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.