Factors Associated with Urethral Stricture Post-Transurethral Resection of the Prostate for Benign Prostatic Hyperplasia: A Case-Control Study

Factors Associated with Urethral Stricture Post-Transurethral Resection of the Prostate for Benign Prostatic Hyperplasia: A Case-Control Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Factors Associated with Urethral Stricture Post-Transurethral Resection of the Prostate for Benign Prostatic Hyperplasia: A Case-Control Study Gonzalo Vidangos-Paredes, Rubén Vidangos, Magdiel Gonzales-Menéndez, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8836208/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 13 You are reading this latest preprint version Abstract Background: The clinical relevance of urethral stricture (US) as a late complication after transurethral resection of the prostate (TURP) underscores the need to better understand its associated factors in contemporary practice. The aim was to evaluate demographic, clinical, and perioperative factors associated with post-TURP US for benign prostate hyperplasia (BPH). Materials and Methods: A case–control study was conducted including patients who underwent TURP for BPH between 2015 and 2024. From a cohort of 578 patients, 50 cases with confirmed US and 150 controls without stricture were randomly selected. Demographic variables, comorbidities, hematological markers, preoperative, perioperative, and postoperative factors were analyzed. Bivariate and multivariate logistic regression analyses were performed to estimate OR. The discriminative capacity of significant numerical variables was calculated using ROC curves Results: The incidence of US was 10.9%. Multivariate analysis identified older age (aOR: 1.08; 95% CI: 1.01–1.15), larger prostate volume (aOR: 1.03; 95% CI: 1.01–1.05), history of urinary catheterization (aOR: 2.96; 95% CI: 1.05–8.32), monopolar TURP (aOR: 4.38; 95% CI: 1.59–12.08), postoperative urinary tract infection (aOR: 6.98; 95% CI: 2.57–19.01), and longer postoperative catheterization duration (aOR: 1.46; 95% CI: 1.19–1.80) as independent associated factors. Postoperative catheter duration showed the highest discriminative ability (AUC: 0.724), with an optimal cutoff ≥8.5 days. Conclusions: Post-TURP US is associated with multiple clinical and surgical factors. Postoperative catheterization duration emerged as the most clinically useful and potentially modifiable factor, highlighting the importance of optimizing catheter management and preventing postoperative urinary tract infections. Urethral Stricture Benign Prostatic Hyperplasia Transurethral Resection of Prostate Urinary Catheterization Figures Figure 1 Figure 2 Figure 3 Introduction Benign prostatic hyperplasia (BPH) is a public health problem in the male population, especially in men over 60 years of age [ 1 ]. Transurethral resection of the prostate (TURP) remains the treatment of choice for symptomatic cases and is one of the most frequently performed urological procedures worldwide. However, despite being a safe and effective technique, it is not without complications, with urethral stricture (US) being one of the most significant. This is a late complication that can cause urinary obstruction, undoubtedly affecting quality of life [ 2 ]. In the Peruvian context, BPH represents the main demand for urology services in the country, being a significant cause of hospitalization. Therefore, the appearance of a concomitant complication prolongs hospital stay and increases healthcare costs [ 3 ]. The incidence of US after TURP varies widely in the literature, with reported rates between 1.5% and 19% [ 4 ]. Several studies have proposed prolonged operative time, comorbidities [ 5 ], resection ratio [ 6 , 7 , 8 ], prior catheterization [ 9 ] and duration of postoperative catheterization as possible risk factors [ 2 , 10 ]. However, the heterogeneity of results prevents reaching a definitive consensus on the risk factors involved. Despite the clinical relevance of this complication, the available evidence in Peru is limited, with few studies associating risk factors with the development of this complication, which hinders clinical decision-making at the local level. Therefore, the objective of this study was to determine the factors associated with the development of post-TURP US due to BPH. Materials and Methods Type and Design A case–control study was conducted including patients who underwent TURP for BPH between 2015 and 2024 in a tertiary-level hospital in Peru. This study was reported in accordance with the STROBE statement for observational studies. Population and Sample The study population consisted of 578 patients. The sample size was determined using the formula proposed by Díaz et al. [ 11 ], based on previous catheterization as the exposure variable [ 12 ]. Assuming an exposure prevalence of 16.33%, an odds ratio (OR) of 2.98, 80% statistical power, and a 5% margin of error, a 1:3 case–control ratio was established. Fifty cases and 150 controls were selected through simple random sampling. Eligibility criteria Cases were defined as patients who underwent TURP and developed US confirmed by cystoscopy, with pathology-confirmed BPH and complete medical history. Controls were defined as patients who underwent the same procedure and did not develop US during follow-up. For both group, exclusion criteria were history of malignancy, US of other etiologies, follow-up of less than 3 months, and patients who underwent laser TURP. Variables and Operational Definition The variables were extracted from the medical records and grouped as follows: Demographic factors: geographic origin and age Comorbidities: hypertension, diabetes mellitus (DM), chronic obstructive pulmonary disease (COPD), and anemia Hematological markers: neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and prostate-specific antigen (PSA) Preoperative factors: prostate volume (PV), use of nonsteroidal anti-inflammatory drugs (NSAIDs), and prior catheterization Perioperative factors: energy type (monopolar or bipolar), operative time Postoperative factors: postoperative urinary tract infection (UTI) and catheter duration. For hematological markers and PV, the most recent blood test and ultrasound prior to surgery were used, respectively. For NSAID and prior catheterization, one month and one year prior to surgery were considered, respectively. For energy type, were considered: monopolar (M-TURP) and bipolar (B-TURP). Postoperative UTI was defined as a positive urine culture (> 10⁵ CFU/mL) within one month after surgery. Data Processing and Analysis Statistical analysis was performed using STATA 19.5®. For descriptive analysis, categorical variables were expressed as number and percentage. Numerical variables were expressed as mean and standard deviation (SD), and the median and interquartile range (IQR) depending on their normality distribution. Bivariate logistic regression was performed to estimate crude ORs. Multivariate analysis was performed on those variables that were significant. Furthermore, to determine the relationship between the variables, the OR was used, with a 95% confidence interval (95% CI), values not including 1 were considered statistically significant. Subsequently, cut-off points with their respective sensitivity and specificity were calculated using Receiver Operating Characteristic (ROC) curves and Area Under the Curve (AUC), only for those significant numerical variables. AI-assisted technologies statement During the preparation of this manuscript, ChatGPT (version 5.2) was used solely to assist with language editing, grammar refinement, and improvement of clarity and coherence of the text. This tool was not used for data analysis, statistical analysis, data interpretation, or generation of results. All authors critically reviewed and edited the content generated with the assistance of this tool and take full responsibility for the integrity, accuracy, and originality of the work. Results Among 578 patients undergoing TURP, 63 developed US, yielding an incidence of 10.9%. The final analytical sample included 200 patients (Fig. 1 ). As shown in Table 1 , the mean age was 67.9 ± 8.2 years, and most patients were from Lima (84.5%). Hypertension was the most frequent comorbidity (34.5%). The median NLR was 1.9 (IQR: 1.5–2.4); while PLR was 130.7 (IQR: 105.1–159.6). The medians of PSA and PV were 2.8 ng/mL (IQR: 1.6–4.3) and 58.5 cm 3 (IQR: 43.0–80.0), respectively. Additionally, only 29 patients (14.5%) received any NSAID regimen at least one month before surgery; while a history of catheter use within the year prior to surgery was observed in only 51 patients (25.5%). Furthermore, the use of bipolar energy (B-TURP) was slightly higher than monopolar (M-TURP), at 56% versus 44%, respectively. The median operative time was 85 minutes (IQR: 60–105) and the median catheter duration was 7 days (IQR: 6–9). Finally, 42 patients (21%) experienced UTI as a postoperative complication. Table 1 Descriptive analysis Frequency Percentage Urethral stricture No 150 75.0% Yes 50 25.0% Geographic origin Lima 169 84.5% Provinces 31 15.5% Age (y) 67.9 ± 8.2 HT No 131 65.5% Yes 69 34.5% DM No 161 80.5% Yes 39 19.5% COPD No 196 98.0% Yes 4 2.0% Anemia No 167 83.5% Yes 33 16.5% NLR 1.9 (1.5–2.4) PLR 130.7 (105.1–159.6) PSA (ng/mL) 2.8 (1.6–4.3) PV (cm 3 ) 58.5 (43.0–80.0) Use of NSAIDs No 171 85.5% Yes 29 14.5% Prior catheterization No 149 74.5% Yes 51 25.5% Energy B-TURP 112 56.0% M-TURP 88 44.0% Operating time (min) 85 (60.0 − 105.0) Postoperative UTI No 158 79.0% Yes 42 21.0% Catheter duration (d) 7 (6.0–9.0) Values are presented as number (%), mean ± SD, or median (IQR). HT: hypertension, DM: diabetes mellitus, COPD: chronic obstructive pulmonary disease, NLR: neutrophil-to-lymphocyte ratio, PLR: platelet-to-lymphocyte ratio, PSA: prostate-specific antigen, PV: prostate volume, NSAIDs: non-steroidal anti-inflammatory drugs, B-TURP: bipolar transurethral resection of the prostate, M-TURP: monopolar transurethral resection of the prostate, UTI: urinary tract infection. In the bivariate analysis, significant differences were observed between cases and controls for age, NLR, PLR, PSA, PV, operative time, energy type, postoperative UTI, prior catheterization, and catheter duration (p < 0.05). These variables showed significant associations in the unadjusted analysis (Table 2 ). Table 2 Bivariate analysis Urethral stricture Yes No Total OR [95% IC] p Geographic origin Lima 43 (86.0%) 126 (84.0%) 169 Ref Provinces 7 (14.0%) 16 (16.0%) 31 0.85 [0.34–2.12] 0.735 Age (y) 70.7 ± 8.6 66.9 ± 7.8 67.9 ± 8.2 1.06 [1.01–1.10] 0.005 HT No 33 (66.0%) 98 (65.3%) 131 Ref 0.932 Yes 17 (34.0%) 52 (34.7%) 69 0.97 [0.49–1.90] DM No 38 (76.0%) 123 (82.0%) 161 Ref 0.354 Yes 12 (24.0%) 27 (18.0%) 39 1.43 [0.67–3.11] COPD No 49 (98.0%) 147 (98.0%) 196 Ref 1.000 Yes 1 (2.0%) 3 (2.0%) 4 1.00 [0.10–9.84] Anemia No 38 (76.0%) 129 (86.0%) 167 Ref 0.099 Yes 12 (24.0%) 21 (14.0%) 33 1.93 [0.87–4.30] NLR 2.30 (1.7–2.7) 1.85 (1.4–2.2) 1.9 (1.5–2.4) 2.18 [1.44–3.30] < 0.001 PLR 144.4 (113.6–182.5) 128.8 (103.8–154.9) 130.7 (105.1–159.6) 1.01 [1.00–1.02] 0.020 PSA (ng/mL) 3.6 (2.0–5.7) 2.5 (1.4–4.1) 2.8 (1.6–4.3) 1.11 [1.03–1.21] 0.009 PV (cm 3 ) 69 (53–93) 56 (42–76) 59 (43–80) 1.02 [1.00–1.03] 0.012 Use of NSAIDs No 44 (88.0%) 127 (84.7%) 171 Ref 0.562 Yes 6 (12.0%) 23 (15.3%) 29 0.75 [0.29–1.97] Prior catheterization No 25 (50.0%) 124 (82.7%) 149 Ref < 0.001 Yes 25 (50.0%) 26 (17.3%) 51 4.80 [2.38–9.58] Energy B-TURP 19 (38.0%) 93 (62.0%) 112 Ref 0.003 M-TURP 31 (62.0%) 57 (38.0%) 88 2.66 [1.38–5.15] Operating time (min) 95 (75–100) 80 (55–100) 85 (60–105) 1.02 [1.01–1.03] 0.001 Postoperative UTI No 23 (46.0%) 135 (90.0%) 158 Ref < 0.001 Yes 27 (54.0%) 15 (10.0%) 42 10.56 [4.89–22.83] Catheter duration (d) 7 (6–8) 9 (7–11) 7 (6–9) 1.47 [1.25–1.72] < 0.001 Values are presented as number (%), mean ± SD, or median (IQR) OR was calculated by univariate logistic regression; the p –value corresponds to the test of comparison between groups. OR: odds ratio, 95% IC: 95% confidence level, p : p –value, HT: hypertension, DM: diabetes mellitus, COPD: chronic obstructive pulmonary disease, NLR: neutrophil-lymphocyte ratio, PLR: platelet-lymphocyte ratio, PSA: prostate-specific antigen, PV: prostate volume, NSAIDs: non-steroidal anti-inflammatory drugs, B-TURP: bipolar transurethral resection of the prostate, M-TURP: monopolar transurethral resection of the prostate, UTI: urinary tract infection. For multivariate analysis, logistic regression was used with the variables age, NLR, PLR, PSA, PV, prior catheterization, energy type, operative time, postoperative UTI, and catheter duration (Table 3 ). Independent factors associated with US were age (aOR: 1.08; 95% CI: 1.01–1.15), prostate volume (aOR: 1.03; 95% CI: 1.01–1.05), prior catheterization (aOR: 2.96; 95% CI: 1.05–8.32), monopolar TURP (aOR: 4.38; 95% CI: 1.59–12.08), postoperative UTI (aOR: 6.98; 95% CI: 2.57–19.01), and catheter duration (aOR: 1.46; 95% CI: 1.19–1.80). However, NLR showed a trend towards significance (p = 0.066) (Fig. 2 ). Table 3 Multivariate analysis aOR [95% CI] p Age 1.08 [1.01–1.15] 0.017 NLR 1.83 [0.96–3.49] 0.066 PLR 1.00 [0.99–1.01] 0.553 PSA 1.01 [0.90–1.14] 0.885 PV 1.03 [1.01–1.05] 0.011 Prior catheterization No Ref Yes 2.96 [1.05–8.32] 0.040 Energy B-TURP Ref M-TURP 4.38 [1.59–12.08] 0.004 Operating time 1.00 [0.98–1.01] 0.667 Postoperative UTI No Ref Yes 6.98 [2.57–19.01] < 0.001 Catheter duration 1.46 [1.19–1.80] < 0.001 aOR: adjusted odds ratio, 95% CI: 95% confidence interval, p : p –value, NLR: neutrophil-to-lymphocyte ratio, PLR: platelet-to-lymphocyte ratio, PSA: prostate-specific antigen, PV: prostate volume, B-TURP: bipolar transurethral resection of the prostate, M-TURP: monopolar transurethral resection of the prostate, UTI: urinary tract infection. The discriminative performance of the quantitative variables age, prostate volume, and catheter duration as predictors of post-TURP US was evaluated using ROC curves (Fig. 3 ). In Table 4 , we observed that postoperative catheter duration showed the greatest discriminatory capacity, with an AUC of 0.724 (95% CI: 0.640–0.809), indicating good predictive power. The optimal cutoff point was ≥ 8.5 days, with a sensitivity of 56% and a specificity of 78%. Age had an AUC of 0.631 (95% CI: 0.543–0.720), with an optimal cutoff point of ≥ 66.5 years, achieving a sensitivity of 70% and a specificity of 51%. Prostate volume, meanwhile, reached an AUC of 0.619 (95% CI: 0.529–0.709). The optimal cutoff point was ≥ 57.5 cm³, with a sensitivity of 66% and a specificity of 52%. Table 4 Discriminative capacity of quantitative variables associated with post-TURP urethral stricture Cut-off Sensitivity (%) Specificity (%) AUC [95% IC of AUC] Age ≥ 66.5 70 51 0.631 [0.543–0.720] Prostate volume ≥ 57.5 60 52 0.619 [0.529–0.709] Catheter duration ≥ 8.5 56 78 0.724 [0.640–0.809] AUC: Area under the curve, 95% CI: 95% confidence interval Discussion This study included a total population of 578 patients who underwent TURP for BPH. The incidence of US was 10.9%. This is consistent with the incidence reported in other international studies, where the incidence was 9.8% [ 4 ] and 10.5% [ 2 ]. The incidence in the Peruvian population is still unknown; this is one of the few studies that reports a precise estimate of the incidence in a Peruvian hospital. However, in Mexico, a similar population, Garza-Montúfar et al. [ 9 ] reported an incidence of 29%; nevertheless, this study also included bladder neck stenosis (BNS), so that incidence does not explicitly correspond to US. In our study, age was significantly associated with the development of US, with an increased risk directly proportional to increasing age. These results are consistent with the study by Wan Mokhter et al. [ 13 ], where this variable was included in their multivariate model, confirming the significant association (aOR: 1.121, 95% CI: 1.044–1.204). Similarly, Golomb et al. [ 14 ] conducted a retrospective cohort study of 43,525 patients who underwent M-TURP, identifying advanced age as an independent predictor of post-TURP US, even after adjusting for comorbidities and procedural characteristics ( p < 0.001). Therefore, the observed association could be explained by age-related degenerative changes, such as decreased urethral vascularization, reduced tissue repair capacity, and increased susceptibility to iatrogenic trauma during endoscopic instrumentation; this, coupled with immunosenescence and a decrease in the urethral mucosal defense mechanism [ 15 ]. On the other hand, previous studies such as that by Venugopalan et al. [ 4 ] demonstrated a significant association between prostate volume and urethral stricture post-TURP in unadjusted models, but only in bivariate analyses. Our study expands on this analysis, demonstrating that after multivariate analysis this variable retains its significance, reinforcing the hypothesis that prostate volume acts as an independent risk factor. This finding is consistent with the study by Wan Mokhter et al. [ 13 ], who identified that a larger prostate size was independently associated with a higher risk of urethral stricture after TURP (aOR: 1.038, 95% CI: 1.014–1.062). Elsaqa et al. [ 16 ], in their two-center study, showed similar results in their multivariate analysis (HR: 1.222, 95% CI: 1.057–1.411). Similarly, Grechenkov et al. [ 17 ] also identified this variable as an independent factor (aOR: 1.035, 95% CI: 1.009–1.061), although in these series the outcome included both US and BNS. It is known that urine extravasation into the subepithelial area following epithelial damage is part of the pathogenesis of stricture formation, as this results in inflammation, activation of fibrotic processes in the sinusoids of the corpus spongiosum, and subsequent eschar formation. Myofibroblasts are likely responsible for stricture formation, while giant cells are responsible for collagen synthesis. Type 1 collagen is responsible for the formation of the post-traumatic scar by TURP, unlike other stenoses, in which type 3 collagen is responsible [ 4 , 18 ]. Thus, a large prostate implies a longer operating time, therefore, a greater exposure to urethral trauma. Additionally, a history of urinary catheterization in the last year was observed in 25.5% of cases. This incidence is relevant, as it is one of the variables most strongly associated with US, as evidenced in a study conducted in Malaysia, where a history of catheterization had an aOR of 5.413 ( p = 0.002); furthermore, they included this variable in their predictive nomogram for post-TURP US [ 13 ]. In our country, Segovia-Quintanilla [ 12 ], found that this variable had an OR of 2.97, consistent with our results, making it a significant risk factor. Urethral exposure to catheters can cause areas of ischemia by forcefully compressing the urethral epithelium, especially when the appropriate diameter is not used, which could be involved in the development of the disease [ 19 ]. Likewise, the American Urology Association (AUA) [ 20 ] and the European Association of Urology (EUA) [ 21 ] indicate that any form of urethral instrumentation, including prior catheterization, has significant clinical relevance. This variable has been proposed as one of the strongest predictors and has been included in the AUA and EUA guidelines as one of the main risk factors to consider. Regarding the energy used, in our study, the use of monopolar energy was an independent risk factor for the development of post-TURP US, with a risk more than four times higher than that of B-TURP. Pirola et al. [ 22 ] refer to possible thermal damage from urethral exposure to electric current. This could be justified by the fact that monopolar current covers a larger area of ​​heat, increasing urethral trauma. In M-TURP, current travels from the current generator to the cutting loop, and then to the electrode on the skin. Furthermore, the heat wave produced is close to 300 watts (W), and the generated temperature reaches up to 400 degrees Celsius (°C), distributed over a large area of ​​tissue. In contrast, in B-TURP, the current starts and ends at the cutting loop. This results in a shorter circuit and lower energy intensity (170 W). Consequently, temperatures are significantly lower (40–70°C) and distributed over a smaller amount of tissue [ 10 ]. While previous studies have shown conflicting results regarding the impact of energy type on post-TURP US, most are based on unadjusted analyses. For example, a meta-analysis determined that the incidence of US was higher after TURP, particularly with monopolar energy; however, this comparison was mainly made against enucleation and ablation techniques, and not through a direct, adjusted comparison between monopolar and bipolar TURP [ 22 ]. In contrast, Komura et al. [ 23 ] found in their randomized controlled trial (RCT) that B-TURP was associated with a higher incidence of US in their unadjusted model; however, the energy type was not included in the multivariate analysis, as it was limited to identifying factors within the bipolar TURP group. Our findings provide further evidence when evaluating this factor using a multivariate model. This is the first study, to our knowledge, to identify M-TURP as an independent predictor of US. On the other hand, our study identified a postoperative UTI rate of 21%, which is considerably higher in the case group compared to the control group (54% vs. 10%, respectively). Like our results, a Nigerian study reported a 19.1% rate of symptomatic UTI post-TURP [ 15 ]. This variable was the most significant in our study, coinciding with the study by Tao et al. [ 8 ], who concluded that postoperative UTI was strongly associated with the development of post-TURP US ( p < 0.028). Previous studies have demonstrated an association between postoperative catheter duration and the development of UTI [ 2 , 10 ]; however, these studies did not include this variable in their adjusted models. Our study expands upon these results by maintaining its significance in the multivariate analysis, coinciding with Wan Mokhter et al. [ 13 ], who obtained an aOR of 2.147 ( p < 0.001) and included it in their predictive nomogram. Urethral manipulation, such as catheter use, is known to be directly related to the development of UTIs. This is demonstrated by the study by Yu et al. [ 24 ], where postoperative catheter duration was significantly related to the presence of postoperative UTIs ( p = 0.003). Similarly, Osman et al. [ 25 ] also found an association between both variables ( p = 0.007). The use of a urinary catheter promotes the upward colonization of bacteria, primarily from perianal or hospital-acquired flora. Consequently, bacteria form biofilms on the catheter surface, making them resistant to antibiotics and potentially affecting the renal parenchyma or causing life-threatening sepsis, especially considering that most patients are elderly. [ 26 ] Urinary catheterization, particularly if prolonged, can cause microlesions, ischemia, and local inflammation that strengthen the fibrotic process leading to UTI. Sustained inflammation of the lower urinary tract promotes prolonged urothelial damage. [ 25 ] In this study, the discriminative capacity of significant variables was evaluated using ROC curves. The duration of postoperative catheterization proved to have the best discriminative capacity for patients at risk of post-TURP US (AUC: 0.724), with acceptable discriminative performance. The