OUTCOMES OF INTERNAL URETHROTOMY AFTER TRANSURETHRAL RESECTION RELATED URETHRAL STRICTURES AND LITERATURE REVIEW

Abstract

Abstract

Introduction: Urethral stricture is one of the complex issues of urology due to the difficulty of diagnosis,

treatment and risk of recurrence. The incidence of urethral stricture after Transurethral Resection of Prostate

(TUR-P) surgery has been reported to be 1.5-29%. Some factors have been suggested to have effect on

developing urethral stricture after TUR-P surgery but, the etiology remains controversial. The treatment

depends on the localization, length and nature of the stricture. Urethrotomy has been considered an effective

treatment for urethral strictures for more than 15 years with a success rate of 56 to 95%. Recently, visual

endoscopic internal urethrotomy is the most popular technique. The aim of this study was to evaluate the

patients with urethral stricture after TUR-P surgery, according to the risk factors and internal urethrotomy

outcomes of these patients.

Materials and Methods: From 1998 to 2001, 720 patients who had TUR-P surgery were studied

retrospectively. Sixty patients with urethral stricture after TUR-P surgery were included in the study. Patients

were evaluated for risk factors such as age, time of resection, urethral catheter type, urethral catheter

diameter, postoperative duration period of catheter, size of resectoscope and urinary infection. Uroflowmetry

was performed in all patients, localization and length of stricture was determined by retrograde

urethrocystography. Visual endoscopic internal urethrotomy procedure was performed in patients with

urethral stricture. Patients were followed-up at 3 months interval. At each follow-up the prognosis was

evaluated by anamnesis, uroflowmetry and retrograde urethrocystography. Internal urethrotomy outcomes of

these 60 patients were compared with the literature.

Results: The mean age was 67.6 (51-80) and the median follow-up was 19 (5-36) months. Strictures were

mostly localized at bulbous and membranous urethra. 26-F resectoscope was used in the 53.3 % patients. Most

of the patients had operation period between 45-60 minutes. The mean postoperative urethral catheter

duration was 3.7 days. The majority of postoperatively used urethral catheters were latex and had a diameter

of 20 F. Statistically significant relationship between developing stricture and patients’ age, time of resection

and postoperative urethral catheter duration period was determined. Complication was occurred in 11

patients. Hemorrhage, epididymo-orchitis, fever and false road were found to be frequent. Thirty-four patients

had complete recovery, 16 had partial recovery and 10 patients had persistence; overall success rate was 84%.

Conclusion: The role of trauma on the development of urethral stricture has been largely known for a

long time. Especially, TUR-P is one of the most frequent causes of trauma in urologic surgery and has been the

subject of much discussion and conflicting data has been published. Most authors stressed that the patients’

age, size of the resectoscope sheath, time of resection, duration of transurethral catheterization, urinary

infection are predisposing factors for development of postoperative urethral strictures. According to our

results, the resection time and postoperative urethral catheter duration time may be short enough to prevent

urethral stricture development after TUR-P surgery. Internal urethrotomy is a favorable method for the

treatment of urethral stricture due to its easy use, low complication rate and feasibility for more than once

time.