Development of predictive model for urethral stricture after ThuLEP and TURP

doi:10.3877/cma.j.issn.1674-3253.2026.05.007

Abstract

Abstract:

Objective

To compare the efficacy of transurethral thulium laser enucleation of the prostate (ThuLEP) with transurethral resection of the prostate (TURP), and to develop a nomogram-based prediction model for urethral stricture occurrence based on the outcomes of these two procedures.

Methods

The clinical data of 174 patients with benign prostatic hyperplasia were retrospectively analyzed. The observation group (n=95) underwent ThuLEP, while the control group (n=79) underwent TURP. Perioperative indicators, including operation time, indwelling catheterization duration, hospital stay, and hospitalization cost were collected. At six months postoperatively, the international prostate symptom score (IPSS), quality of life (QOL), and incidence of urethral stricture were assessed. Logistic regression analysis was performed to identify risk factors for urethral stricture, and a predictive nomogram model was established. The model's performance was evaluated using the receiver operating characteristic (ROC) curve, calibration curve, and clinical decision curve.

Results

Both groups successfully completed their respective surgeries and were discharged without complications. Compared with the TURP group, the ThuLEP group demonstrated less hospitalization cost, shorter hospital stay, and shorter operation time. No significant difference was observed in indwelling catheterization duration between the two groups. Additionally, there was no significant difference in the incidence of postoperative urethral stricture between the ThuLEP and TURP groups. Preoperative IPSS, prostate size, operation time, and catheter placement duration were identified as independent risk factors for urethral stricture, and a nomogram-based prediction model was developed accordingly.

Conclusions

ThuLEP demonstrates superior efficacy compared to TURP, with less medical cost and shorter operation time. Furthermore, a predictive model incorporating preoperative IPSS, prostate size, operation time, and catheter placement duration can effectively estimate the probability of postoperative urethral stricture.

Key words: Thulium laser enucleation of the prostate, Transurethral resection of the prostate, Urethral stricture, Nomogram

Siguo Ling, Jun Yang, Xuhua Qiao. Development of predictive model for urethral stricture after ThuLEP and TURP[J]. Chinese Journal of Endourology(Electronic Edition), 2026, 20(05): 534-541.

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References 29

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指标	例数	年龄(岁)	前列腺体积(cm³)	IPSS评分	QOL评分
TURP组	79	72.01±7.15	117.00±25.04	19.94±4.74	4.86±0.69
ThuLEP组	95	73.49±6.97	115.61±25.35	19.48±4.90	4.80±0.65
t值		-1.378	0.362	0.618	0.594
P值		0.170	0.718	0.538	0.553

指标	例数	年龄(岁)	前列腺体积(cm³)	IPSS评分	QOL评分
TURP组	79	72.01±7.15	117.00±25.04	19.94±4.74	4.86±0.69
ThuLEP组	95	73.49±6.97	115.61±25.35	19.48±4.90	4.80±0.65
t值		-1.378	0.362	0.618	0.594
P值		0.170	0.718	0.538	0.553

组别	例数	住院费用[万元，M(Q)]	手术时间[min，(±s)]	尿管留置天数[d，(±s)]	术后IPSS评分[M(Q)]	住院天数[d，(±s)]	术后QOL评分[M(Q)]	尿道狭窄发生率[例（%）]
TURP	79	1.39(1.22，1.67)	97.65±21.28	5.09±0.92	7.0 (4.0，10.0)	11.51±3.68	1.0 (1.0，3.0)	10 (12.7)
ThuLEP	95	1.27(1.14，1.54)	74.93±12.47	5.02±0.91	3.0 (2.0，7.0)	10.45±3.20	0 (0，2.0)	7 (7.4)
统计值		Z=-2.921	t=8.756	t=0.484	Z=-3.348	t=1.993	Z=-3.829	χ²=0.835
P值		0.003	<0.001	0.629	0.001	0.048	<0.001	0.361

组别	例数	住院费用[万元，M(Q)]	手术时间[min，(±s)]	尿管留置天数[d，(±s)]	术后IPSS评分[M(Q)]	住院天数[d，(±s)]	术后QOL评分[M(Q)]	尿道狭窄发生率[例（%）]
TURP	79	1.39(1.22，1.67)	97.65±21.28	5.09±0.92	7.0 (4.0，10.0)	11.51±3.68	1.0 (1.0，3.0)	10 (12.7)
ThuLEP	95	1.27(1.14，1.54)	74.93±12.47	5.02±0.91	3.0 (2.0，7.0)	10.45±3.20	0 (0，2.0)	7 (7.4)
统计值		Z=-2.921	t=8.756	t=0.484	Z=-3.348	t=1.993	Z=-3.829	χ²=0.835
P值		0.003	<0.001	0.629	0.001	0.048	<0.001	0.361

变量	类型	数量	OR	95%CI	P值
前列腺大小	数值变量	174	0.953	0.935～0.973	<0.001
手术时间	数值变量	174	0.957	0.935～0.980	<0.001
术前IPSS	数值变量	174	0.822	0.736～0.918	<0.001
留置尿管时间	数值变量	174	0.533	0.318～0.894	0.017

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