Urethral stricture is a well-known complication after transurethral prostate surgery (TPS) and it is usually considered an easy-to-treat condition. We aimed to examine characteristics of post-TPS urethral stricture cases that were referred for urethroplasty at our tertiary center.
We identified 201 patients with TPS-induced stricture treated with urethroplasty at our institution from 2017-2021. First, stricture length and location were evaluated during preoperative assessment. Second, multiple sets of multivariable logistic regression (MLR) analyses were run to assess whether clinical variables were associated with the location of the stricture.
Median stricture length was 5 cm (4-7). 141 (70.1%) patients received previous no-invasive treatments (dilatation and/or DVIU). Proximal bulbar urethra was the commonest site for stricture, while panurethral stricture (≥10cm) was diagnosed in 41 (20.4%) patients. Lichen sclerosus was more common in patients with penile stricture location, compared to patients with other involved segments (26% vs 19%, p=0.03), and it was the only predictor of penile and mid bulbar urethra location at MLR. Surgical approaches were augmented urethroplasty in 94% of patients, especially for patients with previous treatment including urethroplasty (95.8% vs 82.5% for naïve, p=0.004). Dorsal onlay was the preferred approach for bulbar (53.4%) and penile urethra (90.7%), while ventral onlay (38.2%) and double face augmentation (20.6%) were the preferred approach in membranous strictures.
The majority of patients that were referred for TPS-induced stricture attempted previous non-invasive managements. Referred TPS-induced urethral stricture were long and frequently involving multiple segments of urethra. Augmentation urethroplasty was our preferred surgical approach due to the characteristics and complexity of these strictures. The presence of lichen may increase the risk of post-TPS stricture in specific segment of urethra, namely the penile and mid-bulbar urethra.
Journal of endourology. 2022 Jun 14 [Epub ahead of print]
Marco Bandini, Christian Yepes, Pankaj M Joshi, Giuseppe Basile, David Naranjo, Shreyas Bhadranavar, Ahmed Alrefaey, Sandeep Bafna, Francesco Montorsi, Sanjay B Kulkarni
San Raffaele Hospital, 9372, Milano, Italy; ., Kulkarni EndoSurgery Institute and Reconstructive Urology Centre, 80252, Pune, Maharashtra, India; ., Kulkarni EndoSurgery Institute and Reconstructive Urology Centre, 80252, Pune, Maharashtra, India; ., San Raffaele Hospital, 9372, Milano, Italy; ., Kulkarni EndoSurgery Institute and Reconstructive Urology Centre, 80252, Pune, Maharashtra, India; ., Kulkarni EndoSurgery Institute and Reconstructive Urology Centre, 80252, Pune, Maharashtra, India; ., Kulkarni EndoSurgery Institute and Reconstructive Urology Centre, 80252, Pune, Maharashtra, India; ., Kulkarni EndoSurgery Institute and Reconstructive Urology Centre, 80252, Pune, Maharashtra, India; ., San Raffaele Hospital, 9372, Milano, Italy; ., Kulkarni EndoSurgery Institute and Reconstructive Urology Centre, 80252, Pune, Maharashtra, India; .