Urethral strictures are a well-known complication following endoscopic treatment of benign prostatic hyperplasia (BPH). Although the exact cause remains unclear, repetitive instrument movement and pressure-induced ischemia are likely contributing factors.
While the incidence seems lower after enucleation compared to transurethral resection of the prostate, it remains important to prevent this iatrogenic complication. A small randomized trial suggested a benefit from preoperative urethral dilatation, though findings were constrained by limited sample size and follow-up. Similarly, studies comparing resectoscope sizes have not yet demonstrated significant differences in stricture rates. Drawing parallels with ureteral stricture prevention, where prestenting with a ureteral catheter is commonly used, we hypothesize that preoperative transurethral catheterization may relax and dilate the urethra, potentially lowering the risk of stricture formation. Clinical observations support this: patients with preoperative indwelling catheters before endoscopic treatment of BPH often display a more compliant urethra during surgery. While mechanical irritation remains a theoretical concern of placing a catheter, the relaxing effect may outweigh potential harm, much like DJ-stent use in the ureter. A prospective study will be conducted within the EAU Endourology Consortium to evaluate this hypothesis, incorporating force-sensing dilators and standardized follow-up with uroflowmetry and cystoscopy at 3 and 6 months. If successful, preoperative catheterization may offer a simple, low-risk strategy to reduce urethral strictures in BPH surgery, particularly in patients with a narrow urethra.
World journal of urology. 2025 May 26*** epublish ***
Joren Vanthoor, Thomas R W Herrmann, Vincent De Coninck
Department of Urology, AZ Klina, Brasschaat, Belgium., Department of Urology, Spital Thurgau AG, Kantonsspital Frauenfeld, Pfaffenholzstrasse 4, Frauenfeld, CH, 8501, Switzerland., Department of Urology, AZ Klina, Brasschaat, Belgium. .
PubMed http://www.ncbi.nlm.nih.gov/pubmed/40418263