Creta Massimiliano, Manfredi Celeste, Arcaniolo Davide, Spirito Lorenzo, Kaplan Steven A, Woo Henry H, De Nunzio Cosimo, Gilling Peter, Bach Thorsten, De Sio Marco, Imbimbo Ciro, Mirone Vincenzo, Longo Nicola, Fusco Ferdinando
Interdepartmental Center for Advances in Robotic Surgery, University of Naples Federico II, Naples, Italy.
Department of Woman, Child and General and Specialized Surgery, University of Campania 'Luigi Vanvitelli', Naples, (IT), Italy.
Prostate Cancer Prostatic Dis. 2024 Sep;27(3):367-384. doi: 10.1038/s41391-023-00678-y. Epub 2023 May 27.
Outcomes of radical prostatectomy (RP) in men with history of lower urinary tract symptoms related to benign prostatic enlargement (LUTS/BPE) surgery represents a controversial issue. We performed an updated systematic review and meta- analysis evaluating oncological and functional outcomes of RP in this subset of patients.
Eligible studies were identified from MEDLINE, Web of Science and the Scopus databases. The following outcomes were evaluated: incidence of positive surgical margins (PSM), incidence of biochemical recurrence (BCR), 3-mo and 1-year urinary continence (UC) rates, incidence of nerve-sparing (NS) procedures, 1-year erectile function (EF) recovery rates. We estimated pooled Odds ratios (OR) and 95% confidence intervals (CI) using random effects models. Sub-analyses were performed according to the type of RP and LUTS/BPE surgery.
Twenty-five retrospective studies including 11,101 patients undergoing RP were included in the analysis (2113 with history of LUTS/BPE surgery, and 8898 controls). PSM rate was significantly higher in patients with history of LUTS/BPE surgery (OR 1.39, 95% CI 1.18-1.63, p < 0.001). No statistically significant difference in terms of BCR emerged between patients with or without history of LUTS/BPE surgery (OR 1.46, 95% CI 0.97-2.18, p = 0.066). Three-months and 1-year UC rates were significantly lower in patients with previous LUTS/BPE surgery (OR 0.48, 95% CI 0.34-0.68, p < 0.001 and OR 0.44, 95% CI 0.31-0.62, p < 0.001; respectively). Although not statistically significant differences between the two groups emerged in terms of adoption of NS procedures (OR 0.59, 95% CI 0.32-1.12, p = 0.107), 1-year EF recovery was significantly lower in patients with history of LUTS/BPE procedures (OR 0.60, 95% CI 0.40-0.89, p = 0.010).
In conclusions, RP in patients with history of previous LUTS/BPE surgery is associated with increased incidence of PSM, lower UC rates at both 3-months and 1-year follow-up as well as lower rates of EF recovery at 1-year follow-up.
对于有与良性前列腺增生相关的下尿路症状（LUTS/BPE）手术史的男性，根治性前列腺切除术（RP）的结果是一个有争议的问题。我们进行了一项更新的系统评价和荟萃分析，以评估该亚组患者RP的肿瘤学和功能结果。
从MEDLINE、科学网和Scopus数据库中识别符合条件的研究。评估以下结果：手术切缘阳性（PSM）发生率、生化复发（BCR）发生率、3个月和1年尿失禁（UC）率、保留神经（NS）手术发生率、1年勃起功能（EF）恢复率。我们使用随机效应模型估计合并比值比（OR）和95%置信区间（CI）。根据RP和LUTS/BPE手术的类型进行亚组分析。
分析纳入了25项回顾性研究中的11101例接受RP的患者（2113例有LUTS/BPE手术史，8898例为对照）。有LUTS/BPE手术史的患者PSM率显著更高（OR 1.39，95%CI 1.18 - 1.63，p < 0.001）。有或无LUTS/BPE手术史的患者在BCR方面未出现统计学显著差异（OR 1.46, 95%CI 0.97 - 2.18, p = 0.066）。既往有LUTS/BPE手术的患者3个月和1年UC率显著更低（分别为OR 0.48，95%CI 0.34 - 0.68，p < 0.001；OR 0.44，95%CI 0.31 - 0.62，p < 0.00）。虽然两组在采用NS手术方面未出现统计学显著差异（OR 0.59，95%CI 0.32 - 1.12，p = 0.107），但有LUTS/BPE手术史的患者1年EF恢复率显著更低（OR 0.60，95%CI 0.40 - 0.89，p = 0.010）。
总之，既往有LUTS/BPE手术史的患者接受RP与PSM发生率增加、3个月和1年随访时UC率降低以及1年随访时EF恢复率降低相关。
