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Incidence and management of BPH surgery-related urethral stricture: results from a large U.S. database

Prostate Cancer and Prostatic Diseases (2024)Cite this article

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Abstract

Introduction and objectives

Urethral stricture (US) is a well-known complication after surgical treatment of benign prostatic hyperplasia (BPH). This study aimed to evaluate the contemporary incidence of the US after different types of BPH surgery, to identify associated risk factors and to assess its management.

Methods

A retrospective analysis was conducted using the PearlDiver™ Mariner database, containing de-identified patient records compiled between 2011 and 2022. Specific International Classification of Diseases (ICD) and Current Procedural Terminology (CPT) codes were employed to identify population characteristics and outcomes. All the most employed surgical procedures for BPH treatment were considered. Multivariable logistic regression was employed to evaluate factors associated with diagnosis of post-operative US.

Results

Among 274,808 patients who underwent BPH surgery, 10,918 developed post-operative US (3.97%) within 12 months. Higher incidence of US was observed following TURP (4.48%), Transurethral Incision of the Prostate (TUIP) (3.67%), Photoselective Vaporization of the Prostate (PVP) (3.92%), HoLEP/ThuLEP (3.85%), and open Simple Prostatectomy (SP) (3.21%). Lower incidence rates were observed after laparoscopic\robot-assisted SP (1.76%), Aquablation (1.59%), Prostatic Urethral Lift (PUL) (1.07%), Rezum (1.05%), and Prostatic Artery Embolization (PAE) (0.65%). Multivariable analysis showed that patients undergoing PUL, Rezum, Aquablation, PAE, and PVP were associated with a reduced likelihood of developing US compared to TURP. US required surgical treatment in 18.95% of patients, with direct visual internal urethrotomy (DVIU) and urethroplasty performed in 14.55% and 4.50% of cases, respectively. Urethral dilatation (UD) in an outpatient setting was the primary management in most cases (76.7%).

Conclusions

The present analysis from a contemporary large dataset suggests that the incidence of US after BPH surgery is relatively low (<5%) and varies among procedures. Around 94% of US cases following BPH surgery are managed using minimally invasive treatment approaches such as UD and DVIU.

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Fig. 1: Overview of urethral stricture diagnosis and treatment patterns.

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Data availability

The analyses conducted in this study are based on custom code developed to interface with the PearlDiver™ Mariner database. The code is maintained and available upon reasonable request under a nondisclosure agreement to ensure compliance with privacy regulations and database usage policies.

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Authors and Affiliations

  1. Department of Urology, Rush University, Chicago, IL, USA

    Leslie Claire Licari, Eugenio Bologna, Celeste Manfredi, Antonio Franco, Francesco Ditonno, Ephrem O. Olweny, Edward E. Cherullo & Riccardo Autorino

  2. Department of Maternal-Child and Urological Sciences, Sapienza University Rome, Policlinico Umberto I Hospital, Rome, Italy

    Leslie Claire Licari & Eugenio Bologna

  3. Unit of Urology, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy

    Celeste Manfredi & Marco De Sio

  4. Department of Urology, Sant’Andrea Hospital, Sapienza University, Rome, Italy

    Antonio Franco & Cosimo De Nunzio

  5. Department of Urology, Azienda Ospedaliera Universitaria Integrata Verona, University of Verona, Verona, Italy

    Francesco Ditonno & Alessandro Antonelli

  6. Department of Urology, “Regina Elena” National Cancer Institute, Rome, Italy

    Giuseppe Simone & Costantino Leonardo

  7. Department of Urology, Villa Stuart Hospital, Rome, Italy

    Luca Cindolo

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Contributions

Conception and design: LCL, EB. Acquisition of data: CM, AF, FD. Analysis and interpretation of data: LCL, EB, CM. Statistical analysis: LCL, EB, FD. Drafting of manuscript: LCL, AF, RA, CL, LC, GS. Critical revision of the manuscript for important intellectual content: CDN, AA, EEC, EOO, MDS, RA.

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Correspondence to Riccardo Autorino.

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Licari, L.C., Bologna, E., Manfredi, C. et al. Incidence and management of BPH surgery-related urethral stricture: results from a large U.S. database. Prostate Cancer Prostatic Dis (2024). https://doi.org/10.1038/s41391-024-00841-z

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