AUC values allow for estimating the discriminative performance of each variable as an individual test. These finding positions prolonged catheterization time as a useful clinical marker for identifying patients with a higher probability of developing the complication. With a cutoff point of ≥ 8.5 days, it does not detect all cases (sensitivity 56%), but it predicts risk well (specificity 78%). This variable is useful for confirming risk rather than ruling it out. Cerda-Guerrero et al. [ 10 ] determined that for a catheterization duration of 2 days, the risk was 0.7%, for 5 days it was 3%, and for 12 days it was 46%; results that can be indirectly compared with our cutoff point. An Egyptian RCT determined that removing the catheter before 24 postoperative hours is a safe and effective strategy. Since it shortens hospital stay, reduces pain and discomfort, without increasing complications [ 27 ]. However, another study concluded that very early removal of a urinary catheter can lead to re-catheterization, especially when removed on the same day [ 28 ]. This is why it is very important to determine an appropriate cutoff point to prevent the risk of complications, considering the modifiable nature of this variable. Overall, the results support the idea that the duration of postoperative catheterization is not only an independent risk factor, but also the parameter with a clinically useful practical utility for stratifying the risk of urethral stricture after TURP. In contrast, age and prostate volume, although independently associated with the outcome, showed limited discriminatory capacity, reflecting their lower clinical utility as isolated predictors. It is important to highlight that the objective of the ROC analysis was to evaluate the individual performance of each variable and not to construct a predictive model. Therefore, AUC values ​​should be interpreted as complementary tools to multivariate analysis and not as definitive diagnostic tests. Among the limitations found in our study, we emphasize the retrospective, single-center design, which implies dependence on pre-existing medical records, with an inherent risk of selection bias, as well as a limitation on extrapolating this study to other hospital settings. Furthermore, other variables such as resectoscope caliber, catheter diameter, type of lubricant, and resection speed were not considered, which we suggest be included in future studies. Postoperative UTI was the strongest variable in our study; however, the associated pathogen was not determined in each case. Finally, the ROC curve analysis was performed on individual variables, without developing a combined predictive model, as this was not the objective of this study. However, it is important to highlight that this study represents one of the few case-contol studies conducted in Peru and in Latin America evaluating clinical and surgical factors associated with the development of post-TURP US. These findings provide relevant local evidence and suggest that optimizing potentially modifiable factors, such as catheterization duration and preventing postoperative urinary tract infections, could contribute to reducing the incidence of urethral stricture after TURP. Prospective and multicenter studies are needed. Conclusions In this study, demographic (age), preoperative (prostate volume and prior catheterization), perioperative (energy type used), and postoperative (UTI and catheter duration) factors were identified as significantly associated with a higher risk of urethral stricture after TURP for BPH. Among the variables, the duration of postoperative catheterization stands out, both as an independent risk factor and as the parameter with the greatest discriminatory capacity for identifying patients more likely to develop urethral stricture, giving it particular clinical relevance. Abbreviations AUA American Urological Association AUC Area Under the Curve BNS Bladder Neck Stenosis BPH Benign Prostatic Hyperplasia B-TURP Bipolar Transurethral Resection of the Prostate CI Confidence Interval COPD Chronic Obstructive Pulmonary Disease DM Diabetes Mellitus EAU European Association of Urology HT Hypertension IQR Interquartile Range M-TURP Monopolar Transurethral Resection of the Prostate NLR Neutrophil-to-Lymphocyte Ratio NSAIDs Nonsteroidal Anti-inflammatory Drugs OR Odds Ratio PLR Platelet-to-Lymphocyte Ratio PSA Prostate-Specific Antigen PV Prostate Volume RCT Randomized Controlled Trial ROC Receiver Operating Characteristic SD Standard Deviation STROBE Strengthening the Reporting of Observational Studies in Epidemiology TURP Transurethral Resection of the Prostate US Urethral Stricture UTI Urinary Tract Infection W Watts °C Degrees Celsius Declarations Ethics approval and consent to participate This study was approved by the Institutional Review Board of the Hospital Central de la Fuerza Aérea del Perú (approval number: NC-50-HCCE-Nº001). The requirement for informed consent was waived by the Institutional Review Board due to the retrospective nature of the study. Consent for publication Not applicable Clinical Trial Number Not applicable Availability of data and materials The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests. Funding This study was funded by Ricardo Palma University, which covered the article processing charges (RUC: 20147883952). The funder had no role in the study design, data collection, analysis, interpretation of data, or writing of the manuscript. Authors' contributions GVP, MGM, and RV contributed to the conceptualization and methodology of the study. GVP and RV were responsible for data acquisition. GVP and JMVR performed the statistical analysis and contributed to data analysis and interpretation. All authors contributed to drafting the manuscript. MGM and JMVR critically revised the manuscript for important intellectual content. JMVR obtained funding. RV provided administrative, technical, and material support. GVP, RV, and JMVR supervised the study. All authors approved the final manuscript. Acknowledgements Not applicable References Miernik A, Gratzke C. Current Treatment for Benign Prostatic Hyperplasia. Dtsch Ärztebl Int 2020;117:843-54. Afandiyev F, Ugurlu O. Factors predicting the development of urethral stricture after bipolar transurethral resection of the prostate. Rev Assoc Médica Bras 2022;68:50-5. Ugarte-Carbajal V, Vela-Ruiz JM, Guillen-Ponce R, Correa-Lopez LE, Rubin-de-Celis V, De La Cruz-Vargas JA. The Relationship Between Metabolic Syndrome and Benign Prostate Enlargement: A Case–Control Study in a Peruvian Military Hospital. Urol Res Pract 2023;49:19-24. Venugopalan A, Shanmugha Das K, Rasheed R, Cardoza F. Predictive Value of Inflammatory Markers in determining anterior urethral stricture after transurethral resection of prostate. J Med Sci Clin Res 2019;7:666-72. Gür A, Sönmez G, Demirtaş T, Tombul ŞT, Halitgil K, Demirtaş A, et al. Risk Factors for Early Urethral Stricture After Mono-Polar Transurethral Prostate Resection: A Single-Center Experience. Cureus 2021;13:e19663. Saputra D, Agil A, Mustafa A. Predictors of Urethral Stricture After Transurethral Resection of the Prostate Procedure. Majalah Kedokteran Bandung 2023;55:106-10. Tan GH, Shah SA, Ali NM, Goh EH, Singam P, Ho CCK, et al. Urethral strictures after bipolar transurethral resection of prostate may be linked to slow resection rate. Investig Clin Urol 2017;58:186-91. Tao H, Jiang YY, Jun Q, Ding X, Jian DL, Jie D, et al. Analysis of risk factors leading to postoperative urethral stricture and bladder neck contracture following transurethral resection of prostate. Int Braz J Urol 2016;42:302–11. Garza-Montúfar ME, Cobos-Aguilar H, Treviño-Baez JD, Pérez-Cortéz P. Factors Associated with Urethral and Bladder Neck Stricture After Transurethral Resection of the Prostate. J Endourol 2021;35:1400–4. Cerda-Guerrero E, Hernández-Manzo D, Ramírez-García-Luna S, Gutiérrez-Aguilera E, Zubieta-Huerta A, Cabeza-Bucio E, et al. Post-TURP urinary catheter duration as a risk factor for urethral stricture. Rev Mex Urol 2020;80:1-10. Díaz P, Fernández P. Cálculo del tamaño muestral en estudios de casos y controles. Unidad de Epidemiología Clínica y Bioestadística. Complexo Hospitalario Juan Canalejo A Coruña. Cad Aten Primaria 2002;9:148–50. Segovia-Quintanilla GS. Riesgos asociados a estenosis uretral en pacientes post prostatectomía transuretral, Hospital María Auxiliadora, enero - diciembre del 2018 [bachelor’s thesis]. Lima: Universidad Privada San Juan Bautista; 2022 Wan Mokhter WM, Duan X, Yang J, Daud MAM. Construction of a nomogram to predict urethral stricture after transurethral resection of the prostate: A retrospective cohort study. PLoS ONE 2025;20:e0313557. Golomb D, Atias M, Goldberg H, Shvero A, Kozlov Y, Rappaport YH, et al. Incidence and Predictors of Urethral Stricture Following Transurethral Resection of the Prostate and Open Simple Prostatectomy: A 21-Year Retrospective Cohort Study. J Clin Med 2025;14:3777. Amu OC, Affusim EA, Mbadiwe O, Nwachukwu DC, Anyimba SK. Postoperative Incidence of Symptomatic Urinary Tract Infection (UTI) and Microbial Pattern Seen in TURP Patients with Negative Cultures Preoperatively. Eur J Med Health Sci 2024;6:84-7. Elsaqa M, Serag M, Leenlani N, Elsawy MM, Sakr M, Youssif TA, et al. The incidence of urethral stricture and bladder neck contracture with transurethral resection vs. holmium laser enucleation of prostate: A matched, dual-center study. Can Urol Assoc J 2023;17:E35-8. Grechenkov A, Sukhanov R, Bezrukov E, Butnaru D, Barbagli G, Vasyutin I, et al. Risk factors for urethral stricture and/or bladder neck contracture after monopolar transurethral resection of the prostate for benign prostatic hyperplasia. Urol J 2018; 85:150–7. Topal K, Demirbas A, Balci A, Gercek O, Ulusoy K, Karalar M, et al. Relación entre insuficiencia cardiaca, tabaquismo y desarrollo de estenosis uretral. Cir Cir 2024;92:442–50. Mundy AR, Andrich DE. Urethral strictures. BJU Int 2011;107:6–26. Wessells H, Morey A, Vanni A, Rahimi L, Souter L. Urethral stricture disease guideline amendment (2023). J Urol 2023;210:64-71. European Association of Urology. EAU Guidelines on Urethral Strictures. Arnhem: European Association of Urology; 2024 Pirola GM, Castellani D, Lim EJ, Wroclawski ML, Le Quy Nguyen D, Gubbiotti M, et al. Urethral stricture following endoscopic prostate surgery: a systematic review and meta-analysis of prospective, randomized trials. World J Urol 2022;40:1391-411. Komura K, Inamoto T, Takai T, Uchimoto T, Saito K, Tanda N, et al. Incidence of urethral stricture after bipolar transurethral resection of the prostate using TURis: results from a randomised trial. BJU Int 2015;115:644-52. Yu SH, Jung SI, Hwang EC, Kim TH, Choi JD, Yoo KH, et al. Korean Multicenter Study of Infectious Complications after Transurethral Prostate Surgery in Patients with Preoperative Sterile Urine. Urogenit Tract Infect 2022;17:81-8. Osman T, ElSaeed KO, Youssef HA, Shabayek M, Emam A, Hussein MS. Evaluation of the risk factors associated with the development of post-transurethral resection of the prostate persistent bacteriuria. Arab J Urol 2017;15:260-6. Werneburg GT. Catheter-Associated Urinary Tract Infections: Current Challenges and Future Prospects. Res Rep Urol 2022;14:109–33. Al-Demour S, Al-Zubi MT, Ababneh M, Al-Rawashdah SF, Ahmad M. A randomized clinical trial: timing of indwelling urethral catheter removal following transurethral resection of prostate. Future Sci OA 2023;10:FSO927. Şahin C, Kalkan M. The Effect of Catheter Removal Time Following Transurethral Resection of the Prostate on Postoperative Urinary Retention. Electron J Gen Med 2011;8:280-3. