Urethral Stricture is an Unpleasant Complication after Prostate Surgery: A Critical Review of Current Literature

Abstract

Prostatectomy is one of the main causes of surgery in aging male population. Besides traditional techniques, novel minimally invasive approaches may also end up with certain complications following prostate surgery. Transurethral procedures may cause iatrogenic urethral trauma. Factors that may influence the development of iatrogenic endoscopic urethral strictures include "electrical dispersion" generated by unipolar current and the "diameter of the instruments" used. Those complications not only bother quality of life of the patients but also may cause various adjunctive procedures with an economical impact.Urethral stricture is the abnormal narrowing of any segment of the urethra surrounded by corpus spongiosum. It specifically means varying degrees of spongiofibrosis that refers to scarring of the corpus spongiosum (1). Any inflammation of the urethra can result in scarring that can lead to a stricture or a narrowing of the urethra. Besides prostate surgery, trauma, infections, tumors or any other cause of scarring may trigger urethral stricture (2). A recent metaanalysis including 732 patients showed that idiopathic and iatrogenic etiologies were by far the most common, accounting for 33% and 33% of all cases, respectively. Inflammatory and posttraumatic etiologies were found in only 15% and 19% of patients, respectively (3).Here, we tried to review the incidence and the basic risk factors that cause urethral stricture following prostate surgery. ÖZÜretral striktür enflamasyona bağlı olarak skarlaşma sonrası üretradaki daralmadır. Elli yaş üzeri erkeklerde benign ve malign hastalıklara bağlı olarak yapılan prostatektomiler oldukça yaygın olarak uygulanmaktadır. Prostatın transüretral rezeksiyonu sonrası farklı serilerde %19'a kadar çıkan oranlarda üretral darlık ve mesane boynu kontraksiyonu görülmektedir. Lazer prostatektomi sonrası üretral darlık prostatın transüretral rezeksiyonuna oranla daha az olarak görülmektedir, yaklaşık olarak %3,6 oranındadır. Açık prostatektomi en eski yöntem olmasına rağmen büyük prostat boyutlu hastalarda oldukça mantıklı bir alternatiftir. Açık prostatektomi sonrası yaklaşık olarak %1,9-4,8 oranında darlık bildirilmiştir. Radikal prostatektomi (RP) lokalize prostat kanseri tedavisinde bütün dünyada en yaygın olarak uygulanan yöntemdir. RP sonrası anastomoz seviyesinde mesane boynu kontraksiyonu olması iyi bilinen bir komplikasyondur ve yaklaşık olarak hastaların %0,4-32'sinde görülmektedir. Darlık büyük oranda endoskopik yöntemlerle tedavi edilmektedir, nadiren komplike olgularda bukkal mukoza greftli üretroplasti gerekebilmektedir. Anahtar Kelimeler: Üretral darlık, prostat cerrahisi, transüretral rezeksiyon, açık prostatektomi, radikal prostatektomi ABSTRACTUrethral stricture is narrowing of the urethra due to inflammation that results in scarring. Prostatectomies for benign and malign prostatic diseases are common surgical procedures among men mainly after their fifties. Urethral stricture or bladder neck contraction following transurethral resection of the prostate (TURP)...

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.…”

“…All our patients who needed urethrotomy or resection of BNC had previously undergone TURP. 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).…”

“…In 1.9% and 0.9% of all the 212 patients, the reintervention was an internal urethrotomy for urethral stricture and loop resection of bladder neck for bladder neck contracture (BNC), respectively. Both complications are more common after TURP (20). All our patients who needed urethrotomy or resection of BNC had previously undergone TURP.…”

Impact of a clinical care pathway developed through the action research method on the psychological well-being and quality of life in male patients with urethral stricture

“…[4] Individuals with urethral stenosis frequently experience preoperative challenges, including depression, anxiety, and other adverse reactions attributed to the prolonged symptoms of progressive dysuria, thereby influencing their daily life and interpersonal interactions. [5] The onset of urethral stenosis following transurethral resection of the prostate exacerbates anxiety and depression in elderly patients. This not only significantly impacts their postoperative recuperation but also results in diminished confidence in treatment, rehabilitation, and overall life.…”

Tiempo de sondaje postquirúrgico recomendado para evitar complicaciones en cirugías endourológicas del tracto urinario inferior

“…En estados de pH que superen la cifra de 7,5 o sean inferiores a 6,5 ocurre una inhibición del crecimiento bacteriano; siendo el pH óptimo para el desarrollo de estos gérmenes y los hongos levaduriformes de entre 6,5 -7,5 y 5 -6, respectivamente. Este aspecto puede explicar la forma en la cual un cateterismo de corto período, reduce el riesgo de infección del tracto urinario asociado a catéter 12 .…”