Urethral Strictures After Endoscopic Enucleation of the Prostate and Its Associated Clinical Outcomes in Aging Men

• Published in: Medicina (Kaunas, Lithuania) Vol. 60; no. 11; p. 1771
• Main Authors: Hou, Chen-Pang, Wu, Jen-Hsuan, Weng, Shu-Chuan, Lin, Yu-Hsiang, Chen, Chien-Lun, Tsai, Han-Yu, Chen, Yu-Ting, Juang, Horng-Heng
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 01.11.2024; MDPI
• Subjects: Aged; Aged, 80 and over; Antibiotics; Antigens; benign prostatic hyperplasia; Biopsy; Bladder; endoscopic enucleation; Endoscopy; Endoscopy - adverse effects; Endoscopy - methods; Hematuria; Hospitals; Humans; Incidence; Lasers; Lasers in surgery; Male; Medical research; Medicine, Experimental; Middle Aged; Patient outcomes; Patients; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Prostate cancer; Prostatic Hyperplasia - surgery; Quality of life; Regression analysis; Retrospective Studies; Risk Factors; Surgery; Surgical outcomes; Surgical techniques; Taiwan - epidemiology; Transurethral Resection of Prostate - adverse effects; Transurethral Resection of Prostate - methods; Treatment Outcome; Tumors; Ultrasonic imaging; Urethral Stricture - etiology; Urethral Stricture - surgery; urethral strictures; Urinary retention; urinary tract Infection; Urinary tract infections; Urine; Urogenital system; Taiwan; Germany; Europe; urinary tract Infection; endoscopic enucleation; benign prostatic hyperplasia; urethral strictures
• DOI: 10.3390/medicina60111771
• ISSN: 1648-9144; 1010-660X

Background and Objectives: Benign prostatic hyperplasia is a common condition among aging men, leading to bladder outlet obstruction and associated lower urinary tract symptoms. Surgical intervention, particularly endoscopic enucleation of the prostate, has become increasingly popular over traditional methods such as transurethral resection of the prostate. However, urethral strictures remain a major postoperative complication. This study evaluated the incidence, risk factors, and clinical outcomes of urethral strictures after endoscopic enucleation of the prostate. Materials and Methods: This study retrospectively analyzed prospectively collected data from 246 patients who underwent either thulium laser enucleation of the prostate or bipolar transurethral enucleation of the prostate at Chang Gung Memorial Hospital between October 2018 and December 2022. Patients were evaluated preoperatively using uroflowmetry, International Prostate Symptom Score (IPSS), and other relevant clinical metrics. Follow-up assessments at 2 weeks, 3 months, and 6 months post-surgery included uroflowmetry, IPSS evaluation, and cystoscopy when indicated. A urethral stricture was deemed to be present if a 5.5 mm fiber cystoscope was unable to pass through the urethra. Results: Of the 246 patients, 23 (9.3%) developed urethral strictures, with the membranous urethra being the most common site (69.2%). Patients with strictures had significantly smaller prostate volumes and enucleated tissue weights, higher trial without catheter (TWOC) failure rates, and a higher postoperative urinary tract infection (UTI) incidence. Multivariate analysis identified smaller prostate size, lower resected tissue weight, TWOC failure, and postoperative UTI as significant risk factors for stricture formation. The type of energy source used for enucleation (bipolar or Thulium laser) was not identified as a factor influencing the incidence of urethral stricture. Conclusions: Urethral strictures constitute a major complication following endoscopic enucleation of the prostate, particularly in patients with smaller prostates and those experiencing postoperative complications such as UTIs and TWOC failure. These findings underscore the importance of careful surgical technique and rigorous postoperative monitoring to reduce the incidence of this complication.