Radical prostatectomy after previous transurethral resection of the prostate: oncological, surgical and functional outcomes—a meta-analysis

Abstract

Background

The current study aimed to carry out a comprehensive meta-analysis on the existing evidence to quantify and compare the oncological, surgical and functional outcomes following radical prostatectomy between TURP group and Non-TURP group.

Methods

A systematic literature search was conducted using EMBASE, PubMed and Cochrane databases to identify relevant studies published in English up to March 2019. A meta-analysis was conducted using Review Manager.

Results

There were 13 studies included in the present study. Our results suggest that TURP group demonstrates a significantly higher positive surgical margin rate, bladder neck reconstruction rate and overall complication rate compared with Non-TURP group (OR = 1.31, 95% CI 1.09–1.58, P = 0.004, I2 = 0%; OR = 14.36, 95% CI 2.93–70.45, P = 0.001, I2 = 81%; OR = 2.63, 95% CI 1.87–3.71, P < 0.00001, I2 = 0%); whereas TURP group demonstrates a significantly lower nerve sparing rate compared with Non-TURP group (OR = 0.30, 95% CI 0.22–0.43, P < 0.00001, I2 = 40%); the operation time, blood loss and 1-year urinary continence rate are same between TURP group and Non-TURP group (MD = 4.25, 95% CI − 0.13 to 8.63, P = 0.06, I2 = 34%; MD = 27.29, 95% CI − 10.31 to 64.90, P = 0.15, I2 = 39%; OR = 0.68, 95% CI 0.43–1.06, P = 0.09, I2 = 0%).

Conclusion

This meta-analysis demonstrates that Non-TURP group may have a great advantage over TURP group in terms of positive surgical margin rate, bladder neck reconstruction rate, overall complication rate and sparing rate. The operation time, blood loss and 1-year urinary continence rate are comparable between TURP group and Non-TURP group. Therefore, important information should be given to those patients at risk of prostate cancer that TURP procedure may increase perioperative complications in case of a following radical prostatectomy. In the meantime, our meta-analysis found that each of these four subgroups (RARP, LRP, ORP and RARP/ORP) has its own advantages or disadvantages in every pool results. So when radical prostatectomy is performed on patients with TURP history, the appropriate operation method should be selected as per the conditions of patients, doctors and hospitals.

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8

References

  1. 1.

    Mustafa M, Davis JW, Gorgel SN, Pisters L (2017) Robotic or open radical prostatectomy in men with previous transurethral resection of prostate. Urol J 14:2955

    PubMed  Google Scholar 

  2. 2.

    Rassweilera J, Kuntz R, Hofmann R (2006) Complications of transurethral resection of the prostate (TURP)—incidence, management, and prevention. Eur Urol 50:969–980

    Article  Google Scholar 

  3. 3.

    Merrill RM, Wiggins CL (2002) Incidental detection of population-based prostate cancer incidence rates through transurethral resection of the prostate. Urol Oncol 7:213–219

    Article  Google Scholar 

  4. 4.

    Menard J, de la Taille A, Hoznek A et al (2008) Laparoscopic radical prostatectomy after transurethral resection of the prostate: surgical and functional outcomes. Urology 72:593–597

    Article  Google Scholar 

  5. 5.

    Elder JS, Gibbons RP, Correa RJ, Brannen GE (1984) Morbidity of radical perineal prostatectomy following transurethral resection of the prostate. J Urol 132:55–57

    CAS  Article  Google Scholar 

  6. 6.

    Zugor V, Labanaris AP, Porres D, Witt JH (2012) Surgical, oncologic, and short-term functional outcomes in patients undergoing robot-assisted prostatectomy after previous transurethral resection of the prostate. J Endourol 26:515–519

    Article  Google Scholar 

  7. 7.

    Colombo R, Naspro R, Salonia A et al (2006) Radical prostatectomy after previous prostate surgery: clinical and functional outcomes. J Urol 176:2459–2463

    Article  Google Scholar 

  8. 8.

    Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 339:b2535

    Article  Google Scholar 

  9. 9.

    Higgins JPT, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327:557–560

    Article  Google Scholar 

  10. 10.

    Gupta NP, Singh P, Nayyar R (2011) Outcomes of robot-assisted radical prostatectomy in men with previous transurethral resection of prostate. BJU Int. 108:1501–1505

    Article  Google Scholar 

  11. 11.

    Hampton L, Nelson RA, Satterthwaite R, Wilson T, Crocitto L (2008) Patients with prior TURP undergoing robot-assisted laparoscopic radical prostatectomy have higher positive surgical margin rates. J Robot Surg 2:213–216

    Article  Google Scholar 

  12. 12.

    Hung C, Yang C, Ou Y (2014) Robotic assisted laparoscopic radical prostatectomy following transurethral resection of the prostate: perioperative, oncologic and functional outcomes. Prostate Int 2:82–89

    Article  Google Scholar 

  13. 13.

    Pompe RS, Leyh-Bannurah S, Preisser F et al (2018) Radical prostatectomy after previous TUR-P: oncological, surgical, and functional outcomes. Urol Oncol Semin Original Investig 36:521–527

    Google Scholar 

  14. 14.

    Su Y, Katz BF, Sehgal SS et al (2015) Does previous transurethral prostate surgery affect oncologic and continence outcomes after RARP? J Robot Surg. 9:291–297

    Article  Google Scholar 

  15. 15.

