World J Urol. 2026 May 18;44(1):367. doi: 10.1007/s00345-026-06473-3.
ABSTRACT
PURPOSE: Urethral stricture remains a clinically relevant complication after transurethral resection of the prostate (TURP). While procedural factors have been extensively studied, the contribution of systemic comorbidities to stricture development is less well defined. This study aimed to evaluate the association between common cardiovascular and metabolic comorbidities and urethral stricture formation following TURP.
METHODS: A retrospective cohort of 713 patients who underwent bipolar TURP for benign prostatic hyperplasia between January 2021 and January 2024 was analyzed. Urethral stricture was identified in 47 patients (6.6%). Propensity score matching (1:4) was performed based on age, prostate volume, operative time, and PSA levels, yielding a matched cohort of 235 patients. Comorbidities including smoking, hypertension, diabetes mellitus, dyslipidemia, and coronary artery disease (CAD) were assessed using clinical records and prescription data. Univariable and multivariable Cox proportional hazards regression analyses were performed to identify factors associated with time to urethral stricture development.
RESULTS: In the matched cohort, smoking, hypertension, CAD, and dyslipidemia were significantly more prevalent in patients who developed urethral stricture (all p < 0.05), whereas diabetes mellitus was not. In univariable Cox analysis, smoking (HR 2.13), hypertension (HR 2.76), CAD (HR 3.15), and dyslipidemia (HR 2.46) were significantly associated with an increased hazard of urethral stricture development. In multivariable Cox analysis, only CAD remained independently associated with the outcome (HR 2.06, 95% CI 1.02-4.16, p = 0.04). The most common stricture location was the bulbar urethra.
CONCLUSION: Coronary artery disease was independently associated with urethral stricture development following TURP. Other comorbidities may contribute through overlapping vascular and metabolic pathways. These findings highlight the importance of systemic disease burden when assessing postoperative stricture risk and planning perioperative management.
PMID:42149232 | DOI:10.1007/s00345-026-06473-3