A multicentre retrospective analysis of anterior urethroplasty techniques and outcomes for urethral stricture disease secondary to transurethral resection of the prostate.

INTRODUCTION

Urethroplasty remains the gold standard treatment of recurrent urethral stricture disease (USD). While the literature extensively discusses urethroplasty outcomes in various contexts, there remains a need for focussed exploration into its efficacy, specifically in cases arising from transurethral resection of the prostate (TURP)-related strictures.

OBJECTIVES

To evaluate and compare different anterior urethroplasty techniques and their effectiveness in a large homogenous cohort of USD secondary to TURP.

MATERIALS AND

METHODS

A multicentre retrospective cohort study was conducted in three reconstructive urology centres in Poland, which are the referral centres for USD repair. This included patients who underwent urethral reconstruction surgery between 2015 and 2022 because of urethral stricture secondary to TURP. In all patients, the stricture was diagnosed and evaluated prior to urethroplasty by retrograde urethrography and/or voiding cystourethrography. Basic demographic and medical data including the length and localisation of the stricture, as well as details about performed urethral reconstruction and follow-up data regarding the recurrence of the stricture and reintervention were recorded. The primary outcome was re-intervention-free survival after urethroplasty. Statistical analysis was performed using STATA 18 (StataCorp).

RESULTS

One hundred forty-seven patients underwent urethroplasty because of recurrent anterior USD secondary to TURP with a mean age of 69 years. Ninety-nine patients (67%) had a bulbar stricture, 35 (24%) had a penile urethra stricture, while 13 patients (9%) were diagnosed with penobulbar stricture. The mean length of the stricture was 24 mm, and it was significantly different among different localisations (penile - 30 mm, bulbar - 16 mm, penobulbar - 67 mm; p < 0.05). Half of the patients (73-50%) were treated with anastomotic urethroplasty (including transecting and non-transecting techniques), 60 (41%) with augmentation urethroplasty, seven (5%) with substitution urethroplasty and seven (5%) underwent perineal or penile urethrostomy. Follow-up data were available for 138 patients (94%). In the median follow-up of 19.5 months, 19 patients (13.8%) had another procedure because of the recurrence of USD. Longer stricture length was independently associated with an increased risk of recurrence. Around 103/120 patients (85.8%) were overall satisfied with the treatment.

CONCLUSIONS

USD secondary to TURP can present with various clinical manifestations, with short bulbar strictures being the most common location. The outcomes of urethroplasty are highly favourable, resulting in high levels of patient satisfaction, but do not depend on surgical technique.