Post-TURP urinary catheter duration as a risk factor for urethral stricture

Abstract

Background: Urinary stricture is a relatively frequent urologic entity and is a common cause of lower urinary tract symptoms, with a prevalence of 0.6%.

The energy modality utilized in transurethral resection of the prostate (TURP), as a risk factor for the development of urethral stricture, is currently a subject of debate. Different authors have published conflicting data on post-TURP stricture.  

Materials and methods: The case records of patient that underwent bipolar and monopolar TURP at the Hospital General de Occidente, within the time frame of January 1, 2018 and December 31, 2018, were reviewed. The number of patients that presented with post-TURP urinary symptomatology, determined by the presence of moderate symptoms (>8 points) on the International Prostate Symptom Score (IPSS), were evaluated. Urethral stricture was determined through retrograde urethrogram or a record of having undergone internal urethrotomy after TURP. 

The primary aim was to determine the incidence of urethral stricture in patients that underwent TURP at the Hospital General de Occidente within the abovementioned time frame.

Results: The case records of 113 patients were reviewed. They were assigned to 2 groups, according to the energy modality utilized: Group A, monopolar energy, 59 patients (52.2%) and Group B, bipolar energy, 54 patients (47.8%). Sixteen variables (8 categorical and 8 continuous) were analyzed. 

The incidence of urethral stricture was 6.7% in the monopolar energy group and 5.5% in the bipolar energy group. No statistically significant increase in the incidence of stricture was found in relation to the bipolar energy group.

Conclusions: Upon comparing each of the variables separately, only catheter duration had a statistically significant association with the appearance of urethral stricture (p <0.05). We found a 0.7% risk for stricture with 2-day catheter use, a 3% risk with 5-day use, and a risk reaching 46% with 12-day catheter use.

The prolonged use of a urethral catheter after TURP was shown to be the most important risk factor for the appearance of urethral stricture.