TRANSVERSE FIBROUS BAR IN PROSTATIC URETHRA AFTER TRANSURETHRAL PROSTATECTOMY METE K ˙ ILC ˙ ILER, EM ˙ IN AYDUR, ˙ IBRAH ˙ IM YILDIRIM, YAS  AR ¨ OZG ¨ OK, DOGAN ERDURAN AND C  ET ˙ IN HARMANKAYA From the Department of Urology, Gu ¨ lhane Military Medical Academy, School of Medicine, Ankara, Turkey KEY WORDS: transurethral resection of prostate, urethral obstruction, bladder neck obstruction, adhesions Transurethral prostatic resection is now considered the gold standard for surgical treatment of obstructing benign prostatic hyperplasia. However, transurethral prostatic re- section is associated with several perioperative and postop- erative complications. We describe the development of a transverse fibrous bar within the prostatic urethra, resulting from transurethral prostatic resection, with interesting en- doscopic images. To our knowledge this condition has not been reported previously. CASE REPORT A 71-year-old man presented with obstructive voiding symp- toms 3 years after transurethral prostatic resection docu- mented nodular hyperplasia. Digital rectal examination, uri- nalysis and ultrasound were unremarkable. Uroflowmetry measurements were performed and peak flow rate was 9.7 ml. per second, which was considered to be low based on the pa- tient’s age. Post-void residual urine volume was not significant. Urethrocystoscopy performed with the patient under gen- eral anesthesia revealed minimal prostatic obstruction with a transverse fibrous synechia that divided the bladder outlet into 2 openings just anterior to the bladder neck within the prostatic urethra (part A of figure). The synechia was incised with a cold knife and repeat transurethral prostatic resection was performed (part B of figure). A urethral catheter was placed, which was removed on postoperative day 3. One month after the procedure clinical and uroflowmetry im- provements, including a peak flow rate of 19.6 ml. per second above baseline, were seen. The patient remained continent and continued to do well. DISCUSSION Bladder neck contracture and urethral stricture are the most common late complications of transurethral prostatic resection. Although the causes are not understood com- pletely, these conditions are part of an obliterative process resulting from fibrosis and the effect of distraction of the urethra and bladder neck during transurethral prostatic re- section. 1, 2 However, urethral synechia formation is not en- countered in every patient who undergoes transurethral prostatic resection. In our case this condition was found because of obstructive symptoms, possibly due to insufficient prostatic resection. We do not know which factors contrib- uted to the development of this condition in the absence of urethral stricture and especially bladder neck contracture. Several risk factors have been considered as having a possible role in the development of bladder neck contracture and ure- thral stricture after transurethral prostatic resection, including postoperative infection, patient age, duration of postoperative catheterization, histological nature of the disease and electrical injury caused by application of greater than critical power den- sity. 3 In particular, cigarette smoking has been reported as a strong predictor. Preoperative co-morbidities associated with microvascular disease may also contribute to the development of bladder neck contracture by altering tissue healing at the bladder neck after radical transurethral prostatic resection. 2 On the other hand, bladder neck contracture commonly occurs in men who have a relatively small opening at the bladder neck and a small prostate at the time of resection. In this case we named the condition “transverse fibrous bar” due to the physical hindrance it presented, as well as its shape, in a patient with reported risk factors for urethral stricture and bladder neck contracture, including cigarette smoking, athero- sclerotic vascular disease, a relatively small opening at the bladder neck and a small prostate at the time of primary resec- tion. To our knowledge this is the first reported case of a trans- verse fibrous bar developing in the prostatic urethra as a result of transurethral prostatic resection. REFERENCES 1. Zwergel, U., Wullich, B., Lindenmeir, U., Rohde, V. and Zwergel, T.: Long-term results following transurethral resection of the prostate. Eur Urol, 33: 476, 1998 2. Borboroglu, P. G., Sands, J. P., Roberts, J. L. and Amling, C. L.: Risk factors for vesicourethral anastomotic stricture after rad- ical prostatectomy. Urology, 56: 96, 2000 3. Balbay, M. D., Ergen, A., Sahin, A., Lekili, M., Ulucay, S. and Karaagaoglu, E.: Development of urethral stricture after transurethral prostatectomy: a retrospective study. Int Urol Nephrol, 24: 49, 1992 Accepted for publication January 18, 2002. A, endoscopic appearance of transverse fibrous bar. B, incision of fibrous bar. 0022-5347/02/1676-2530/0 THE JOURNAL OF UROLOGY ® Vol. 167, 2530, June 2002 Copyright © 2002 by AMERICAN UROLOGICAL ASSOCIATION,INC. ® Printed in U.S.A. 2530