OBJECTIVES: To determine the oncological impact and adverse events of performing simultaneous transurethral resection of bladder tumour (TURB) and transurethral resection of the prostate (TURP), as evidence on the outcomes of simultaneous TURB for bladder cancer and TURP for obstructive benign prostatic hyperplasia is limited and contradictory. PATIENTS AND METHODS: Patients from 12 European hospitals treated with either TURB alone or simultaneous TURB and TURP (TURB+TURP) were retrospectively analysed. A propensity score matching (PSM) 1:1 was performed with patients from the TURB+TURP group matched to TURB-alone patients. Associations between surgery approach with recurrence-free (RFS) and progression-free (PFS) survivals were assessed in Cox regression models before and after PSM. We performed a subgroup analysis in patients with risk factors for recurrence (multifocality and/or tumour size >3 cm). RESULTS: A total of 762 men were included, among whom, 76% (581) underwent a TURB alone and 24% (181) a TURB+TURP. There was no difference in terms of tumour characteristics between the groups. We observed comparable length of stay as well as complication rates including major complications (Clavien-Dindo Grade ≥III) for the TURB-alone vs TURB+TURP groups, while the latest led to longer operative time (P < 0.001). During a median follow-up of 44 months, there were more recurrences in the TURB-alone (47%) compared to the TURB+TURP group (28%; P < 0.001). Interestingly, there were more recurrences at the bladder neck/prostatic fossa in the TURB-alone group (55% vs 3%, P < 0.001). TURB+TURP procedures were associated with improved RFS (hazard ratio [HR] 0.39, 95% confidence interval [CI] 0.29-0.53; P < 0.001), but not PFS (HR 1.63, 95% CI 0.90-2.98; P = 0.11). Within the PSM cohort of 254 patients, the simultaneous TURB+TURP was still associated with improved RFS (HR 0.33, 95% CI 0.22-0.49; P < 0.001). This was also true in the subgroup of 380 patients with recurrence risk factors (HR 0.41, 95% CI 0.28-0.62; P < 0.001). CONCLUSION: In our contemporary cohort, simultaneous TURB and TURP seems to be an oncologically safe option that may, even, improve RFS by potentially preventing disease recurrence at the bladder neck and in the prostatic fossa.

Cancer Prognostics and Health Outcomes Unit University of Montreal Health Centre Montreal Canada

Departement of Urology University of Verona Verona Italy

Department of Minimally Invasive and Robotic Urology University Center of Excellence in Urology Wrocław Medical University Wroclaw Poland

Department of Surgery Prince of Wales Hospital The Chinese University of Hong Kong Hong Kong China

Department of Urology 2nd Faculty of Medicine Charles University Prague Czech Republic

Department of Urology Clinique Pasteur Toulouse France

Department of Urology Comprehensive Cancer Center Medical University of Vienna Vienna Austria

Department of Urology La Croix du Sud Hospital Institut Universitaire du Cancer Toulouse Oncopole Toulouse France

Department of Urology Marien Hospital Herne Herne Germany

Department of Urology The Jikei University School of Medicine Tokyo Japan

Department of Urology University Hospital of Toulouse Rangueil Toulouse France

Department of Urology University of Texas Southwestern Dallas TX USA

Department of Urology Weill Cornell Medical College New York NY USA

Division of Experimental Oncology Unit of Urology Urological Research Institute Milan Italy

Division of Urology Department of Surgical Sciences AOU Città della Salute e della Scienza di Torino Torino School of Medicine Turin Italy

Hourani Center for Applied Scientific Research Al Ahliyya Amman University Amman Jordan

IRCCS Regina Elena National Cancer Institute Rome Italy

Karl Landsteiner Institute of Urology and Andrology Vienna Austria

Service d'Urologie Hôpital Erasme Université Libre de Bruxelles Brussels Belgium

Servicio de Urología Hospital Universitario La Paz Madrid Spain

University Vita Salute San Raffaele Milan Italy

Aktuelle Urol. 2023 Jun;54(3):185. doi: 10.1055/a-2017-7108. PubMed

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