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Post-Procedural Urethral Strictures after Aquablation - Beyond the Abstract

As the landscape for benign prostatic hypertrophy treatment is evolving in an era of multiple surgical options for benign prostatic hypertrophy treatment, we investigated the iatrogenic urethral stricture rate in patients following Aquablation. Our cohort of 170 patients with a nearly 2-year median follow up demonstrated a symptomatic US rate of 5.3% after Aquablation. Eighty-nine percent of strictures affected the fossa navicularis. Stricture formation was associated with longer indwelling catheter time and longer traction time.

Traction following Aquablation provides constant prostatic pressure for postoperative hemostasis, and its use varies by institution. Traction also confers persistent pressure on the fossa navicularis, further potentiating urethral microtrauma and likely contributing to the high stricture rate in this location. Strictures in our series were typically repaired with substitution urethroplasty using buccal mucosa grafts, which represents an additional surgery and delay to achieving a desired improvement in their lower urinary tract symptoms.

We have made several practice changes due to these findings. We more clearly counsel patients on the risk of stricture after endoscopic prostate surgery. Additionally, our institution has taken steps to reduce traction time, limit potential scope trauma to the fossa navicularis by pre-dilating with Van-Buren sounds, and limit indwelling catheter duration, regardless of preoperative prostate size.

Written by: Jessica Pryor, MD, PGY-5 Department of Urology, Temple Urologic Institute at Fox Chase Cancer Center, Philadelphia, PA, US