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 30 Mar, 2026 Reviews received at journal 15 Mar, 2026 Reviews received at journal 10 Mar, 2026 Reviewers agreed at journal 10 Mar, 2026 Reviewers agreed at journal 05 Mar, 2026 Reviews received at journal 04 Mar, 2026 Reviewers agreed at journal 04 Mar, 2026 Reviewers agreed at journal 04 Mar, 2026 Reviewers invited by journal 04 Mar, 2026 Editor invited by journal 18 Feb, 2026 Editor assigned by journal 17 Feb, 2026 Submission checks completed at journal 17 Feb, 2026 First submitted to journal 09 Feb, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8836208","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":602660533,"identity":"2bbd50bc-ae45-460e-b4ef-cab09a2d741e","order_by":0,"name":"Gonzalo Vidangos-Paredes","email":"","orcid":"","institution":"Universidad Ricardo Palma","correspondingAuthor":false,"prefix":"","firstName":"Gonzalo","middleName":"","lastName":"Vidangos-Paredes","suffix":""},{"id":602660534,"identity":"4f36d643-5770-4aa2-bf46-fa44eeb9d6d6","order_by":1,"name":"Rubén Vidangos","email":"","orcid":"","institution":"Hospital Central de la Fuerza Aérea del Perú","correspondingAuthor":false,"prefix":"","firstName":"Rubén","middleName":"","lastName":"Vidangos","suffix":""},{"id":602660535,"identity":"7408fb02-7db4-4fbd-bb40-99f9b4849ccf","order_by":2,"name":"Magdiel Gonzales-Menéndez","email":"","orcid":"","institution":"Universidad Ricardo Palma","correspondingAuthor":false,"prefix":"","firstName":"Magdiel","middleName":"","lastName":"Gonzales-Menéndez","suffix":""},{"id":602660536,"identity":"a6812744-f1ec-4655-82d9-8cdf6997bacb","order_by":3,"name":"José M. Vela-Ruiz","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA6klEQVRIiWNgGAWjYBACxgYILcPA3oAiQFgLDwPPASK1wAAPg0QCkVqY29sfPmBss+Hhn/nG7HMBg43shgO8Bx/gdVjPGWMDxrY0HonbOcazZzCkGW84wJdsgFfLjBw2CYYzh3kYgFqYeRgOJ244wGMmgV9L+vMfDGf+88jfPAPS8h+kxfwHfi0JZgwMFQd4DG7wgLQcANuCTwfYLxIJFck8hmfSiplnGCQbzzzMl4zXYYbAEPvwwcBOTu744c3MBRV2sn3Hew9+wKulAUgkQDnMDKCgAjoPL5BH5jBDKAJaRsEoGAWjYMQBAC+CRM6BGOE9AAAAAElFTkSuQmCC","orcid":"","institution":"Universidad Ricardo Palma","correspondingAuthor":true,"prefix":"","firstName":"José","middleName":"M.","lastName":"Vela-Ruiz","suffix":""}],"badges":[],"createdAt":"2026-02-10 04:24:41","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8836208/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8836208/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":104321499,"identity":"97b27c2a-605f-4984-a6fe-44a7680c8135","added_by":"auto","created_at":"2026-03-10 13:21:03","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":140842,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFlowchart of the study population.\u003c/strong\u003e TURP: transurethral resection of the prostate, BPH: benign prostatic hyperplasia, US: urethral stricture\u003c/p\u003e","description":"","filename":"Figure1Flowchart.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8836208/v1/30c4bc3128daa53e280aae33.jpg"},{"id":104405377,"identity":"1cdb3c99-9009-496f-90b5-58943ac10464","added_by":"auto","created_at":"2026-03-11 12:22:44","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":165274,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eForest Plot of the multivariate analysis.\u003c/strong\u003e The statistically significant variables were age, prostate volume, history of catheter use, monopolar TURP, postoperative UTI, and catheter duration.\u003c/p\u003e","description":"","filename":"Figure2ForestPlot.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8836208/v1/204bda9fca503df0e3e5abea.jpg"},{"id":104321497,"identity":"ab4e3e31-419e-4b0c-9b31-719ca31a0940","added_by":"auto","created_at":"2026-03-10 13:21:03","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":68928,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eROC curves of quantitative variables associated with post-TURP urethral stricture. \u003c/strong\u003eAge (blue): AUC = 0.631, Prostate volume (red): AUC = 0.619; Catheter duration (green): AUC = 0.724.\u003c/p\u003e","description":"","filename":"Figure3ROCcurves.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8836208/v1/25c291478a8024a7c1ec1cde.jpg"}],"financialInterests":"No competing interests reported.","formattedTitle":"Factors Associated with Urethral Stricture Post-Transurethral Resection of the Prostate for Benign Prostatic Hyperplasia: A Case-Control Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eBenign prostatic hyperplasia (BPH) is a public health problem in the male population, especially in men over 60 years of age [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Transurethral resection of the prostate (TURP) remains the treatment of choice for symptomatic cases and is one of the most frequently performed urological procedures worldwide. However, despite being a safe and effective technique, it is not without complications, with urethral stricture (US) being one of the most significant. This is a late complication that can cause urinary obstruction, undoubtedly affecting quality of life [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. In the Peruvian context, BPH represents the main demand for urology services in the country, being a significant cause of hospitalization. Therefore, the appearance of a concomitant complication prolongs hospital stay and increases healthcare costs [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe incidence of US after TURP varies widely in the literature, with reported rates between 1.5% and 19% [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Several studies have proposed prolonged operative time, comorbidities [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], resection ratio [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], prior catheterization [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] and duration of postoperative catheterization as possible risk factors [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. However, the heterogeneity of results prevents reaching a definitive consensus on the risk factors involved.\u003c/p\u003e \u003cp\u003eDespite the clinical relevance of this complication, the available evidence in Peru is limited, with few studies associating risk factors with the development of this complication, which hinders clinical decision-making at the local level. Therefore, the objective of this study was to determine the factors associated with the development of post-TURP US due to BPH.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eType and Design\u003c/h2\u003e \u003cp\u003eA case\u0026ndash;control study was conducted including patients who underwent TURP for BPH between 2015 and 2024 in a tertiary-level hospital in Peru. This study was reported in accordance with the STROBE statement for observational studies.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003ePopulation and Sample\u003c/h3\u003e\n\u003cp\u003eThe study population consisted of 578 patients. The sample size was determined using the formula proposed by D\u0026iacute;az et al. [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], based on previous catheterization as the exposure variable [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Assuming an exposure prevalence of 16.33%, an odds ratio (OR) of 2.98, 80% statistical power, and a 5% margin of error, a 1:3 case\u0026ndash;control ratio was established. Fifty cases and 150 controls were selected through simple random sampling.\u003c/p\u003e\n\u003ch3\u003eEligibility criteria\u003c/h3\u003e\n\u003cp\u003eCases were defined as patients who underwent TURP and developed US confirmed by cystoscopy, with pathology-confirmed BPH and complete medical history. Controls were defined as patients who underwent the same procedure and did not develop US during follow-up. For both group, exclusion criteria were history of malignancy, US of other etiologies, follow-up of less than 3 months, and patients who underwent laser TURP.\u003c/p\u003e\n\u003ch3\u003eVariables and Operational Definition\u003c/h3\u003e\n\u003cp\u003eThe variables were extracted from the medical records and grouped as follows:\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eDemographic factors: geographic origin and age\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eComorbidities: hypertension, diabetes mellitus (DM), chronic obstructive pulmonary disease (COPD), and anemia\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eHematological markers: neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and prostate-specific antigen (PSA)\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003ePreoperative factors: prostate volume (PV), use of nonsteroidal anti-inflammatory drugs (NSAIDs), and prior catheterization\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003ePerioperative factors: energy type (monopolar or bipolar), operative time\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003ePostoperative factors: postoperative urinary tract infection (UTI) and catheter duration.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003cp\u003eFor hematological markers and PV, the most recent blood test and ultrasound prior to surgery were used, respectively. For NSAID and prior catheterization, one month and one year prior to surgery were considered, respectively. For energy type, were considered: monopolar (M-TURP) and bipolar (B-TURP). Postoperative UTI was defined as a positive urine culture (\u0026gt;\u0026thinsp;10⁵ CFU/mL) within one month after surgery.\u003c/p\u003e\n\u003ch3\u003eData Processing and Analysis\u003c/h3\u003e\n\u003cp\u003eStatistical analysis was performed using STATA 19.5\u0026reg;. For descriptive analysis, categorical variables were expressed as number and percentage. Numerical variables were expressed as mean and standard deviation (SD), and the median and interquartile range (IQR) depending on their normality distribution. Bivariate logistic regression was performed to estimate crude ORs. Multivariate analysis was performed on those variables that were significant. Furthermore, to determine the relationship between the variables, the OR was used, with a 95% confidence interval (95% CI), values not including 1 were considered statistically significant. Subsequently, cut-off points with their respective sensitivity and specificity were calculated using Receiver Operating Characteristic (ROC) curves and Area Under the Curve (AUC), only for those significant numerical variables.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eAI-assisted technologies statement\u003c/h2\u003e \u003cp\u003eDuring the preparation of this manuscript, ChatGPT (version 5.2) was used solely to assist with language editing, grammar refinement, and improvement of clarity and coherence of the text. This tool was not used for data analysis, statistical analysis, data interpretation, or generation of results. All authors critically reviewed and edited the content generated with the assistance of this tool and take full responsibility for the integrity, accuracy, and originality of the work.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eAmong 578 patients undergoing TURP, 63 developed US, yielding an incidence of 10.9%. The final analytical sample included 200 patients (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eAs shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, the mean age was 67.9\u0026thinsp;\u0026plusmn;\u0026thinsp;8.2 years, and most patients were from Lima (84.5%). Hypertension was the most frequent comorbidity (34.5%). The median NLR was 1.9 (IQR: 1.5\u0026ndash;2.4); while PLR was 130.7 (IQR: 105.1\u0026ndash;159.6). The medians of PSA and PV were 2.8 ng/mL (IQR: 1.6\u0026ndash;4.3) and 58.5 cm\u003csup\u003e3\u003c/sup\u003e (IQR: 43.0\u0026ndash;80.0), respectively. Additionally, only 29 patients (14.5%) received any NSAID regimen at least one month before surgery; while a history of catheter use within the year prior to surgery was observed in only 51 patients (25.5%). Furthermore, the use of bipolar energy (B-TURP) was slightly higher than monopolar (M-TURP), at 56% versus 44%, respectively. The median operative time was 85 minutes (IQR: 60\u0026ndash;105) and the median catheter duration was 7 days (IQR: 6\u0026ndash;9). Finally, 42 patients (21%) experienced UTI as a postoperative complication.