Benign prostatic hyperplasia (BPH), which causes lower urinary tract symptoms (LUTS), is a common diagnosis among the ageing male population with increasing prevalence.[1]

The symptoms can be obstructive (resulting in urinary hesitancy, weak stream, straining or prolonged voiding) or irritative (resulting in increased urinary frequency and urgency, nocturia, urge incontinence and reduced voiding volumes), or can affect the patient after micturition (for example, postvoid dribble or incomplete emptying). [1] Transurethral resection of the prostate (TURP) has been the gold-standard therapy for severe benign prostatic hyperplasia [2],[3] The incidence of urethral strictures after monopolar prostate resection varies between 2.2% and 9.8% [4] Urethral stricture is common complication of transurethral resection of the prostate and is more common with 26Fr resectoscope[5].

To minimize such complications, usual practice before starting TURP is to do OTIS urethrotomy. It may reduce chances of possible stricture urethra but it also damages healthy mucosa. OTIS urethrotomy further increases post operative pain and discomfort.[5],[6] External urethral meatus is narrowest part of urethra[8]. By dilating meatus OTIS urethrotomy can be avoided thereby improving feasibility for 26 Fr resectoscope. Thus, avoiding injury to other parts of urethra.[9]

In our study we have compared postoperative outcomes following OTIS urethrotomy versus meatal dilatation before TURP.

Inclusion criteria:

Patient undergoing TURP with 26 Fr resectoscope willing to participate in study

Exclusion criteria:

1. Patients with associated urethral pathology.
2. Patients with associated neurogenic urinary bladder conditions

Patient were evaluated for post operative pain using pain scale

Catheter removal was done on postoperative day two

Patient were followed up at 1 month and at 3 months after surgery with uroflowmetry

• Total 72 patients were enrolled in our study.
• Thirty-six patients were enrolled in two groups. First group underwent OTIS urethrotomy and second group underwent meatal dilatation.
• Average age for OTIS urethrotomy group was 67 years and that of meatal dilatation was 64 years
• In postoperative period only two patients experienced severe discomfort who was from OTIS urethrotomy group

Uroflowmetry Qmax assessment on follow-up at first and third month. At first month after surgery 4 patients from OTIS urethrotomy group had reduced maximum urine flow rate while 8 patients from meatal dilatation had reduced maximum urine flow rate below 15 ml/sec.

After three months of surgery two more patients from meatal dilatation group with total 10 patients developed reduced maximum flow rate below 15ml/sec. Also, two patients from meatal dilatation group had maximum urine flow rate below 10ml/sec.

Benign prostatic hyperplasia (BPH) is common problem in ageing men causing Lower urinary tract symptoms [10]. Transurethral resection prostate (TURP) is gold standard treatment for BPH [11]. Most common complication of TURP is formation of stricture urethra [12]. Amongst many causes size of resectoscope tightly fitting urethra causing ischemic injury is common cause of formation stricture urethra [13]. OTIS urethrotomy is standard procedure before TURP to avoid this complication but it may lead to postoperative discomfort. External urethral meatus being narrowest part of urethra only dilating external urethral meatus will avoid OTIS urethrotomy.

In our study we compared both OTIS urethrotomy group and meatal dilatation group on basis of immediate postoperative pain and discomfort and on followup with help of uroflowmetry to assess stricture formation with average followup of 3 months In immediate postoperative period OTIS urethrotomy had more pain and discomfort compared to meatal dilatation which is comparable to study by Steenfos HH et. al.[7] On followup study at 3 months results were comparable with slightly more preponderance to form stricture in meatal dilation group which is comparable with study by Schultz A et.al.[5] and Walton JK et. al.[9]

• OTIS urethrotomy will lead to more postoperative discomfort
• There is high chance of development of stricture urethra after meatal dilatation alone before TURP.

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12. Rassweiler J, Teber D, Kuntz R, Hofmann R. Complications of transurethral resection of the prostate (TURP)—incidence, management, and prevention. European urology. 2006 Nov 1;50(5):969-80.
13. Günes M, Keles MO, Kaya C, Koca O, Sertkaya Z, Akyüz M, Altok M, Umul M, Karaman MI. Does resectoscope size play a role in formation of urethral stricture following transurethral prostate resection?. International braz j urol. 2015;41(4):744-9.