Transurethral resection of bladder tumor (TURB) and transurethral resection of the prostate (TURP) are common surgical procedures used to treat bladder cancer and benign prostatic hyperplasia (BPH), respectively. However, there is limited and contradictory evidence regarding the outcomes and safety of performing these procedures simultaneously. To address this knowledge gap, a group of researchers conducted a retrospective analysis of patients treated with either TURB alone or simultaneous TURB and TURP. The study aimed to determine the oncological impact and adverse events associated with the simultaneous performance of these surgeries.

Research Study Details

The research study, led by Ekaterina Laukhtina, Marco Moschini, and other esteemed urologists, involved 12 European hospitals and included a total of 762 male patients. Out of these patients, 76% underwent TURB alone, while 24% underwent simultaneous TURB and TURP (TURB+TURP). The patients were analyzed for their oncological outcomes, recurrence-free survival (RFS), progression-free survival (PFS), and complications related to the surgical procedures.

Oncological Outcomes of Simultaneous TURB and TURP

During the median follow-up period of 44 months, the research findings revealed that the group of patients who underwent TURB alone had a higher recurrence rate than those who underwent simultaneous TURB+TURP. Specifically, 47% of patients in the TURB-alone group experienced recurrences, while only 28% of patients in the TURB+TURP group experienced recurrences. This difference was statistically significant, with a p-value of less than 0.001.

Importantly, the researchers observed that recurrences at the bladder neck and prostatic fossa were more prevalent in the TURB-alone group compared to the TURB+TURP group. Specifically, 55% of recurrences in the TURB-alone group occurred at the bladder neck/prostatic fossa, whereas only 3% of recurrences in the TURB+TURP group occurred in this location. These findings suggest that simultaneous TURB+TURP may be an oncologically safer option, potentially preventing disease recurrence at these anatomical sites.

The study further utilized Cox regression models to assess the impact of surgery approach on RFS and PFS, both before and after propensity score matching (PSM). The analysis revealed that simultaneous TURB+TURP was associated with improved RFS, with a hazard ratio (HR) of 0.39 (95% confidence interval [CI] 0.29–0.53, p < 0.001). However, no significant association was found between surgery approach and PFS (HR 1.63, 95% CI 0.90–2.98, p = 0.11). These findings highlight the potential benefit of simultaneous TURB+TURP in preventing disease recurrence.

Safety Profiles of Simultaneous TURB and TURP

The safety profiles of the two surgical approaches were also analyzed in the study. Length of hospital stay and complication rates, including major complications (Clavien–Dindo Grade III), were similar between the TURB-alone and TURB+TURP groups. However, the TURB+TURP group exhibited a longer operative time than the TURB-alone group (p < 0.001).

Risk Factors for Recurrence in Patients undergoing TURB and TURP

In addition to analyzing the oncological outcomes and safety profiles, the researchers aimed to identify risk factors for recurrence in patients undergoing TURB and TURP. The study focused on risk factors such as multifocality and tumor size larger than 3 cm.

Within the subgroup of 380 patients who displayed one or both of these risk factors, simultaneous TURB+TURP was associated with significantly improved RFS (HR 0.41, 95% CI 0.28–0.62, p < 0.001). This finding suggests that patients with these risk factors may particularly benefit from the simultaneous performance of TURB+TURP.

Complications Associated with TURB and TURP

The study’s analysis of complications associated with TURB and TURP showed no significant difference between the two surgical approaches. Both groups had comparable complication rates, including major complications. This finding indicates that simultaneous TURB+TURP does not pose additional safety risks compared to TURB alone.

Impact of Simultaneous TURB and TURP on Tumor Characteristics

The study did not report any significant impact of simultaneous TURB+TURP on tumor characteristics. The tumor characteristics, such as size and other factors, were found to be similar between the TURB-alone and TURB+TURP groups.

Takeaways

In conclusion, this contemporary research study provides valuable insights into the oncological impact and safety profiles of simultaneous TURB and TURP. The findings suggest that performing simultaneous TURB+TURP may offer an oncologically safe option and potentially improve recurrence-free survival (RFS) by preventing disease recurrence at the bladder neck and in the prostatic fossa. The study’s results also confirm the comparable safety profiles and complication rates between TURB alone and simultaneous TURB+TURP. However, it is important to note that further research and validation of these findings are needed to establish robust guidelines and recommendations for the simultaneous performance of TURB and TURP in clinical practice.

Source: https://bjui-journals.onlinelibrary.wiley.com/doi/abs/10.1111/bju.15898

Disclaimer: While I have a passion for health, I am not a medical doctor and this is not medical advice.

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