Management of urethral strictures and stenosis caused by the endo-urological treatment of benign prostatic hyperplasiad-a single-center experience

Objective:Urethral stricture disease after endo-urological treatment of benign prostatic hyperplasia(BPH)is a sparsely described complication.We describe management of five categories of these strictures in this retrospective observational case series.Methods:One hundred and twenty-one patients presenting with symptoms of bladder outflow obstruction after endo-urological intervention for BPH from February 2016 to March 2019 were evaluated.Among them,76 were eligible for this study and underwent reconstructive surgery.Preoperative and postoperative assessments were done with symptom scores,uroflowmetry,ultrasound for post-void residue,and urethrogram.Any intervention during follow-up was classed as a failure.The recurrence and 95%confidence interval for recurrence percentage were calculated.Results:The following five categories of patients were identified:Bulbo-membranous(33[43.4%]),navicular fossa(21[27.6%]),penile/peno-bulbar(8[10.5%]),bladder neck stenosis(6[7.9%]),and multiple locations(8[10.5%]).The average age was 69 years(range:60-84 years).Overall average symptom score,flow rate,and post-void residue changed from 21 to 7,6 mL/s to 19 mL/s,and 210 mL to 20 mL,respectively.The average follow-up was 34 months(range:12-58 months).Overall recurrence and complication rates were 10.5%and 9.2%,respectively.The recurrence in each category was seen in 3,1,2,1,and 1 patient,respectively.Overall 95% confidence interval for recurrence percentage was 4.66-19.69.Conclusion:Urethral stricture disease is a major long-term complication of endo-urological treatment of BPH.The bulbo-membranous strictures need continence preserving approach.Navicular fossa strictures require minimally invasive and cosmetic consideration.Peno-bulbar strictures require judicious use of grafts and flaps.Bladder neck stenosis in this cohort could be treated with endoscopic measures.Multiple locations need treatment based on their sites in single-stage as far as possible.

Prostate resection speed:A key factor for training and broad outcomes?

BACKGROUND Trans-urethral resection of prostate(TURP) is one of the most commonly performed operations in urology to treat bladder outflow obstruction(BOO) in men. TURP surgery is also a key for endo-urological training in the British National Health Service(NHS) for training junior urologists. The working hypothesis is that prostate resection speed(PRS) in the context of bipolar TURP surgery, is not a key factor in major complication rates or broad patient outcomes at 3 mo after surgery, and therefore supervising consultants should not focus primarily on resection speed when teaching TURP.AIM To investigate objective differences in consultants vs trainees PRS and whether PRS affected complication rates/outcomes after TURP.METHODS Retrospective descriptive study analyzing patient case-notes, operative and electronic records, study undertaken at Burton Queen's Hospital NHS Foundation Trust, United Kingdom, a secondary care centre in the public sector of the NHS. Participants included: all Bipolar TURPs undertaken between13/04/2016 and 27/06/2017. Exclusions: patients undergoing concomitant operations or where intra-operative equipment problems occurred. Resected prostate(g), operative time, post-operative complications and outcomes at 3-mo were obtained from electronic records. Clavien-Dindo Grade II complications or above considered significant. Binary successful yes/no outcome at 3-mo after surgery included both patients who reported moderate to significant symptom improvement, or being catheter-free for those catheterized before TURP.RESULTS157 patients were identified. After exclusion a total of 125 patients were included from analysis. The mean PRS for trainees(0.34 g/min) was found to be lower than the mean PRS for consultants(0.41 g/min). The operating urologist's PRS was not observed to be related to the number of TURPs that they performed during the period of the study. The trainee vs consultant means post-operative success rates(86.5% vs 90.5%) were comparable. The Trainees' patients did not suffer any significant complications as defined by the study. There was no clear relationship observed between PRS and the rate of significant post-operative complications or patients' 3-mo binary successful outcome. PRS was noted to increase with increasing intra-operative experience for both Trainees 1 and 2 when comparing the first half of their TURPs to their latter half.CONCLUSION Consultants have a higher PRS in comparison to trainees. There is no trend between PRS and significant post-operative complication rates or 3-mo outcomes.