Previous Transurethral Resection Of The Prostate Research Articles

Does previous transurethral resection of the prostate negatively influence subsequent robotic-assisted radical prostatectomy in men diagnosed with prostate cancer? A systematic review and meta-analysis.

It is not uncommon to incidentally discover prostate cancer during the transurethral resection of the prostate (TURP) for the treatment of benign prostatic hyperplasia and necessitate a subsequent robotic-assisted radical prostatectomy (RARP). The study aims to evaluate whether TURP have negative influence on subsequent RARP. Through a literature search using MEDLINE, EMBASE and the Cochrane Library, 10 studies with 683 patients who underwent RARP after previous TURP and 4039 patients who underwent RARP only were identified for the purposes of the meta-analysis. Compared to standard RARP, RARP after TURP was related to longer operative time (WMD: 29.1min, 95% CI: 13.3-44.8, P < 0.001), more blood loss (WMD: 49.3ml, 95% CI: 8.8-89.7, P = 0.02), longer time to catheter removal (WMD: 0.93days, 95% CI: 0.41-1.44, P < 0.001), higher rates of overall (RR: 1.45, 95% CI: 1.08-1.95, P = 0.01) and major complications (RR: 3.67, 95% Cl: 1.63-8.24, P = 0.002), frequently demand for bladder neck reconstruction (RR: 5.46, 95% CI: 3.15-9.47, P < 0.001) and lower succeed in nerve sparing (RR: 0.73, 95% CI: 0.62-0.87, P < 0.001). In terms of quality of life, there are worse recovery of urinary continence (RR of incontinence rate: RR: 1.24, 95% CI: 1.02-1.52, P = 0.03) and potency (RR: 0.8, 95% CI: 0.73-0.89, P < 0.001) at 1 year in RARP with previous TURP. In addition, the RARP with previous TURP had greater percentage positive margins (RR: 1.24, 95% CI: 1.02-1.52, P = 0.03), while there is no difference in length of stay and biochemical recurrence rate at 1year. RARP is feasible but challenging after TURP. It significantly increases the difficulty of operation and compromises surgical, functional and oncological outcomes. It is important for urologists and patients to be aware of the negative impact of TURP on subsequent RARP and establish treatment strategies to lessen the adverse effects.

Retzius-sparing robot-assisted radical prostatectomy after previous trans-urethral resection of the prostate: Assessment of functional and oncological outcomes

Backgroundno data exist concerning functional and oncological outcomes of Retzius-sparing robot-assisted radical prostatectomy (RS-RARP), in patients previously treated with trans-urethral resection of the prostate (p-TURP), for benign prostate obstruction. Our study addressed the impact of p-TURP on immediate and 12-months urinary continence recovery (UCR), as well as peri-operative outcomes and surgical margins, after RS-RARP. Methodsall patients treated with RS-RARP for prostate cancer at a single high-volume European institution, between 2010 and 2021, were identified and stratified according to p-TURP status. Logistic, Poisson and Cox regression models were performed. ResultsOf 1386 RS-RARP patients, 99 (7%) had history of p-TURP. Between p-TURP and no-TURP patients no differences were detected regarding both intra- and post-operative complications (p values = 0.9). The rates of immediate UCR were 40 vs 67% in p-TURP vs no-TURP patients (p < 0.001). At 12 months from RS-RARP, the rates of UCR were 68 vs 94% in p-TURP vs no-TURP patients (p < 0.001). At multivariable logistic and Cox regression models, p-TURP was independently associated, respectively, with lower immediate (odds ratio [OR]: 0.32, p < 0.001) and 12-months UCR (hazard ratio: 0.54, p < 0.001). At multivariable Poisson analyses, p-TURP predicted longer operative time (rate ratio: 1.08, p < 0.001) but not longer length of stay or time to catheter removal (p values > 0.05). Positive surgical margins rates were 23 vs 17% in p-TURP vs no-TURP patients (p = 0.1), which translated in a non-statistically significant multivariable OR of 1.14 (p = 0.6). Conclusionsp-TURP does not increase surgical morbidity but portends longer operative time and worse urinary continence after RS-RARP.

