MP04-06: Incidence of urethral stricture following endoscopic prostate surgery: A systematic review and meta-analysis of prospective, randomized trials

Ee Jean Lim*, Vineet Gauhar, Singapore, Singapore, Giacomo Maria Pirola, Arezzo, Italy, Emanuele Rubilotta, Verona, Italy, Marcelo Langer Wroclawski, São Paulo, Brazil, Dong Le Quy Nguyen, Danang, Vietnam, Marilena Gubbiotti, Arezzo, Italy, Vinson Wai‑Shun Chan, Leeds, United Kingdom, Mariela Corrales, Paris, France, Esther Garcia Rojo, Madrid, Spain, Thomas R.W. Herrman, Frauenfeld, Switzerland, Jeremy Yuen‑Chun Teoh, Hong Kong, Hong Kong, Daniele Castellani, Ancona, Italy

Introduction: Urethral stricture (US) is a well-known long-term complication of endoscopic procedures for benign prostatic hyperplasia (BPH). This systematic review aims to evaluate the incidence and influencing factors of US in relation to different surgical endoscopic techniques for treating clinical BPH.

Methods: We performed a systemic literature review using MEDLINE, EMBASE, and Cochrane Central Controlled Register of Trials. The PICOS (Patient Intervention Comparison Outcome Study type) model was used to frame and answer the clinical question.

The incidence of urethral stricture was estimated by comparing the results of the studies that used different endoscopic techniques. Patients were assigned in groups according to the type of surgery and regardless of energy used (enucleation, ablation and resection group). The incidences of US were pooled using the Cochran-Mantel-Haenszel Method with the random effect model and reported as Risk Ratio (RR), 95% Confidence Intervals (CI), and p-values. Analyses were two-tailed, and the significance was set at p <0.05 and a 95% CI. Study heterogeneity was assessed utilizing the I2 value. Substantial heterogeneity was defined as an I2 value >50% or a Chi2 p-value <0.10.

Results: A total of 80 studies were included for meta-analysis. There was no significant heterogeneity among the studies, with an I2 0%, Chi2 16.98, p = 0.88 for Enucleation vs TURP studies and I2 0%, Chi2 27.71, p = 0.99 for the Ablation vs TURP ones. The pooled incidence of US was 1.7% after enucleation, 2.1% after ablation, 3.8% after monopolar (M)-TURP and 2.1% after bipolar (B)-TURP. The incidence of US was significantly lower after Enucleation than after TURP (RR 0.58 95% CI 0.39-0.84, p=0.004). US incidence was lower for Ablation procedures than after TURP, but the difference did not reach significance (RR 0.79 95% CI 0.61-1.3, p=0.08). However, this was significant in the subgroup of M-TURP studies (RR 0.67, 95% CI, 0.49-0.91, p=0.01). Sub-analysis showed that the risk of US was significantly lower after Enucleation than after TURP within 12 months after surgery (RR 0.51 95% CI 0.33-0.81, p=0.004). The mean postoperative catheterization was significantly shorter in laser treatments than in TURP also potentially influencing US incidence.

Conclusions: The study shows an increased incidence of US after TURP compared to enucleation and ablation procedures. The main factors related to increased US incidence are the use of monopolar energy, instrument caliber and duration of postoperative catheterization.

Source of Funding: none