One-Year Outcomes of Transurethral Treatment of Bladder Neck Stenosis Following Transurethral Resection of the Prostate. Results from a Large, Multicenter Series

Figures & data

Table 1 Baseline Characteristics of Patients

	N=372
Age, years, median [IQR]	67 [60, 73]
Type of previous TURP, n (%)
Monopolar	18 (4.8)
Bipolar	354 (95.2)
Diabetes mellitus, n (%)	115 (31.0)
Hypertension, n (%)	221 (59.4)
Ischemic heart disease, n (%)	58 (15.6)
Cardiovascular disease, n (%)	20 (5.4)
ASA score, n (%)
1	66 (17.8)
2	231 (62.3)
3	74 (19.9)
Anticoagulation stopped, n (%)	73 (38.2)
Urine culture positive, n (%)	55 (25.8)
Preoperative antibiotics, n (%)	105 (38.0)
Preoperative post-voiding residual of urine, median [IQR]	100 [55, 180]
Previous outpatient urethral dilation, n (%)	101 (27.2)
Preoperative indwelling catheter, n (%)	78 (21.0)

Abbreviations: TURP, transurethral resection of the prostate. IQR, interquartile range. ASA, American Society of Anesthesiologists.

Table 2 Intraoperative Characteristics

Concomitant bladder lithotripsy, n (%)	29 (7.8)
Incision modality, n (%)	N=224
End-firing laser	79 (35.3)
Collings knife	137 (61.2)
Cold knife	2 (0.8)
Loop	6 (2.7)
Main energy type, n (%)	N=372
Holmium laser <50W	27 (7.3)
Holmium laser ≥50W	24 (6.5)
Holmium with MOSES technology	10 (2.4)
Thulium fiber laser	8 (1.9)
Bipolar	246 (66.5)
Monopolar	57 (15.4)
Scope size (French), n (%)	N=367
21	2 (0.5)
22	5 (1.4)
24	104 (28.3)
26	256 (69.8)
Incision type, n (%)	N=245
1-side	34 (13.9)
2-side	115 (46.9)
Mercedes-Benz	96 (39.2)
Incision length ureteral orifice to veru montanum, n (%)	62 (26.3)
Additional haemostasis with loop, n (%)	60 (26.3)
Total operation time, minutes, median [IQR]	30 [25, 45]

Abbreviation: IQR, interquartile range.

Table 3 Postoperative Outcomes

	N=372
Removal of postoperative catheter, n (%)
<7 days	317 (86.1)
7–14 days	41 (11.1)
15–30 days	6 (1.6)
>30 days	4 (1.1)
30-day complications, n (%)	46 (12.4)
Acute urinary retention (Clavien 2)	19 (5.1)
Continuous bladder washout for persistent haematuria (Clavien 2)	6 (1.6)
Blood transfusion (Clavien 2)	0
Bleeding requiring surgical control (Clavien 3)	8 (2.2)
Urinary tract infection (Clavien 2)	17 (4.6)
Sepsis requiring intensive care unit admission (Clavien 4)	1 (0.3)
Overall postoperative incontinence, n (%)	64 (17.2)
Incontinence type, n (%)	N=64
Urge	29 (45.3)
Stress	27 (42.2)
Mixed	8 (12.5)
Duration of incontinence, n (%)	N=64
<1 month	37 (58.7)
1–3 months	17 (27.0)
>3 months	9 (14.3)
Delayed complications (up to 1 year), n (%)	45 (12.1)
Urethral stricture, dilation only	8 (2.2)
Urethral stricture, urethrotomy	8 (2.2)
Bladder neck stenosis, dilation only	6 (1.6)
Bladder neck stenosis, repeat incision	21 (5.6)
Artificial urinary sphincter	1 (0.3)
Urethroplasty for recalcitrant bladder neck stenosis	2 (0.5)

Table 4 Univariable and Multivariable Logistic Regression Analysis of Factors Associated with Overall Incontinence

	Univariable analysis		Multivariable analysis
	OR (95% CI)	p	OR (95% CI)	p
Age	1.04 (1.01–1.072)	0.01	1.04 (0.97 – 1.11)	0.26
Diabetes mellitus	2.304 (1.324–4.001)	0.003	0.98 (0.31 – 2.88)	0.975
Preoperative post-voiding residual of urine	0.999 (0.996–1.002)	0.726	- - -	- - -
Previous outpatient urethral dilation	3.757 (2.149–6.601)	<0.001	0.87 (0.29 – 2.48)	0.794
Incision modality (ref. end-firing laser)				0.008
Collings knife	2.828 (1.401–6.129)	0.005	3.93 (1.45 – 11.13)
Cold knife	6.182 (0.233–164.28)	0.209
Main energy type (ref. Holmium <50W)
Holmium HP ≥50W	0.408 (0.079–1.692)	0.237
Holmium with MOSES	0 (0–731.38)	0.985
Thulium fiber laser	0.476 (0.023–3.53)	0.525
Bipolar	0.427 (0.173–1.161)	0.075
Monopolar	1.544 (0.574–4.5)	0.403
Incision type (ref. 1-side)
2-side	1.502 (0.594–4.342)	0.416
Mercedes-Benz	1.47 (0.568–4.317)	0.449
Monopolar TURP (versus bipolar TURP)	0.961 (0.218–3.02)	0.951	- - -	- - -

Abbreviation: TURP, transurethral resection of the prostate. Bold value stands for significant p value.

Table 5 Univariable Logistic Regression Analysis of Factors Associated with Re-Stenosis

	OR (95% CI)	p
Age	0.988 (0.95–1.029)	0.556
Diabetes mellitus	2.014 (0.887–4.511)	0.088
Urine culture positive	0.512 (0.116–1.615)	0.303
Previous outpatient urethral dilation	0.935 (0.357–2.187)	0.882
Incision modality (ref. end-firing laser)
Collings knife	3.589 (1.157–15.7)	0.047
Cold knife	0.855 (0.567–1.347)	0.12
Incision type (ref. 1-side)
2-side	3.49 (0.642–64.99)	0.24
Mercedes-Benz	3.414 (0.606–64.18)	0.253

Note: Bold value stands for significant p value.