Retzius-sparing robot-assisted radical prostatectomy after previous trans-urethral resection of the prostate: Assessment of functional and oncological outcomes

Retzius-sparing robot-assisted radical prostatectomy after previous trans-urethral resection of the prostate: Assessment of functional and oncological outcomes

The Association between Dose Escalation and Risk of Developing Metastases in Intermediate and High-Risk Prostate Cancer Patients Treated with Radiotherapy

<h3>Purpose/Objective(s)</h3> Radiotherapy dose escalation through brachytherapy or simultaneous integrated boost have been successfully introduced to clinical practice, facilitating improved local control of the tumor in intermediate and high-risk prostate cancer (PCa) patients, but not necessarily improved metastasis-free survival. Moreover, the improvement in clinical endpoints is often associated with increased risk of adverse effects. In this article, we analyzed effect of high dose-rate (HDR) brachytherapy boost (BT) dose escalation on freedom from metastases (FFM), based on real-world data. <h3>Materials/Methods</h3> The analysis was based on a multi-institutional retrospective database of 1641 consecutive intermediate (30%) or high risk (70%) prostate cancer patients treated with external beam radiotherapy (EBRT; 70.9%) or EBRT, combined with single or double fraction BT boost (29.1%). The majority of the patients (95%) received anti-androgen therapy (ADT). The biologically effective dose was calculated using α/β of 3 Gy. The follow-up data was acquired from institutional databases. The analysis included the Kaplan-Meier method and Cox regression models. A multivariable model was constructed utilizing backward stepwise feature selection based on Akaike information criterion. The model presented adjusted hazard ratios (HR) in multivariable analysis, and was further used to create a nomogram. C-index was used to assess the model. <h3>Results</h3> The median age was 63.8 years (IQR 62.9 – 73.5). Median FFM was not achieved, metastasis occurred in 234 patients (14.1%) over the course of follow up. The univariate analysis showed that BED was significantly associated with FFM (HR 0.99; CI 95% 0.98-0.99; p<0.001), along with Gleason grade group, PSA density, maximum PSA, pre-treatment PSA, T and N stage according to TNM, previous transurethral resection of the prostate, and NCCN risk group. Backward stepwise feature selection allowed to create multivariable model which included BED, prostate volume, Gleason grade group and NCCN risk groups. This model presented c-index of 0.665 and 5-fold cross-validation-corrected c-index of 0.652. The results are presented in Table 1. This model was used to create a clinical nomogram for FFM. <h3>Conclusion</h3> Biologically effective dose is an independent prognostic factor for developing metastases in patients treated with radiotherapy for intermediate or high-risk group prostate cancer. Dose escalation through brachytherapy boost can be used to decrease the risk of developing metastases in patients with adverse features.

Surgical Treatments of Benign Prostatic Hyperplasia and Prostate Cancer Stereotactic Radiotherapy: Impact on Long-Term Genitourinary Toxicity

AimsAlthough the results on acute and late toxicity of ultrahypofractionation are encouraging, data on safety in prostate cancer patients with a medical history of transurethral resection of the prostate (TURP) or adenomectomy remain scarce, especially in cases of repeated procedures. The aim of the present study was to report on long-term toxicities after stereotactic body radiotherapy (SBRT) of prostate cancer patients with previous surgical treatment of benign prostatic hyperplasia. Materials and methodsAmong 150 patients treated with SBRT (median dose 36.25 Gy in five fractions) realised from 2014 to 2019 in a single-centre institution, data of 24 men with a history of TURP (n = 19) or adenomectomy (n = 5) were analysed. Repeated TURP was carried out in three patients, with a median time between surgery and SBRT of 54 months. Genitourinary toxicity was assessed using the Common Terminology Criteria for Adverse Events v4.0 grading scale. ResultsWith a median follow-up of 45 months, 10 of 24 (42%) patients experienced at least one episode of transient haematuria. One patient (4%) with three previous TURP presented a grade 3 acute non-infective cystitis. Late grade 2 and 3 genitourinary toxicities were observed in eight (33%) and four patients (17%) (two treated with adenomectomy, one with multiple TURP and one with a 140 cm3 prostate size), respectively, with no grade ≥4 adverse events. A complete recovery of grade 3 genitourinary toxicities was observed for all patients after hyperbaric oxygen therapy. ConclusionProstate SBRT is feasible and well-tolerated in patients with a medical history of surgical treatments of benign hyperplasia. Patients with prior adenomectomy or multiple TURP are at higher risk of developing severe genitourinary toxicity and should be carefully evaluated before SBRT treatments.

