Patients who undergo radical prostatectomy with a history of transurethral resection of prostate (TURP) may have worse surgical or oncologic outcomes compared with patients with no history of TURP, according to the results of a meta-analysis.

TURP is commonly used for benign prostatic hyperplasia, and prostate cancer can be found in as many as 3% to 16% of specimens from the procedure. It is currently recommended that radical prostatectomy occur in the first month after TURP or until 4 months after TURP in patients found to have prostate cancer. 

Here, the researchers conducted a meta-analysis to compare outcomes of patients who had previous TURP prior to prostatectomy with patients with no TURP. 

The study included data from 13 studies of 1163 patients with TURP history and 5587 patients without TURP history. Results suggested that a history of TURP was associated with a higher positive surgical margin rate (odds ratio, 1.31; P =.004) compared with non-TURP.

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“Radical prostatectomy in patients undergoing TURP accounts for a difficulty in precisely identifying the prostatic apex and prostatic margins; due to peripheral venous fibrosis, the anatomy of patients after TURP is technically difficult; capsular perforation and fluid absorption during TURP can lead to fibrotic postinflammatory reaction, this eventually leads to more difficult bladder neck dissection, which negatively affects the surgical margins in this area,” the researchers explained. 

In addition, a history of TURP was also associated with worse outcomes for bladder neck reconstruction rate (OR, 14.36; P =.001), and overall complication rate (OR, 2.63; P <.00001) compared with the non-TURP group. History of TURP demonstrated significantly lower nerve sparing rate (OR, 0.30; P <.00001). 

There were some similarities identified between the 2 groups including outcomes for operation time, blood loss, and 1-year urinary continence rate. 

“In order to reduce the influence of TURP on radical prostatectomy, the interval time between TURP and radical prostatectomy is an important factor,” the researchers wrote. “However, currently no consensus has been reached in this regard. Consequently, more relevant studies are warranted to identify the optional interval, so that prostate cancer patients with a TURP history can have a better recovery after radical prostatectomy.”

Reference

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 [published online November 2, 2019]. World J Urol. doi:10.1007/s00345-019-02986-2