Outcomes of robot-assisted radical prostatectomy in men with previous transurethral resection of prostate

Study Type – Therapy (case series) Level of Evidence 4

OBJECTIVE

? To critically analyze and compare surgical, oncological and functional outcomes of robot‐assisted radical prostatectomy (RARP) in patients with and without previous transurethral resection of prostate (TURP).

PATIENTS AND METHODS

? The study comprised 158 cases of RARP for clinically localized prostate cancer, including 26 cases that had undergone previous TURP (Group A). ? Surgical, oncological and functional (short‐ and intermediate‐term) outcomes of Group A were compared with 132 cases without previous TURP (Group B).

RESULTS

? Post TURP patients were found to have significantly greater blood loss (494 vs 324 mL) and a need for bladder neck reconstruction (26.7% vs 9.7%) compared to the non‐TURP group. ? Surgical time (189 vs 166 min), conversion rate, margin positivity rate and biochemical recurrence rate were also higher. ? Incontinence rates were higher both at 6 (14% vs 11.8%) and 12 (25% vs 8%) months follow‐up.

CONCLUSIONS

? RARP is feasible but challenging after TURP. It entails a longer operating time, greater operative difficulty and compromised oncological or continence outcomes. ? These cases should be handled by an experienced robotic surgeon with the appropriate expertise.     

两种方法治疗前列腺增生的临床疗效比较

目的 评价经尿道前列腺等离子电切术的临床疗效.方法 回顾性分析和比较150例经尿道前列腺等离子电切术(TURP组)和152例经尿道前列腺电切术(PKRP组)良性前列腺增生患者的临床资料,比较术中出血量、手术时间、术后膀胱冲洗时间、术后症状改善程度、术后并发症及术后住院时间.PKRP组病例前列腺体积36～58 cm3,平均(43±2.3)cm3.TURP组病例前列腺体积34～55 cm3,平均(42±2.1)cm3.所有病例术后病理结果均为良性前列腺增生.结果 PKRP、TURP两组术中出血量分别为(120±25)mL和(180±30)mL(P<0.01),两组手术时间分别为(55±15)min和(58±13)min(P>0.05),术后膀胱冲洗时间分别为(3.6±1.2)d和(6.4±1.6)d,(P<0.05),术后状改善程度分别为(97±2.5)%和(89±3.1)%(P<0.05),术后并发症分别为(3.4±0.4)%和(6.9±0.7)%(P<0.01),术后住院时间分别为(6.3±1.6)d和(11.7±3.3)d(P<0.01).结论 经尿道前列腺等离子电切术较经尿道前列腺电切术中出血量少,术后膀胱冲洗时间短,术后症状改善程度高,术后并发症发生率低,术后住院时间短.     

前列腺电切术的麻醉处理

目的观察经尿道前列腺电切术(TURP)患者的麻醉效果以及电切综合征(TURPS)的防治。方法对47例前列腺增生症(BPH)患者TURP麻醉处理中体征及TURPS观察。结果本组47例患者麻醉均一次成功。多数患者在麻醉后血压有不同程度的降低,在加速输液的同时用麻黄碱纠正。心动过缓者使用阿托品对症处理。本组患者术中出血量大约200mL,均未输血。麻醉效果满意,患者无痛感,尿道松弛,手术顺利。术后无麻醉并发症,无经尿道前列腺电切综合征(TURPS)及膀胱意外穿孔和前列腺包膜穿孔发生。本组围术期无死亡病例。结论经尿道前列腺电切术(TURP)具有不需开刀、创伤小、恢复快、并发症少和安全性大的优点,是前列腺增生症(BPH)主要治疗方式。TURP期间术中应严密监测生命体征,若估计手术时间过长,术中冲洗液应用量过大的患者,应给予预防性的补钠、利尿、脱水等处理,从而预防水中毒、低钠血症等并发症的发生。     

膀胱微穿刺造瘘低压灌注在TURP中的应用

目的：探讨膀胱微穿刺造瘘低压灌注方法在经尿道前列腺电切术（TURP）治疗重度前列腺增生症（BPH）的疗效与安全性。方法：未行膀胱微穿刺造瘘的TURP治疗重度BPH52例为A组,行膀胱微穿刺造瘘的TURP治疗重度BPH58例为B组,通过比较术中出血量,前列腺切除重量,术中心率和血压变化情况,静脉血清钠下降值,评价两种方法的安全性,通过比较术后3个月最大尿流率（Qmax）、残余尿（RU）、国际前列腺症状评分（IPSS）,生活质量评分（QOL）,评价两种方法的疗效,并比较术后出血,尿道狭窄,拔管后排尿困难等术后并发症。结果：B组术中出血量,冲洗液吸收量,术中心率和血压变化情况,静脉血清钠下降值均低于A组,差异有显著意义,术后3个月两组Qmax、RU、IPSS、QOL较术前均明显改善,且差异有显著意义,两组间术后并发症比较无显著差异。结论：TURP术中行膀胱微穿刺造瘘出血少,冲洗液吸收量少,血压和心率变化小,血清钠浓度降低不明显,不增加术后并发症,能显著增加患者的手术安全性,适用于重度BPH的手术治疗。     

