Glienke Maximilian, Sigle A, Himmelsbach R, von Bargen M F, Schoenthaler M, Özkan A, Schoeb D S, Wilhelm K, Gratzke C, Miernik A
Department of Urology, Faculty of Medicine, Medical Centre, University of Freiburg, Hugstetter Straße 55, 79016, Freiburg, Germany.
World J Urol. 2025 Jul 7;43(1):419. doi: 10.1007/s00345-025-05763-6.
Holmium laser enucleation of the prostate (HoLEP) is a well-established treatment for benign prostatic hyperplasia (BPH). However, long-term data on postoperative urethral strictures remain scarce. This study aimed to evaluate the incidence, anatomical characteristics, timing, and potential pre- and perioperative risk factors for stricture formation following HoLEP.
A retrospective analysis was conducted on 1,724 patients who underwent HoLEP between September 2015 and October 2022. Patients with pre-existing urethral strictures were excluded. Data on demographics, surgical details, and postoperative outcomes were collected. Follow-up was achieved in 1,512 patients (87.7%) over a mean duration of 5.03 years. Urethral and bladder neck strictures requiring intervention were identified through clinical follow-up or structured telephone interviews. Risk factors were assessed using logistic regression.
Urethral strictures (US) were found in 5.0% of patients and bladder neck strictures (BNS) in 2.0%. Most US were located in the bulbar urethra (90.7%) and developed within two years postoperatively. Smaller prostate volume and lower PSA were significantly associated with increased stricture risk. BNS risk was additionally linked to shorter operative time, lower laser energy, and less surgeon experience. Strictures were predominantly short-segmented; 21.1% were longer than 2 cm.
Stricture formation after HoLEP, though infrequent, remains a relevant long-term complication. Identifying patients at higher risk based on prostate size, catheter use, and surgical parameters can help inform preventative strategies and improve postoperative counseling and outcomes.
钬激光前列腺剜除术（HoLEP）是治疗良性前列腺增生（BPH）的一种成熟疗法。然而，关于术后尿道狭窄的长期数据仍然匮乏。本研究旨在评估HoLEP术后狭窄形成的发生率、解剖特征、发生时间以及潜在的术前和围手术期风险因素。
对2015年9月至2022年10月期间接受HoLEP手术的1724例患者进行回顾性分析。排除既往存在尿道狭窄的患者。收集患者的人口统计学数据、手术细节和术后结果。1512例患者（87.7%）获得随访，平均随访时间为5.03年。通过临床随访或结构化电话访谈确定需要干预的尿道和膀胱颈狭窄。使用逻辑回归评估风险因素。
5.0%的患者出现尿道狭窄（US），2.0%的患者出现膀胱颈狭窄（BNS）。大多数US位于球部尿道（90.7%），且在术后两年内发生。前列腺体积较小和前列腺特异性抗原（PSA）较低与狭窄风险增加显著相关。BNS风险还与手术时间较短、激光能量较低和术者经验较少有关。狭窄主要为短节段性；21.1%的狭窄长度超过2 cm。
HoLEP术后狭窄形成虽不常见，但仍是一种相关的长期并发症。根据前列腺大小、导尿管使用情况和手术参数识别高危患者有助于制定预防策略，并改善术后咨询和治疗效果。
