The impact of previous transurethral prostate resection on functional and oncological outcomes of laparoscopic radical prostatectomy

Objectives: To evaluate the effect of previous transurethral resection of the prostate (TURP) on surgical, functional, and oncological outcomes after laparoscopic radical prostatectomy (LRP).

Material and methods: In 251 consecutive LRP patients, we retrospectively compared intraoperative, functional and oncological outcomes of 20 cases who had previous TURP and found to have an incidental carcinoma (Group 1) with 20 patients who had not (Group 2) by using match-pair analysis. The patients were match-paired for age, preoperative prostate specific antigen (PSA), and prostate volume on transrectal ultrasonography. Perioperative parameters including catheterization time, complications, oncological and functional results were analyzed.

Results: Patients in both groups had similar age, body mass indices, PSA level, and prostate volume. Median operation time was 250 min vs. 210 min (p=0.02), median catheterization time was 9 days vs. 7 dayso, mean tumor volume was 4.1 cc vs. 3.4 cc (p=0.807) for Groups 1 and 2, respectively. Perioperative complications were rectal perforation due to severe adhesion in 1 patient, bladder perforation due to traction in 2 patients, and perirectal fascial tearing due to adhesion in 2 patients in Group 1 and managed during surgery without conversion. Rectal perforation was detected in 1 patient in Group 2 as perioperative complication. Continence rate after 6 months was 80% and 85% (p=0.01) for Group 1 and 2, respectively. Positive surgical margin rates for Group 1 and 2 were 25% and 15%, respectively, with no surgical margin positivity in pT2 disease.

Conclusion: LRP after TURP is a challenging but safe procedure. The time of complete continence is delayed and the rate of possible neurovascular bundle preservation might be reduced in these patients. While preoperative complication rate was higher in patients with previous transurethral resection, there was no difference between groups in postoperative follow-up.