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Minimally Invasive Radical Prostatectomy after Previous Bladder Outlet Surgery: A Systematic Review and Pooled Analysis of Comparative Studies.
J Urol. 2019 09; 202(3):511-517.JU

Abstract

PURPOSE

Prostate cancer surgery after previous bladder outlet surgery of benign prostatic hyperplasia is an uncommon yet challenging scenario. We performed a systematic review and pooled analysis of comparative studies on laparoscopic and robotic minimally invasive radical prostatectomy after bladder outlet surgery.

MATERIALS AND METHODS

We searched the literature on PubMed®, Embase® and Web of Science™ up to February 2019 according to the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analyses) statement to identify eligible studies. Surgical, oncologic and functional outcomes in patients who underwent minimally invasive radical prostatectomy after bladder outlet surgery were compared to those without a history of bladder outlet surgery. Sensitivity analysis was done according to surgical technique (laparoscopic or robotic). RevMan 5.3 was used for statistical analysis.

RESULTS

A total of 12 comparative studies were included in analysis. Patients who underwent minimally invasive radical prostatectomy after bladder outlet surgery were older (p ≤0.00001) and had a smaller prostate (p = 0.04) and lower prostate specific antigen (p = 0.003). The previous bladder outlet surgery group had lower odds of nerve sparing procedures, longer operative time, a higher rate of bladder neck reconstruction (each p <0.0001) and longer catheter time (p = 0.03). They were at higher risk for intraoperative (p = 0.001), overall (p <0.00001) and major complications (p = 0.0008), a higher positive surgical margin rate (p = 0.0005) and biochemical recurrence (p = 0.05). Moreover, potency (p = 0.03) and continence recovery (p = 0.007) at 12 months were lower in men with previous bladder outlet surgery. Robotic surgery seemed to offer better outcomes than laparoscopy.

CONCLUSIONS

Minimally invasive radical prostatectomy after previous bladder outlet surgery represents a challenging surgical task with a higher risk of complications, and higher odds of worse functional and oncologic outcomes. Patients should be aware of these drawbacks and these factors should be considered during patient counseling. When surgery is pursued, robot-assisted radical prostatectomy should be preferred over laparoscopic radical prostatectomy since it can offer superior outcomes. The overall literature on this topic is of low quality and further efforts should be made to obtain higher levels of evidence.

Authors+Show Affiliations

Division of Urology, Department of Surgery, VCU Health, Richmond, Virginia. Urology Unit, ASST Spedali Civili Hospital and Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Brescia, Italy.Urology Unit, ASST Spedali Civili Hospital and Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Brescia, Italy.Urology Unit, ASST Spedali Civili Hospital and Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Brescia, Italy.Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, Orbassano, Italy.Urology Unit, ASST Spedali Civili Hospital and Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Brescia, Italy.Departments of Urology, Hospital of Braga, Braga, Portugal.Royal Melbourne Hospital, Melbourne, Victoria, Australia.Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania.Division of Urology, Department of Surgery, VCU Health, Richmond, Virginia.Division of Urology, Department of Surgery, VCU Health, Richmond, Virginia.

Pub Type(s)

