Impact of previous transurethral prostate surgery on health-related quality of life after radical prostatectomy: Does the interval between surgeries matter?

Abstract

Purpose

To assess the impact of previous transurethral surgery for benign prostate enlargement (BPE) and time interval between procedures on functional outcomes and health-related quality of life (HRQOL) after radical prostatectomy (RP).

Methods

A propensity score-matched patient cohort [n = 685, (513 without previous BPE surgery, 172 with BPE surgery)] was created and HRQOL was pre- and postoperatively assessed using validated questionnaires (EORTC QLQ-C30). Urinary continence was measured via ICIQ-SF questionnaire and pad usage. Multivariable analysis included binary logistic and Cox regression models (p < 0.05).

Results

Median follow-up was 18 months. There was no significant difference in recurrence-free survival in multivariate analysis (HR 0.66, 95%CI 0.40–1.07, p = 0.093). We observe higher mean ICIQ-SF scores (5.7 vs. 8.2, p < 0.001) and daily pad usage (1.3 vs. 2.5, p < 0.001), and decreased continence recovery (OR 0.46, 95%CI 0.30–0.71, p < 0.001) for patients with BPE surgery. Postoperative general HRQOL scores were significantly lower for patients with previous BPE surgery (70.6 vs. 63.4, p = 0.003). In multivariate analysis, continence recovery (OR 5.19, 95%CI 3.10–8.68, p < 0.001) but not previous BPE surgery (0.94, 0.57–1.54, p = 0.806) could be identified as independent predictors of good general HRQOL. There was no significant correlation between time interval between both surgeries and continence (p = 0.408), and HRQOL (p = 0.386) outcomes.

Conclusions

We observe favourable continence outcomes for patients without previous BPE surgery. Our results indicate that RP can be safely performed after transurethral BPE surgery, regardless of the time interval between both interventions.

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Abbreviations

BPE:

Benign prostate enlargement

GHS:

Global health status

HRQOL:

Health-related quality of life

ICIQ-SF:

International consultation on incontinence (short form)

ISUP:

International Society of Urological Pathologists

IIEF-5:

International Index on Erectile Function

ORP:

Open radical prostatectomy

RARP:

Robot-assisted radical prostatectomy

RP:

Radical prostatectomy

TUR-P:

Transurethral resection of the prostate

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Affiliations

Authors

Contributions

MC, FF, RB, and AK: study design, data collection, data analysis, and manuscript writing/editing. PP, FJ, TW, FS, PW, GM, BS, and AB: data collection and manuscript editing. SO: data analysis and manuscript editing. AB: data collection/analysis and manuscript editing. CGS: protocol/project development, data analysis, coordination of study, and manuscript editing.

Corresponding author

Correspondence to Alexander Kretschmer.

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The authors declare that they have no conflict of interest.

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This study was performed according to the 1964 Helsinki Declaration and was approved by an institutional review board. Informed consent was obtained from all individuals participating in the study.

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Chaloupka, M., Figura, F., Weinhold, P. et al. Impact of previous transurethral prostate surgery on health-related quality of life after radical prostatectomy: Does the interval between surgeries matter?. World J Urol (2020). https://doi.org/10.1007/s00345-020-03327-4

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Keyword

  • EORTC QLQ-C30
  • Radical prostatectomy
  • Robot-assisted radical prostatectomy
  • Health-related quality of life
  • Transurethral resection of the prostate
  • Laser enucleation of the prostate
  • Laser vaporization of the prostate