Early urinary retention after catheter removal following radical prostatectomy predicts for future symptomatic urethral stricture formation

Abstract

Objectives: Urinary retention after urethral catheter removal is a well-established complication of radical prostatectomy (RP). Its effect on subsequent urethral stricture formation has not been established. The objective of this study was to evaluate the association between post-RP early urinary retention (EUR) and subsequent symptomatic urethral stricture formation.

Methods: A total of 1289 patients who underwent RP from January 1998 to November 2004 at our tertiary medical center were included in a prospective database project. EUR was defined as that which occurred 7 days or earlier after urethral catheter removal and was identified by retrospective chart review. Multivariate logistic regression models were constructed to evaluate the association between EUR and symptomatic urethral stricture formation.

Results: Of the 1289 patients, 44 (3.4%) experienced EUR, and 16 of these patients (36.4%) developed symptomatic urethral strictures. The stricture rate for patients without EUR was 9.0% (112 of 1245). Compared with the patients without EUR, the patients with EUR had a greater rate of bladder neck contracture (94% versus 68%, P = 0.04) and exhibited a significantly decreased time to stricture formation (1.6 months versus 3.0 months, P = 0.002). After adjusting for patient age, clinical stage, surgeon, and Gleason score, the odds of developing a symptomatic urethral stricture were 4.7 times greater in the patients with EUR (95% confidence interval 2.3 to 9.6).

Conclusions: The results of this study have shown that patients with EUR after RP are at a significantly greater risk of developing symptomatic urethral strictures, tend to form bladder neck contractures instead of more distal strictures, and to form strictures sooner after surgery. EUR might be a previously unrecognized risk factor for the development of post-RP urethral stricture.