Hu Anneng, Lin Yuhang, Zhu Xiaole, Li Junyang, Luo Fuwen, Yu Xiaodong
Department of Urology, Affiliated Hospital of North Sichuan Medical College, No. 1 Mao Yuan South Road, Shunqing, Nanchong, 637000, Sichuan, People's Republic of China.
J Robot Surg. 2025 Feb 20;19(1):74. doi: 10.1007/s11701-025-02234-3.
In clinical practice, it is not uncommon for a history of trans-urethral resection of the prostate (TURP) to complicate a future robotic-assisted radical prostatectomy (RARP). This study aims to determine if prior TURP adversely affects outcomes in subsequent RARP, analyzing perioperative, functional, and oncological results between the procedures. Research published in English before September 2024 was systematically reviewed using Web of Science, PubMed, Cochrane Library, and the EMBASE. Review Manager 5.4 was used to do the meta-analysis, included 15 studies, with 869 patients who underwent RARP following TURP and 5,879 patients who underwent RARP alone. Compared to standard RARP, RARP following TURP was associated with extended operative time (OT) (WMD: 26.63 min, 95% CI: 16.79-36.48, P < 0.00001), increased estimated blood loss (EBL) (WMD: 19.85 ml, 95% CI: 9.22-30.48, P = 0.0003), longer hospital stay(LOS) (WMD: 0.52 days, 95% CI: 0.28-0.77, P < 0.0001), and extended catheter removal duration (WMD: 0.18 days, 95% CI: 0.02-0.35, P = 0.03). The overall nerve-sparing success rate was lower (OR: 0.53, 95% CI: 0.35-0.78, P = 0.001), with reduced bilateral nerve-sparing success rates (OR: 0.58, 95% CI: 0.39-0.84, P = 0.005). Patients in the TURP group had higher rates of bladder neck reconstruction (OR: 8.38, 95% CI: 5.80-12.10, P < 0.0001) and major complications (Clavien grade ≥ 3) (OR: 1.94, 95% CI: 1.10-3.41, P = 0.02). Furthermore, the positive surgical margin (PSM) rate was elevated in the prior-TURP group (OR: 1.25, 95% CI: 1.02-1.53, P = 0.03). Quality-of-life outcomes indicated that patients undergoing RARP after TURP experienced lower urinary incontinence recovery rates at one year (OR: 0.58, 95% CI: 0.34-0.97, P = 0.04) and reduced continence recovery rates (OR: 0.60, 95% CI: 0.44-0.81, P = 0.007). Nevertheless, there were no notable differences between the two groups in terms of the rates of transfusions, unilateral nerve-sparing, lymphadenectomy, minor complications (Clavien grade < 3), or biochemical recurrence (BCR) after a year. Although RARP after TURP is achievable, it is notably more complex. Findings suggest that while the surgical difficulty is increased, oncological and functional outcomes for the prior-TURP group remain comparable to the non-TURP group. This research aims to provide clinicians with data to support informed decision-making when treating individuals who have experienced TURP in the past.
在临床实践中，经尿道前列腺切除术（TURP）史使未来的机器人辅助根治性前列腺切除术（RARP）变得复杂的情况并不少见。本研究旨在确定既往TURP是否会对后续RARP的结果产生不利影响，分析两种手术之间的围手术期、功能和肿瘤学结果。使用科学网、PubMed、考克兰图书馆和EMBASE对2024年9月之前发表的英文研究进行了系统综述。使用Review Manager 5.4进行荟萃分析，纳入15项研究，其中869例患者在TURP后接受了RARP，5879例患者单独接受了RARP。与标准RARP相比，TURP后行RARP与手术时间延长（WMD：26.63分钟，95%CI：16.79 - 36.48，P＜0.00001）、估计失血量增加（WMD：19.85毫升，95%CI：9.22 - 30.48，P = 0.0003）、住院时间延长（WMD：0.52天，95%CI：0.28 - 0.77，P＜0.0001）以及导尿管拔除时间延长（WMD：0.18天，95%CI：0.02 - 0.35，P = 0.03）相关。总体神经保留成功率较低（OR：0.53，95%CI：0.35 - 0.78，P = 0.001），双侧神经保留成功率降低（OR：0.58，95%CI：0.39 - 0.84，P = 0.005）。TURP组患者膀胱颈重建率较高（OR：8.38，95%CI：5.80 - 12.10，P＜0.0001）和严重并发症（Clavien分级≥3级）发生率较高（OR：1.94，95%CI：1.10 - 3.41，P = 0.02）。此外，既往TURP组的手术切缘阳性（PSM）率升高（OR：1.25，95%CI：1.02 - 1.53，P = 0.03）。生活质量结果表明，TURP后接受RARP的患者在一年时尿失禁恢复率较低（OR：0.58，95%CI：0.34 - 0.97，P = 0.04）且控尿恢复率降低（OR：0.60，95%CI：0.44 - 0.81，P = 0.007）。然而，两组在输血率、单侧神经保留、淋巴结清扫、轻微并发症（Clavien分级＜3级）或一年后生化复发（BCR）率方面没有显著差异。虽然TURP后行RARP是可行的，但明显更复杂。研究结果表明，虽然手术难度增加，但既往TURP组的肿瘤学和功能结果与非TURP组相当。本研究旨在为临床医生提供数据，以支持在治疗既往有TURP经历的患者时做出明智的决策。
