Factores predictivos del desarrollo de estenosis uretral en pacientes con tumor vesical: el papel de la terapia intravesical con BCG

Abstract

Objective: This study aims to investigate the predictive role of intravesical Bacillus Calmette-Guerin (BCG) therapy on urethral stricture development in male patients undergoing bladder tumor surveillance, while also assessing the impact of repeated urethral instrumentation on stricture risk. Methods: This retrospective study included male patients aged 18-90 with non-muscle invasive bladder tumors followed between 2018 and 2024. Demographics, cystoscopy and TUR procedures, intravesical treatments (BCG and chemotherapy), and urethral stricture diagnosis were recorded. Urethral stricture was confirmed by uroflowmetry, cystoscopy, and urethrography. Patients with prior urethral stricture or incomplete records were excluded. Statistical analyses included logistic regression to identify predictors of stricture development, adjusting for age and comorbidities. Sample size was calculated to ensure adequate power to detect a 15% difference in stricture incidence related to BCG therapy. Results: A total of 187 male patients were analyzed, with a 12.3% urethral stricture incidence. BCG therapy was administered to 32.6% of patients and significantly increased stricture risk (OR: 4.11, p = 0.015). Each additional dose was associated with an increased risk (OR: 2.11, p = 0.001). TURP (OR: 2.95, p = 0.045) and the number of cystoscopies (OR: 1.42 per procedure, p = 0.040) were also significant predictors. Tumor size >= 3 cm was associated with higher risk (OR: 1.88, p = 0.037). Spearman analysis showed positive correlations between stricture severity and both BCG doses and cystoscopy number. Conclusion: Intravesical BCG therapy, repeated cystoscopies, and TURP increase urethral stricture risk in bladder tumor patients. Preventive measures and careful monitoring are essential to reduce urethral complications.