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDescriptive analysis\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercentage\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrethral stricture\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e150\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e75.0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25.0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGeographic origin\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLima\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e169\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e84.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProvinces\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge (y)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e67.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026plusmn;\u0026thinsp;8.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHT\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e131\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e65.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e34.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDM\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e161\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e80.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e19.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCOPD\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e196\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e98.0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAnemia\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e167\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e83.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNLR\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e(1.5\u0026ndash;2.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePLR\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e130.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e(105.1\u0026ndash;159.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePSA (ng/mL)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e(1.6\u0026ndash;4.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePV (cm\u003c/b\u003e\u003csup\u003e\u003cb\u003e3\u003c/b\u003e\u003c/sup\u003e\u003cb\u003e)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e58.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e(43.0\u0026ndash;80.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eUse of NSAIDs\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e171\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e85.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePrior catheterization\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e149\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e74.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEnergy\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eB-TURP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e112\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e56.0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eM-TURP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e44.0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOperating time (min)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e(60.0 \u0026minus;\u0026thinsp;105.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePostoperative UTI\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e158\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e79.0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e21.0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCatheter duration (d)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e(6.0\u0026ndash;9.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003eValues are presented as number (%), mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD, or median (IQR).\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003eHT: hypertension, DM: diabetes mellitus, COPD: chronic obstructive pulmonary disease, NLR: neutrophil-to-lymphocyte ratio, PLR: platelet-to-lymphocyte ratio, PSA: prostate-specific antigen, PV: prostate volume, NSAIDs: non-steroidal anti-inflammatory drugs, B-TURP: bipolar transurethral resection of the prostate, M-TURP: monopolar transurethral resection of the prostate, UTI: urinary tract infection.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eIn the bivariate analysis, significant differences were observed between cases and controls for age, NLR, PLR, PSA, PV, operative time, energy type, postoperative UTI, prior catheterization, and catheter duration (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). These variables showed significant associations in the unadjusted analysis (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBivariate analysis\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eUrethral stricture\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eOR [95% IC]\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGeographic origin\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLima\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e43 (86.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e126 (84.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e169\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProvinces\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (14.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16 (16.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.85 [0.34\u0026ndash;2.12]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.735\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge (y)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e70.7\u0026thinsp;\u0026plusmn;\u0026thinsp;8.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e66.9\u0026thinsp;\u0026plusmn;\u0026thinsp;7.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e67.9\u0026thinsp;\u0026plusmn;\u0026thinsp;8.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.06 [1.01\u0026ndash;1.10]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.005\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHT\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e33 (66.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e98 (65.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e131\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.932\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17 (34.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e52 (34.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.97 [0.49\u0026ndash;1.90]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDM\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e38 (76.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e123 (82.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e161\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.354\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12 (24.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27 (18.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.43 [0.67\u0026ndash;3.11]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCOPD\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e49 (98.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e147 (98.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e196\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (2.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (2.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.00 [0.10\u0026ndash;9.84]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAnemia\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e38 (76.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e129 (86.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e167\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.099\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12 (24.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21 (14.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.93 [0.87\u0026ndash;4.30]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNLR\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.30 (1.7\u0026ndash;2.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.85 (1.4\u0026ndash;2.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.9 (1.5\u0026ndash;2.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.18 [1.44\u0026ndash;3.30]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePLR\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e144.4 (113.6\u0026ndash;182.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e128.8 (103.8\u0026ndash;154.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e130.7 (105.1\u0026ndash;159.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.01 [1.00\u0026ndash;1.02]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.020\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePSA (ng/mL)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.6 (2.0\u0026ndash;5.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.5 (1.4\u0026ndash;4.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.8 (1.6\u0026ndash;4.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.11 [1.03\u0026ndash;1.21]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.009\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePV (cm\u003c/b\u003e\u003csup\u003e\u003cb\u003e3\u003c/b\u003e\u003c/sup\u003e\u003cb\u003e)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e69 (53\u0026ndash;93)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e56 (42\u0026ndash;76)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e59 (43\u0026ndash;80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.02 [1.00\u0026ndash;1.03]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.012\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eUse of NSAIDs\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e44 (88.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e127 (84.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e171\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.562\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (12.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23 (15.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.75 [0.29\u0026ndash;1.97]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePrior catheterization\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25 (50.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e124 (82.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e149\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25 (50.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26 (17.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.80 [2.38\u0026ndash;9.58]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEnergy\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eB-TURP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19 (38.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e93 (62.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e112\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.003\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eM-TURP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31 (62.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e57 (38.