Robotic or open Radical Prostatectomy in Men with Previous Transurethral Resection of Prostate
Publication Type
Conference Paper

-Purpose; To assess and compare the surgical, oncological and functional outcomes of robotic and open
radical prostatectomy in patients with history of transurethral section of prostate (TURP).
Material and methods: The study population consisted of a consecutive series of 2400 men who had RP
for prostate cancer between January 2007 and January 2011 in one academic institution. In all, 48
patients with median age 65.5 (range, 46-74) had undergone TURP prior to RP. Thirty one (64.58%)
patients underwent robotic RP and 17 patients had open RP. Thirty five patients (74.91%) had standard
TUR and 13 patients underwent laser prostatectomy. The initial median values of P_~Aand Gleason
score were 4.85ng/ml(0.45-22) and 7(6-10) respectively. The clinical stage was tlc in 35 patients, T2 in
12 and t4 in 1 patient. Thirteen patient was diagnosed by TUR while the remaining patients were
diagnosed by transrectal ultrasound biopsy. Pelvic lymph node dissection and nerve sparing was done
in 37 (77.08%) and 26 (54.16%) patients respectively. Continence was defined as being pad free with 6
months or longer follow up. The mean operative period was 4.17(range, 2.44-10.29). The mean
hospitalization and follow-up periods were 2 days(range,l-10) and 13 months(range 1-52) respectively.
Results: Two patients had intra operative rectal laceration and primary repair was enough; one from
robotic series and one from open RP series. Two patients from open RP series had ureter transaction
which also was managed intra-operatively by ureteral re-implantation without further postoperative
sequelae. Postoperatively; three patients developed Iymphocele which resolved spontaneously, one
patient developed hematuria due to benign polpoid mass at vesico-urethral anastomosis, thus TUR
resection was done, and no urethral stricture was observed in any patient. Six patients (12.5%)had
positive margins and three patients had bilateral seminal vesicle involvement. Blood loss was 250cc
(range, 20-3025) and transfusion was done in 4 patients (1 from robotic RP ,3 from open RP). Lymph
node yield was 11 (range, 2-40). Three patients had positive lymph nodes. All patients had undetectable
PSA after RP. Biochemical recurrence occurred in 4 patients at median period of 7 months (rang, 3-21);
four had salvage therapies (lhormonal therapy, 3 radiotherapy); two of them achieved undetectable
PSA and two had PSA values of 0.2 and 1 ngjml respectively. Continence data was available in 31
patients of which 23 (74.19%) were pad-free. Erection with or without medication was achieved in 21
Conclusion: Significant complications can occur during open or robotic RP after TURP; however these
complications can be successfully managed intraoperatrively with no long-term sequelae. Thus, both
open and robotic RP after TURP are and with acceptable oncologic and functional
outcomes. The outcomes of robotic RP are comparable to that of open RP. Patients should be made
aware of possibility of intra operative difficulty and Informedof the expected postoperative functional
outcome before undergoing RPfollowing TURP.
.ratients (60%) (data on erectile dysfunction were available on 35 cases). Ten patients from those who
did not have postoperative erection with/ without medication had erectile dysfunction score of 9.5/25
(range, 3-20). The PSA value at the last follow-up was less than 0.1 in- all patient except in two patients
who had PSA values of 0.2 and lng/ml respectively.

Conference Title
The Ninth Conference of the Arab Association of Urology & the Seventh International Conference of the Jordanian Association of Urological Surgeons
Conference Country
Conference Date
Nov. 22, 2011 - Nov. 22, 2011
Conference Sponsor
Department of Urology, The University of Texas MD Anderson Cancer Center-Houston, Texas, UnitedStates .