Outcomes of robot-assisted radical prostatectomy in men with previous transurethral resection of prostate.

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.