Comparative Study
Journal Article
Systematic Review

Language

eng

PubMed ID

31039100

Citation

Veccia, Alessandro, et al. "Minimally Invasive Radical Prostatectomy After Previous Bladder Outlet Surgery: a Systematic Review and Pooled Analysis of Comparative Studies." The Journal of Urology, vol. 202, no. 3, 2019, pp. 511-517.
Veccia A, Antonelli A, Francavilla S, et al. Minimally Invasive Radical Prostatectomy after Previous Bladder Outlet Surgery: A Systematic Review and Pooled Analysis of Comparative Studies. J Urol. 2019;202(3):511-517.
Veccia, A., Antonelli, A., Francavilla, S., Porpiglia, F., Simeone, C., Lima, E., Zargar, H., Eun, D., Hampton, L. J., & Autorino, R. (2019). Minimally Invasive Radical Prostatectomy after Previous Bladder Outlet Surgery: A Systematic Review and Pooled Analysis of Comparative Studies. The Journal of Urology, 202(3), 511-517. https://doi.org/10.1097/JU.0000000000000312
Veccia A, et al. Minimally Invasive Radical Prostatectomy After Previous Bladder Outlet Surgery: a Systematic Review and Pooled Analysis of Comparative Studies. J Urol. 2019;202(3):511-517. PubMed PMID: 31039100.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Minimally Invasive Radical Prostatectomy after Previous Bladder Outlet Surgery: A Systematic Review and Pooled Analysis of Comparative Studies. AU - Veccia,Alessandro, AU - Antonelli,Alessandro, AU - Francavilla,Simone, AU - Porpiglia,Francesco, AU - Simeone,Claudio, AU - Lima,Estevão, AU - Zargar,Homayoun, AU - Eun,Daniel, AU - Hampton,Lance J, AU - Autorino,Riccardo, Y1 - 2019/08/08/ PY - 2019/5/1/pubmed PY - 2019/8/28/medline PY - 2019/5/1/entrez KW - laparoscopy KW - prostatectomy KW - prostatic neoplasms KW - robotic surgical procedures KW - urinary bladder neck obstruction SP - 511 EP - 517 JF - The Journal of urology JO - J. Urol. VL - 202 IS - 3 N2 - PURPOSE: Prostate cancer surgery after previous bladder outlet surgery of benign prostatic hyperplasia is an uncommon yet challenging scenario. We performed a systematic review and pooled analysis of comparative studies on laparoscopic and robotic minimally invasive radical prostatectomy after bladder outlet surgery. MATERIALS AND METHODS: We searched the literature on PubMed®, Embase® and Web of Science™ up to February 2019 according to the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analyses) statement to identify eligible studies. Surgical, oncologic and functional outcomes in patients who underwent minimally invasive radical prostatectomy after bladder outlet surgery were compared to those without a history of bladder outlet surgery. Sensitivity analysis was done according to surgical technique (laparoscopic or robotic). RevMan 5.3 was used for statistical analysis. RESULTS: A total of 12 comparative studies were included in analysis. Patients who underwent minimally invasive radical prostatectomy after bladder outlet surgery were older (p ≤0.00001) and had a smaller prostate (p = 0.04) and lower prostate specific antigen (p = 0.003). The previous bladder outlet surgery group had lower odds of nerve sparing procedures, longer operative time, a higher rate of bladder neck reconstruction (each p <0.0001) and longer catheter time (p = 0.03). They were at higher risk for intraoperative (p = 0.001), overall (p <0.00001) and major complications (p = 0.0008), a higher positive surgical margin rate (p = 0.0005) and biochemical recurrence (p = 0.05). Moreover, potency (p = 0.03) and continence recovery (p = 0.007) at 12 months were lower in men with previous bladder outlet surgery. Robotic surgery seemed to offer better outcomes than laparoscopy. CONCLUSIONS: Minimally invasive radical prostatectomy after previous bladder outlet surgery represents a challenging surgical task with a higher risk of complications, and higher odds of worse functional and oncologic outcomes. Patients should be aware of these drawbacks and these factors should be considered during patient counseling. When surgery is pursued, robot-assisted radical prostatectomy should be preferred over laparoscopic radical prostatectomy since it can offer superior outcomes. The overall literature on this topic is of low quality and further efforts should be made to obtain higher levels of evidence. SN - 1527-3792 UR - https://www.unboundmedicine.com/medline/citation/31039100/Minimally_Invasive_Radical_Prostatectomy_after_Previous_Bladder_Outlet_Surgery:_A_Systematic_Review_and_Pooled_Analysis_of_Comparative_Studies_ L2 - https://www.jurology.com/doi/full/10.1097/JU.0000000000000312?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -