Management of post TURP strictures

Area of Science:

• Urology
• Surgical Innovation
• Reconstructive Surgery

Background:

• Urethral stricture is a common complication following transurethral surgeries, particularly transurethral resection of the prostate (TURP).
• The incidence of post-TURP urethral stricture ranges from 2.2% to 9.8%, often presenting within six months with symptoms like poor urinary flow, infection, or retention.
• Strictures can occur anywhere along the urethra, posing a significant challenge in management.

Purpose of the Study:

• To evaluate the efficacy and outcomes of Buccal Mucosa Graft (BMG) urethroplasty for managing urethral strictures secondary to TURP.
• To compare different surgical approaches (dorsal, ventral, combined) for stricture repair.
• To assess the long-term success rates and continence preservation of BMG urethroplasty.

Main Methods:

• A prospective study conducted from January 2010 to June 2017 included 170 patients with post-TURP urethral strictures.
• Patients were treated using various urethroplasty techniques: dorsal approach (94 patients), ventral approach (71 patients), and combined dorsal/ventral approach (5 patients).
• Five patients underwent endoscopic procedures. Mean BMG dimensions were 6.25 cm in length and 1.5 cm in width.

Main Results:

• The study population comprised patients aged 54-87 years (mean 67.34 years) with varying stricture lengths.
• The overall success rate for BMG urethroplasty was 82.43%.
• The ventral approach demonstrated suitability for proximal bulbar strictures near the membranous urethra.

Conclusions:

• Buccal Mucosa Graft (BMG) urethroplasty is a safe, feasible, and effective treatment for post-TURP urethral strictures, offering long-term success.
• BMG urethroplasty should be strongly considered over intermittent self-catheterization (CIC) and visual internal urethrotomy (VIU) for these complex strictures.
• The ventral approach is particularly advantageous for proximal bulbar strictures, and the procedure preserves urinary continence.