Two-Staged Sacral Neuromodulation for the Treatment of Nonobstructive Urinary Retention: A Multicenter Study Assessing Predictors of Success

ObjectivesThe aims of this study were to 1) determine the success rate of the tined lead test phase in patients with nonobstructive urinary retention (NOUR), 2) determine predictive factors of a successful test phase in patients with NOUR, and 3) determine long-term treatment efficacy and satisfaction in patients with NOUR. Materials and MethodsThe first part was a multicenter retrospective study at two centers in The Netherlands. Patients with NOUR received a four-week tined lead test phase. Success was defined as a ≥50% reduction of clean intermittent catheterization frequency or postvoid residual. We analyzed possible predictors of success with multivariable logistic regression. Second, all patients received a questionnaire to assess efficacy, perceived health (Patient Global Impression of Improvement), and treatment satisfaction. ResultsThis study included 215 consecutive patients (82 men and 133 women) who underwent a tined lead test phase for the treatment of NOUR. The success rate in women was significantly higher than in men, respectively 62% (83/133) and 22% (18/82, p < 0.001). In women, age per ten years (odds ratio [OR] 0.74, 95% CI: 0.59–0.93) and a history of psychiatric illness (OR 3.92, 95% CI: 1.51–10.2), including posttraumatic stress disorder (PTSD), significantly predicted first stage sacral neuromodulation (SNM) success. In men, age per ten years (OR 0.43, 95% CI: 0.25–0.72) and previous transurethral resection of the prostate and/or bladder neck incision (OR 7.71, 95% CI: 1.43–41.5) were significant predictors of success. Conversely, inability to void during a urodynamic study (for women, OR 0.79, 95% CI: 0.35–1.78; for men, OR 3.06, 95% CI: 0.83–11.3) was not predictive of success. Of the patients with a successful first stage, 75% (76/101) responded to the questionnaire at a median follow-up of three years. Of these patients, 87% (66/76) continued to use their SNM system, and 92% (70/76) would recommend SNM to other patients. ConclusionsA history of psychiatric illness, including PTSD, in women with NOUR increased the odds of first stage SNM success 3.92 times. A previous transurethral resection of the prostate and/or bladder neck incision in men increased the odds of success 7.71 times. In addition, a ten-year age increase was associated with an OR of 0.43 in men and 0.74 in women, indicating a 2.3- and 1.3-times decreased odds of success, respectively.

The Feasibility of Open Prostatectomy in Patients with History of Previous Prostate Surgery.

Benign prostatic hyperplasia (BPH) is one of the most common problems in elderly men. Transurethral resection of the prostate (TURP) can be performed for most patients who need re-do prostate surgery, but open prostatectomy should be considered in patients with prostate size larger than 70 grams. This study assessed the feasibility of open prostatectomy (OP) after previous TURP in patients whose prostate size was larger than 70 grams. We subdivided patients into two groups: group 1 included patients who had a history of prostate surgery presented with severe voiding symptoms and a large prostate (>70 gram). Patients who were candidate for open simple prostatectomy without a history of prostate surgery were allocated to group 2. Between June 2007 and April 2018, 2700 patients underwent TURP or open prostatectomy in our department. 152 of 2700 patients came to us because of severe voiding symptoms after previous prostate surgery, but only 30 patients met the criteria to be enrolled in this study. Perioperative complication (capsular perforation) occurred in 4 (13.3%) patients in group 1 whereas none of the patients in the group 2 had capsular perforation. Hemoglobin drop in group 1 was not significantly different from patients in group 2. The rate of blood transfusion did not differ between the groups (2 [6.6%] patients in group 1 and 41 (5.6%) patients in group 2). After 6-12 months, re-operation rate because of urethral/bladder neck stricture was done in 10 (30%) patients in group 1 and 15 (2%) patients in group 2 (p < 0.05). Four (13.3%) patients in group 1 complained of urinary leakage (more than one pad per day) 6 months after the operation whereas 5 patients in group 2 used more than one pad per day (0.7%) (p > 0.05). Hospital stay was slightly longer in patients in group 1. Six months after the operation, the patients' quality of life was better in group 2 compared with group 1 (p < 0.05). Open simple prostatectomy was a feasible procedure in patients with large prostate after previous TURP, but it was associated with more complications in the long term.

Impact of previous transurethral resection of prostate on robot-assisted radical prostatectomy: a matched cohort analysis.

