Laparoscopic Radical Prostatectomy in Patients following Transurethral Resection of the Prostate

Abstract

Objectives: Previous transurethral resection of the prostate (TURP) was reported to impose difficulties during open radical prostatectomy. We describe our experience in laparoscopic radical prostatectomy (LRP) following transurethral resection of the prostate. Patients and Methods: The series included 35 patients: 22 patients underwent transperitoneal LRP (tpLRP) and 13 underwent extraperitoneal LRP (epLRP). The minimal interval between TURP and laparoscopy was 3 months. Patients’ charts were reviewed for their preoperative characteristics, intraoperative difficulties and complications, and outcome. Results: Patients’ mean age was 67.5 ± 4.4 years. 12 patients were cT1a,b and 23 patients were cT1c/T2. Twenty-two patients underwent tpLRP and 13 underwent epLRP. No statistical difference was found between the preoperative characteristics and the pathological results of cT1a,b vs. T1c/cT2 patients, or tpLRP vs. epLRP patients. Thirty-three procedures were completed laparoscopically and 2 were converted to open surgery. Perioperative complications included two leaking anastomoses, prolonged lymph drainage in 1 case, atelectasis (n = 1) and duodenal ulcer (n = 1). Twelve positive margins were noted, half of them in pT2 tumors. The mean follow-up was 28.5 months. Twenty-five of 35 patients had more than 12 months of follow-up. Among them 19 patients were completely continent (76%) and 6 (24%), reported mild stress incontinence. Conclusions: Although LRP following TURP is sometimes more technically difficult, simple modifications in the operative strategy help facilitate surgery. LRP following TURP favorably compares to open radical prostatectomy after TURP and laparoscopy in non-TURP patients.

Patients with prior TURP undergoing robot-assisted laparoscopic radical prostatectomy have higher positive surgical margin rates

“…As we have shown, there is a signiWcantly higher rate of positive margins (35.3%) in these patients when compared with patients without a history of prior TURP (17.6%). This is similar to the 21.8% positive margin rates seen in patients with prior TURP who underwent "pure" laparoscopic radical prostatectomy [2,4,9].…”

“…As the numbers of procedures increase, surgeons are becoming more willing to expand this procedure to patients with a history of prior surgery, including prior transurethral resection of the prostate (TURP). Previously, several groups have written that although open radical retropubic prostatectomy may be more diYcult in men with a prior history of TURP, complication rates, morbidity, and cure rates are not statistically diVerent [1][2][3].…”

Surgical Outcomes for Men Undergoing Laparoscopic Radical Prostatectomy After Transurethral Resection of the Prostate

“…[2][3][4][5] Historically it was thought that previous TURP led to increased intraoperative and postoperative morbidity but today it is believed that RRP may sometimes be more difficult after previous TURP, although operative complication rates, morbidity and the opportunity for surgical cure are no different from those in patients without a history of TURP. [2][3][4][5] There are few studies of a limited number of patients exploring the effect of TURP on LRP in the literature. To our knowledge this is the largest series to date comparing men undergoing LRP after TURP with respect to operative, postoperative and pathological parameters compared to a cancer matched control group.…”

“…Katz et al noted that LRP is feasible after TURP but they did not compare their results to those of a control group. 4 We performed a retrospective review of our database to determine whether a history of TURP adversely affected the outcome of LRP at a high volume laparoscopic center. …”

“…Several groups recently reported that, although RRP may sometimes be more difficult after previous TURP, complication rates, morbidity and the opportunity for surgical cure are no different from those in patients without a history of TURP. [3][4][5] Colombo et al recommended that candidates for radical prostatectomy after previous prostate surgery must be informed that functional results, specifically erectile function and urinary continence are less predictable and usually less satisfactory than those achieved after the same surgical approach in surgically naive patients. 6 LRP is becoming a more commonly performed procedure for the primary treatment of localized prostate cancer.…”