Abstract
PurposeTo 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).MethodsA 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).ResultsMedian 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.ConclusionsWe 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.
Highlights
Transurethral resection of the prostate (TUR-P) is the gold standard procedure in the management of refractory bladder outlet obstruction due to benign prostate enlargement, even though laser ablative transurethral procedures have become increasingly popular in recent years [1]
Generalizability of the current evidence is hampered by the fact that some studies analyzed historic cohorts [3, 4] or focused on a single surgical technique only [3, 4, 7]. None of these studies evaluated healthrelated quality of life (HRQOL) and did not give information regarding the effect of the time interval between transurethral surgery and radical prostatectomy
We provide data from a large contemporary propensity score-matched patient cohort and found favourable functional outcomes for patients that did not undergo previous benign prostate enlargement (BPE) surgery and confirmed previous BPE surgery as an independent risk factor for decreased continence recovery in multivariable analysis
Summary
Transurethral resection of the prostate (TUR-P) is the gold standard procedure in the management of refractory bladder outlet obstruction due to benign prostate enlargement, even though laser ablative transurethral procedures have become increasingly popular in recent years [1]. Generalizability of the current evidence is hampered by the fact that some studies analyzed historic cohorts [3, 4] or focused on a single surgical technique only [3, 4, 7]. None of these studies evaluated healthrelated quality of life (HRQOL) and did not give information regarding the effect of the time interval between transurethral surgery and radical prostatectomy.
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