We aimed to compare surgical, oncological, and functional outcomes of robot-assisted radical prostatectomy (RARP) in prostate cancer patients with and without prior history of transurethral resection of the prostate (TURP), using a matched cohort analysis. In an IRB-approved protocol, all patients who underwent RARP at our institution between April 2005 and July 2018 with at least 1-year follow-up were included. Among these, patients who had undergone a previous TURP (Group A) were compared with those without TURP (Group B) using the Survival, Continence, and Potency outcomes reporting system. Using propensity score matching for age, PSA and Gleason score, the two cohorts were further subdivided in a 1:2 ratio into Group C (prior TURP from Group A) and Group D (without prior TURP from Group B). Similar comparisons were made between Group C and D. Patients in Group A (n = 40) had lower PSA (p = 0.031) and were more likely to have Gleason grade 1 disease (p = 0.035) than patients in Group B (n = 143). In the propensity-matched group analysis, patients of Group C (n = 38) had higher operative time and blood loss than Group D (n = 76) patients. Group C patients also had lower continence at 3, 6, and 12months after surgery. However, oncological and potency outcomes were similar in both the groups. We concluded that previous TURP is a predictor for surgical and continence outcomes following RARP. Even though these patients have a potentially lower stage or grade of disease, they are less likely to achieve social continence than men who have not had a previous TURP. This information would be important in counseling them for treatment options.

Factors Associated with Urethral and Bladder Neck Stricture After Transurethral Resection of the Prostate.

Introduction: Urethral and bladder neck stricture (U/BNS) is a complication that occurs in up to 9% of patients following transurethral resection of the prostate (TURP). The most relevant risk factors reported are prolonged surgical duration and prostatic volume. The purpose of this study is to analyze risk factors associated with the development of U/BNS following TURP. Materials and Methods: Case-control study. Population: patients who underwent TURP. Cases: patients with U/BNS following TURP, diagnosed between January 2010 and December 2018. We included patients with obstructive symptoms after TURP with clinical or radiographical evidence of U/BNS. Controls were patients who underwent TURP between January 2016 and December 2017, without evidence of stricture. Patients with history of pelvic fracture and previous U/BNS were excluded. We analyzed as risk factors age, prostatic volume, diabetes mellitus, previous use of transurethral catheter, urinary tract infection, bladder calculi, prostate cancer, previous TURP, resection time, resected volume during TURP, transoperative complications, and number of surgical procedures performed during the same event. We used chi-square or Mann-Whitney's U test for between-group comparison; association was established by odds ratios (ORs) and 95% confidence interval (CI), variables with p < 0.05 were included in the logistic regression. Results: We included 101 cases and 207 controls. Cases had lower incidence of prostate cancer, smaller prostates, less resection time during TURP, lower grams resected and prostate-specific antigen values than controls. History of transurethral catheter was more frequent in controls than cases (46% vs 29%, p = 0.004); there were no differences between groups in the other factors analyzed. On multivariate analysis, the use of a transurethral catheter was a protective factor against U/BNS (OR 0.16, 95% CI 0.064-0.442, p < 0.001). Conclusions: In this study, the use of urethral catheter before TURP is a protective factor against U/BNS.

MP03-12 MULTI-INSTITUTIONAL FEASIBILITY OF DORSAL ONLAY URETHROPLASTY FOR MEMBRANOUS URETHRAL STRICTURE FOLLOWING ENDOSCOPIC PROSTATE PROCEDURES: OPERATIVE RESULTS AND MULTIVARIATE ANALYSIS

INTRODUCTION AND OBJECTIVE:Reconstruction of membranous urethral stenosis in patients with previous transurethral resection of the prostate (TURP) or other endoscopic prostate ablative procedures i...

Prostatic Artery Embolization for the Treatment of Recurrent Lower Urinary Tract Symptoms following Transurethral Resection of the Prostate

PurposeTo evaluate the safety and efficacy of prostatic artery embolization (PAE) in patients with recurrent lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) who underwent a previous transurethral resection of the prostate (TURP). Materials and MethodsThis retrospective study analyzed 15 of 19 patients who underwent PAE for recurrent LUTS after TURP between February 2014 and April 2019. The technical and clinical success rates and complications related to the procedure were recorded. International Prostate Symptom Score (IPSS), quality of life (QoL), and prostatic volume (PV) were evaluated at baseline and 3- and 12-mo follow-up. ResultsThe intervals from TURP to recurrent symptoms and from TURP to PAE were 4.3 y ± 3.2 and 5.6 y ± 3.8, respectively. Technical success was achieved in all patients. The clinical success rate for LUTS relief at 12 mo was 93.3% (14 of 15). IPSS significantly reduced from 22.5 ± 4.1 at baseline to 9.9 ± 4.9 at 12-mo follow-up, and QoL score improved from 4.7 ± 1.0 to 2.1 ± 1.1 (P < .05 for both). There was a significant mean reduction of 26.6% in PV at 12 mo, improving from 100.7 cm3 ± 38.5 to 73.9 cm3 ± 29.4 (P < .05). No severe complications were encountered. ConclusionsPAE may be a safe and effective treatment option for the management of recurrent LUTS secondary to BPH in patients who have previously undergone TURP.

