Management of complications after surgical outlet reduction for benign prostatic obstruction.
BACKGROUND
Lower urinary tract symptoms are a common complaint. Surgery to debulk hyperplastic prostate tissue is indicated for men with symptoms refractory to medical therapy, or for those who cannot tolerate first-line medications. In recent decades, new endoscopic techniques have been developed to reduce the morbidity of transurethral resection of the prostate (TURP). Nonetheless, complications are still frequently encountered in the immediate, early, and remote postoperative setting.


METHODS
In this review, we perform an in-depth examination of contemporary treatment strategies for long term complications of surgical outlet reduction procedures. Complications encountered in the remote postoperative setting such as erectile dysfunction (ED), urethral stricture, refractory incontinence, and bladder neck contracture were identified in the literature.


RESULTS
Treatment strategies for ED after TURP do not differ from algorithms applied for ED due to other causes. Management of urethral stricture following TURP depends on the size and location of narrowing and can range from simple dilation to complex excision with grafting techniques or perineal urethrostomy. Refractory urinary incontinence requires a full diagnostic evaluation, and artificial urinary sphincter placement is efficacious for cases that do not respond to first-line medical therapy. Finally, numerous therapies for bladder neck contracture exist and vary in their invasiveness.


CONCLUSIONS
Endoscopic reduction of the prostate for the male with benign prostatic obstruction via most contemporary modalities is a safe and effective means to decrease outlet resistance to urinary flow. However, late complications from these procedures still exist. Management of remote morbidity following TURP can be diagnostically and therapeutically complex, necessitating prompt referral to a genitourinary reconstruction specialist.
Department of Urology, Fox Chase Cancer Center, Temple University Health System, Philadelphia, Pennsylvania, USA.
Daniel C
DC
Parker
Jay
J
Simhan
D000368:Aged; D000369:Aged, 80 and over; D019468:Disease Management; D007172:Erectile Dysfunction / Q000209:etiology / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods; D011183:Postoperative Complications / Q000175:diagnosis / Q000601:surgery*; D011470:Prostatic Hyperplasia / Q000150:complications / Q000601:surgery*; D012086:Reoperation / Q000379:methods; D018570:Risk Assessment; D020728:Transurethral Resection of Prostate / Q000009:adverse effects* / Q000379:methods; D016896:Treatment Outcome; D014524:Urethral Obstruction / Q000209:etiology / Q000601:surgery; D014525:Urethral Stricture / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D001748:Urinary Bladder Neck Obstruction / Q000209:etiology / Q000601:surgery*; D014549:Urinary Incontinence / Q000209:etiology / Q000601:surgery; D014567:Urography / Q000379:methods