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.66 [1.38\u0026ndash;5.15]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOperating time (min)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e95 (75\u0026ndash;100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e80 (55\u0026ndash;100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e85 (60\u0026ndash;105)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.02 [1.01\u0026ndash;1.03]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePostoperative UTI\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23 (46.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e135 (90.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e158\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27 (54.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15 (10.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10.56 [4.89\u0026ndash;22.83]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCatheter duration (d)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (6\u0026ndash;8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (7\u0026ndash;11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7 (6\u0026ndash;9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.47 [1.25\u0026ndash;1.72]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eValues are presented as number (%), mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD, or median (IQR)\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eOR was calculated by univariate logistic regression; the \u003cem\u003ep\u003c/em\u003e\u0026ndash;value corresponds to the test of comparison between groups.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eOR: odds ratio, 95% IC: 95% confidence level, \u003cem\u003ep\u003c/em\u003e: \u003cem\u003ep\u003c/em\u003e\u0026ndash;value, HT: hypertension, DM: diabetes mellitus, COPD: chronic obstructive pulmonary disease, NLR: neutrophil-lymphocyte ratio, PLR: platelet-lymphocyte ratio, PSA: prostate-specific antigen, PV: prostate volume, NSAIDs: non-steroidal anti-inflammatory drugs, B-TURP: bipolar transurethral resection of the prostate, M-TURP: monopolar transurethral resection of the prostate, UTI: urinary tract infection.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eFor multivariate analysis, logistic regression was used with the variables age, NLR, PLR, PSA, PV, prior catheterization, energy type, operative time, postoperative UTI, and catheter duration (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Independent factors associated with US were age (aOR: 1.08; 95% CI: 1.01\u0026ndash;1.15), prostate volume (aOR: 1.03; 95% CI: 1.01\u0026ndash;1.05), prior catheterization (aOR: 2.96; 95% CI: 1.05\u0026ndash;8.32), monopolar TURP (aOR: 4.38; 95% CI: 1.59\u0026ndash;12.08), postoperative UTI (aOR: 6.98; 95% CI: 2.57\u0026ndash;19.01), and catheter duration (aOR: 1.46; 95% CI: 1.19\u0026ndash;1.80). However, NLR showed a trend towards significance (p\u0026thinsp;=\u0026thinsp;0.066) (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMultivariate analysis\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eaOR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e[95% CI]\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e[1.01\u0026ndash;1.15]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.017\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNLR\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e[0.96\u0026ndash;3.49]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.066\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePLR\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e[0.99\u0026ndash;1.01]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.553\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePSA\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e[0.90\u0026ndash;1.14]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.885\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePV\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e[1.01\u0026ndash;1.05]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.011\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePrior catheterization\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e[1.05\u0026ndash;8.32]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.040\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEnergy\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eB-TURP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eM-TURP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e[1.59\u0026ndash;12.08]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.004\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOperating time\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e[0.98\u0026ndash;1.01]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.667\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePostoperative UTI\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e[2.57\u0026ndash;19.01]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCatheter duration\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e[1.19\u0026ndash;1.80]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eaOR: adjusted odds ratio, 95% CI: 95% confidence interval, \u003cem\u003ep\u003c/em\u003e: \u003cem\u003ep\u003c/em\u003e\u0026ndash;value, NLR: neutrophil-to-lymphocyte ratio, PLR: platelet-to-lymphocyte ratio, PSA: prostate-specific antigen, PV: prostate volume, B-TURP: bipolar transurethral resection of the prostate, M-TURP: monopolar transurethral resection of the prostate, UTI: urinary tract infection.\u003c/p\u003e \u003cp\u003eThe discriminative performance of the quantitative variables age, prostate volume, and catheter duration as predictors of post-TURP US was evaluated using ROC curves (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). In Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e, we observed that postoperative catheter duration showed the greatest discriminatory capacity, with an AUC of 0.724 (95% CI: 0.640\u0026ndash;0.809), indicating good predictive power. The optimal cutoff point was \u0026ge;\u0026thinsp;8.5 days, with a sensitivity of 56% and a specificity of 78%. Age had an AUC of 0.631 (95% CI: 0.543\u0026ndash;0.720), with an optimal cutoff point of \u0026ge;\u0026thinsp;66.5 years, achieving a sensitivity of 70% and a specificity of 51%. Prostate volume, meanwhile, reached an AUC of 0.619 (95% CI: 0.529\u0026ndash;0.709). The optimal cutoff point was \u0026ge;\u0026thinsp;57.5 cm\u0026sup3;, with a sensitivity of 66% and a specificity of 52%.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDiscriminative capacity of quantitative variables associated with post-TURP urethral stricture\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCut-off\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSensitivity (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSpecificity (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAUC\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e[95% IC of AUC]\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;66.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.631\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e[0.543\u0026ndash;0.720]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eProstate volume\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;57.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.619\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e[0.529\u0026ndash;0.709]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCatheter duration\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;8.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.724\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e[0.640\u0026ndash;0.809]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eAUC: Area under the curve, 95% CI: 95% confidence interval\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study included a total population of 578 patients who underwent TURP for BPH. The incidence of US was 10.9%. This is consistent with the incidence reported in other international studies, where the incidence was 9.8% [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] and 10.5% [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The incidence in the Peruvian population is still unknown; this is one of the few studies that reports a precise estimate of the incidence in a Peruvian hospital. However, in Mexico, a similar population, Garza-Mont\u0026uacute;far et al. [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] reported an incidence of 29%; nevertheless, this study also included bladder neck stenosis (BNS), so that incidence does not explicitly correspond to US.\u003c/p\u003e \u003cp\u003eIn our study, age was significantly associated with the development of US, with an increased risk directly proportional to increasing age. These results are consistent with the study by Wan Mokhter et al. [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], where this variable was included in their multivariate model, confirming the significant association (aOR: 1.121, 95% CI: 1.044\u0026ndash;1.204). Similarly, Golomb et al. [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] conducted a retrospective cohort study of 43,525 patients who underwent M-TURP, identifying advanced age as an independent predictor of post-TURP US, even after adjusting for comorbidities and procedural characteristics (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Therefore, the observed association could be explained by age-related degenerative changes, such as decreased urethral vascularization, reduced tissue repair capacity, and increased susceptibility to iatrogenic trauma during endoscopic instrumentation; this, coupled with immunosenescence and a decrease in the urethral mucosal defense mechanism [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOn the other hand, previous studies such as that by Venugopalan et al. [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] demonstrated a significant association between prostate volume and urethral stricture post-TURP in unadjusted models, but only in bivariate analyses. Our study expands on this analysis, demonstrating that after multivariate analysis this variable retains its significance, reinforcing the hypothesis that prostate volume acts as an independent risk factor. This finding is consistent with the study by Wan Mokhter et al. [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], who identified that a larger prostate size was independently associated with a higher risk of urethral stricture after TURP (aOR: 1.038, 95% CI: 1.014\u0026ndash;1.062). Elsaqa et al. [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], in their two-center study, showed similar results in their multivariate analysis (HR: 1.222, 95% CI: 1.057\u0026ndash;1.411). Similarly, Grechenkov et al. [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] also identified this variable as an independent factor (aOR: 1.035, 95% CI: 1.009\u0026ndash;1.061), although in these series the outcome included both US and BNS. It is known that urine extravasation into the subepithelial area following epithelial damage is part of the pathogenesis of stricture formation, as this results in inflammation, activation of fibrotic processes in the sinusoids of the corpus spongiosum, and subsequent eschar formation. Myofibroblasts are likely responsible for stricture formation, while giant cells are responsible for collagen synthesis. Type 1 collagen is responsible for the formation of the post-traumatic scar by TURP, unlike other stenoses, in which type 3 collagen is responsible [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Thus, a large prostate implies a longer operating time, therefore, a greater exposure to urethral trauma.