Genitourinary Toxicity In Prostate Cancer Patients With History Of Transurethral Resection Of The Prostate Undergoing High Dose Rate Brachytherapy With A Novel Urethral-Sparing Technique

Prior transurethral resection of the prostate (TURP) is traditionally considered a contraindication to high dose rate prostate brachytherapy (HDR-B) due to increased risk of urinary morbidity and poor dose distribution in the prostate. We previously described a novel technique using a modified triple-lumen catheter to visualize and spare the TURP defect during CT-based HDR-B. We now report genitourinary (GU) toxicity in our institutional experience with this urethral-sparing technique. Prostate cancer patients with >3 months follow-up who underwent HDR-B using a modified triple-lumen catheter to visualize the TURP defect were included. Patient demographics, disease characteristics, dosimetry, and clinical outcomes were retrospectively reviewed. Toxicity was graded using NCI CTCAE v5.0 and classified as acute (≤90 days after HDR-B) or late (>90 days). Thirty-three patients met inclusion criteria. Median age was 76 years (IQR 74-80) and median follow up was 17.0 months (range 3.3-64.8). Thirty patients had 1 previous TURP and 3 patients had 2. Median time from most recent TURP to HDR-B was 49.0 months (IQR 6.1-125.8). Twenty-nine patients had newly diagnosed prostate cancer: 9 intermediate risk, 17 high risk, and 3 regional risk disease per NCCN. Among these, 1 patient received HDR-B monotherapy (27 Gy/2 fractions) and 28 received HDR-B boost (15 Gy/1 fraction) combined with external beam radiotherapy (EBRT). Four patients underwent salvage HDR-B for local recurrence 3-12 years after definitive radiotherapy: 1 received EBRT, 1 LDR-B and 2 HDR-B monotherapy. Among these, 2 patients received whole gland monotherapy (15 Gy/1 fraction, 36 Gy/6 fractions), 1 received partial gland monotherapy (27 Gy/2 fractions), and 1 received whole gland boost (18 Gy/3 fractions) combined with EBRT. Twenty-seven (82%) patients did not experience acute G2 or higher GU toxicity. Five (15%) patients experienced G2 toxicity (4 with retention or hematuria requiring temporary catheter placement and 1 with urinary frequency). One patient had G3 hematuria requiring procedural intervention 2 months after HDR-B. Only 2 of 29 newly diagnosed patients experienced acute G2 or higher GU toxicity, compared to 4 of 4 patients receiving salvage HDR-B re-irradiation. Twenty-seven (82%) patients did not experience late G2 or higher GU toxicity. Three (9%) patients experienced G2 hematuria (2 with clot retention requiring catheter placement and 1 requiring hyperbaric oxygen therapy) and 4 (12%) experienced G2 urinary incontinence. Two (6%) patients had late G3 toxicity (hematuria and retention) requiring procedural intervention. HDR-B in prostate cancer patients with a history of TURP has an acceptably low risk of G2 or higher GU toxicity when the urethral defect is adequately spared during CT-based planning. Acute G2 or higher GU toxicity occurred primarily in patients receiving salvage HDR-B re-irradiation and did not predict late G2 or higher GU toxicity.

Preliminary result of carbon-ion radiotherapy using the spot scanning method for prostate cancer

BackgroundCarbon-ion radiotherapy (CIRT) for prostate cancer was initiated at Kanagawa Cancer Center in 2015. The present study analyzed the preliminary clinical outcomes of CIRT for prostate cancer.MethodsThe clinical outcomes of 253 patients with prostate cancer who were treated with CIRT delivered using the spot scanning method between December 2015 and December 2017 were retrospectively analyzed. The irradiation dose was set at 51.6 Gy (relative biological effectiveness) delivered in 12 fractions over 3 weeks. Biochemical relapse was defined using the Phoenix definition. Toxicities were assessed according to CTCAE version 4.0. Results: The median patient age was 70 (47–86) years. The median follow-up duration was 35.3 (4.1–52.9) months. According to the D’Amico classification system, 8, 88, and 157 patients were classified as having low, intermediate, and high risks, respectively. Androgen deprivation therapy was administered in 244 patients. The biochemical relapse-free rate in the low-, intermediate-, and high-risk groups at 3 years was 87.5, 88.0, and 97.5%, respectively (P = 0.036). Grade 2 acute urinary toxicity was observed in 12 (4.7%) patients. Grade 2 acute rectal toxicity was not observed. Grade 2 late urinary toxicity and grade 2 late rectal toxicity were observed in 17 (6.7%) and 3 patients (1.2%), respectively. Previous transurethral resection of the prostate was significantly associated with late grade 2 toxicity in univariate analysis. The predictive factor for late rectal toxicity was not detected.ConclusionThe present study demonstrated that CIRT using the spot scanning method for prostate cancer produces favorable outcomes.

