Urethral strictures (US) and bladder neck contracture (BNC) are troublesome complications of transurethral surgery. We aimed to report the incidence, risk factors, and management of US and BNC post-HoLEP together with review of literature.
A retrospective review of prospectively managed HoLEP patients in one institution between 2015 and 2021 was performed. The study included patients with complete follow up of at least one-year. Multivariate regression analysis for risk factors of US or BNC was performed. Appropriate statistical analysis methods were used.
Out of total 1055 HoLEP patients, 566 patients were included. Eleven (1.94%), eight (1.41%) and one (0.17%) patients developed US, BNC, and both respectively while eight (1.41%) patients had postoperative recurrence of intraoperative diagnosed US. With multivariate regression analysis, intraoperative urethral stricture (p = 0.0055, OR= 15.5, 95% CI= 2.2- 37.7), intraoperative need for meatotomy (p = 0.0019, OR=7.69, 95% CI= 2.12- 27.8) and longer operative time (p =0.0250, OR= 1.043, 95% CI= 1.005-1.083) were predictors of US/BNC. For US patients, urethral dilatation under local anesthesia was sufficient in 14 (70%) patients while 6 (30%) patients had visual urethrotomy. Patients with BNC were managed by endoscopic bladder neck incision.
Although the US/BNC are annoying long term sequalae that may complicate HoLEP, the incidence is still low and can be easily managed. Diagnosed intraoperative stricture, need for meatotomy and longer operative time are the main predictors of urethral complications post-HoLEP.
Journal of endourology. 2022 Aug 18 [Epub ahead of print]
Mohamed Elsaqa, James Risinger, Marawan El Tayeb
Baylor Scott and White Central Texas, Urology division, Department of Surgery, Temple, Texas, United States., Texas A&M University, Temple, Texas, United States; ., Baylor Scott and White Central Texas, Urology division, Department of Surgery, Temple, Texas, United States; .
PubMed http://www.ncbi.nlm.nih.gov/pubmed/35983597