Currently, transurethral resection (TURP) and endoscopic enucleation of the prostate (EEP) are the ”gold” standards of endoscopic surgery for benign prostatic obstruction (BPO). Nonetheless, many complications such as bladder neck contracture (BNC) steel occurs after endoscopic surgery for benign prostatic obstruction (BPO). There are many theories and risk factors concerning development of bladder neck contracture. This study aims to determine the main risk factor of postoperative BNC by providing a retrospective analysis the groups of patients who have underwent endoscopic prostate resection and enucleation.

We retrospectively analyzed the complication reports of 458 patients, who underwent TURP and EEP for symptomatic BPH during the period 2016-2019. Patients are divided in two groups:  TURP group (n-213) and EEP group (n-245).  The patients in all two groups had comparable characteristics (IPSS, Qmax, PVR, prostate volume, urine tract infection) before surgery. All interventions are performed by single expertise surgeon, using two- and tree lobe enucleation techniques and bipolar energy for TURP.  During endoscopic enucleations of the prostate were clear seen and separated bladder neck structures, avoiding their damage. Following perioperative and follow-up clinical data being collected.

After TURP and EEP were observed the following intraoperative and early postoperative complications: severe hemorrhage in 4 (1.9%), 0 (0%), bladder neck injury in 7 (3,9%), 0 (0%), fever due to UTI in 3 (1.4%), 2 (0,8%), the bladder tamponade in 2 (0.9%), 1 (0.4%) and acute urinary retention in 8 (3.7%), 5 (2%) patients, respectively. At 6 months’ follow-up, patients in all groups had a significant improvement from baseline in IPSS, Qmax, and PVR. In both TURP and EEP groups were included the late complications: urethral stricture n-2 (0,94%) and n-1 (0,4%), stress incontinence n-1 (0,47%) and n-4 (1,6%), continuing urine tract infection n-16 (7,5%) and n-22 (8,9%), respectively.  Bladder neck contracture in the postoperative period were diagnosed in 3 (1,4%) patients after TURP and no such complication recorded in EEP group.

Correctly performed endoscopic enucleation of the prostate preserves the bladder neck by clear identification of plane between adenomas and surgical capsule. In contrast, transurethral resection of BPH may overcut and damage bladder neck due to difficulties in differentiation of underlying structures.  In our opinion, other risk factors, such as prostate volume, UTI are minor and worsening ones. But these statements are required further well-designed research in a large cohort of patients.

Preserving the bladder neck during endoscopic surgical treatment is key point in avoiding of its contracture.