Risk Factors for Urethral Stricture After Transurethral Resection of the Prostate for Benign Prostatic Hyperplasia: A Case–Control Study

Abstract Background: The clinical relevance of urethral stricture (US) as a late complication after transurethral resection of the prostate (TURP) underscores the need to better understand its associated factors in contemporary practice. The aim was to evaluate demographic, clinical, and perioperative factors associated with post-TURP US for benign prostate hyperplasia (BPH). Materials and Methods: A case–control study was conducted including patients who underwent TURP for BPH between 2015 and 2024. From a cohort of 578 patients, 50 cases with confirmed US and 150 controls without stricture were randomly selected. Demographic variables, comorbidities, hematological markers, preoperative, perioperative, and postoperative factors were analyzed. Bivariate and multivariate logistic regression analyses were performed to estimate OR. The discriminative capacity of significant numerical variables was calculated using ROC curves Results: The incidence of US was 10.9%. Multivariate analysis identified older age (aOR: 1.08; 95% CI: 1.01–1.15), larger prostate volume (aOR: 1.03; 95% CI: 1.01–1.05), history of urinary catheterization (aOR: 2.96; 95% CI: 1.05–8.32), monopolar TURP (aOR: 4.38; 95% CI: 1.59–12.08), postoperative urinary tract infection (aOR: 6.98; 95% CI: 2.57–19.01), and longer postoperative catheterization duration (aOR: 1.46; 95% CI: 1.19–1.80) as independent associated factors. Postoperative catheter duration showed the highest discriminative ability (AUC: 0.724), with an optimal cutoff ≥8.5 days. Conclusions: Post-TURP US is associated with multiple clinical and surgical factors. Postoperative catheterization duration emerged as the most clinically useful and potentially modifiable factor, highlighting the importance of optimizing catheter management and preventing postoperative urinary tract infections.