Abstract
Background
no data exist concerning functional and oncological outcomes of Retzius-sparing robot-assisted
radical prostatectomy (RS-RARP), in patients previously treated with trans-urethral
resection of the prostate (p-TURP), for benign prostate obstruction. Our study addressed
the impact of p-TURP on immediate and 12-months urinary continence recovery (UCR),
as well as peri-operative outcomes and surgical margins, after RS-RARP.
Methods
all patients treated with RS-RARP for prostate cancer at a single high-volume European
institution, between 2010 and 2021, were identified and stratified according to p-TURP
status. Logistic, Poisson and Cox regression models were performed.
Results
Of 1386 RS-RARP patients, 99 (7%) had history of p-TURP. Between p-TURP and no-TURP
patients no differences were detected regarding both intra- and post-operative complications
(p values = 0.9). The rates of immediate UCR were 40 vs 67% in p-TURP vs no-TURP patients
(p < 0.001). At 12 months from RS-RARP, the rates of UCR were 68 vs 94% in p-TURP
vs no-TURP patients (p < 0.001). At multivariable logistic and Cox regression models,
p-TURP was independently associated, respectively, with lower immediate (odds ratio
[OR]: 0.32, p < 0.001) and 12-months UCR (hazard ratio: 0.54, p < 0.001). At multivariable
Poisson analyses, p-TURP predicted longer operative time (rate ratio: 1.08, p < 0.001)
but not longer length of stay or time to catheter removal (p values > 0.05). Positive
surgical margins rates were 23 vs 17% in p-TURP vs no-TURP patients (p = 0.1), which
translated in a non-statistically significant multivariable OR of 1.14 (p = 0.6).
Conclusions
p-TURP does not increase surgical morbidity but portends longer operative time and
worse urinary continence after RS-RARP.
Keywords
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Abbreviations
Trans-urethral resection of the prostateTURP
Benign prostate obstructionBPO
Prostate cancerPCa
Radical prostatectomyRP
Robot-assisted RPRARP
Retzius-sparing RARPRS-RARP
Previous TURPp-TURP
Urinary continence recoveryUCR
Body mass indexBMI
Charlson comorbidity indexCCI
Prostate specific antigenPSA
International Society of Urological PathologyISUP
Trans-rectal ultrasound of the prostateTRUS
Tumor, Node, MetastasisTNM
Prostate volumePV
Intraoperative Adverse Incident Classification proposed by the European Association of UrologyEAUiaiC
Clavien–DindoCD
Length of stayLOS
Positive surgical marginsPSM
Interquartile rangesIQR
Nerve sparing techniqueNS
Operative time,OT
Surgical experienceSE
Odds ratioOR
Hazard ratioHR
Rate ratioRR
Article info
Publication history
Accepted:
March 14,
2023
Received in revised form:
March 1,
2023
Received:
December 19,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.
