Prevention of urethral stricture formation after transurethral resection of the prostate: a controlled randomized study of Otis urethrotomy versus urethral dilation and the use of the polytetrafluoroethylene coated versus the uninsulated metal sheath

A Delphi consensus to standardize the technique of anatomical endoscopic enucleation of prostate: a study by ESUT endoscopic enucleation of prostate study group

PURPOSE

Our objective was to establish a standardized technique for Anatomical Endoscopic Enucleation of Prostate (AEEP) utilizing a consensus statement to provide robust recommendations for urologists who are new to this procedure.

METHODS

The participants were electronically sent a questionnaire in three consecutive rounds. In the second and third rounds, the anonymous aggregate results of the previous round were presented. Experts' feedback and comments were then incorporated to refine existing questions or to explore more controversial topics in greater depth.

RESULTS

Forty-one urologists participated in the first round. In the second round, all Round 1 participants received a 22-question survey, resulting in a consensus on 21 items. In the third round, 76% (19/25) of the second-round respondents also participated, reaching a consensus on 22 additional items. The panelists consensually agreed on detaching the urethral sphincter at the beginning of the enucleation and not at the end of the enucleation. To prevent incontinence, it was recommended that the apical mucosa be preserved through various approaches between 11 and 1 o'clock while gently disrupting the lateral lobes in their apical part, avoiding an excess energy delivery approximation to the apical mucosa.

CONCLUSION

To optimize laser AEEP procedures, urologists must follow expert guidelines on equipment and surgical technique, including early apical release, using the 3-lobe technique for enucleation, preserving apical mucosa with appropriate approaches, gently disrupting lateral lobes at their apical regions, and avoiding excessive energy delivery near the apical mucosa. Following these recommendations can lead to improved outcomes and patient satisfaction.

Relationship between development of urethral stricture after transurethral resection of prostate and glycemic control

Objectives:

The purpose of this study is to investigate the association of glycemic control prior to TUR-P and postoperative urethral stricture development.

Materials and Methods:

Of the 168 patients with a diagnosis of urethral stricture, who underwent internal urethrotomy in our hospital were retrospectively analyzed for this study.

98 patients who underwent monopolar TUR-P in our hospital previously and were developed urethral stricture were divided into two groups as diabetic and nondiabetic. Based on their HbA1c concentrations, diabetics were allocated to two groups with good (HbA1c ≤6.5%) or poor (HbA1c > 6,5%) glycemic control. Time to internal urethrotomy and the other operative parameters were compared among groups.

Results:

Time to internal urethrotomy after TUR-P was significantly shorter in diabetic patients with poor glycemic control than Group 1 and Group 2 (P = 0,02, P = 0,012) but no significant difference was found between Group 1 and Group 2 (P = 0,368). There was no significant difference in the mean diagnosed and resected prostate wight among groups There was no significant difference in the mean resection time and the mean time to urethral catheter removal among groups.

Conclusions:

Especially in poor glycemic control patients, urethral stricture development was seen in the early period after TUR-P. For this reason, in the elective TUR-P scheduled poor glycemic controlled patients the operation should be done after glycemic control.

Severe Penile Curvature following Otis Urethrotomy

Urethral stricture is a common urological pathology with a high recurrence rate after treatment. Urethral manipulations are among its main causes. In this paper, urethral stricture developed secondary to urethral catheterization and was treated with cold-knife internal urethrotomy and the Otis urethrotomy procedure. During the follow-up period, severe ventral penile curvature preventing sexual intercourse developed due to fibrosis of the corpus spongiosum and tunica albuginea of the penis. This ventral penile curvature was corrected with a separate operation using a tunica vaginalis flap harvested from the left scrotum.

Urethral reconstruction of strictures resulting from treatment of benign prostatic hypertrophy and prostate cancer

Urethral strictures commonly result from treatments for prostate disease, such as transurethral resection, radical prostatectomy, and radiotherapy. Treating these strictures can be difficult: it may be complicated by previous irradiation, and endoscopy often fails. We review the risk factors for development of strictures resulting from the treatment of prostate disease and discuss the success rates of both endoscopic and open therapies.

Urethral stricture following transurethral resection of the prostate. The role of local anaesthetics

In a multicentre prospective study, 261 patients undergoing transurethral resection of the prostate (TURP) in 17 urology departments were randomised to receive lubricating jelly containing either 3% tetracaine hydrochloride, 1% lignocaine hydrochloride, or no local anaesthetic. No patient had a history of urethral instrumentation or a previous urethral stricture. After 6 months' follow-up, 25/79 patients (32%) treated with 3% tetracaine jelly developed urethral strictures, as did 4/92 patients (4%) who received 1% lignocaine and 2/90 (2%) who received the jelly without anaesthetic. It was concluded that the use of 3% tetracaine jelly is associated with a high incidence of post-TURP urethral strictures.

Transcervical prostatectomy in perspective

In a prospective study, 175 consecutive patients were included in transcervical prostatectomy. The results of the operation were evaluated by the mean weighted score and the postoperative morbidity. Although, urethral catheter was routinely removed on the second postoperative day, there was no evidence of suprapubic urinary fistula, clot retention or incontinence of urine noticed in any patient. Recatheterisation was required only in 2 patients for atony of the bladder muscles. Apart from wound infection in 3.4%, there was no other morbidity encountered with this technique. It is encouraging that about 77% of the patients went home before the fifth postoperative day and only one patient died on the second day. The merits of this technique have been highlighted in perspective with other studies reported in the literature.

Effect of catheter material on the incidence of urethral strictures

The aetiology of urethral strictures in patients catheterised for short periods at the time of surgery is the subject of some debate. The occurrence of epidemics of strictures associated with certain batches of latex catheters, and the demonstrable in vitro cytotoxicity of latex in general, have supported the suggestion that catheter material (and in particular latex) has an important role. We have looked retrospectively at 299 patients undergoing transurethral resection of the prostate gland by 1 urologist, 135 of whom had a latex catheter and 164 a plastic one; 19 patients developed strictures over the next 12 months with no proven difference attributable to the catheter material. The study provides no evidence that the short-term use of latex catheters is associated with stricture formation.

Complications in hyperthermia treatment of benign prostatic hyperplasia

Of 435 patients treated with local hyperthermia to the prostate 27 had 29 complications, for an over-all complication rate of 6.6%. Urinary tract infections (7 cases), hematuria (6), and epididymitis (2) accounted for roughly half of the complications and could be attributed to the insertion of a catheter rather than the treatment itself but this remains to be proved. Most of the complications occurred within the first 3 treatment sessions. Despite the complication, 9 patients continued and completed the treatment course. Mean age of the study group was 73 +/- 8.3 years. Given the age of these patients, high incidence of accompanying diseases and low rate of complications, local hyperthermia should be considered a viable low risk treatment option in patients with benign prostatic hyperplasia.