Risk factors for bladder neck contracture after transurethral resection of the prostate

Abstract Introduction Transurethral resection of the prostate (TURP) is the most frequently used treatment of benign prostate hyperplasia with a prostate volume of <80 mL. A long‐term complication is bladder neck contracture (BNC). The aim of the present study was to identify the risk factors for BNC formation after TURP. Methods We conducted a retrospective analysis of all TURP primary procedures which were performed at one academic institution between 2013 and 2018. All patients were analyzed and compared with regard to postoperative formation of a BNC requiring further therapy. Uni‐ and multivariable logistic regression analyses (MVAs) were performed to identify possible risk factors for BNC development. Results We included 1368 patients in this analysis. Out of these, 88 patients (6.4%) developed BNC requiring further surgical therapy. The following factors showed a statistically significant association with BNC development: smaller preoperative prostate volume ( p = 0.001), lower resected prostate weight ( p = 0.004), lower preoperative levels of prostate‐specific antigen (PSA, p < 0.001), shorter duration of the surgery ( p = 0.027), secondary transurethral intervention (due to urinary retention or gross hematuria) during inpatient stay ( p = 0.018), positive (≥100 CFU/mL) preoperative urine culture ( p = 0.010), and urethral stricture (US) formation requiring direct visual internal urethrotomy (DVIU) postoperatively after TURP ( p < 0.001), in particular membranous ( p = 0.046) and bulbar ( p < 0.001) strictures. Preoperative antibiotic treatment showed a protective effect ( p = 0.042). Histopathological findings of prostate cancer (PCA) in the resected prostate tissue were more frequent among patients who did not develop BNC ( p = 0.049). On MVA, smaller preoperative prostate volume ( p = 0.046), positive preoperative urine culture ( p = 0.021), and US requiring DVIU after TURP ( p < 0.001) were identified as independent predictors for BNC development. Conclusion BNC is a relevant long‐term complication after TURP. In particular, patients with a smaller prostate should be thoroughly informed about this complication.