New-Onset Urethral Stricture After HoLEP: Incidence, Predictors and Treatment Outcomes From an 8-Year Single-Centre Analysis.

OBJECTIVES

The objective of this study is to evaluate the incidence, timing, anatomical characteristics, predictors and management outcomes of urethral stricture formation following HoLEP at an academic institution in the United States.

MATERIALS AND

METHODS

A retrospective review was conducted of 857 patients who underwent HoLEP at a single academic institution between July 2017 and August 2025. Patients with prior or incidental urethral stricture diagnosis at the time of HoLEP were excluded. Enucleation was performed using a 26-Fr resectoscope, and morcellation was completed through a 26-Fr morcelloscope sheath. If initial cystoscopy suggested small-sized meatus or non-distensible penile urethra, Otis urethrotomy or urethral calibration was performed. Demographic, clinical and perioperative data were collected and analysed using multivariable logistic regression to identify predictors of postoperative urethral stricture formation.

RESULTS

Among 857 patients, 16 had preoperative or intraoperative strictures and were excluded. Seventeen patients (2.0%) developed urethral stricture at a mean of 6.2 months postoperatively. Patients with stricture had lower BMI (24.1 vs. 27.4 kg/m2, p = 0.0042) and smaller prostates (65 vs. 105 ml, p = 70.0131). Median age was higher in the stricture group (73 vs. 69 years, p = 0.0702). On multivariable analysis, higher BMI was independently associated with lower odds of postoperative urethral stricture. (OR 0.84, 95% CI 0.73-0.97; p = 0.016). Stricture locations included bulbar (52.9%), bulbo-membranous (11.8%), sub-meatal (11.8%), penile (5.9%), membranous (5.9%), prostatic (5.9%) and combined bulbar and sub-meatal (5.9%). Most strictures (76.5%) were <1 cm. Initial management included laser incision (seven), dilation (nine) and drug-coated balloon dilation (one). At mean post-treatment follow-up of 17.53 months, four patients (23.5%) experienced recurrence of stricture that required additional management.

CONCLUSION

The overall risk of urethral stricture following HoLEP was low (2%). Higher BMI was associated with a lower risk of urethral stricture formation. Following initial intervention, 23.5% experienced relapse needing additional management.