Clinical application of the F21 multipurpose cystoscope with continuous irrigation capability in photoselective vaporization of the prostate: a retrospective controlled study.

OBJECTIVE: To evaluate whether an F21 multipurpose cystoscope with continuous irrigation capability is associated with a lower incidence of postoperative urethral stricture after photoselective vaporization of the prostate (PVP), while maintaining satisfactory short-term functional outcomes.

METHODS: This single-center retrospective comparative cohort included consecutive male patients aged ≥60 years who underwent PVP between January 2024 and January 2025. Procedures were performed using either the F21 multipurpose cystoscope with continuous irrigation capability or a conventional F26 resectoscope. All patients underwent standardized postoperative follow-up at 3 and 6 months, including assessment of the International Prostate Symptom Score (IPSS), maximum urinary flow rate (Qmax), postvoid residual urine volume (PVR), and clinical symptoms suggestive of urethral stricture. Postoperative urethroscopy was not performed routinely in all asymptomatic patients; instead, diagnostic urethroscopy was performed in patients with new or persistent obstructive voiding symptoms, a marked decrease in Qmax, increased PVR, or clinical suspicion of urethral stricture. Urethral stricture was defined as obstructive voiding symptoms combined with endoscopic confirmation of urethral narrowing with a caliber of <15 Fr. Between-group comparisons and multivariable logistic regression were used to assess the association between instrument type and urethral stricture while accounting for clinically relevant covariates.

RESULTS: A total of 240 patients were included, of whom 50 underwent PVP with the F21 instrument and 190 with the F26 resectoscope. Baseline characteristics and key perioperative variables were comparable between groups. Both groups showed marked postoperative improvement in IPSS and Qmax. Compared with the F26 group, the F21 group had significantly lower PVR at 3 months (2.316 ± 11.463 vs. 6.559 ± 16.714 mL, p = 0.038) and 6 months (0.520 ± 3.677 vs. 4.458 ± 14.020 mL, p = 0.001). The incidence of postoperative urethral stricture was lower in the F21 group than in the F26 group [2/50 (4.0%) vs. 28/190 (14.7%), p = 0.041].

CONCLUSION: In this retrospective cohort study, the use of the F21 multipurpose cystoscope with continuous irrigation capability during PVP was associated with a lower rate of clinically detected postoperative urethral stricture and improved postoperative bladder emptying, while maintaining short-term improvements in urinary symptoms and urinary flow. However, given the retrospective design, symptom-triggered urethroscopic confirmation, and limited 6-month follow-up period, these findings should be interpreted as short-term, hypothesis-generating clinical evidence. Because urethral strictures may occur beyond 6 months after surgery, further prospective studies with longer follow-up periods, ideally at least 12-24 months, are warranted to validate these results.