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.