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Introduction: Ureteral stricture disease (UTSD) poses significant challenges in reconstructive urology, with recent advances highlighting disparities in healthcare outcomes based on race and ethnicity. This study investigates the impact of race and ethnicity on clinical outcomes following ureteral reconstruction., Methods: We conducted a single-centre prospective analysis of 233 patients who underwent ureteral reconstruction for UTSD from 2014 to 2023. Patient demographics, clinical characteristics, surgical details and outcomes were collected. Patients were stratified by race (White vs. non-White) and ethnicity (Hispanic vs. non-Hispanic). Statistical analyses included Kruskal-Wallis, Mann-Whitney U tests, ANOVA, Kaplan-Meier analysis and multivariate logistic regression., Results: Our cohort included 233 patients who underwent ureteroplasty with 108 (46.4%) non-White patients, and 71 (30.5%) were Hispanic. No significant differences were found in recurrence rates, complications, or stricture-free survival between racial and ethnic groups. Prior reconstructions were more prevalent among non-White patients (26.9% vs. 16.0%; p  = 0.043). Unadjusted and adjusted regressions showed significant associations between non-White race (unadjusted β  = 0.76, p  = 0.008; adjusted β  = 0.82, p  = 0.008) and Hispanic ethnicity (unadjusted β  = 0.70, p  = 0.025; adjusted β  = 0.79, p  = 0.020) with increased stricture lengths., Conclusion: This study highlights that although recurrence and complication rates do not significantly differ by race or ethnicity, disparities exist in clinical presentations, with non-White and Hispanic patients presenting with longer stricture lengths and higher body mass index. These findings underscore the need for targeted interventions to address underlying disparities in healthcare delivery and access., Competing Interests: All authors declare no conflicts exist., (© 2024 The Author(s). BJUI Compass published by John Wiley & Sons Ltd on behalf of BJU International Company.)