The association of prostate stem cell antigen (PSCA) mRNA expression and subsequent prostate cancer risk in men with benign prostatic hyperplasia following transurethral resection of the prostate

BACKGROUND: Prior data showed prostate stem cell antigen (PSCA) mRNA expression in benign prostatic hyperplasia (BPH) tissues. The purpose of the present investigation was to determine whether PSCA mRNA expression in resected BPH samples was associated with the subsequent presence of cancer following transurethral resection of the prostate (TURP). METHODS: PSCA in situ hybridization was performed on the TURP-resected tissues from 288 patients, who were histopathologically confirmed BPH without cancer. All these patients were continuously followed for 9-70 months postoperatively. Univariate and multivariate cox regression analyses were used to evaluate the predictive performance of PSCA mRNA for subsequent cancer onset following TURP. RESULTS: PSCA mRNA was detected in 93/288 (32.3%) of the resected BPH specimens, with a mean positive-labeling cells of 23.8%, in which 22 patients (23.7%) were identified as having PCa on follow-up. Of 195 patients with negative expression for PSCA mRNA 2 (1.0%) were subsequently found with PCa. PSCA mRNA expression levels were directly proportional to higher Gleason score and clinical T stage. Univariate and multivariate cox regression analyses demonstrated that only PSCA mRNA expression was predictive of the subsequent cancer development after TURP, however, PSA velocity was an univariately significant but not multivariately significant predictor. CONCLUSIONS: This prospective study identifies PSCA mRNA in BPH as a significant predictor of cancer development after TURP, suggesting that PSCA may be used to identify patients who are at high risk for subsequent cancer onset following TURP for BPH and the PSCA test may be useful when applied for repeat biopsies.     

普外科术后患者口渴及口渴痛苦程度的现况研究

目的 调查普外科术后患者的口渴程度(thirst intensity,TI),口渴不适及口渴痛苦程度(thirst distress, TD)的现况及其影响因素,为改善普外科术后患者因口干、口渴引起的不适感提供支持。方法 对224例普外科术后患者采用一般资料调查表、口渴程度量表、围手术期口渴不适量表和口渴痛苦程度量表进行调查。结果 普外科术后患者口渴程度、口渴不适及口渴痛苦程度均偏高,其中不同年龄段的患者口渴程度不同；开腹手术的患者口渴程度大于未开腹的手术患者；年龄、工作状况及是否开腹是影响患者术后口渴不适的相关因素。是否开腹是普外科术后患者口渴程度、口渴不适及口渴痛苦程度的独立危险因素(均P<0.05)。结论 普外科术后患者口渴程度、口渴不适及口渴痛苦程度普遍较高,临床护理人员应根据不同年龄段的特点采取不同的护理干预措施,注意倾听患者的主诉；对开腹患者应提前做好健康宣教,尽量缩短术前禁食禁水时间,加强患者对手术计划的了解,同时医护应一起探讨患者术后的补液及进食饮水计划,尽量缓解普外科术后患者的口渴症状。     

Oncological and safety profiles in patients undergoing simultaneous transurethral resection (TUR) of bladder tumour and TUR of the prostate

Objectives

To determine the oncological impact and adverse events of performing simultaneous transurethral resection of bladder tumour (TURB) and transurethral resection of the prostate (TURP), as evidence on the outcomes of simultaneous TURB for bladder cancer and TURP for obstructive benign prostatic hyperplasia is limited and contradictory.

Patients and Methods

Patients from 12 European hospitals treated with either TURB alone or simultaneous TURB and TURP (TURB+TURP) were retrospectively analysed. A propensity score matching (PSM) 1:1 was performed with patients from the TURB+TURP group matched to TURB-alone patients. Associations between surgery approach with recurrence-free (RFS) and progression-free (PFS) survivals were assessed in Cox regression models before and after PSM. We performed a subgroup analysis in patients with risk factors for recurrence (multifocality and/or tumour size >3 cm).

Results

A total of 762 men were included, among whom, 76% (581) underwent a TURB alone and 24% (181) a TURB+TURP. There was no difference in terms of tumour characteristics between the groups. We observed comparable length of stay as well as complication rates including major complications (Clavien–Dindo Grade ≥III) for the TURB-alone vs TURB+TURP groups, while the latest led to longer operative time (P < 0.001). During a median follow-up of 44 months, there were more recurrences in the TURB-alone (47%) compared to the TURB+TURP group (28%; P < 0.001). Interestingly, there were more recurrences at the bladder neck/prostatic fossa in the TURB-alone group (55% vs 3%, P < 0.001). TURB+TURP procedures were associated with improved RFS (hazard ratio [HR] 0.39, 95% confidence interval [CI] 0.29–0.53; P < 0.001), but not PFS (HR 1.63, 95% CI 0.90–2.98; P = 0.11). Within the PSM cohort of 254 patients, the simultaneous TURB+TURP was still associated with improved RFS (HR 0.33, 95% CI 0.22–0.49; P < 0.001). This was also true in the subgroup of 380 patients with recurrence risk factors (HR 0.41, 95% CI 0.28–0.62; P < 0.001).

Conclusion

In our contemporary cohort, simultaneous TURB and TURP seems to be an oncologically safe option that may, even, improve RFS by potentially preventing disease recurrence at the bladder neck and in the prostatic fossa.