\u003c/p\u003e \u003cp\u003eAdditionally, a history of urinary catheterization in the last year was observed in 25.5% of cases. This incidence is relevant, as it is one of the variables most strongly associated with US, as evidenced in a study conducted in Malaysia, where a history of catheterization had an aOR of 5.413 (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.002); furthermore, they included this variable in their predictive nomogram for post-TURP US [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. In our country, Segovia-Quintanilla [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], found that this variable had an OR of 2.97, consistent with our results, making it a significant risk factor.\u003c/p\u003e \u003cp\u003eUrethral exposure to catheters can cause areas of ischemia by forcefully compressing the urethral epithelium, especially when the appropriate diameter is not used, which could be involved in the development of the disease [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Likewise, the American Urology Association (AUA) [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] and the European Association of Urology (EUA) [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] indicate that any form of urethral instrumentation, including prior catheterization, has significant clinical relevance. This variable has been proposed as one of the strongest predictors and has been included in the AUA and EUA guidelines as one of the main risk factors to consider.\u003c/p\u003e \u003cp\u003eRegarding the energy used, in our study, the use of monopolar energy was an independent risk factor for the development of post-TURP US, with a risk more than four times higher than that of B-TURP. Pirola et al. [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e] refer to possible thermal damage from urethral exposure to electric current. This could be justified by the fact that monopolar current covers a larger area of ​​heat, increasing urethral trauma. In M-TURP, current travels from the current generator to the cutting loop, and then to the electrode on the skin. Furthermore, the heat wave produced is close to 300 watts (W), and the generated temperature reaches up to 400 degrees Celsius (\u0026deg;C), distributed over a large area of ​​tissue. In contrast, in B-TURP, the current starts and ends at the cutting loop. This results in a shorter circuit and lower energy intensity (170 W). Consequently, temperatures are significantly lower (40\u0026ndash;70\u0026deg;C) and distributed over a smaller amount of tissue [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. While previous studies have shown conflicting results regarding the impact of energy type on post-TURP US, most are based on unadjusted analyses. For example, a meta-analysis determined that the incidence of US was higher after TURP, particularly with monopolar energy; however, this comparison was mainly made against enucleation and ablation techniques, and not through a direct, adjusted comparison between monopolar and bipolar TURP [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. In contrast, Komura et al. [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] found in their randomized controlled trial (RCT) that B-TURP was associated with a higher incidence of US in their unadjusted model; however, the energy type was not included in the multivariate analysis, as it was limited to identifying factors within the bipolar TURP group. Our findings provide further evidence when evaluating this factor using a multivariate model. This is the first study, to our knowledge, to identify M-TURP as an independent predictor of US.\u003c/p\u003e \u003cp\u003eOn the other hand, our study identified a postoperative UTI rate of 21%, which is considerably higher in the case group compared to the control group (54% vs. 10%, respectively). Like our results, a Nigerian study reported a 19.1% rate of symptomatic UTI post-TURP [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. This variable was the most significant in our study, coinciding with the study by Tao et al. [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], who concluded that postoperative UTI was strongly associated with the development of post-TURP US (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.028).\u003c/p\u003e \u003cp\u003ePrevious studies have demonstrated an association between postoperative catheter duration and the development of UTI [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]; however, these studies did not include this variable in their adjusted models. Our study expands upon these results by maintaining its significance in the multivariate analysis, coinciding with Wan Mokhter et al. [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], who obtained an aOR of 2.147 (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and included it in their predictive nomogram. Urethral manipulation, such as catheter use, is known to be directly related to the development of UTIs. This is demonstrated by the study by Yu et al. [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e], where postoperative catheter duration was significantly related to the presence of postoperative UTIs (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.003). Similarly, Osman et al. [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e] also found an association between both variables (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.007).\u003c/p\u003e \u003cp\u003eThe use of a urinary catheter promotes the upward colonization of bacteria, primarily from perianal or hospital-acquired flora. Consequently, bacteria form biofilms on the catheter surface, making them resistant to antibiotics and potentially affecting the renal parenchyma or causing life-threatening sepsis, especially considering that most patients are elderly. [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e] Urinary catheterization, particularly if prolonged, can cause microlesions, ischemia, and local inflammation that strengthen the fibrotic process leading to UTI. Sustained inflammation of the lower urinary tract promotes prolonged urothelial damage. [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eIn this study, the discriminative capacity of significant variables was evaluated using ROC curves. The duration of postoperative catheterization proved to have the best discriminative capacity for patients at risk of post-TURP US (AUC: 0.724), with acceptable discriminative performance. The AUC values allow for estimating the discriminative performance of each variable as an individual test. These finding positions prolonged catheterization time as a useful clinical marker for identifying patients with a higher probability of developing the complication. With a cutoff point of \u0026ge;\u0026thinsp;8.5 days, it does not detect all cases (sensitivity 56%), but it predicts risk well (specificity 78%). This variable is useful for confirming risk rather than ruling it out. Cerda-Guerrero et al. [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] determined that for a catheterization duration of 2 days, the risk was 0.7%, for 5 days it was 3%, and for 12 days it was 46%; results that can be indirectly compared with our cutoff point. An Egyptian RCT determined that removing the catheter before 24 postoperative hours is a safe and effective strategy. Since it shortens hospital stay, reduces pain and discomfort, without increasing complications [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. However, another study concluded that very early removal of a urinary catheter can lead to re-catheterization, especially when removed on the same day [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. This is why it is very important to determine an appropriate cutoff point to prevent the risk of complications, considering the modifiable nature of this variable.\u003c/p\u003e \u003cp\u003eOverall, the results support the idea that the duration of postoperative catheterization is not only an independent risk factor, but also the parameter with a clinically useful practical utility for stratifying the risk of urethral stricture after TURP. In contrast, age and prostate volume, although independently associated with the outcome, showed limited discriminatory capacity, reflecting their lower clinical utility as isolated predictors. It is important to highlight that the objective of the ROC analysis was to evaluate the individual performance of each variable and not to construct a predictive model. Therefore, AUC values ​​should be interpreted as complementary tools to multivariate analysis and not as definitive diagnostic tests.\u003c/p\u003e \u003cp\u003eAmong the limitations found in our study, we emphasize the retrospective, single-center design, which implies dependence on pre-existing medical records, with an inherent risk of selection bias, as well as a limitation on extrapolating this study to other hospital settings. Furthermore, other variables such as resectoscope caliber, catheter diameter, type of lubricant, and resection speed were not considered, which we suggest be included in future studies. Postoperative UTI was the strongest variable in our study; however, the associated pathogen was not determined in each case. Finally, the ROC curve analysis was performed on individual variables, without developing a combined predictive model, as this was not the objective of this study. However, it is important to highlight that this study represents one of the few case-contol studies conducted in Peru and in Latin America evaluating clinical and surgical factors associated with the development of post-TURP US. These findings provide relevant local evidence and suggest that optimizing potentially modifiable factors, such as catheterization duration and preventing postoperative urinary tract infections, could contribute to reducing the incidence of urethral stricture after TURP. Prospective and multicenter studies are needed.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eIn this study, demographic (age), preoperative (prostate volume and prior catheterization), perioperative (energy type used), and postoperative (UTI and catheter duration) factors were identified as significantly associated with a higher risk of urethral stricture after TURP for BPH. Among the variables, the duration of postoperative catheterization stands out, both as an independent risk factor and as the parameter with the greatest discriminatory capacity for identifying patients more likely to develop urethral stricture, giving it particular clinical relevance.