stricture when treated with internal urethrotomy and open urethroplasty. This systematic review compared those two procedures for recurrent urethral stricture. Methods: We searched databases using PubMed, Scopus, and EBSCO for relevant literature published in English up to September 2024. The primary outcome was the recurrence rate at 12 months. Secondary outcomes are symptom relief, maximum urinary flow rate, adverse events and complications, and sexual function. We used Revman to compare the pooled patients. Results: We included three studies with 454 pooled patients. Data for the recurrence rate of 12 months were included for meta-analysis. The results showed a risk ratio of 5.24 ((95% CI 2.89-9.53, p < 0.00001), indicating that open urethroplasty significantly has lower recurrence rate than internal urethrotomy group. Symptoms relief in urethroplasty is better than in urethrotomy but not significantly different between the two groups. Improvement of Qmax happened in both groups with no significant difference, although urethroplasty has better improvement than urethrotomy group. Complications during a 24 month follow up were seen in both groups with the most common complications being urinary symptoms, urinary tract infection, and erectile dysfunction. Those complications were less frequently observed in urethroplasty but there are no significant difference between the groups. Post procedure sexual function was comparable between the two procedures. Conclusions: Our review shows that open urethroplasty has lower recurrence rates at 12 months compared to internal urethrotomy for recurrent urethral strictures. However, symptom relief, improvement in urinary flow rate, complication, and postprocedure sexual function were comparable between the two procedures. Further randomized controlled trials with larger sample sizes, multicenter designs, and longer follow-up periods are needed to confirm the results of our review. © 2025, Page Press Publications. All rights reserved.