Impact of Intraoperative Urethral Stricture Detection on Postoperative Stricture Recurrence Following TURP: A Retrospective Cohort Study

Abstract

Objective: To evaluate the effect of intraoperatively detected urethral strictures requiring concomitant internal urethrotomy on postoperative stricture recurrence following transurethral resection of the prostate (TURP). Methods: This retrospective cohort study included 92 patients who underwent bipolar TURP for benign prostatic hyperplasia (BPH) between March and December 2024. Based on intraoperative findings, 56 patients received TURP alone, whereas 36 underwent TURP combined with internal urethrotomy for an intraoperatively detected urethral stricture. Clinical variables, including age, prostate-specific antigen (PSA) level, prostate volume, and maximum urinary flow rate (Qmax), were recorded preoperatively and at 1 and 6 months postoperatively. Patients who developed a reduction in Qmax) combined with obstructive symptoms were further evaluated for recurrent urethral stricture via flexible cystoscopy. Results: The 2 groups showed no significant differences in baseline demographic or clinical characteristics. Urethral stricture recurrence was not observed in any patient at the 1-month postoperative follow-up. At the 6-month follow-up, stricture recurrence was identified in 3 of 56 patients (5.4%) in the TURP-alone group and 9 of 36 patients (25.0%) in the TURP plus internal urethrotomy group (P = .015). Postoperative Qmax values did not differ significantly between the groups. Conclusion: Postoperative urethral stricture recurrence is significantly more frequent when an intraoperatively identified stricture requires concomitant internal urethrotomy during TURP. These patients require closer postprocedural surveillance and should be counseled regarding the elevated risk of recurrence.