Urethral stricture disease after bipolar prostatectomy: Is it a concern?

Abstract

Introduction: bipolar Transurethral Surgery of Prostate (BTUSP) is growing increasingly popular in the management of Benign prostatic hyperplasia related lower urinary tract symptoms (BPH-related LUTS). Compared to monopolar transurethral resection of the prostate (TURP), BTUSP has the potential advantages of less toxicity related to irrigation fluid absorption, and better hemostasis. However, there have been reports of BTUSP being associated with increased incidence of urethral stricture disease (USD). We aim at 2 years results of B-TUSP with special emphasis on USD and continence.
Patients and methods: This is a retrospective study of patients who underwent BTUSP (resection, vaporiza- tion and enucleation) for BPH-related LUTS at Cairo University Hospital from January 2013 to December 2014. Perioperative parameters were assessed. Patients were evaluated 2 years postoperative to assess inter- national prostate symptom score (IPSS), continence, urinary tract infection (UTI) uroflowmetry and post voiding residual urine (PVR). For patients with suspicion of USD (maximum flow rate “Qmax”≤15 ml/s, PVR ≥100 cc,), retrograde and voiding cystourethrogram and/or cystoscopy were done.
Results: A 2-years follow-up was available for 32 patients. Mean age was 66.2 ± 8.2 years. 16/32 patients were catheter dependent due to bladder outlet obstruction. Mean preoperative flowmetry, IPSS and adenoma size were 9.1 ± 3.02 ml/s, 23.1 ± 2.3 and 60.1 ± 28.1 g, respectively. Of our patients 11/32 (34%), 14/32 (44%) and 7/32 (22%) underwent BTU-enucleation, resection and vaporization of prostate, respectively. There was a difference in mean adenoma size for vaporization, enucleation and resection patients (29.57 ± 11.9 g, 83.36 ± 26.49 g and 58.71 ± 17.82 g, respectively) (p < 0.05). Mean postoperative catheter time was 2.7 ± 1.3 days, IPSS, Qmax, and PVRU at 2 years, were 4.53 ± 1.29 (2–7), 17.94 ± 2.7 (11–22) and 3.13 ± 7.7 (0–35) respectively, this was significantly different from preoperative Qmax and IPSS (p < 0.05). Eight patients with Qmax ≤15 ml/s (11–15 ml/s) were assessed and found not to have USD. None of our patients reported incontinence. At 2 years, there was no significant difference in mean Qmax  or vaporization, resection and enucleation (18 ml/s ± 3.4, 18.71 ml/s ± 2.86, and 16.9 ml/s ± 1.86, respectively) (p = 0.267).
Conclusion: BTUSP is a safe and effective modality for surgical management of BPH-related LUTS. With no evidence of increased incidence of USD, and with significant improvement of flowmetry and IPSS after 2 years follow up.