Urethral stricture following endoscopic prostate surgery: a systematic review and meta-analysis of prospective, randomized trials

Introduction and objectives: This systematic review aims to evaluate the incidence and influencing factors of urethral stricture (US) in relation to different BPH endoscopic techniques. Materials and methods: We performed a systematic literature review using MEDLINE, EMBASE, and Cochrane Central Controlled Register of Trials. The incidence of US was estimated through comparative studies between different endoscopic techniques. Patients were assigned into groups according to the type of surgery (enucleation, ablation and resection group). Incidences of US were pooled using the Cochran-Mantel-Haenszel Method with the random effect model and reported as Risk Ratio (RR), 95% Confidence Intervals (CI), and p-values. Results: A total of 80 studies were included for meta-analysis. The pooled incidence of US was 1.7% after enucleation, 2.1% after ablation, 3.8% after monopolar (M)-TURP and 2.1% after bipolar (B)-TURP. The incidence of US was significantly lower after Enucleation than after TURP (RR 0.58 95% CI 0.39–0.84, p = 0.004). US incidence was lower for Ablation procedures than TURP, but the difference did not reach significance (RR 0.79 95% CI 0.61–1.3, p = 0.08). However, this was significant in the subgroup of M-TURP studies (RR 0.67, 95% CI, 0.49–0.91, p = 0.01). Sub-analysis showed that the risk of US was significantly lower after Enucleation than after TURP within 12 months after surgery (RR 0.51 95% CI 0.33–0.81, p = 0.004). Conclusion: The study shows an increased incidence of US after TURP compared to enucleation and ablation procedures. The main factors related to increased US incidence are the use of monopolar energy, instrument caliber and duration of postoperative catheterization.