Risk factors for urethral stricture and/or bladder neck contracture after monopolar transurethral resection of benign prostatic hyperplasia
Patients and methods. We retrospectively analyzed 402 patients who underwent monopolar TURP for prostatic hyperplasia at the Sechenov First MSMU, Clinic of Urology (Moscow, Russia) between January 2011 and December 2014. Sixty-one patients (15.27%) developed urethral strictures and/or bladder neck contractures postoperatively. Of these 61 patients, 34 (8.6%) developed urethral strictures, 20 (4.97%) developed bladder neck contractures, and 7 (1.7%) developed both urethral strictures and bladder neck contractures. Three hundred and forty-one patients (84.73%) had no postoperative complications. One hundred and six patients out of 341 were selected based on the inclusion criteria, i.e., if their medical records contained all the relevant variables: prostate volume, length of surgery, size of endoscope, comorbidities, prostatic fluid analysis, etc. Thus, the patients were divided into two groups. Group 1 (n = 106) was the control group that included patients without urethral strictures or bladder neck contractures. Group 2 included 61 patients who had such complications.
Results. Prostate volumes differed significantly between the two groups. In group 1, the mean prostate volume was 60 (45–75) cm3; in group 2, the mean prostate volume was 70 (40–85) cm3 (р = 0.005). In group 1, the mean length of surgery was 60 (30–140) minutes, whereas in group 2, it was 70 (51–105) minutes (р = 0.004). Diabetes mellitus was observed in 9.4% of patients (n = 10) from group 1 and in 24.6% of patients (n = 15) from group 2 (p = 0.004). The percentage of patients with hypertension in the control group was 24.6% (n = 15), whereas that in group 2 was 41% (n = 25) (p = 0.06). Chronic inflammation confirmed by morphological analysis of resected prostate tissue specimens was found in 28.3% of patients (n = 30) from group 1 and in 63.9% of patients (n = 39) from group 2 (p = 0.001).
Conclusion. The study results suggest that the possible risk factors for urethral stricture and/or bladder neck contracture during the late postoperative period are length of surgery over 60 minutes, prostate volume over 70 cm3, diabetes mellitus, and chronic inflammation of the prostate.
Key words: urethral stricture, benign prostatic hyperplasia, transurethral resection of the prostate, complication, bladder neck contracture.
For citation: Grechenkov A.S., Glybochko P.V., Alyaev Yu.G., Butnaru D.V., Bezrukov E.A., Vinarov A.Z., Sukhanov R.B. Risk factors for urethral stricture and/or bladder neck contracture after monopolar transurethral resection of benign prostatic hyperplasia. Vopr. urol. androl. (Urology and Andrology). 2017; 5(1): 5–9. (In Russian).