Elsaqa Mohamed, Risinger James, El Tayeb Marawan M
Division of Urology, Department of Surgery, Baylor Scott & White Health, Temple, Texas, USA.
Faculty of Medicine, Alexandria University, Alexandria, Egypt.
J Endourol. 2022 Dec;36(12):1575-1579. doi: 10.1089/end.2022.0422. Epub 2022 Sep 14.
Urethral strictures (US) and bladder neck contracture (BNC) are troublesome complications of transurethral surgery. We aimed to report the incidence, risk factors, and management of US and BNC post-holmium laser enucleation of the prostate (HoLEP) together with review of literature. A retrospective review of prospectively managed HoLEP patients in one institution between 2015 and 2021 was performed. The study included patients with complete follow-up of at least 1-year. Multivariate regression analysis for risk factors of US or BNC was performed. Appropriate statistical analysis methods were used. Out of total 1055 HoLEP patients, 566 patients were included. Eleven (1.94%), 8 (1.41%), and 1 (0.17%) patients developed US, BNC, and both, respectively, while 8 (1.41%) patients had postoperative recurrence of intraoperatively diagnosed US. With multivariate regression analysis, intraoperative US ( = 0.0055, odds ratio [OR] = 15.5, confidence interval [95% CI] = 2.2-37.7), intraoperative need for meatotomy ( = 0.0019, OR = 7.69, 95% CI = 2.12-27.8), and longer operative time ( = 0.0250, OR = 1.043, 95% CI = 1.005-1.083) were predictors of US/BNC. For US patients, urethral dilatation under local anesthesia was sufficient in 14 (70%) patients while 6 (30%) patients had visual urethrotomy. Patients with BNC were managed by endoscopic bladder neck incision. Although the US/BNC are annoying long-term sequalae that may complicate HoLEP, the incidence is still low and can be easily managed. Diagnosed intraoperative stricture, need for meatotomy, and longer operative time are the main predictors of urethral complications post-HoLEP.
尿道狭窄（US）和膀胱颈挛缩（BNC）是经尿道手术中棘手的并发症。我们旨在报告前列腺钬激光剜除术（HoLEP）后US和BNC的发生率、危险因素及处理方法，并对文献进行综述。对2015年至2021年期间在一家机构接受前瞻性管理的HoLEP患者进行了回顾性研究。该研究纳入了至少有1年完整随访的患者。对US或BNC的危险因素进行了多因素回归分析。采用了适当的统计分析方法。在总共1055例HoLEP患者中，纳入了566例患者。分别有11例（1.94%）、8例（1.41%）和1例（0.17%）患者发生了US、BNC以及两者均发生，而8例（1.41%）患者术中诊断的US术后复发。通过多因素回归分析，术中US（P = 0.0055，比值比[OR] = 15.5，置信区间[95% CI] = 2.2 - 37.7）、术中需要尿道口切开术（P = 0.0019，OR = 7.69，95% CI = 2.12 - 27.8）以及较长的手术时间（P = 0.0250，OR = 1.043，95% CI = 1.005 - 1.083）是US/BNC的预测因素。对于US患者，14例（70%）患者在局部麻醉下进行尿道扩张就足够了，而6例（30%）患者进行了直视下尿道切开术。BNC患者通过内镜下膀胱颈切开术进行处理。虽然US/BNC是令人烦恼的长期后遗症，可能使HoLEP复杂化，但发生率仍然较低且易于处理。术中诊断的狭窄、需要尿道口切开术以及较长的手术时间是HoLEP后尿道并发症的主要预测因素。
