Channel-Focused Modified TURP for Post-Radiation Bladder Outlet Obstruction: A Case Series

Background/Objectives: Bladder outlet obstruction (BOO) after prostate radiotherapy is surgically challenging because of radiation-induced tissue changes and functional complications. We evaluated the efficacy and safety of channel-focused modified transurethral resection of the prostate (RadTURP) for post-radiation BOO. Methods: This retrospective case series included 11 patients who underwent RadTURP for post-radiation BOO between 2014 and 2025. Outcomes included symptom scores, voiding parameters, and postoperative complications. Pre-post changes were assessed using the Wilcoxon signed-rank test. Results: Median age was 75 years and median follow-up was 29 months. The median resection proportion was 24%. IPSS improved from 27 to 10 (p = 0.003), QoL from 5 to 3 (p = 0.007), OABSS from 12 to 6 (p = 0.016), Qmax from 6 to 17 mL/s (p = 0.006), and PVR from 59 to 0 mL (p = 0.047). De novo urinary incontinence occurred in four patients (36.4%), including two (18.2%) with persistent stress urinary incontinence requiring artificial urinary sphincter implantation. Among six patients undergoing symptom-driven postoperative cystoscopy, five (83.3%) had stone/calcification-related findings requiring energy-free endoscopic removal. One patient (9.1%) developed a urethral stricture requiring repeated dilation. Conclusions: In this small case series, channel-focused RadTURP was associated with improved urinary symptoms and voiding function after prostate radiotherapy. However, de novo urinary incontinence occurred in 36.4% of patients, highlighting an important postoperative safety concern for patient counseling and selection. Larger studies are needed to define durability and safety.