Six-Month Urethral Outcomes After Intraoperative Accessory Access Maneuvers for a Narrow Urethra During Anatomical Endoscopic Enucleation of the Prostate: A Prospective Single-Arm Cohort Study

Abstract Purpose Postoperative urethral stricture occurs in 1.4%–4.4% of patients after anatomical endoscopic enucleation of the prostate (AEEP), but the impact of the intraoperative maneuvers required to overcome a narrow urethra is unknown. We assessed whether urethral caliber deteriorates within 6 months after these maneuvers. Methods Single-center, prospective, single-arm cohort study (July–December 2025). Consecutive AEEP patients were staged intraoperatively with the Purohit-Blaivas scale; those with Stage 1–2 narrowing requiring an accessory maneuver (Béniqué dilation, resectoscope downsizing, meatotomy, or internal urethrotomy) were included. Flexible cystoscopy was repeated at 6 months. Paired changes were compared using the Wilcoxon signed-rank test. Results Of 518 patients screened, 36 (7.0%) were included, with 40 treated stricture sites. Dilation was the most frequent maneuver (31/40, 77.5%). At 6 months, 16 sites (40.0%) downstaged, 19 (47.5%) remained stable, and 5 (12.5%; 95% CI 4.2–26.8%) worsened (p = 0.041). Four worsened sites were asymptomatic (Stage 1→2); one patient (2.8%; 95% CI 0.1–14.5%) progressed to Stage 4 after meatotomy and required surgical reconstruction. IPSS improved from 23.0 to 8.0 (n = 31) and Qmax from 9.9 to 19.0 mL/s (n = 30) (both p < 0.001). Conclusion Most Stage 1–2 urethral narrowings downstaged or remained stable 6 months after accessory maneuvers during AEEP, and clinically significant stricture was uncommon. Comparative studies with longer follow-up are warranted.