The study conducted by Anneng Hu et al. evaluates the impact of prior transurethral resection of the prostate (TURP) on the outcomes of subsequent robot-assisted radical prostatectomy (RARP) in patients diagnosed with prostate cancer. TURP is commonly used for treating benign prostatic hyperplasia but can complicate future surgeries due to anatomical alterations. This research aims to provide a clearer understanding of whether a history of TURP adversely affects the perioperative, functional, and oncological outcomes of RARP.

Methodology

The researchers systematically reviewed literature published in English before September 2024, utilizing databases such as Web of Science, PubMed, Cochrane Library, and EMBASE. They included 15 studies in their meta-analysis, comprising 869 patients who underwent RARP following transurethral resection of the prostate and 5,879 patients who underwent RARP alone. The analysis focused on various outcomes, including operative time, blood loss, hospital stay, nerve-sparing rates, and quality of life measures such as urinary incontinence and sexual function recovery.

Key Findings

1. Perioperative Outcomes:
   • The study found that RARP after TURP resulted in significantly longer operative time (WMD: 26.63 minutes) and increased estimated blood loss (WMD: 19.85 ml). Additionally, patients experienced longer hospital stays (WMD: 0.52 days) and extended catheter removal times (WMD: 0.18 days) compared to the non-TURP group.
   • The overall nerve-sparing success rate was notably lower in patients with prior transurethral resection of the prostate (OR: 0.53). Bilateral nerve-sparing procedures showed even reduced success rates (OR: 0.58).
2. Surgical Complications:
   • Patients in the TURP group had higher rates of bladder neck reconstruction (OR: 8.38) and major complications (OR: 1.94) classified as Clavien grade ≥ 3. The positive surgical margin (PSM) rate was also elevated (OR: 1.25) in the prior-TURP group.
3. Functional Outcomes:
   • Quality-of-life assessments indicated that patients who underwent RARP after TURP had lower rates of urinary incontinence recovery at one year (OR: 0.58) and reduced potency recovery rates (OR: 0.60).
4. Oncological Outcomes:
   • Despite the higher rates of PSM in the prior-TURP group, there were no significant differences in biochemical recurrence rates between the two groups at one year.

Discussion

The authors discuss the complexity added to RARP due to prior TURP. The changes in anatomical structures and potential scarring can complicate nerve-sparing techniques and increase the risk of complications during surgery. They highlight the need for careful preoperative counselling and surgical planning for patients with a history of TURP.

Conclusion

The study concludes that prior transurethral resection of the prostate has adverse effects on the perioperative, functional, and oncological outcomes of RARP. The findings emphasize the necessity for clinicians to consider these factors when planning treatment for patients with a history of TURP, advocating for more research to further understand these impacts and optimize management strategies.

READ MORE… https://link.springer.com/article/10.1007/s11701-025-02234-3

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