Is it oncologically safe performing simultaneous transurethral resection of the bladder and prostate? A meta-analysis on 1,234 patients

It is not unusual to encounter the clinical scenario of a male patient undergoing endoscopic treatment for bladder cancer (TURBT) who also needs transurethral resection of prostate (TURP). The aims of this meta-analysis were to understand whether it is oncologically safe or advantageous to combine the two procedures in terms of subsequent overall recurrences with particular interest to that in the prostatic fossa and to understand whether some characteristics of the bladder tumors can influence the recurrence rate.

A bibliographic search covering the period from January 1950 to December 2011 was conducted in PubMed, MEDLINE and EMBASE. Meta-analysis approach was applied comparing prostatic fossa recurrences and total recurrences in simultaneous TURBT and TURP and control. Also, prostatic fossa recurrences and tumors’ grading and multifocality in patients treated with simultaneous TURBT and TURP were analyzed. To investigate to what extent observational time influenced relapses/recurrence, a random effect meta-regression logistic model–based approach was applied. All statistical evaluations were performed using SAS version 9.2 and by RevMan 5.0. An α level of 0.05 was considered as statistically significant.

Overall, there were 1,234 participants in the eight studies considered. The study group consists of 634 patients and the control group 600. Mean age was 67.88 and 61.64 years, respectively, in the study and control groups. In the study group, on a total of 634 patients, 65 recurrences in the prostatic fossa appear. In the control group, on a total of 600 patients, 58 recurrences in the prostatic fossa occurred. Data do not show a statistically significant difference in recurrence in the prostatic fossa between patients treated simultaneously with TURB and TURP and the control group. Meta-analysis does not show a statistically significant difference in recurrence in the prostatic fossa with the increased grading of the neoplasms. But there is a statistically significant increased recurrence in patients with multifocal tumors. There is a statistically significant reduction in recurrence between patients treated simultaneously with TURB and TURP and the control group, but there is no reduction in the recurrence rate in the time.

This meta-analysis emphasized that the two operations could be performed during the same session without any negative oncologic results. The resolution during the same session of bladder outlet obstruction will improve the patients’ quality of life and performing the procedures in the same session sparing the patients from a further anesthesiological maneuvers and the need for a further hospitalization for the surgical resolution of the prostatic obstruction.