When do post-Transurethral Resection of the Prostate (TURP) strictures typically occur?

Timing of Post-TURP Urethral Strictures

Post-TURP urethral strictures typically develop within 1-3 months after the procedure, with most cases presenting within the first 6 months following transurethral surgery. 1, 2

Epidemiology and Incidence

• Urethral stricture is a well-documented complication after TURP with incidence rates varying between 2.2% and 9.8% 2
• In some studies, the overall incidence may be as high as 10% when including all types of post-TURP urethral narrowing 1
• If meatal stenosis and meatitis are included as complications, the overall incidence of post-TURP strictures would be even higher 3

Timing of Stricture Development

• Most post-TURP strictures occur within 1-3 months after the operation 1
• The average time until urethral stricture diagnosis in clinical studies is approximately 58 days (±27 days) after TURP 4
• The majority of cases present within the first 6 months following transurethral surgery 2

Clinical Presentation

• Patients with post-TURP strictures typically present with:
  • Poor urinary flow (decreased stream) 2
  • Urinary tract infections 2
  • Acute urinary retention 2
  • Incomplete bladder emptying 5
  • Rising post-void residual volume 5

Risk Factors for Post-TURP Stricture Development

• Prostate-related factors:

  • Larger prostate volume (>70-80 cm³) significantly increases risk 6
  • Presence of chronic prostate inflammation (found in 66.6% of patients who developed strictures vs. 32.5% in those who did not) 6, 4
  • Higher inflammation intensity in peri-urethral, stromal, and periglandular areas 4

• Procedure-related factors:

  • Longer operative time (>60 minutes) significantly increases risk 6
  • Larger resectoscope sheath size (26 Fr vs. 24 Fr) 3
  • Larger catheter size (24 Fr vs. 22 Fr) 3
  • Lack of preoperative urethral calibration 3
  • Use of Salvaris swab traction (especially associated with meatal stenosis) 3

• Patient-related factors:

  • Diabetes mellitus (30% in stricture group vs. 12.5% in non-stricture group) 6
  • Hypertension (60.6% in stricture group vs. 37.5% in non-stricture group) 6
  • Pre-existing urethral catheter or cystostomy drainage 6

Anatomical Distribution

• Distal bulbar urethra is the most common site of narrowing following TURP 3
• Meatal stenosis is particularly associated with use of Salvaris swab and full-thigh traction 3

Pathophysiology

• Acute inflammatory attacks on a background of chronic inflammation in the prostate appear to be related to urethral stricture development 4
• Higher neutrophil, plasmocyte, and eosinophil cell ratios in peri-urethral areas are predictive of postoperative stricture formation 4
• Intraglandular destruction ratios are significantly higher in patients who develop strictures 4

Prevention Strategies

• Use smaller resectoscope sheaths (24 Fr rather than 26 Fr) 3
• Perform preoperative urethral calibration 3
• Use appropriate catheter size (smaller catheters when possible) 3
• Minimize operative time when feasible 6
• Consider prophylactic measures in patients with known risk factors such as diabetes, hypertension, or chronic prostate inflammation 6

Understanding the typical timing and risk factors for post-TURP strictures is essential for appropriate patient counseling and timely intervention to minimize morbidity and preserve quality of life.