Correlation Between Urethral Length and Urethral Stricture After Transurethral Resection of Prostate

Yıl 2024, Cilt: 7 Sayı: 3, 170 - 174, 30.09.2024

Eray Hasırcı , Enis Kervancıoğlu

Öz

Aim: To show the effects of urethral length, and surgical or patient related parameters on urethral strictures after Transurethral Prostate Resection (TURP).
Materials and Methods: The study included 127 patients who underwent TURP for benign prostate hyperplasia (BPH) unresponsive to medical treatment in our clinic between May XXX and February XXX. The patients were separated into two subgroups as those who underwent second surgery because of urethral stricture and those who did not. These two groups were compared in respect of age, height, weight, total prostate specific antigen, fall in hemoglobin values, increase in urine peak flow rate, decrease in the post-micturition residual volume, prostate volume, operating time, tissue amounts, resection rate, and urethral length.
Results: Urethral stricture was determined in 13.4% of the patients. A statistically significant difference was determined between the two groups in respect of age and urethral length (p<0.05). At the postoperative 6-week follow-up, urine peak flow rates were seen to be statistically significantly lower in the stricture group (p<0.05).
Conclusion: Together with an increase in urethral length there could be an increased risk of damage to the urethral mucosa, and it should be kept in mind that this could contribute to the development of urethral stricture.

Anahtar Kelimeler

Benign prostate hyperplasia;, urethral stricture;, urethral length;, transurethral prostate resection

Etik Beyan

This study was approved by the clinical research ethics committee of the Baskent University Institutional Review Board and Ethics Committee (Date: 13/03/2019, Project no: KA 19/93). There is no conflicts of interest in connection with this article.

Destekleyen Kurum

There is no financial disclosure in connection with this article.

Proje Numarası

KA 19/93

: Transüretral Prostat Rezeksiyonu Sonrası Gelişen Üretral Darlığın Üretra Uzunluğu ile İlişkisi

Öz

Amaç: Transüretral Prostat Rezeksiyonu (TURP) sonrası üretral uzunluk, cerrahi veya hastaya ilişkin parametrelerin üretra darlıkları üzerindeki etkisini göstermek.
Materyal ve Metot: Mayıs XXX ile Şubat XXX tarihleri arasında kliniğimizde medikal tedaviye yanıt vermeyen benign prostat hiperplazisi nedeniyle Transüretral Prostat Rezeksiyonu uygulanan 127 hasta çalışmaya dahil edildi. Hastalar üretra darlığı nedeniyle ikinci kez ameliyat olanlar ve olmayanlar olarak iki gruba ayrıldı. Her iki grup yaş, boy, kilo, total prostat spesifik antijen, serum hemoglobin değerlerindeki düşüş, idrar pik akım hızında artış, miksiyon sonrası rezidüel hacimde azalma, prostat hacmi, operasyon süresi, doku miktarları, rezeksiyon hızı ve üretra uzunluğu açısından kıyaslandı.
Bulgular: Hastaların %13,4'ünde üretra darlığı belirlendi. Her iki grup arasında yaş ve üretra uzunluğu açısından istatistiksel olarak anlamlı fark belirlendi (p<0,05). Ameliyat sonrası 6 haftalık takipte idrar tepe akım hızlarının darlık grubunda istatistiksel olarak anlamlı derecede düşük olduğu görüldü (p<0,05).
Sonuç: Üretral uzunluktaki artışla birlikte üretral mukozanın hasarlanma riski de artabilir ve bunun üretral darlık gelişimine katkıda bulunabileceği akılda tutulmalıdır.

Anahtar Kelimeler

Benign Prostat Hiperplazisi;, Üretral darlık;, Üretral uzunluk;, Transüretral Prostat Rezeksiyonu