Linac-based stereotactic body radiation therapy for low and intermediate-risk prostate cancer : Long-term results and factors predictive for outcome and toxicity.

Stereotactic body radiation therapy (SBRT) is considered an effective and safe treatment in patients with low- and intermediate-risk prostate cancer (PC). However, due to alack of long-term follow-up and late toxicity data, this treatment is not universally accepted. The present study aimed to evaluate outcome and early and late toxicity in acohort of patients with low- and intermediate-risk PC treated prospectively with linear accelerator (linac)-based SBRT. Patients with low- or intermediate-risk (NCCN criteria) PC were included. All patients received linac-based SBRT to 35 Gy in 5fractions delivered on alternate days. Endpoints were toxicity, biochemical relapse-free survival (BRFS), metastatic progression-free survival (mPFS), and overall survival (OS). From 2012 to 2018, 178 patients were treated. Median baseline prostate-specific antigen (iPSA) was 6.37 ng/ml (range 1.78-20). Previous transurethral resection of the prostate (TURP) was present in 23 (12.9%) patients. Median follow-up was 58.9 months (range 9.7-89.9). BRFS rates at 1, 3, and 5years were 98.3 (95% confidence interval, CI, 94.7-99.4%), 94.4 (95%CI 89.4-97), and 91.6% (95%CI 85.4-95.2), respectively. In univariate analysis, performance status (PS), iPSA, and nadir PSA (nPSA) were correlated with BRFS. In multivariable analysis iPSA and nPSA remained significant. BRFS rates at 5years were 94.9% (95%CI 86.8-98) for International Society of Urological Pathology (ISUP) grade group1, 93.2% (95%CI 80.5-97.7) for ISUP group2, and 74.8% (95%CI 47.1-89.5) for ISUP group3. At 1, 3, and 5years, mPFS rates were 98.8 (95%CI 95.5-99.7), 96.2 (95%CI 91.9-98.3), and 92.9% (95%CI 87.2-96.2), respectively; OS rates were 100, 97.2 (95%CI 92.9-98.9), and 95.1% (95%CI 90-97.6), respectively. One (0.56%) case of grade3 acute genitourinary (GU), one case of acute gastrointestinal (GI), and one case of grade3 late GU toxicity were observed. GI toxicity positively correlated with prostate volume. At long-term follow-up, linac-based SBRT continues to be avalid option for the management localized PC. Biochemical control remains high at 5years, albeit with some concerns regarding the optimal schedule for unfavorable intermediate-risk PC. Considering the excellent prognosis, patient selection is crucial for prevention of severe late toxicity.

Surgical and Functional Outcomes of Robotic-Assisted Radical Prostatectomy in Patients with Previous Transurethral Resection of the Prostate

Purpose: The purpose of this study was to assess the surgical and functional outcomes of robotic-assisted radical prostatectomy (RARP) in patients with previous transurethral resection of the prostate (TURP). Materials and Methods: The present article studies 99 patients who underwent RARP, including 13 patients with previous TURP at a single institution, in the period from April 2016 to February 2019. Propensity score matching 1:1 was performed to identify 13 patients with no previous TURP. The matched variables were age and preoperative prostate-specific antigen level. Surgical and functional outcomes were compared between the two groups. Descriptive statistics were evaluated using the Chi-square test. t-test was performed for continuous variables. Results: Regarding preoperative characteristics, no previous TURP group had a higher clinical stage (P = 0.026). The nerve-sparing procedure was similar between the two groups. Concerning intraoperative outcomes for the group with previous TURP history, the operating room time was increased by 25 min (P = 0.140), and the estimated blood loss was increased by 50 ml (P = 0.192). As for the postoperative pathological characteristics, there was no significant difference in the positive surgical margin rate between the two groups. The continence rate in the 3rd month for the group with previous TURP history was 69.2% versus 92.3% for the group with no previous TURP history, and after the 1st year, the rates were 100% versus. 92.3%. There was no significant difference in the potence recovery rate between the two groups after 1-year follow-up. Conclusion: RARP is safe and feasible in patients with localized prostate cancer with previous TURP history. Functional outcomes after 1-year follow-up were comparable for patients with previous TURP.

Radical prostatectomy after previous transurethral resection of the prostate: a systematic review and meta-analysis.

