How does previous transurethral resection of the prostate affect the results of robotic radical prostatectomy?

Year 2019, Volume: 14 Issue: 2, 91 - 98, 01.06.2019

Murat Keske , Abdullah Erdem Canda , Ali Fuat Atmaca , Nurullah Hamidi Mevlana Derya Balbay

https://doi.org/10.33719/yud.582509

Abstract

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.

Keywords

Robotic prostatectomy , Prostate cancer , TUR-P

Transüretral prostat rezeksiyonu geçirmiş olmak robotik radikal prostatektomi sonuçlarını nasıl etkiler?

Abstract

Giriş:
Bu çalışmada robot yardımlı radikal prostatektomi (RYRP) yapılan hastalarda
geçirilmiş transüretral prostat rezeksiyonu (TUR-P) cerrahisinin perioperatif
sonuçlar üzerine etkisi araştırılmıştır.

Materyal ve Metod:
Şubat 2009-Aralık 2017 arasında 3 cerrah tarafından gerçekleştirilen toplam 752
vakanın verileri retrospektif olarak incelendi. Her bir cerrahın ilk 100 vakası
öğrenme eğrisi nedeniyle çalışma dışı bırakıldı. Tüm hastalar (n=452) RYRP
öncesinde TUR-P öyküsü olup olmamasına göre iki gruba ayrıldı. Grup 1=TUR-P
öyküsü olanlar (n=38), Grup 2=TUR-P öyküsü olmayanlar, (n=414).

Bulgular:
Sırasıyla grup 1 ve 2’de ortalama hasta yaşı 68.3± 5.9 ve 63.3±6.8 yıl p=0.00; ortalama konsol
süresi 144.3±37.1
ve 124.6±24.0
dakika, p=0.02; mesane boynu rekonstrüksiyon gereksinim oranı %31.6 ve %16.7, p=0.02; ortalama transüretral
kateter kalış süresi 11.3±5.1
ve 8.6±2.7
gün, p=0.00 saptanmıştır. Sırasıyla grup 1 ve 2’de, pozitif cerrahi sınır,  grup 1’de %26.3, grup 2’de %27.3, p=0.897 ve erektil
fonksiyon oranları (IIEF≥17)
(postoperatif 12. ay grup 1’de %60, grup 2’de %67, p=0.644) benzer saptanmıştır.
Erken dönemde (3. ay) kontinans oranları grup 1 ve grup 2 de sırasıyla  %52.6 ve %72 olarak bulunmuştur (p=0.035). 12.
ay sonunda kontinans oranları açısından iki grupta %94.7 ve %97.3 olarak birbirine
benzer sonuçlar elde edilmiştir (p=0.562).

Sonuç:
TUR-P sonrası RYRP ameliyatı yapılması, TUR-P geçirmeyen hastalara göre benzer
onkolojik sonuçları olan, daha uzun ameliyat süresi olan, postoperatif erken
kontinans kazanılması oranları daha az olan ve daha uzun süre idrar sondası
takılması gerektiren bir ameliyattır.

Keywords

Prostat kanseri , Robotik prostatektomi , TUR-P

References

• 1. Ficarra V, Cavalleri S, Novara G, et al. Evidence from robotassisted laparoscopic radical prostatectomy: A systematic review. Eur Urol 2007;51:45–56.
• 2. Ficarra V, Novara G, Artibani W, et al. Retropubic, laparoscopic, and robot-assisted radical prostatectomy: A systematic review and cumulative analysis of comparative studies. Eur Urol 2009;55:1037–1063.
• 3. Bandhauer K, Senn E. Radical prostatectomy after transurethral prostate resection. Eur Urol 1988;15:180–181.
• 4. Jaffe J, Stakhovsky O, Cathelineau X, et al. Surgical outcomes for men undergoing laparoscopic radical prostatectomy after transurethral resection of the prostate. J Urol 2007;178:483–487.
• 5. Colombo R, Naspro R, Salonia A, et al. Radical prostatectomy after previous prostate surgery: Clinical and functional outcomes. J Urol 2006;176:2459–2563.
• 6. Canda AE, Atmaca AF, Akbulut Z, Asil E, Kilic M, et al. Results of robotic radical prostatectomy in the hands of surgeons without previous laparoscopic radical prostatectomy experience. Turk J Med Sci. 2012;42(Suppl 1):1338–46.
• 7. Rosen RC, Cappelleri JC, Smith MD, et al. Development and evaluation of an abridged, 5-item version of the International Index of Erectile Function (IIEF-5) as a diagnostic tool for erectile dysfunction. Int J Impot Res 1999;11: 319–326.
• 8. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–213.
• 9. Ramon J, Rossignol G, Leandri P, Gautier JR. Morbidity of radical retropubic prostatectomy following previous prostate resection. J Surg Oncol 1994;55:14–19. 10.
• 10. Katz R, Borkowski T, Hoznek A, et al. Laparoscopic radical prostatectomy in patients following transurethral resection of the prostate. Urol Int 2006;77:216–221. 11.
• 11. Bujons Tur A, Montlleo Gonzalez M, Pascual Garcia X, et al. Radical prostatectomy in patients with history of transurethral resection of the prostate. Arch Esp Urol 2006; 59:473–478.
• 12. Gupta NP, Singh P, Nayyar R. Outcomes of robot-assisted radical prostatectomy in men with previous transurethral resection of prostate. BJU Int. 2011 Nov;108(9):1501-5. doi: 10.1111/j.1464-410X.2011.10113.x. Epub 2011 Mar 10.
• 13. Eden CG, Richards AJ, Ooi J, et al. Previous bladder outlet surgery does not affect medium-term outcomes after laparoscopic radical prostatectomy. BJU Int. 2007;99:399–402. 15.
• 14. Teber D, Cresswell J, Ates M, et al. Laparoscopic radical prostatectomy in clinical T1a and T1b prostate cancer: oncologic and functional outcomes: a matched-pair analysis. Urology. 2009;73:577–81.
• 15. Do M, Haefner T, Liatsikos E, et al. Endoscopic extraperitoneal radical prostatectomy after previous transurethral resection of prostate: oncologic and functional outcomes of 100 cases. Urology. 2010;75:1348–1352.
• 16. Yazici S, Inci K, Yuksel S. Radical prostatectomy after previous prostate surgery: effects on surgical difficulty and pathologic outcomes. Urology. 2009;73:856–859.
• 17. Hampton LJ, Jacobsohn K, Nelson RA. Patients with prior TURP undergoing robotic assisted laparoscopic radical prostatectomy have higher positive surgical margin rates. J Urol 2008; 179 (Suppl.): 606
• 18. Zugor V, Labanaris AP, Porres D, Witt JH. Surgical, oncologic, and short-term functional outcomes in patients undergoing robot-assisted prostatectomy after previous transurethral resection of the prostate. J Endourol. 2012 May;26(5):515-9. doi: 10.1089/end.2011.0205. Epub 2011 Sep 13.
• 19. Menard J, de la Taille A, Hoznek A, Allory Y, Vordos D, Yiou R, Abbou CC, Salomon L. Laparoscopic radical prostatectomy after transurethral resection of the prostate: surgical and functional outcomes. Urology 2008; 72: 593–7. doi:10.1016/j.urology.2008.03.019.