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

OBJECTIVES: To examine oncological, surgical, and functional outcomes of radical prostatectomy (RP) in patients with history of transurethral resection of the prostate (TUR-P).

MATERIALS AND METHODS: Retrospective 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).

RESULTS: After 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).

CONCLUSIONS: This 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.