內視鏡攝護腺刨除術後下泌尿道狹窄與其相關臨床結果

吳任軒、陳昱廷、蔡翰宇、曹書瀚、林友翔、陳建綸、侯鎮邦

林口長庚紀念醫院泌尿外科

Lower Urinary Tract Stricture after Endoscopic Prostate Enucleation and its Associated Clinical Outcomes

Jen-Hsuan Wu, Yu-Ting Chen, Han-Yu Tsai, Shu-Han Tsao, Yu-Hsiang Lin, Chien-Lun Chen, Chen-Pang Hou

Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan

Purpose

This study aimed to investigate risk factors and ascertain the associated clinical outcomes of lower urinary tract stricture following endoscopic prostate enucleation.

Materials and Methods

We conducted a retrospective analysis of 246 patients who underwent endoscopic prostate enucleation including both Thulium laser enucleation and transurethral bipolar enucleation at Chang Gung Memorial Hospital Linkou between October 2018 and December 2022. Perioperative parameters and follow-up clinical data were evaluated and compared between patients with and without postoperative lower urinary tract stricture. Uni- and multivariate logistic regression analyses assessed potential risk factors.
Results

A total of 246 patients were included in this retrospective cohort study. Among them, 23 patients (9%) developed urethral stricture. The most common location for urethral stricture was membranous urethra (52%), followed by the penile urethra (16%), prostatic urethra(12%), and bladder neck(12%). The median  time to diagnosis was four months postoperatively. Among the 23 patients with stricture, 18(78%) underwent single endoscopic incision with cold knife, 4(17%) underwent twice ,1(4%) underwent three times. Analysis indicated significant improvement in maximum flow rate(from 9.05±5.36 to 15.62±8.03, p=0.001), voiding volume(from 246.67±139.97 to 318±148.88, p=0.02), residual urine(from 68.95±81.66 to 30±40.30, p=0.024). There was no significant difference in operation methods. Multivariate logistic regression analysis revealed that postoperative urinary tract infection(OR=9.1, p=0.001), re-catherization(OR=7.44, p=0.046), lower resection weight(OR=0.89, p=0.036), and higher preoperative voiding volume(OR=1.01, p=0.003) were identified as independent risk factors for the development of urethral stricture.

Conclusion

In this study, we observed that postoperative urinary tract infection, re-catherization, lower resection weight, and higher preoperative voiding volume were associated with a higher risk of lower urinary tract stricture following endoscopic prostate enucleation surgery. The emergence of postoperative voiding symptoms should prompt clinical concern and active intervention.