Does transurethral resection of the prostate before robot-assisted radical prostatectomy have adverse effects on patients diagnosed with prostate cancer: a comparative evidence-based analysis?

Abstract

In clinical practice, it is not uncommon for a history of trans-urethral resection of the prostate (TURP) to complicate a future robotic-assisted radical prostatectomy (RARP). This study aims to determine if prior TURP adversely affects outcomes in subsequent RARP, analyzing perioperative, functional, and oncological results between the procedures. Research published in English before September 2024 was systematically reviewed using Web of Science, PubMed, Cochrane Library, and the EMBASE. Review Manager 5.4 was used to do the meta-analysis, included 15 studies, with 869 patients who underwent RARP following TURP and 5,879 patients who underwent RARP alone. Compared to standard RARP, RARP following TURP was associated with extended operative time (OT) (WMD: 26.63 min, 95% CI: 16.79-36.48, P < 0.00001), increased estimated blood loss (EBL) (WMD: 19.85 ml, 95% CI: 9.22-30.48, P = 0.0003), longer hospital stay(LOS) (WMD: 0.52 days, 95% CI: 0.28-0.77, P < 0.0001), and extended catheter removal duration (WMD: 0.18 days, 95% CI: 0.02-0.35, P = 0.03). The overall nerve-sparing success rate was lower (OR: 0.53, 95% CI: 0.35-0.78, P = 0.001), with reduced bilateral nerve-sparing success rates (OR: 0.58, 95% CI: 0.39-0.84, P = 0.005). Patients in the TURP group had higher rates of bladder neck reconstruction (OR: 8.38, 95% CI: 5.80-12.10, P < 0.0001) and major complications (Clavien grade ≥ 3) (OR: 1.94, 95% CI: 1.10-3.41, P = 0.02). Furthermore, the positive surgical margin (PSM) rate was elevated in the prior-TURP group (OR: 1.25, 95% CI: 1.02-1.53, P = 0.03). Quality-of-life outcomes indicated that patients undergoing RARP after TURP experienced lower urinary incontinence recovery rates at one year (OR: 0.58, 95% CI: 0.34-0.97, P = 0.04) and reduced continence recovery rates (OR: 0.60, 95% CI: 0.44-0.81, P = 0.007). Nevertheless, there were no notable differences between the two groups in terms of the rates of transfusions, unilateral nerve-sparing, lymphadenectomy, minor complications (Clavien grade < 3), or biochemical recurrence (BCR) after a year. Although RARP after TURP is achievable, it is notably more complex. Findings suggest that while the surgical difficulty is increased, oncological and functional outcomes for the prior-TURP group remain comparable to the non-TURP group. This research aims to provide clinicians with data to support informed decision-making when treating individuals who have experienced TURP in the past.