Concurrent Transurethral Resection of Bladder Tumor and Prostate in Patients with Non–Muscle-Invasive Bladder Cancer: A Narrative Review of Current Evidence and Clinical Implications

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Concurrent transurethral resection of bladder tumor (TURBT) and transurethral resection of the prostate (TURP) is frequently considered in men with non–muscle-invasive bladder cancer (NMIBC) and symptomatic benign prostatic hyperplasia (BPH). The procedure has historically been avoided because of concern that viable urothelial carcinoma cells released during TURBT may implant within the denuded prostatic fossa created during TURP, resulting in bladder neck or prostatic urethral recurrence. This narrative review summarizes the biological rationale underlying this concern, critically evaluates comparative clinical evidence regarding oncological and functional outcomes, and highlights current evidence gaps relevant to patient selection. Early comparative studies consistently demonstrated no increase in bladder neck/prostatic urethral (BN/PU) recurrence following concurrent TURBT and TURP. Contemporary randomized trials, multicenter cohorts, and propensity score–matched analyses similarly reported no increase in recurrence or progression. In the largest multicenter study, overall recurrence occurred in 28% of patients undergoing concurrent TURBT and TURP compared with 47% after TURBT alone, with improved recurrence-free survival (HR 0.39, 95% CI 0.29–0.53; P<0.001). Six published meta-analyses consistently demonstrated no increase in BN/PU recurrence or progression, while several reported lower overall recurrence after concurrent surgery. Functional outcomes, including International Prostate Symptom Score, maximum urinary flow rate, and quality of life, were generally improved in patients undergoing concurrent surgery. Current evidence supports concurrent TURBT and TURP as an oncologically safe treatment option in appropriately selected patients with NMIBC and symptomatic BPH. Remaining uncertainty relates primarily to carcinoma in situ, extensive multifocal disease, suspected prostatic urethral involvement, and immediate postoperative intravesical chemotherapy.