Yu Seob Shin1, Jong Kwan Park1. 1. Department of Urology, Chonbuk National University Medical School, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute and Clinical Trial Center of Medical Device of Chonbuk National University Hospital, Jeonju, Korea.
To the editor:The article by Tan et al. [1] is indeed interesting. This article is one of the rare reports about surgical risk factors associated with urethral stricture (US) occurrence after bipolar transurethral resection of prostate (B-TURP) using the Gyrus PlasmaKinetic Tissue Management System (Gyrus ACMI, Southborough, MA, USA). The results seem some interesting and were consistent with reports published before [2]. The results of their study indicate that slow resection rate appears to be associated with US formation after B-TURP [1]. We agree that B-TURP configuration creates a concentrated electrical energy and it has a greater potential to cause more thermal damage to the urethra. During tissue development, remodeling, and wound healing of the thermal injury site, US is caused by scar formation and fibrosis. However, one critical issue remains unclear. Author's reported that 13 cases of US after B-TURP were identified in this cohort, giving a US rate of 3.5% [1]. Six of these 13 patients had B-TURP performed by a consultant urologist, while the remaining 7 patients had their surgeries done by a trainee in urology under the supervision of a consultant [1]. In our opinion, US can be influenced by the surgical skill of operators. Authors have to give a clear explanation about this matter.Despite these limitations, the present study raises awareness to the readers about occurrence of US after B-TURP. If so, it is reader's role to make effort to reduce US after B-TURP. The triggering factors for US after transurethral prostate surgery reported include infection, mechanical injury, and indwelling of the Foley catheter [3]. Warm irrigation and a system to maintain the penis at isothermia during B-TURP might decrease the incidence of US [4]. Also, the use of hyaluronicacid and carboxymethylcellulose in the urethra during B-TURP might decrease the incidence of US [5]. Finally, we ardently expect small-diameter resectoscope for B-TURP to reduce US to come out from device company.