Presented by: Mohammad Abed Elal MD
Department of Urology, Shamir Medical Center, Israel

Introduction

The prevalence of urethral stricture is about 0.9% in the general population. There is little data regarding its incidence when encountered during BPH surgery, and there is a debate on the right way to manage such strictures when encountered. We dilated the stricture with gradual dilators and proceeded with HoLEP surgery. The aim of this study was to examine the short-term outcome of this approach.

Materials

We retrospectively reviewed all HoLEP surgeries performed by a single surgeon (EG) in two major hospitals. HoLEP was done using a 26F scope. Patients in whom a urethral stricture was encountered and dilated during surgery composed our cohort. We reviewed the postoperative outcomes within the follow-up period. The primary endpoint was stricture recurrence requiring additional treatment.

Results

,

Out of 644 consecutive HoLEP surgeries performed between January 2020 and July 2022, we identified 38 (5.9%) with a urethral stricture that was found during surgery. Most of the strictures were bulbar 32/38 (84%) or assessed as clinically insignificant 24/38 (63%) (at least 14F). During a median follow-up of 89 days, 24/38 (63%) did well and did not need further assessment or treatment. Factors predicting stricture recurrence were; non-bulbar urethral stricture (penile or membranous) of whom about two thirds failed, and clinically significant strictures of whom 64% failed.

Conclusion

In our cohort, the incidence of a urethral stricture encountered during HoLEP is approximately 6%. Following initial dilation of the stricture during surgery - about a quarter of the insignificant urethral strictures, and two-thirds of the significant strictures will recur and require additional intervention.

Funding

none

Lead Authors

Guy Verhovsky, MD
Shamir Medical Center

Ehud Gnessin, MD
Shamir Medical Center and Assuta Hospital

Co-Authors

Amir Zarror, MD
Shamir Medical Center

Itay Sabler, MD
Shamir Medical Center

Amnon Zisman, MD
Shamir Medical Center