Independent Predictors and a Nomogram for Postoperative Urethral Stricture After TURP in Elderly Patients: A Real-World Study

AIM: Postoperative urethral stricture is an important complication after transurethral resection of the prostate (TURP). This study aimed to identify independent predictors of urethral stricture within 3 months after TURP in elderly patients and to develop a nomogram for predicting this complication.METHODS: This retrospective study consecutively included 300 elderly patients who underwent transurethral resection of the prostate at Deqing County People’s Hospital between June 2024 and November 2025. Patients were divided into a stricture group and a non-stricture group according to whether a urethral stricture occurred within 3 months after surgery. Demographic, clinical, and laboratory data were collected, and the controlling nutritional status (CONUT) score, prognostic nutritional index (PNI), and neutrophil-to-lymphocyte ratio (NLR) were calculated. Univariate and multivariable logistic regression analyses were performed to identify independent predictors of postoperative urethral stricture. A nomogram was subsequently constructed with variables of statistical significance. Model discrimination was assessed using the receiver operating characteristic (ROC) curve, and internal validation was performed by bootstrap resampling. Model performance was further evaluated using calibration and decision curve analyses.RESULTS: Among the 300 elderly patients included in the final cohort, 84 were identified as having urethral stricture within 3 months after TURP. Multivariate logistic regression analysis showed that a higher CONUT score was an independent risk factor for postoperative urethral stricture (odds ratio [OR] = 2.41, 95% confidence interval [CI]: 1.43–4.04). Higher fasting glucose (OR = 1.56, 95% CI: 1.11–2.21), lower body mass index (BMI) (OR = 0.80, 95% CI: 0.70–0.91), alcohol use (OR = 3.02, 95% CI: 1.33–6.88), acute urinary retention (OR = 2.15, 95% CI: 1.07–4.31), longer catheterization duration (OR = 1.34, 95% CI: 1.03–1.74), and longer operative time (OR = 1.04, 95% CI: 1.02–1.07) were also independently associated with an increased risk of postoperative urethral stricture. The nomogram based on these variables demonstrated good discriminative ability, with an area under the curve (AUC) of 0.836 (95% CI: 0.789–0.882), a sensitivity of 76.2%, and a specificity of 75.0%. After 1000 bootstrap resamples for internal validation, the optimism-corrected AUC was 0.810 (95% CI: 0.731–0.878). Calibration analysis showed good agreement between predicted and observed probabilities, and decision curve analysis indicated that the model provided a certain net benefit.CONCLUSIONS: Preoperative CONUT score, fasting glucose, BMI, alcohol use, acute urinary retention, catheterization duration, and operative time were associated with postoperative urethral stricture in elderly patients undergoing TURP. The nomogram based on these variables showed good discriminative performance, although further validation in larger samples and multicenter studies is still required.