Incidence and management of BPH surgery-related urethral stricture: results from a large U.S. database

Abstract

Abstract Introduction and objectives: Urethral stricture (US) is a well-known complication after surgical treatment of benign prostatic hyperplasia (BPH), whose treatment options range from conservative or endoscopic approaches to more invasive ones. This study aimed to evaluate the contemporary incidence of US after different types of BPH surgery, to identify associated risk factors and to assess its management.Methods A retrospective analysis was conducted using the PearlDiver™ Mariner database, containing de-identified patient records compiled between 2011 and 2022. Specific International Classification of Diseases (ICD) and Current Procedural Terminology (CPT) codes were employed to identify population characteristics and outcomes. All the most employed surgical procedures for BPH treatment were considered. Multivariable logistic regression was employed to evaluate factors associated with diagnosis of post-operative US.Results Among 274,808 patients who underwent BPH surgery, 10,918 developed post-operative US (3.97%). Higher incidence of US was observed following TURP (4.48%), Transurethral Incision of the Prostate (TUIP) (3.67%), Photoselective Vaporization of the Prostate (PVP) (3.92%), HoLEP/ThuLEP (3.85%), and open Simple Prostatectomy (SP) (3.21%). Lower incidence rates were observed after Robot-assisted SP (1.76%), Aquablation (1.59%), Prostatic Urethral Lift (PUL) (1.07%), Rezum (1.05%), and Prostatic Artery Embolization (PAE) (0.65%). Multivariable analysis showed that patients undergoing PUL, Rezum, Aquablation, PAE and PVP were associated with a reduced likelihood of developing US compared to TURP. US required surgical treatment in 18.95% of patients, with direct visual internal urethrotomy (DVIU) and urethroplasty performed in 14.55% and 4.50% of cases, respectively. Urethral dilatation (UD) was the primary management in most cases (76.7%).Conclusions The present analysis from a contemporary large dataset suggests that the incidence of US after BPH surgery is relatively low (< 5%) and varies among procedures. Around 94% of US cases following BPH surgery are managed using minimally invasive treatment approaches such as UD and DVIU.