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

Abstract

We assessed the incidence and risks factors of bladder neck and urethral stenosis after Thulium laser enucleation of the prostate. Patients who underwent surgery at two centres were retrospectively reviewed (December 2014-June 2020).Exclusion criteria: previous urethral/prostatic surgery, pelvic irradiation, prostate cancer, neurogenic bladder, history of bladder neck and urethral stenosis, concomitant transurethral surgery, active urinary tract infection. Significant variables at univariate analysis (p < 0.05) were included in a multivariate logistic regression analysis to establish their association with bladder neck/urethral stenosis. One thousand and three patients were included. Median age was 69.0 (63.0-75.0) years. Median prostate volume was 65.0 (46.3-82.0) ml. Median follow-up was 31 (25-75) months. Thirty patients (2.99%) developed bladder neck stenosis [median time after surgery: 15 (11-17.75) months], 50 patients (4.98%) urethral stenosis [median time after surgery: 9 (7-11) months]. Men with bladder neckand urethral stenosis had significantly smaller prostate volume (median volume 43.5 ml vs. 66.0 ml, p = 0.008, and 52.0 ml vs. 66.0 ml, p = 0.009, respectively).At multivariable analysis, short surgical time predicted for bladder neck stenosis (OR 0.973; 95% CI 0.957-0.994, p = 0.002), and re-catheterization (OR 3.956; 95% CI 1.867-8.382, p < 0.001) for urethral stenosis, whereas prostate volume was significantly associated with a lower incidence of US (OR 0.984, 95% CI 0.972-0.998, p = 0.03).

Surgical treatment of benign prostatic hyperplasia: Thulium enucleation versus single‐port transvesical robotic simple prostatectomy

“…The vigorous movements during enucleation risks formation of urethral and meatal strictures. Incidence of urethral and bladder neck strictures after ThuLEP or HoLEP range from 1 to 5%, and while this risk was significantly greater for smaller glands in these studies, this risk can be reduced with a transvesical approach due to almost complete avoidance of urethral instrumentation 30,31 …”

“…Incidence of urethral and bladder neck strictures after Thu-LEP or HoLEP range from 1 to 5%, and while this risk was significantly greater for smaller glands in these studies, this risk can be reduced with a transvesical approach due to almost complete avoidance of urethral instrumentation. 30,31 Many laser enucleation scopes commonly used during enucleation are 26 or 28 Fr in size, though our institution utilizes the 24Fr…”