The influence of a previous transurethral resection of the prostate (TURP) on the outcomes of radical prostatectomy (RP) is still controversial. Therefore, we performed a meta-analysis to evaluate the perioperative, functional and oncological outcomes of RP with or without a previous TURP. We conducted a computerized literature search of PubMed, Embase, and the Cochrane Library and included 15 retrospective studies evaluating RPs with or without a previous TURP in this meta-analysis. Fifteen studies, including 6,840 cases, were analyzed. RP after a previous TURP were related to smaller prostate volumes (WMD: -6.93 cm3; 95% CI, -10.89 to -2.97; P<0.001), lower preoperative prostate-specific antigen (PSA) levels (WMD: -1.51; 95% CI, -2.49 to -0.53; P=0.002), longer operative times (WMD: 13.22 min; 95% CI, 4.55 to 21.89 min; P=0.003), more blood loss (WMD: 55.38 mL; 95% CI, 12.35 to 98.41 mL; P=0.01), higher overall complication rates (OR =1.98; 95% CI, 1.27 to 3.08; P=0.002), longer hospital stays (WMD: 1.16 days; 95% CI, 0.65 to 1.67; P<0.001), longer duration of catheter (WMD: 0.60 days; 95% CI, 0.56 to 0.64; P<0.001), higher positive surgical margin rates (OR =1.30; 95% CI, 1.09 to 1.55; P=0.004), lower complete continence rates at 3 months (OR =0.67; 95% CI, 0.56 to 0.81; P<0.001), 6 months (OR =0.52; 95% CI, 0.31 to 0.88; P=0.01), 12 months (OR =0.59; 95% CI, 0.46 to 0.74; P<0.001), and lower potency rates at 12 months (OR =0.62; 95% CI, 0.51 to 0.77; P<0.001). Subgroup analysis indicated that open RP after previous TURP could achieve better outcomes. RP after a previous TURP leads to worse perioperative, oncological, and functional outcomes. For these patients an open procedure is recommended. Due to the low number of studies and known biases, further large-scale studies are needed to support this result.

How can we prevent postprostatectomy urinary incontinence by patient selection, and by preoperative, peroperative, and postoperative measures? International Consultation on Incontinence-Research Society 2018.

To review current prevention strategies for urinary incontinence among patients undergoing radical prostatectomy (RP). This is a consensus report of the proceedings of a research proposal from the annual International Consultation on Incontinence-Research Society (ICI-RS), 14 to 16 June 2018(Bristol, UK): "How can we prevent postprostatectomy incontinence by patient selection, and by preoperative, peroperative, and postoperative measures?" Several baseline parameters were proposed as predicting factors for postprostatectomy urinary incontinence (PPUI), including age, tumor stage, prostate volume, preoperative lower urinary tract symptoms, maximum urethral closure pressure, and previous transurethral resection of the prostate. More recently, magnetic resonance imaging has been used to measure the membranous urethral length and sphincter volume. Peroperative techniques include preservative and reconstructive approaches. Bladder neck preservation improved early (6 months), as well as long-term (>12 months) continence rates. Several prospective studies have reported earlier return of continence following preservation of puboprostatic ligaments, although no long-term data are available. Preservation of the urethral length yielded controversial outcomes. Concerning postoperative strategies, it is probably optimal to remove the catheter in a window between 4 and 7 days if clinically appropriate; however, more research in this regard is still required. Postoperative PFME (preoperative pelvic floor muscle exercise) appears to speed up the recovery of continence after RP. Conservative strategies to prevent PPUI include proper patient selection and PFME. Peroperative techniques have largely shown benefit in the short term. Postoperative complications and timing of trial without catheter can influence continence status. Future research initiatives must assess peroperative and postoperative measures, with longer-term follow-up.

Transüretral Prostat Rezeksiyonu Geçirmiş Olmak Robotik Radikal Prostatektomi Sonuçlarını Nasıl Etkiler?

