Session: MP61: Prostate Cancer: Localized: Surgical Therapy II
MP61-11: Retzius-sparing robot-assisted radical prostatectomy after previous trans-urethral resection of the prostate: assessment of functional and oncological outcomes
Introduction: To date, no data exist concerning functional and oncological outcomes of Retzius-sparing robot-assisted radical prostatectomy (RS-RARP) in patients previously treated with trans-urethral resection of the prostate (p-TURP) for benign prostate obstruction. The current study aimed to address the impact of p-TURP on immediate and 12-months urinary continence recovery (UCR), as well as perioperative outcomes and surgical margins after RS-RARP. Methods: Patients treated with RS-RARP for prostate cancer at a single high-volume European institution were identified and stratified according to p-TURP. Intraoperative and postoperative complications were reported according to EAU guidelines standardized methodology. Univariable and multivariable logistic, Poisson log-linear and Cox regression models were performed. Results: Of 1,386 RS-RARP patients, 99 (7%) had history of p-TURP. According to EAU intraoperative adverse events classification (EAUiaiC), the most common intraoperative complications were EAUiaiC grade 1 (n=26/31, 84%). The most common postoperative complications were Clavien-Dindo grade 2 (n=67/174, 39%), and the most common reason of readmission was infected lymphocele (n=8/16, 50%). Between p-TURP and no-TURP patients no differences were detected in terms of rates of intraoperative complications (2 vs 2%), in-hospital postoperative complications (12 vs 11%), and readmissions (1 vs 1%; all p values =0.8). At catheter removal, the rates of immediate UCR were 40 vs 67% in p-TURP vs no-TURP patients (p < 0.001). At 12 months from RS-RARP, the rates of UCR were 68 vs 94% in p-TURP vs no-TURP patients (p < 0.001). At multivariable logistic and Cox regression models, p-TURP was independently associated, respectively, with lower immediate (odds ratio [OR]: 0.32, p<0.001) and 12-months UCR (hazard ratio: 0.54, p<0.001). At multivariable Poisson analyses, p-TURP predicted longer operative time (rate ratio: 1.08, p<0.001) but not longer length of stay or time to catheter removal (p values >0.05). Positive surgical margins rates were 23 vs 17% in p-TURP vs no-TURP patients (p=0.1), which translated in a non significant multivariable OR of 1.14 (p=0.58). Conclusions: RS-RARP in patients with history of TURP for BPO may be longer and associated with worse urinary continence recovery both at bladder catheter removal and at subsequent time-points. In the current series, p-TURP patients harbored low complication rates, and surgical margins rates comparable to their no-TURP counterparts. SOURCE OF Funding: None
