Li Huihuang, Zhao Cheng, Liu Peihua, Hu Jiao, Yi Zhenglin, Chen Jinbo, Zu Xiongbing
Department of Urology, Xiangya Hospital, Central South University, Changsha 410008, China.
Transl Androl Urol. 2019 Dec;8(6):712-727. doi: 10.21037/tau.2019.11.13.
The influence of a previous transurethral resection of the prostate (TURP) on the outcomes of radical prostatectomy (RP) is still controversial. Therefore, we performed a meta-analysis to evaluate the perioperative, functional and oncological outcomes of RP with or without a previous TURP.
We conducted a computerized literature search of PubMed, Embase, and the Cochrane Library and included 15 retrospective studies evaluating RPs with or without a previous TURP in this meta-analysis.
Fifteen studies, including 6,840 cases, were analyzed. RP after a previous TURP were related to smaller prostate volumes (WMD: -6.93 cm; 95% CI, -10.89 to -2.97; P<0.001), lower preoperative prostate-specific antigen (PSA) levels (WMD: -1.51; 95% CI, -2.49 to -0.53; P=0.002), longer operative times (WMD: 13.22 min; 95% CI, 4.55 to 21.89 min; P=0.003), more blood loss (WMD: 55.38 mL; 95% CI, 12.35 to 98.41 mL; P=0.01), higher overall complication rates (OR =1.98; 95% CI, 1.27 to 3.08; P=0.002), longer hospital stays (WMD: 1.16 days; 95% CI, 0.65 to 1.67; P<0.001), longer duration of catheter (WMD: 0.60 days; 95% CI, 0.56 to 0.64; P<0.001), higher positive surgical margin rates (OR =1.30; 95% CI, 1.09 to 1.55; P=0.004), lower complete continence rates at 3 months (OR =0.67; 95% CI, 0.56 to 0.81; P<0.001), 6 months (OR =0.52; 95% CI, 0.31 to 0.88; P=0.01), 12 months (OR =0.59; 95% CI, 0.46 to 0.74; P<0.001), and lower potency rates at 12 months (OR =0.62; 95% CI, 0.51 to 0.77; P<0.001). Subgroup analysis indicated that open RP after previous TURP could achieve better outcomes.
RP after a previous TURP leads to worse perioperative, oncological, and functional outcomes. For these patients an open procedure is recommended. Due to the low number of studies and known biases, further large-scale studies are needed to support this result.
既往经尿道前列腺切除术（TURP）对根治性前列腺切除术（RP）预后的影响仍存在争议。因此，我们进行了一项荟萃分析，以评估既往有或无TURP的RP患者的围手术期、功能和肿瘤学预后。
我们对PubMed、Embase和Cochrane图书馆进行了计算机文献检索，并纳入了15项评估既往有或无TURP的RP的回顾性研究进行该荟萃分析。
共分析了15项研究，包括6840例病例。既往有TURP史的RP与前列腺体积较小（加权均数差：-6.93 cm；95%可信区间，-10.89至-2.97；P<0.001）、术前前列腺特异性抗原（PSA）水平较低（加权均数差：-1.51；95%可信区间，-2.49至-0.53；P=0.002）、手术时间较长（加权均数差：13.22分钟；95%可信区间，4.55至21.89分钟；P=0.003）、失血量较多（加权均数差：55.38 mL；95%可信区间，12.35至98.41 mL；P=0.01）、总体并发症发生率较高（比值比=1.98；95%可信区间，1.27至3.08；P=0.002）、住院时间较长（加权均数差：1.16天；95%可信区间，0.65至1.67；P<0.001）、导尿管留置时间较长（加权均数差：0.60天；95%可信区间，0.56至0.64；P<0.001）、手术切缘阳性率较高（比值比=1.30；95%可信区间，1.09至1.55；P=0.004）、3个月时完全控尿率较低（比值比=0.67；95%可信区间，0.56至0.81；P<0.001）、6个月时（比值比=0.52；95%可信区间，0.31至0.88；P=0.01）、12个月时（比值比=0.59；95%可信区间，0.46至0.74；P<0.001）以及12个月时性功能恢复率较低（比值比=0.62；95%可信区间，0.51至0.77；P<0.001）相关。亚组分析表明，既往有TURP史的开放手术RP可获得更好的预后。
既往有TURP史的RP导致更差的围手术期、肿瘤学和功能预后。对于这些患者，建议采用开放手术。由于研究数量较少且存在已知偏倚，需要进一步的大规模研究来支持这一结果。
