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

Urethral stricture (US) is a clinically relevant late complication of transurethral resection of the prostate (TURP), and identifying associated factors may improve perioperative assessment. We conducted a retrospective case–control study of patients who underwent TURP for benign prostatic hyperplasia between 2015 and 2024. Of 578 patients, 469 met the eligibility criteria, including 57 with cystoscopy-confirmed US, corresponding to an incidence of 12.2% among eligible patients. A simple random sample of 50 cases and 150 controls was analyzed using bivariable and multivariable logistic regression. Older age (aOR 1.08, 95% CI 1.01–1.15), higher neutrophil-to-lymphocyte ratio (aOR 2.01, 95% CI 1.19–3.63), prior catheterization (aOR 3.11, 95% CI 1.13–8.77), monopolar TURP (aOR 4.10, 95% CI 1.60–11.56), postoperative urinary tract infection (aOR 7.18, 95% CI 2.72–19.95), and longer postoperative catheterization (aOR 1.47, 95% CI 1.22–1.83) were independently associated with US. Prostate volume was also associated with US, with a significant non-linear relationship in restricted cubic spline analysis (global p = 0.0105; non-linear component p = 0.0392), whereas operating time was not independently associated. These findings identify several clinical and perioperative factors associated with post-TURP US, although they should be interpreted cautiously and validated in larger populations.