Lower Urinary Tract Stenosis Following Surgery for Benign Prostatic Hyperplasia

This article reviews the mechanisms, risk factors, evaluation and current management options for iatrogenic lower urinary tract stenosis, including urethral stricture and bladder neck contracture, caused by surgery for benign prostatic hyperplasia (BPH).

The incidence of iatrogenic stenosis following endoscopic BPH surgery ranges from 0 to 9.7%. New endoscopic techniques and technologies for treating BPH do not appear to substantially mitigate this risk. However, new advances in our understanding of urethral sphincter anatomy combined with both innovative open urethroplasty techniques and utilization of robotic surgery for bladder neck reconstruction, offer promise in improving treatment outcomes for this patient population. Treating patient with stenosis following BPH-related surgery can be challenging, especially in patients with recurrent disease. Optimizing outcomes and patient satisfaction relies on performing a thorough work-up and openly discussing treatment choices, risks and postoperative expectations with patients. Future research and emerging technology in both endoscopic BPH treatment surgical options and management of postoperative stenosis is critical to continuing to improve patient care.