The urethral stricture after transurethral resection of the bladder tumor for non-muscle invasive bladder cancer is important to follow up non-muscle invasive bladder cancer, although the incidence of urethral stricture after transurethral resection of the bladder tumor is very low. Thus, we retrospectively investigated the predictive factors for urethral stricture after transurethral resection of the bladder tumor for non-muscle invasive bladder cancer.

From January 2010 to December 2019, a total of 759 men who underwent transurethral resection of the bladder tumor for non-muscle invasive bladder cancer was included in this study. transurethral resection of the bladder tumor was performed by a single surgeon. We excluded a history of previous urethral or prostate surgery in this study. We used a 26Fr resectoscope sheath, 30-degree telescope, and bipolar resector during transurethral resection of the bladder tumor. Urethral stricture after transurethral resection of the bladder tumor was assessed by cystoscopy for regular follow-up of non-muscle invasive bladder cancer. We investigated the clinico-pathological variables, including age, tumor size, tumor location, tumor stage, intravesical prostatic protrusion, prostate volume, operation time, and etc.

The mean age was 67.5±8.9 years and tumor recurrence rate were 23.1% (175/759). The incidence of urethral stricture after transurethral resection of the bladder tumor is 2.76% (21/759). Of 21 patients, 19 men (90.5%) conducted transurethral resection of the bladder tumor more than twice in follow-up periods (Table 1). When divided into two groups (stricture vs no stricture), there were no significant differences of clinical variables, such as age, prostate volume, tumor stage, tumor location, operation times, tumor size, and etc. (Table 2). However, multivariate logistic regression analysis showed that the presence of intravesical prostatic protrusion and the number of transurethral resection of the bladder tumor per patient were independent factors associated with urethral stricture after transurethral resection of the bladder tumor (p=0.045 and <0.001, respectively).

Although the incidence of urethral stricture after transurethral resection of the bladder tumor was very low in this study, the patients who had urethral stricture after transurethral resection of the bladder tumor had voiding dysfunction, especially residual urine sensation and weak urine stream. There was no additional procedure for treatment of urethral stricture such as direct visual urethrotomy or urethroplasty. The parameter of uroflowmetry, such as Qmax was significant changed in patients who have urethral stricture after transurethral resection of the bladder tumor.

Our study revealed that the presence of intravesical prostatic protrusion and the number of transurethral resection of the bladder tumor per patient were predictive factors associated with urethral stricture after transurethral resection of the bladder tumor for non-muscle invasive bladder cancer.