Introduction

Urethral stricture disease is seen in 2-9% of patients after transurethral resection of the prostate (TURP) but data is limited as to treatment outcomes. Our purpose is to establish patterns of disease severity and treatment for post-TURP stricture among 7 high volume centers.

Methods

A retrospective database was created for patients who underwent management of post-TURP strictures at 7 reconstructive urology centers. Data consisted of demographics, TURP method, location/length of urethral strictures, interventions prior to urethroplasty, surgical technique used for urethroplasty, and outcomes. Exclusion criteria included age <18 and follow-up period <1 year. Success was defined as no need for intervention within the observation period. Data analysis was done from 7 institutions for a total of 130 patients.

Results

Mean age was 68 years (range 41-86). 77% of patients underwent monopolar TURP (n=100). Other modalities reported were: 10% bipolar TURP (n=13), 3% GreenLightTM laser (n=4), 3% holmium laser (n=4), 2% other lasers (n= 3) and 5% unknown modality (n=6). Urethral stricture locations were: 29% bulbar urethra (n=38), 17% membranous urethra (n=22), 11% penile urethra (n=15), 5% fossa navicularis urethra (n=6), and 38% multiple locations (n=49). The average intraoperative length of strictures was 4.4cm (range 1-23cm). Average number of endoscopic interventions prior to urethroplasty is 3.6 (range 0-36)._x000D_ _x000D_ Urethroplasty techniques were: anastomotic (33%, n=43), dorsal graft (39%, n=51), ventral graft (15%, n=19), flap (6%, n=8), perineal urethrostomy (2%, n=3). 5% of patients underwent advanced reconstructive techniques such as: double graft, augmented dorsal anastomotic, Duckett, or first stage Johanson (n=6). Overall success rate was 85% with an average time-to-failure of 23 months (range 2-151 months). Success rates for patients who had prior endoscopic intervention (urethrotomy or dilation) was 83% versus those with no prior endoscopic intervention who had a success rate of 100%, p> 0.05. Complications were reported in 17% of patients, including recurrent UTI, erectile dysfunction, urinary incontinence, and penile shortening.

Conclusions

Our study represents the first multi-institutional report on the severity and management of post-TURP urethral strictures. Our data shows that the majority of post-TURP strictures are successfully managed with urethroplasty, with 85% success. Better success rates are seen in patients with no prior endoscopic intervention, suggesting early urethroplasty or referral to a reconstructive urology center is warranted.

Funding

None