Management of urethral strictures and stenosis caused by the endo-urological treatment of benign prostatic hyperplasia—a single-center experience
Objective: Urethral stricture disease after endo-urological treatment of benign prostatic hyperplasia (BPH) is a sparsely described complication. We describe management of five categories of these strictures in this retrospective observational case series. Methods: One hundred and twenty-one patient...
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| Format: | Article |
| Language: | English |
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Elsevier
2023-04-01
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| Series: | Asian Journal of Urology |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2214388221000722 |
| _version_ | 1811159945474736128 |
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| author | Rajiv N. Kore |
| author_facet | Rajiv N. Kore |
| author_sort | Rajiv N. Kore |
| collection | DOAJ |
| description | Objective: Urethral stricture disease after endo-urological treatment of benign prostatic hyperplasia (BPH) is a sparsely described complication. We describe management of five categories of these strictures in this retrospective observational case series. Methods: One hundred and twenty-one patients presenting with symptoms of bladder outflow obstruction after endo-urological intervention for BPH from February 2016 to March 2019 were evaluated. Among them, 76 were eligible for this study and underwent reconstructive surgery. Preoperative and postoperative assessments were done with symptom scores, uroflowmetry, ultrasound for post-void residue, and urethrogram. Any intervention during follow-up was classed as a failure. The recurrence and 95% confidence interval for recurrence percentage were calculated. Results: The following five categories of patients were identified: Bulbo-membranous (33 [43.4%]), navicular fossa (21 [27.6%]), penile/peno-bulbar (8 [10.5%]), bladder neck stenosis (6 [7.9%]), and multiple locations (8 [10.5%]). The average age was 69 years (range: 60–84 years). Overall average symptom score, flow rate, and post-void residue changed from 21 to 7, 6 mL/s to 19 mL/s, and 210 mL to 20 mL, respectively. The average follow-up was 34 months (range: 12–58 months). Overall recurrence and complication rates were 10.5% and 9.2%, respectively. The recurrence in each category was seen in 3, 1, 2, 1, and 1 patient, respectively. Overall 95% confidence interval for recurrence percentage was 4.66–19.69. Conclusion: Urethral stricture disease is a major long-term complication of endo-urological treatment of BPH. The bulbo-membranous strictures need continence preserving approach. Navicular fossa strictures require minimally invasive and cosmetic consideration. Peno-bulbar strictures require judicious use of grafts and flaps. Bladder neck stenosis in this cohort could be treated with endoscopic measures. Multiple locations need treatment based on their sites in single-stage as far as possible. |
| first_indexed | 2024-04-10T05:49:18Z |
| format | Article |
| id | doaj.art-0c77591406bc49748b0f2f6954a023ff |
| institution | Directory Open Access Journal |
| issn | 2214-3882 |
| language | English |
| last_indexed | 2024-04-10T05:49:18Z |
| publishDate | 2023-04-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Asian Journal of Urology |
| spelling | doaj.art-0c77591406bc49748b0f2f6954a023ff2023-03-05T04:24:26ZengElsevierAsian Journal of Urology2214-38822023-04-01102137143Management of urethral strictures and stenosis caused by the endo-urological treatment of benign prostatic hyperplasia—a single-center experienceRajiv N. Kore0Warana Institute of Urosurgery, Kolhapur, IndiaObjective: Urethral stricture disease after endo-urological treatment of benign prostatic hyperplasia (BPH) is a sparsely described complication. We describe management of five categories of these strictures in this retrospective observational case series. Methods: One hundred and twenty-one patients presenting with symptoms of bladder outflow obstruction after endo-urological intervention for BPH from February 2016 to March 2019 were evaluated. Among them, 76 were eligible for this study and underwent reconstructive surgery. Preoperative and postoperative assessments were done with symptom scores, uroflowmetry, ultrasound for post-void residue, and urethrogram. Any intervention during follow-up was classed as a failure. The recurrence and 95% confidence interval for recurrence percentage were calculated. Results: The following five categories of patients were identified: Bulbo-membranous (33 [43.4%]), navicular fossa (21 [27.6%]), penile/peno-bulbar (8 [10.5%]), bladder neck stenosis (6 [7.9%]), and multiple locations (8 [10.5%]). The average age was 69 years (range: 60–84 years). Overall average symptom score, flow rate, and post-void residue changed from 21 to 7, 6 mL/s to 19 mL/s, and 210 mL to 20 mL, respectively. The average follow-up was 34 months (range: 12–58 months). Overall recurrence and complication rates were 10.5% and 9.2%, respectively. The recurrence in each category was seen in 3, 1, 2, 1, and 1 patient, respectively. Overall 95% confidence interval for recurrence percentage was 4.66–19.69. Conclusion: Urethral stricture disease is a major long-term complication of endo-urological treatment of BPH. The bulbo-membranous strictures need continence preserving approach. Navicular fossa strictures require minimally invasive and cosmetic consideration. Peno-bulbar strictures require judicious use of grafts and flaps. Bladder neck stenosis in this cohort could be treated with endoscopic measures. Multiple locations need treatment based on their sites in single-stage as far as possible.http://www.sciencedirect.com/science/article/pii/S2214388221000722Urethral strictureBenign prostatic hyperplasiaTransurethral resection of prostateUrethroplastyHolmium laser enucleation of prostateTrans-urethral bipolar electro-enucleation |
| spellingShingle | Rajiv N. Kore Management of urethral strictures and stenosis caused by the endo-urological treatment of benign prostatic hyperplasia—a single-center experience Asian Journal of Urology Urethral stricture Benign prostatic hyperplasia Transurethral resection of prostate Urethroplasty Holmium laser enucleation of prostate Trans-urethral bipolar electro-enucleation |
| title | Management of urethral strictures and stenosis caused by the endo-urological treatment of benign prostatic hyperplasia—a single-center experience |
| title_full | Management of urethral strictures and stenosis caused by the endo-urological treatment of benign prostatic hyperplasia—a single-center experience |
| title_fullStr | Management of urethral strictures and stenosis caused by the endo-urological treatment of benign prostatic hyperplasia—a single-center experience |
| title_full_unstemmed | Management of urethral strictures and stenosis caused by the endo-urological treatment of benign prostatic hyperplasia—a single-center experience |
| title_short | Management of urethral strictures and stenosis caused by the endo-urological treatment of benign prostatic hyperplasia—a single-center experience |
| title_sort | management of urethral strictures and stenosis caused by the endo urological treatment of benign prostatic hyperplasia a single center experience |
| topic | Urethral stricture Benign prostatic hyperplasia Transurethral resection of prostate Urethroplasty Holmium laser enucleation of prostate Trans-urethral bipolar electro-enucleation |
| url | http://www.sciencedirect.com/science/article/pii/S2214388221000722 |
| work_keys_str_mv | AT rajivnkore managementofurethralstricturesandstenosiscausedbytheendourologicaltreatmentofbenignprostatichyperplasiaasinglecenterexperience |