    Jaffe J, Stakhovsky O, Cathelineau X, Barret E, Vallancien G, Rozet F (2007) Surgical outcomes for men undergoing laparoscopic radical prostatectomy after transurethral resection of the prostate. J Urol 178:483–487

    Article  Google Scholar 

  16. 16.

    Teber D, Cresswell J, Ates M et al (2009) Laparoscopic radical prostatectomy in clinical T1a and T1b prostate cancer: oncologic and functional outcomes—a matched-pair analysis. Urology 73:577–581

    Article  Google Scholar 

  17. 17.

    Yang Y, Luo Y, Hou G et al (2015) Laparoscopic radical prostatectomy after previous transurethral resection of the prostate in clinical T1a and T1b prostate cancer: a matched-pair analysis. Urol J. 12:2154

    PubMed  Google Scholar 

  18. 18.

    Palisaar JR, Wenske S, Sommerer F, Hinkel A, Noldus J (2009) Open radical retropubic prostatectomy gives favourable surgical and functional outcomes after transurethral resection of the prostate. BJU Int. 104:611–615

    Article  Google Scholar 

  19. 19.

    Yazici S, Inci K, Yuksel S, Bilen CY, Ozen H (2009) Radical prostatectomy after previous prostate surgery: effects on surgical difficulty and pathologic outcomes. Urol 73:856–859

    Article  Google Scholar 

  20. 20.

    Gettman MT, Blute ML (2010) Radical prostatectomy: does surgical technique influence margin control? Urol Oncol. 28:219–225

    Article  Google Scholar 

  21. 21.

    Pastore AL, Palleschi G, Silvestri L et al (2015) Laparoscopic radical prostatectomy after previous transurethral resection of prostate using a catheter balloon inflated in prostatic urethra: oncological and functional outcomes from a matched pair analysis. Int J Urol 22:1037–1042

    Article  Google Scholar 

  22. 22.

    Bandhauer K, Senn E (1988) Radical retropubic prostatectomy after transurethral prostatic resection. Eur Urol 15:180–181

    CAS  Article  Google Scholar 

  23. 23.

    Ramon J, Rossignol G, Leandri P, Gautier JR (1994) Morbidity of radical retropubic prostatectomy following previous prostate resection. J Surg Oncol 55:14–19

    CAS  Article  Google Scholar 

  24. 24.

    Magheli A, Gonzalgo ML, Su LM et al (2011) Impact of surgical technique (open vs laparoscopic vs robotic-assisted) on pathological and biochemical outcomes following radical prostatectomy: an analysis using propensity score matching. BJU Int. 107:1956–1962

    Article  Google Scholar 

  25. 25.

    Walsh PC (1998) Patient-reported impotence and incontinence after nerve-sparing radical prostatectomy. J Urol 159:308–309

    CAS  Article  Google Scholar 

  26. 26.

    Stanford JL, Feng Z, Hamilton AS et al (2000) Urinary and sexual function after radical prostatectomy for clinically localized prostate cancer: the prostate cancer outcomes study. JAMA 283:354–360

    CAS  Article  Google Scholar 

  27. 27.

    Wolin KY, Luly J, Sutcliffe S, Andriole GL, Kibel AS (2010) Risk of urinary incontinence following prostatectomy: the role of physical activity and obesity. J Urol 183:629–633

    Article  Google Scholar 

  28. 28.

    Cooperberg MR, Odisho AY, Carroll PR (2012) Outcomes for radical prostatectomy: is it the singer, the song, or both? J Clin Oncol 30:476–478

    Article  Google Scholar 

  29. 29.

    Hu JC, Gu X, Lipsitz SR et al (2009) Comparative effectiveness of minimally invasive vs open radical prostatectomy. JAMA 302:1557–1564

    CAS  Article  Google Scholar 

  30. 30.

    Talcott JA, Rieker P, Propert KJ et al (1997) Patient-reported impotence and incontinence after nerve-sparing radical prostatectomy. J Natl Cancer Inst 89:1117–1123

    CAS  Article  Google Scholar 

  31. 31.

    Kania P, Wośkowiak P, Salagierski M (2019) Preservation of continence in radical prostatectomy patients: a laparoscopic surgeon’s perspective. Central Eur J Urol 72:32

    Google Scholar 

  32. 32.

    Rieken M, Herrmann T, Fullhase C (2019) Surgical treatment of benign prostatic hyperplasia-resection, vaporization or enucleation? Urol A 58:263–270

    CAS  Article  Google Scholar 

Download references

Acknowledgements

This work was supported by the Natural Science Foundation of Sichuan Provincial Department of Education (16ZB0227), Scientific Research Foundation of Health and Family Planning Commission of Sichuan Province (17PJ155) and City of Nanchong Strategic Cooperation with Local Universities Foundation of technology (NSMC20170421, NSMC20170111, 18SXHZ0581, 18SXHZ0128).

Author information

Affiliations

Authors

Contributions

SC, TW: project development, public funding. XD, XXM, THH, TC, JBL: data collection. HL, XD: data analysis, manuscript writing/editing.

Corresponding authors

Correspondence to Shu Cui or Tao Wu.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Liao, H., Duan, X., Du, Y. et al. Radical prostatectomy after previous transurethral resection of the prostate: oncological, surgical and functional outcomes—a meta-analysis. World J Urol (2019). https://doi.org/10.1007/s00345-019-02986-2

Download citation

Keywords

  • Radical prostatectomy
  • Prostate cancer
  • Transurethral resection of the prostate
  • Meta-analysis