Transurethral resection of prostate prior to radical prostatectomy for prostate cancer: propensity matched analysis of functional outcome from a large volume institution

Objectives The aim of this study was to elucidate the impact of prior transurethral resection of the prostate (TURP) on functional and surgical outcomes following robot-assisted radical prostatectomy (RARP). Methods Electronic medical records of 6,031 patients who underwent RARP were retrospectively reviewed to identify 173 patients with a previous surgical history of TURP self-reported at admission. Patients were propensity-score matched at a 1:4 ratio for age, body mass index (BMI), biopsy Gleason grade group (GG), and clinical stage. Perioperative International Prostate Symptom Score (IPSS) and International Index of Erectile Function-5 (IIEF-5) scores were assessed, as were achievement of continence and rate of postoperative re-catheterization. Results A total of 865 cases were included in the final analysis, with 173 and 692 patients with and without a recorded history of TURP. Patients with TURP were more likely to harbor less aggressive pathology at RARP including lower pathologic stage (pT≥3 26.2% vs. 36.3%; p=0.012) and lower mean PSA (10.3±10.7 vs. 14.2±24.8; p=0.002). Operation time and console time were longer in the TURP (+) group (p=0.001 and 0.022, respectively), with higher rate of estimated blood loss (p=0.004). The positive surgical margin rate did not differ significantly (p=0.063). The re-catheterization rate after RARP was not adversely affected (4.6% vs. 2.2%, p=0.072), although TURP (+) patients were more likely to experience immediate urinary leakage or retention (6.9% vs. 3.2%, p=0.023). Rate of achieving pad-free status was not significantly different (88.3% vs. 90.0%, p=0.532), although patients with previous TURP took longer to achieve continence (6.0±9.9 months vs. 4.3±5.5 months, p=0.044). Conclusion RARP following TURP is challenging, with longer console times and increased blood loss, but does not necessarily prevent eventual continence. Patients with prior TURP should be educated on longer times to reach pad-free status and the favorable prognosis after surgery.