Introduction: To assess the incidence of bladder neck stenosis (BNS) and urethral stenosis (US) and the relative risk factors after Thulium laser enucleation of the prostate (ThuLEP).
Methods: Data regarding patients who underwent ThuLEP at two referral institutions between December 2014 and June 2020 were retrospectively reviewed. Exclusion criteria: previous urethral/prostatic surgery, pelvic irradiation, prostate cancer, neurogenic bladder, history of BNS/US, concomitant transurethral surgery, active urinary tract infection. The relationship between BNS/US occurrence and clinical-demographic variables was analyzed by Wilcoxon-Mann-Whitney or Chi-square test. Significant variables (p < 0.05) were therefore included in a multivariate logistic regression back-wise analysis and their association with BNS or US was established by odds ratio (OR) and 95% confidence intervals (CI).
Results: 1003 patients were included in the analysis. Median age was 69.0 (63.0-75.0). Median prostate volume was 65.0 (46.3-82.0) ml. Median follow-up was 31 months (25-75: 21-50). Thirty patients (2.99%) developed BNS, with a median time to event of 15 (11-17.75) months, whilst 50 patients (4.98%) developed US with a median time to event of 9 (7-11) months. Men suffering from BNS had significantly smaller prostate (median volume 43.5 ml vs 66.0 ml, p=0.008). Men with US had significantly smaller prostate volume (52.0 ml vs 66.0 ml, p=0.009). At multivariable analysis surgical time predicted BNS (OR 0.973; 95% CI 0.957–0.990, p=0.002), and re-catheterization (OR 3.973; 95% CI 1.876–8.414, p<0.001) and prostate volume (OR 0.984, 95%CI 0.97–0.996, p=0.008) for US.
Conclusions: Shorter surgical time and small prostate volume were found to be associated with BNS, whilst re-catheterization significantly predicted US occurrence.