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eAUA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAmerican Urological Association\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eAUC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eArea Under the Curve\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eBNS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eBladder Neck Stenosis\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eBPH\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eBenign Prostatic Hyperplasia\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eB-TURP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eBipolar Transurethral Resection of the Prostate\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eConfidence Interval\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCOPD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eChronic Obstructive Pulmonary Disease\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eDM\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eDiabetes Mellitus\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eEAU\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eEuropean Association of Urology\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eHT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eHypertension\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eIQR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eInterquartile Range\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eM-TURP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMonopolar Transurethral Resection of the Prostate\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eNLR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eNeutrophil-to-Lymphocyte Ratio\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eNSAIDs\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eNonsteroidal Anti-inflammatory Drugs\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eOR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eOdds Ratio\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePLR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePlatelet-to-Lymphocyte Ratio\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePSA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eProstate-Specific Antigen\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePV\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eProstate Volume\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eRCT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eRandomized Controlled Trial\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eROC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eReceiver Operating Characteristic\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eStandard Deviation\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSTROBE\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eStrengthening the Reporting of Observational Studies in Epidemiology\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eTURP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eTransurethral Resection of the Prostate\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eUS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eUrethral Stricture\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eUTI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eUrinary Tract Infection\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eW\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eWatts\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u0026deg;C\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eDegrees Celsius\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Institutional Review Board of the Hospital Central de la Fuerza Aérea del Perú (approval number: NC-50-HCCE-Nº001). The requirement for informed consent was waived by the Institutional Review Board due to the retrospective nature of the study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical Trial Number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was funded by Ricardo Palma University, which covered the article processing charges (RUC: 20147883952). The funder had no role in the study design, data collection, analysis, interpretation of data, or writing of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eGVP, MGM, and RV contributed to the conceptualization and methodology of the study. GVP and RV were responsible for data acquisition. GVP and JMVR performed the statistical analysis and contributed to data analysis and interpretation. All authors contributed to drafting the manuscript. MGM and JMVR critically revised the manuscript for important intellectual content. JMVR obtained funding. RV provided administrative, technical, and material support. GVP, RV, and JMVR supervised the study. All authors approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eMiernik A, Gratzke C. Current Treatment for Benign Prostatic Hyperplasia. Dtsch \u0026Auml;rztebl Int 2020;117:843-54.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eAfandiyev F, Ugurlu O. Factors predicting the development of urethral stricture after bipolar transurethral resection of the prostate. Rev Assoc M\u0026eacute;dica Bras 2022;68:50-5.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eUgarte-Carbajal V, Vela-Ruiz JM, Guillen-Ponce R, Correa-Lopez LE, Rubin-de-Celis V, De La Cruz-Vargas JA. The Relationship Between Metabolic Syndrome and Benign Prostate Enlargement: A Case\u0026ndash;Control Study in a Peruvian Military Hospital. 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Risk factors for urethral stricture and/or bladder neck contracture after monopolar transurethral resection of the prostate for benign prostatic hyperplasia. Urol J 2018; 85:150\u0026ndash;7.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eTopal K, Demirbas A, Balci A, Gercek O, Ulusoy K, Karalar M, et al. Relaci\u0026oacute;n entre insuficiencia cardiaca, tabaquismo y desarrollo de estenosis uretral. Cir Cir 2024;92:442\u0026ndash;50.\u003c/li\u003e\n \u003cli\u003eMundy AR, Andrich DE. Urethral strictures. BJU Int 2011;107:6\u0026ndash;26.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eWessells H, Morey A, Vanni A, Rahimi L, Souter L. Urethral stricture disease guideline amendment (2023). J Urol 2023;210:64-71.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eEuropean Association of Urology. EAU Guidelines on Urethral Strictures. Arnhem: European Association of Urology; 2024\u0026nbsp;\u003c/li\u003e\n \u003cli\u003ePirola GM, Castellani D, Lim EJ, Wroclawski ML, Le Quy Nguyen D, Gubbiotti M, et al. Urethral stricture following endoscopic prostate surgery: a systematic review and meta-analysis of prospective, randomized trials. World J Urol 2022;40:1391-411.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eKomura K, Inamoto T, Takai T, Uchimoto T, Saito K, Tanda N, et al. Incidence of urethral stricture after bipolar transurethral resection of the prostate using TURis: results from a randomised trial. BJU Int 2015;115:644-52.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eYu SH, Jung SI, Hwang EC, Kim TH, Choi JD, Yoo KH, et al. Korean Multicenter Study of Infectious Complications after Transurethral Prostate Surgery in Patients with Preoperative Sterile Urine. Urogenit Tract Infect 2022;17:81-8.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eOsman T, ElSaeed KO, Youssef HA, Shabayek M, Emam A, Hussein MS. Evaluation of the risk factors associated with the development of post-transurethral resection of the prostate persistent bacteriuria. Arab J Urol 2017;15:260-6.\u003c/li\u003e\n \u003cli\u003eWerneburg GT. Catheter-Associated Urinary Tract Infections: Current Challenges and Future Prospects. Res Rep Urol 2022;14:109\u0026ndash;33.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eAl-Demour S, Al-Zubi MT, Ababneh M, Al-Rawashdah SF, Ahmad M. A randomized clinical trial: timing of indwelling urethral catheter removal following transurethral resection of prostate. Future Sci OA 2023;10:FSO927.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eŞahin C, Kalkan M. The Effect of Catheter Removal Time Following Transurethral Resection of the Prostate on Postoperative Urinary Retention. Electron J Gen Med 2011;8:280-3.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-urology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"buro","sideBox":"Learn more about [BMC Urology](http://bmcurol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/buro/default.aspx","title":"BMC Urology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Urethral Stricture, Benign Prostatic Hyperplasia, Transurethral Resection of Prostate, Urinary Catheterization","lastPublishedDoi":"10.21203/rs.3.rs-8836208/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8836208/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e The clinical relevance of urethral stricture (US) as a late complication after transurethral resection of the prostate (TURP) underscores the need to better understand its associated factors in contemporary practice. The aim was to evaluate demographic, clinical, and perioperative factors associated with post-TURP US for benign prostate hyperplasia (BPH).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMaterials and Methods:\u003c/strong\u003e A case–control study was conducted including patients who underwent TURP for BPH between 2015 and 2024. From a cohort of 578 patients, 50 cases with confirmed US and 150 controls without stricture were randomly selected. Demographic variables, comorbidities, hematological markers, preoperative, perioperative, and postoperative factors were analyzed. Bivariate and multivariate logistic regression analyses were performed to estimate OR. The discriminative capacity of significant numerical variables was calculated using ROC curves\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e The incidence of US was 10.9%. Multivariate analysis identified older age (aOR: 1.08; 95% CI: 1.01–1.15), larger prostate volume (aOR: 1.03; 95% CI: 1.01–1.05), history of urinary catheterization (aOR: 2.96; 95% CI: 1.05–8.32), monopolar TURP (aOR: 4.38; 95% CI: 1.59–12.08), postoperative urinary tract infection (aOR: 6.98; 95% CI: 2.57–19.01), and longer postoperative catheterization duration (aOR: 1.46; 95% CI: 1.19–1.80) as independent associated factors. Postoperative catheter duration showed the highest discriminative ability (AUC: 0.724), with an optimal cutoff ≥8.5 days.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e Post-TURP US is associated with multiple clinical and surgical factors. Postoperative catheterization duration emerged as the most clinically useful and potentially modifiable factor, highlighting the importance of optimizing catheter management and preventing postoperative urinary tract infections.\u003c/p\u003e","manuscriptTitle":"Factors Associated with Urethral Stricture Post-Transurethral Resection of the Prostate for Benign Prostatic Hyperplasia: A Case-Control Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-10 13:20:58","doi":"10.21203/rs.3.rs-8836208/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-03-30T20:49:23+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-16T00:04:21+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-10T18:24:06+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"70712916955006519842576496144981204207","date":"2026-03-10T17:07:03+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"166697488348484085875507624661567744016","date":"2026-03-06T03:11:36+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-04T18:41:36+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"121346565438697303067130519969809905223","date":"2026-03-04T18:10:19+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"236048647465392439362982613795606119715","date":"2026-03-04T13:03:39+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-03-04T12:26:23+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-02-18T18:22:40+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-02-17T12:55:30+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-02-17T12:54:36+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Urology","date":"2026-02-10T04:13:51+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-urology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"buro","sideBox":"Learn more about [BMC Urology](http://bmcurol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/buro/default.aspx","title":"BMC Urology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"9452cf1c-0717-49fb-853f-5943c1a0b047","owner":[],"postedDate":"March 10th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-11T10:11:15+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-10 13:20:58","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8836208","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8836208","identity":"rs-8836208","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}