Analysis of risk factors of bladder neck contracture following transurethral surgery of prostate

Abstract

Backgrounds The aim of the present study was to investigate the perioperative parameters associated with bladder neck contracture (BNC) after transurethral surgery of the prostate and to compare the incidence of BNC after transurethral resection of the prostate (TURP) or Thulium vaporesection (resection group) versus Thulium vapoenucleation or enucleation of the prostate (enucleation group). Methods Between March 2008 and March 2020, 2363 patients received TURP and 1656 patients received transurethral surgery of the prostate with Thulium laser (ThuP) at Mackay Memorial Hospital. A total of 62 patients developed BNC. These BNC patients were age-and operation-matched to 124 randomly sampled TURP/ThuP controls without BNC. A 1:1 propensity score matching model was used to evaluate the difference in incidence of BNC. Results Our study demonstrated that a greater proportion of BNC patients had history of cerebrovascular accidents (11/62 vs. 7/124, p = 0.009), coronary artery disease (14/48 vs. 16/108, p = 0.03), chronic kidney disease (14/62 vs. 11/124, p = 0.01), and two or more comorbidities (29/62 vs. 27/124, p = 0.001) compared with NBNC patients. Multivariate analysis showed that smaller prostate volume (OR 0.96 (0.94–0.99), p = 0.008) and recatherization (OR 5.6 (1.02–30.6), p = 0.047) were significantly associated with BNC. A ROC curve predicted that a prostate volume < 42.9 cm3 was associated with a notably higher rate of BNC. The propensity score matching model reported there was no difference in incidence between resection and enucleation groups. Conclusion This study demonstrated that incidence of BNC was the same in different surgical techniques and that low prostate volume, recatherization and ≥ 2 comorbidities were positively correlated with the development of BNC after TURP or ThuP.

Analysis of benign prostatic obstruction surgery: A long-term evaluation in a real-life context

“…Our urethrotomy incidence is similar to the study of Sucki et al (21) and is within the lower range of the 1.4-19% referred in literature (3,20). Our BNC is relatively lower than the 1.7-9.7% mentioned in other studies (20,22,23). We only considered surgical reintervention made in our centre or another one of the Portuguese National Health Service, therefore, there is a chance that some patients who have had surgical reintervention in private clinical setting could be missed.…”

Risk factors for bladder neck contracture after transurethral resection of the prostate

“…We found smaller preoperative prostate volume to be an independent risk factor for postoperative BNC formation. This is in accordance with most of the literature on this topic, which suggests that the ratio between prostate volume and resectoscope diameter contributes significantly to BNC formation 4,8,10–12 …”

Urethral and bladder neck stenosis after thulium laser enucleation of the prostate: Analysis of risk factors in a series of 1003 patients

“…Sun et al showed in a randomized trial that the incidence of BNS in men with small prostate (volume ≤ 30 g) was significantly higher in those who underwent resection with Thulium laser (13.6%) compared with those who underwent enucleation with Thulium laser (1.8%, p = 0.045) (Sun et al, 2019). Chen et al confirmed that small prostates and shorter surgical time were predictors of BNS after ThuLEP and demonstrated that a prostate volume <42.9 cm 3 had 76.6% sensitivity and 40.9% specificity in predicting BNS (Chen et al, 2021). In our study, men suffering from BNS had significantly smaller prostate (median volume 43.5 ml) compared with those with no BNS (median volume 66.0 ml, p = 0.008).…”

“…There might be also other factors that may contribute to the development of the US, such as prostate volume, and duration of surgery. Studies aiming to evaluate risk factors for lower urinary tract stenosis following transurethral surgery for BPH are currently limited (Chen et al, 2021; Garza‐Montúfar et al, 2021; Tao et al, 2016).…”