Incidence and Predictors of Urethral Stricture Following Transurethral Resection of the Prostate and Open Simple Prostatectomy: A 21-Year Retrospective Cohort Study

<b>Background/Objectives:</b> To assess the incidence and factors associated with urethral stricture following monopolar transurethral resection of the prostate (mTURP) and open simple prostatectomy (OSP) over a 21-year period. <b>Methods:</b> We conducted a retrospective cohort study of adult male patients insured by Clalit Health Services in Israel, who underwent either mTURP or OSP at multiple centers. Key baseline characteristics, including age, body mass index (BMI), socioeconomic status, Charlson comorbidity index score, and the incidence of urethral stricture, were collected. Postoperative urethral strictures were identified using the ICD-10 code N35.9 (urethral stricture, unspecified). <b>Results:</b> Between January 2000 and December 2021, 54,872 patients underwent simple prostatectomy across 29 hospitals, with 43,525 (79%) undergoing mTURP and 11,347 (21%) undergoing OSP. The median age of patients undergoing mTURP was 73.6 years, while those undergoing OSP had a median age of 72.1 years (<i>p</i> < 0.0001). The incidence of urethral strictures was 1.15% (500) following mTURP and 0.538% (61) following OSP, with an incidence rate ratio (IRR) of 2.139 (<i>p</i> < 0.0001). On multivariable analysis, factors associated with the development of urethral stricture included the type of procedure (HR = 2.349, 95% CI: 2.081-2.653, <i>p</i> < 0.0001), older age at surgery (HR = 1.012, 95% CI: 1.007-1.018, <i>p</i> < 0.0001), higher Charlson Index score (HR = 1.128, 95% CI: 1.109-1.148, <i>p</i> < 0.0001), and lower BMI (HR = 0.990, 95% CI: 0.982-0.999, <i>p</i> = 0.027). <b>Conclusions:</b> Our study highlights a higher incidence of urethral stricture following mTURP compared to OSP. Additionally, older age and a higher Charlson comorbidity index were associated with increased risk of stricture development postsurgery.