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Functional and oncological outcomes after radical prostatectomy in patients with history of surgery for lower urinary tract symptoms related to benign prostatic enlargement: A systematic review with meta-analysis

Prostate Cancer and Prostatic Diseases (2023)Cite this article

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Abstract

Background

Outcomes of radical prostatectomy (RP) in men with history of lower urinary tract symptoms related to benign prostatic enlargement (LUTS/BPE) surgery represents a controversial issue. We performed an updated systematic review and meta- analysis evaluating oncological and functional outcomes of RP in this subset of patients.

Methods

Eligible studies were identified from MEDLINE, Web of Science and the Scopus databases. The following outcomes were evaluated: incidence of positive surgical margins (PSM), incidence of biochemical recurrence (BCR), 3-mo and 1-year urinary continence (UC) rates, incidence of nerve-sparing (NS) procedures, 1-year erectile function (EF) recovery rates. We estimated pooled Odds ratios (OR) and 95% confidence intervals (CI) using random effects models. Sub-analyses were performed according to the type of RP and LUTS/BPE surgery.

Results

Twenty-five retrospective studies including 11,101 patients undergoing RP were included in the analysis (2113 with history of LUTS/BPE surgery, and 8898 controls). PSM rate was significantly higher in patients with history of LUTS/BPE surgery (OR 1.39, 95% CI 1.18–1.63, p < 0.001). No statistically significant difference in terms of BCR emerged between patients with or without history of LUTS/BPE surgery (OR 1.46, 95% CI 0.97–2.18, p = 0.066). Three-months and 1-year UC rates were significantly lower in patients with previous LUTS/BPE surgery (OR 0.48, 95% CI 0.34–0.68, p < 0.001 and OR 0.44, 95% CI 0.31–0.62, p < 0.001; respectively). Although not statistically significant differences between the two groups emerged in terms of adoption of NS procedures (OR 0.59, 95% CI 0.32–1.12, p = 0.107), 1-year EF recovery was significantly lower in patients with history of LUTS/BPE procedures (OR 0.60, 95% CI 0.40–0.89, p = 0.010).

Conclusions

In conclusions, RP in patients with history of previous LUTS/BPE surgery is associated with increased incidence of PSM, lower UC rates at both 3-months and 1-year follow-up as well as lower rates of EF recovery at 1-year follow-up.

