Transurethral Resection of the Prostate (TURP) is the gold standard for surgical management of bladder outlet obstruction caused by Benign Prostatic Hyperplasia (BPH). Despite its efficacy, urethral stricture remains a notable postoperative complication, with reported incidence ranging from 2.2–9.8%. Preventive strategies such as urethral dilatation are proposed to mitigate this risk. This study aims to evaluate the effectiveness of urethral dilatation in preventing urethral stricture formation post-TURP.

This randomized controlled trial was conducted between May 2023 and May 2024 at RSUP Dr. Johannes Leimena and Siloam Hospital Ambon. A total of 236 male patients aged 50–80 years with urinary retention due to BPH who underwent urinary catheterization prior to TURP were included. Participants were randomized into two groups: the intervention group underwent urethral dilatation before TURP, while the control group did not. TURP was performed using a standardized technique by a single operator. The primary outcome was the incidence of urethral stricture within 12 months postoperatively, assessed using the International Prostate Symptom Score (IPSS), Visual Prostate Symptom Score (VPSS) and retrograde urethrogram (RUG)

Among the 236 participants, 121 (51.3%) underwent urethral dilatation and 115 (48.7%) did not. Urethral stricture developed in 24 patients (10.2%), with the most common site being the bulbar urethra (75%), followed by membranous and penile segments. Urethral dilatation was not significantly associated with a reduced risk of urethral stricture (Relative Risk [RR] 0.922; 95% Confidence Interval [CI] 0.85–1.01; p = 0.064). Prostate volume ≥40 cc was significantly associated with increased risk of urethral stricture (RR 1.144; 95% CI 1.08–1.21; p = 0.011). No significant association was found between age and stricture formation (RR 0.995; 95% CI 0.88–1.12; p = 1.000).

The incidence of urethral stricture post-TURP was significantly correlated with the prostate volume. However, The age and urethral dilatation had no significant relationship with urethral stricture post-TURP. Further study is needed with a longer study duration and more generalized.