Proje Numarası

KA 19/93

Kaynakça

• 1.Hsu TS, Weng SC, Lin YH, et al. Surgical outcomes of endoscopic enuclea-tion of the prostate in community aging males with or without preoperative urinary retention. Int Urol Nephrol. 2024 Aug;56(8):2513-9. https://doi.org/10.1007/s11255-024-04007-7
• 2.Joe W, Owen K, Ivander A, et al. A systematic review and meta-analysis of surgical approaches in pelvic fracture-associated urethral injury in children: Primary endoscopic realignment versus delayed urethroplasty. Injury. 2024 Jul 25;55(10):111728. https://doi.org/10.1016/j.injury.2024.111728
• 3.Kulkarni SB, Joglekar O, Alkandari M, et al. Management of post TURP stric¬tures. World J Urol. 2019;37:589-94. https://doi.org/10.1007/s00345-018-2498-x
• 4.Elsherif E, Salman B, Abozaid M, et al. Evaluation of perioperative risk fac¬tors for bladder neck contracture after bipolar transurethral resection of the prostate. Int Urol Nephrol. 2024 Jul 3. Epub ahead of print. https://doi.org/10.1007/s11255-024-04125-2
• 5.El-Assmy A, ElShal AM, Mekkawy R, et al. Erectile and ejaculatory functions changes following bipolar versus monopolar transurethral resection of the prostate: a prospective randomized study. Int Urol Nephrol. 2018 Sep;50(9):1569-76. https://doi.org/10.1007/s11255-018-1950-6
• 6.Abdeen BM, Badreldin AM. Urethral Strictures. [Updated 2022 Oct 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK564297/
• 7.Chen YZ, Lin WR, Chow YC, et al. Analysis of risk factors of bladder neck contracture following transurethral surgery of prostate. BMC Urol. 2021 Apr 11;21(1):59. https://doi.org/10.1186/s12894-021-00831-6
• 8.Alberca-Del Arco F, Santos-Pérez DE LA Blanca R, Amores Vergara C, et al. Bulbar urethroplasty techniques and stricture recurrence: differences be¬tween end-to-end urethroplasty versus the use of graft. Minerva Urol Neph¬rol. 2024 Jul 24. https://doi.org/10.23736/S2724-6051.24.05812-9
• 9.Holtgrewe HL, Valk WL. Factors influencing the mortality and morbidity of transurethral prostatectomy: a study of 2,015 cases. J Urol. 1962;87:450-9. https://doi.org/10.1016/S0022-5347(17)64980-2
• 10.Marchioni M, Primiceri G, Veccia A, et al. Transurethral prostate surgery in prostate cancer patients: A population-based comparative analysis of complication and mortality rates. Asian J Urol. 2024 Jan;11(1):48-54. Epub 2022 Aug 30. https://doi.org/10.1016/j.ajur.2022.05.008
• 11.Sreekanth KT, Thomas JK, Babu M, et al. Can we predict urethral length of boys? - An observational study. J Pediatr Urol. 2023 Oct;19(5):620.e1-620.e6. Epub 2023 Jun 14. https://doi.org/10.1016/j.jpurol.2023.06.006
• 12.Hampson LA, McAninch JW, Breyer BN. Male urethral strictures and their management. Nat Rev Urol. 2014;11:43-50. https://doi.org/10.1038/nrurol.2013.275
• 13.Patel HV, Li KD, Rourke K, et al. The Impact of Social Deprivation on An-terior Urethral Stricture Recurrence After Urethroplasty - A Trauma and Urologic Reconstructive Network of Surgeons (TURNS) Analysis. J Urol. 2024 Aug 1:101097JU0000000000004188. Epub ahead of print. https://doi.org/10.1097/JU.0000000000004188
• 14.Tefekli A, Muslumanoglu AY, Baykal M, et al. A hybrid technique using bi¬polar energy in transurethral prostate surgery: a prospective, randomized comparison. J Urol. 2005;174:1339-43. https://doi.org/10.1097/01.ju.0000173075.62504.73
• 15.Hueber PA, Al-Asker A, Zorn KC. Monopolar vs. bipolar TURP: assessing their clinical advantages. Can Urol Assoc J. 2011;5:390-1. https://doi.org/10.5489/cuaj.11263
• 16.Mamoulakis C, Schulze M, Skolarikos A, et al. Midterm results from an in¬ternational multicentre randomised controlled trial comparing bipolar with monopolar transurethral resection of the prostate. Eur Urol. 2013;63:667-76. https://doi.org/10.1016/j.eururo.2012.10.003
• 17.Sinha MM, Pietropaolo A, Hameed BMZ, et al. Outcomes of bipolar TURP compared to monopolar TURP: A comprehensive literature review. Turk J Urol. 2022;48:1-10. https://doi.org/10.5152/tud.2022.21250
• 18.Stucki P, Marini L, Mattei A, et al. Bipolar versus monopolar transurethral resection of the prostate: a prospective randomized trial focusing on bleed¬ing complications. J Urol. 2015;193:1371-5. https://doi.org/10.1016/j.juro.2014.08.137
• 19.Sekar H, Palaniyandi V, Krishnamoorthy S, et al. Post-transurethral resec¬tion of prostate urethral strictures: Are they often underreported? A single-center retrospective observational cohort study. Urol Ann. 2021 Oct-Dec;13(4):329-335. Epub 2021 Oct 12. https://doi.org/10.4103/UA.UA_165_19
• 20.Tao H, Jiang YY, Jun Q, et al. Analysis of risk factors leading to postopera¬tive urethral stricture and bladder neck contracture following transurethral resection of prostate. Int Braz J. Urol 2016;42:302-11. https://doi.org/10.1590/S1677-5538.IBJU.2014.0500
• 21.Tan GH, Shah SA, Ali NM, et al. Urethral strictures after bipolar tran-surethral resection of prostate may be linked to slow resection rate. Investig Clin Urol. 2017;58:186-91. https://doi.org/10.4111/icu.2017.58.3.186
• 22.Sinanoglu O, Kurtulus FO, Akgun FS. Long-term Effect of Colchicine Treat¬ment in Preventing Urethral Stricture Recurrence After Internal Urethrot¬omy. Urol J. 2018;15:204-8. https://doi.org/10.22037/uj.v0i0.4198
• 23.Selimoglu A BM, Balaban M, Canguven O, et al. A retrospective evaluation of urethral strictures due to the transurethral resection and related risk fac¬tors. Turkish Journal of Urology. 2010;36:375.
• 24.Balbay MD, Ergen A, Sahin A, et al. Development of urethral stricture after transurethral prostatectomy: a retrospective study. Int Urol Nephrol 1992;24:49-53. https://doi.org/10.1007/BF02552117