Prospective randomized study correlating intra-operative urethral mucosal injury with early period after transurethral resection of the prostate stricture urethra: A novel concept

doi:10.1016/j.ajur.2024.02.006

Asian Journal of Urology, 2024, 11 (3): 466-472 doi: 10.1016/j.ajur.2024.02.006

Regular Papers: Original Articles

Prospective randomized study correlating intra-operative urethral mucosal injury with early period after transurethral resection of the prostate stricture urethra: A novel concept

Suresh B. Patankar,Mayur M. Narkhede^*(

),Gururaj Padasalagi,Kashinath Thakare

Department of Urology, Ace Hospital, Pune, ASP Medical Foundation, Sripad Medisearch PVT LTD, India

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Abstract

Objective: To investigate the incidence of urethral stricture during the early period after transurethral resection of the prostate (TURP) and correlate its incidence with intra-operative urethral mucosal injury during TURP. Also to compare the other established risk factors affecting the development of urethral stricture among patients undergoing monopolar or bipolar TURP over a period of 6 months follow-up as the prospective randomized study.

Methods: One hundred and fifty men older than 50 years with lower-urinary tract symptoms associated with benign prostatic hyperplasia were randomized to undergo either standard monopolar TURP with glycine as the irrigation fluid or bipolar TURP with normal saline as irrigant. The prostate size, operative time, intra-operative mucosal rupture, catheter time, catheter traction duration, uroflowmetry, and post-operative stricture rate were compared.

Results: A total of 150 patients underwent TURP, including 74 patients undergoing monopolar TURP (one patient was excluded as his post-operative histopathological examination report was of adenocarcinoma prostate) and 75 patients undergoing bipolar-TURP, all of which were performed using a 26 Fr sheath resectoscope. The mean International Prostate Symptom Score and maximum urinary flow rate score at post-operative 3 months and 6 months were comparable between the groups. Out of 149 patients, nine patients (6.0%) developed urethral stricture. The severity of the injury (urethral mucosal injury) correlated with the likelihood of developing a subsequent complication (stricture urethra). Patients with stricture had significantly larger prostate volume than patients without stricture (65.0 mL vs. 50.0 mL; p=0.030). Patients with stricture had longer operative time than patients without stricture (55.0 min vs. 40.0 min; p=0.002). In both procedures, formation of post-operative stricture urethra was independently associated with intra-operative mucosal injury.

Conclusion: Intra-operative recognition of urethral mucosal injury helps in prediction of stricture urethra formation in early post-operative period.

Key words： Urethral stricture Transurethral resection of the prostate Mucosal injury Risk factor

Received: 29 May 2023 Available online: 20 July 2024

Corresponding Authors: *E-mail address: acehospitalacademics@gmail.com (M.M. Narkhede).

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Cite this article:

Suresh B. Patankar,Mayur M. Narkhede,Gururaj Padasalagi, et al. Prospective randomized study correlating intra-operative urethral mucosal injury with early period after transurethral resection of the prostate stricture urethra: A novel concept[J]. Asian Journal of Urology, 2024, 11(3): 466-472.

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http://www.ajurology.com/EN/10.1016/j.ajur.2024.02.006 OR http://www.ajurology.com/EN/Y2024/V11/I3/466

Study flowchart. TURP, transurethral resection of prostate; B-TURP, bipolar TURP; M-TURP, monopolar TURP; PCa, prostate cancer.

Representative images of urethral mucosal injury. (A and B) Grade I; (C and D) Grade II; (E and F) Grade III.

Demographic characteristics.

Operative and post-operative characteristics.

Changes from baseline to 3 months and 6 months after surgery. (A) IPSS overall; (B) Q_max overall; (C) IPSS in the M-TURP group; (D) Q_max in the M-TURP group; (E) IPSS in the B-TURP group; (F) Q_max in the B-TURP group. IPSS, the International Prostate Symptom Score; Q_max, maximum urinary flow rate; Pre-op, pre-operative; CI, confidence interval; TURP, transurethral resection of prostate; B-TURP, bipolar TURP; M-TURP, monopolar TURP.

Correlation of prostate size with operative time.

Covariates associated with stricture.

Grade injury wise occurrence of SU. SU, stricture urethra.

Correlation of various parameters with stricture.

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