Objective : We investigated the impact of transurethral resection of the prostate (TUR-P) on perioperative outcomes in patients who underwent robot assisted radical prostatectomy (RARP). Material and Methods: A total of 752 cases performed by 3 surgeons between February 2009 and December 2017 were reviewed retrospectively. First 100 cases of each surgeon were not included to exclude the learning curve effect. All patients (n = 452) were divided into two groups according to having a previous TUR-P history as Group 1 = patients with TUR-P history (n = 38), Group 2 = patients without TUR-P history (n = 414). Results : Mean patient age was 68.3± 5.9 versus 63.3±6.8 years p=0.00; mean console time was 144.3±37.1 versus 124.6±24.0 minutes, p=0.02; bladder neck reconstruction was 31.6% versus 16.7%, p=0.02; transurethral catheter removal time was 11.3±5.1 versus 8.6±2.7 days, p=0.00; for groups 1 and 2, respectively. Positive surgical margin rates were 26.3% versus 27.3%, p=0.897; erectile function (IIEF≥17) rates on postoperative 12th-month were 60% versus 67%, p=0.644 for groups 1 and 2, respectively. First 3 months continence rates were 52.6% versus 72%, p=0.035 for groups 1 and group 2, respectively. Postoperative 12. month continence rates were similar for group 1 and 2(94.7% vs 97.3% ; p=0.562). Conclusion: RARP after TUR-P has similar oncological outcomes, longer operative time, worse postoperative early continence acquisition rates and longer urethral catheter removal time.

Radical prostatectomy after previous TUR-P: Oncological, surgical, and functional outcomes

ObjectivesTo examine oncological, surgical, and functional outcomes of radical prostatectomy (RP) in patients with history of transurethral resection of the prostate (TUR-P). Materials and methodsRetrospective analysis of 18,681 RP-patients including 470 patients with previous TUR-P at a single institution (2002–2015). Kaplan-Meier as well as multivariable Cox and logistic regression analyses compared surgical, oncological, and functional outcomes between TUR-P and non-TUR-P patients after propensity score matching (nearest neighbor in a 1:3 fashion). ResultsAfter propensity score adjustment, pathological and surgical results were similar between both groups. Specifically, rates of positive surgical margins and nerve-sparing (NS) procedure did not differ between groups (positive surgical margins: 18.5% vs. 17.2%, P = 0.7; nerve-sparing: 89.4% vs. 91.6%, P = 0.5). In addition, there was no difference in mean operating room time (185 vs. 184 minutes, P = 0.6), blood loss (710 vs. 666 ml, P = 0.1), and catheterization time (12 days, P = 0.3). In multivariable analyses, TUR-P patients did not exhibit higher risk of biochemical recurrence, metastatic progression, or mortality (all P > 0.05). However, TUR-P patients exhibited higher risk for urinary incontinence at third month (OR: 1.47; 95% confidence interval [CI] 1.01–2.12, P = 0.04) and first year (OR: 2.06; 95% CI 1.23–3.42, P = 0.006) and worse 1-year erectile function recovery (OR: 0.48; 95% CI 0.27–0.86, P = 0.02). ConclusionsThis large series of TUR-P RP patients demonstrated that RP could be safely performed in patients with history of TUR-P without compromising oncological results. However, functional outcomes were worse for patients with previous TUR-P.

Reconstruction of Membranous Urethral Strictures.

Due to the proximity of the rhabdosphincter and cavernous nerves to the membranous urethra, reconstruction of membranous urethral stricture implies a risk of urinary incontinence and erectile dysfunction. To avoid these complications, endoscopic management of membranous urethral strictures is traditionally favored, and bulboprostatic anastomosis is reserved as the main classical approach for open reconstruction of recalcitrant membranous urethral stricture. The preference for the anastomotic urethroplasty among reconstructive urologists is likely influenced by the familiarity and experience with trauma-related injuries. We review the literature focusing on the anatomy of membranous urethra and on the evolution of treatments for membranous urethral strictures. Non-traumatic strictures affecting bulbomembranous urethra are typically sequelae of instrumentation, transurethral resection of the prostate, prostate cancer treatment, and pelvic irradiation. Being a different entity from trauma-related injuries where urethra is not in continuity, a new understanding of membranous urethral anatomy is necessary for the development of novel reconstruction techniques. Although efficacious and durable to achieve urethral patency, classical bulboprostatic anastomosis carries a risk of de-novo incontinence and impotence. Newer and relatively less invasive reconstructive alternatives include bulbar vessel-sparing intra-sphincteric bulboprostatic anastomosis and buccal mucosa graft augmented membranous urethroplasty techniques. The accumulated experience with these techniques is relatively scarce, but several published series present promising results. These approaches are especially indicated in patients with previous transurethral resection of the prostate in which sparing of rhabdosphincter and the cavernous nerves is important in attempt to preserve continence and potency. Additionally, introduction of buccal mucosa onlay grafts could be especially beneficial in radiation-induced strictures to avoid transection of the sphincter in continent patients, and to preserve the blood supply to the urethra for incontinent patients who will require artificial urinary sphincter placement. The evidence regarding erectile functional outcomes is less solid and this item should be furtherly investigated.