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Fig. 1: PRISMA flow diagram for identification of studies.
Fig. 2: Forest Plot of Odds Ratios for PSM comparing patients with and without history of LUTS/BPE surgery (I2 = 19.6, p = 0.189).
Fig. 3: Forest Plot of Odds Ratios for PSM comparing patients with and without history of LUTS/BPE surgery and stratified by type of RP (LRP: I2 = 16.8, p = 0.298; RALP: I2 = 0.00, p = 0.796; RRP: I2 = 0.00, p = 0.871; Mixed procedures: I2 = 0.00, p = 0.382).
Fig. 4: Forest Plot of Odds Ratios for PSM comparing patients with and without history of LUTS/BPE surgery and stratified by type of previous LUTS/BPE surgery (Holep: I2 = 66.56, p = 0.051; Mixed: I2 = 97.01, p = 0.050; TURP: I2 = 50.10, p = 0.051).
Fig. 5: Forest Plot of Odds Ratios for 1-year BCR comparing patients with and without history of LUTS/BPE surgery (I2 = 0.00, p = 0.853).
Fig. 6: Forest plot of Odds Ratios for UC recovery at 3 months comparing patients with and without history of LUTS/BPE surgery (I2 = 62.94, p = 0.003).
Fig. 7: Forest plot of Odds Ratios for UC recovery at 3 months comparing patients with and without history of LUTS/BPE surgery and stratified by type of RP (LRP: I2 = 66.3, p = 0.018; RALP: I2 = 43.21, p = 0.152).
Fig. 8: Forest Plot of Odds Ratios for UC recovery at 3 months comparing patients with and without history of LUTS/BPE surgery and stratified by type of previous LUTS/BPE surgery (Mixed: I2 = 83.34, p = 0.014; TURP: I2 = 34.69, p = 0.140).
Fig. 9: Forest plot of Odds Ratios for 1-year UC recovery comparing patients with and without history of LUTS/BPE surgery (I2 = 70.54, p = 0.000).
Fig. 10: Forest plot of Odds Ratios for 1-year UC recovery comparing patients with and without history of LUTS/BPE surgery and stratified by type of RP (LRP: I2 = 0.00, p = 0.652; RALP: I2 = 13.19, p = 0.329; RRP: I2 = 93.08, p = 0.000; Mixed procedures: I2 = 0.00, p = 0.592).
Fig. 11: Forest plot of Odds Ratios for 1-year UC recovery comparing patients with and without history of LUTS/BPE surgery and stratified by type of previous LUTS/BPE surgery (Holep: I2 = 0.00, p = 0.348; Mixed: I2 = 88.64, p = 0.000; TURP: I2 = 0.00, p = 0.526).
Fig. 12: Forest plot of Odds Ratios for NS procedures comparing patients with and without history of LUTS/BPE surgery (I2 = 91.64, p = 0.000).
Fig. 13: Forest plot of Odds Ratios for NS procedures comparing patients with and without history of LUTS/BPE surgery according to the type of RP (LRP: I2 = 96.96, p = 0.000; Mixed: I2 = 78.56, p = 0.031; RALP: I2 = 2.75, p = 0.399; RRP: I2 = 0.00, p = 0.00).
Fig. 14: Forest plot of Odds Ratios for NS procedures comparing patients with and without history of LUTS/BPE surgery and stratified by type of previous LUTS/BPE surgery (Holep: I2 = 66.56, p = 0.050; Mixed: I2 = 97.01, p = 0.000; TURP: I2 = 50.10, p = 0.051).
Fig. 15: Forest Plot of Odds Ratios for 1-year EF recovery comparing patients with and without history of LUTS/BPE surgery (I2 = 48.64, p = 0.041).
Fig. 16: Forest Plot of Odds Ratios for 1-year EF recovery comparing patients with and without history of LUTS/BPE surgery and stratified according to the type of RP (RALP: I2 = 34.18, p = 0.193; Mixed procedures: I2 = 80.91, p = 0.022).
Fig. 17: Forest Plot of Odds Ratios for 1-year EF recovery comparing patients with and without history of LUTS/BPE surgery and stratified by type of previous BPH surgery (Holep: I2 = 61.69, p = 0.106; Mixed procedures: I2 = 12.46, p = 0.285; TURP: I2 = 33.17, p = 0.187).

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Authors and Affiliations

  1. Interdepartmental Center for Advances in Robotic Surgery, University of Naples Federico II, Naples, Italy

    Massimiliano Creta

  2. Department of Woman, Child and General and Specialized Surgery, University of Campania ‘Luigi Vanvitelli’, Naples, (IT), Italy

    Celeste Manfredi, Davide Arcaniolo, Lorenzo Spirito, Marco De Sio & Ferdinando Fusco

  3. Department of Urology, Icahn School of Medicine at Mount Sinai, New York City, NY, USA

    Steven A. Kaplan

  4. Sydney Adventist Hospital Clinical School, University of Sydney, Sydney, NSW, Australia

    Henry H. Woo

  5. Department of Urology, Sant’Andrea Hospital, Sapienza University of Rome, Rome, Italy

    Cosimo De Nunzio

  6. Department of Urology, Bay of Plenty District Health Board Clinical School, Tauranga, New Zealand

    Peter Gilling

  7. Department of Urology, Asklepios Hospital Barmbek, Hamburg, Germany

    Thorsten Bach

  8. Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy

    Ciro Imbimbo, Vincenzo Mirone & Nicola Longo

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Contributions

Conceptualization, investigation, and supervision: MC and FF; results interpretation and writing: CM, DA; results interpretation: CDN, LS, VM, CI; contribution to an oversight of the overall study: SAK, HHW, PG, TB; review and editing: NL, MDS. All authors have read and agreed to the published version of the manuscript.

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Correspondence to Davide Arcaniolo.

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Creta, M., Manfredi, C., Arcaniolo, D. et al. Functional and oncological outcomes after radical prostatectomy in patients with history of surgery for lower urinary tract symptoms related to benign prostatic enlargement: A systematic review with meta-analysis. Prostate Cancer Prostatic Dis (2023). https://doi.org/10.1038/s41391-023-00678-y

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