Urethral stricture is one of the postoperative complications after transurethral resection of the prostate for benign prostatic hyperplasia and urethral dilation is simple and effective procedure to treat urethral stricture. However, there are no studies that have evaluated the relationship between preoperative urethral dilation and the incidence of post-transurethral resection of the prostate urethral stricture. Thus, we retrospectively investigated the effect of routinely urethral dilation just before surgery on preventing urethral stricture after transurethral resection of the prostate for benign prostatic hyperplasia.

From January 2010 to December 2018, a total of 651 patients who underwent transurethral resection of the prostate for benign prostatic hyperplasia was included in this study. We divided into two groups: Group A (295 patients, routinely urethral dilation before transurethral resection of the prostate) and B (356 patients, control group). We used a 26Fr resectoscope sheath, 30-degree telescope, and bipolar resectoscope. Urethral dilation was performed immediately before insertion of resectoscope sheath and 28Fr dilator was used. Urethral stricture after transurethral resection of the prostate was assessed by cystoscopy. Each patient was evaluated at 1 month, 3 months, and 6 months after transurethral resection of the prostate. The effect of urethral dilation was assessed based on International Prostate Symptom Score (IPSS), peak urine flow rate, voiding volume, and post-void residual urine.

There were no significant differences of clinical variables, such as prostate volume, serum prostate specific antigen (PSA), age, operation time, and duration of catheterization between two groups (p>0.05). However, peak urine flow rate was significantly different between group A and B (19.87±9.12 vs 16.18±9.79, p=0.047). The incidence of urethral stricture after transurethral resection of the prostate was 4.06% (12/295) and 8.71% (31/356) in group A and B, respectively (p=0.032).

As you see in Table 1, there were no significant differences of clinical variable between two group, except the incidence of urethral stricture after surgery. The mean duration of the urethral stricture after transurethral resection of the prostate was 137.5±102.9 days. In all patients who had urethral stricture, the mean lengths of stricture was 8.1±7.6 mm and the sites of stricture were bladder neck (18/43), urethral meatus (21/43), and bulbous urethra (4/43).

This study demonstrated that the preoperative urethral dilation decreased the incidence of urethral stricture after transurethral resection of the prostate. We suggested that the routinely preoperative urethral dilation is simple and effective way to prevent urethral stricture after transurethral resection of the prostate for benign prostatic hyperplasia.

Continence 2S2 (2022) 100223
DOI: 10.1016/j.cont.2022.100223