Undergoing radical prostatectomy (RP) for prostate cancer after surgery for lower urinary tract symptoms due to benign prostatic hyperplasia (BPH) is associated with higher rates of positive surgical margins and lower rates of urinary continence and erectile function recovery, an updated review finds.

In a systematic review of 25 retrospective studies including 11,101 men undergoing radical prostatectomy, 2113 men had a history of LUTS/BPH surgery and 8898 did not. LUTS/BPH surgeries included transurethral resection of the prostate, holmium laser enucleation of the prostate (HoLEP), or mixed procedures. Radical prostatectomies  included laparoscopic radical prostatectomy (LRP), robot-assisted laparoscopic radical prostatectomy (RALP), and retropubic radical prostatectomy (RRP).

The odds of positive surgical margins were significantly increased 1.4-fold in patients with vs without a history of LUTS/BPH surgery, Massimiliano Creta, MD, PhD, of the University of Naples Federico II in Naples, Italy, and colleagues reported in Prostate Cancer and Prostatic Diseases. In subgroup analyses, the finding was significant only for patients with a history of TURP but not HoLEP or mixed procedures. It also only significantly pertained to patients undergoing RALP or LRP, but not RRP or mixed procedures. Biochemical recurrence rates did not differ significantly between men with and without BPH surgery.

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The odds of urinary continence recovery at 3 months and 1 year were significantly decreased by 52% and 56%, respectively, in patients with previous LUTS/BPH surgery. In subgroup analysis, the 1-year result was significant only for patients undergoing RALP, LRP, and mixed procedures but not RRP.

The odds of erectile function recovery within 1 year were significantly decreased by 40% in patients with history of LUTS/BPH surgery. This finding was significant for patients undergoing LRP but not those undergoing RRP, RALP, or mixed procedures. By type of LUTS/BPH surgery, the finding was significant only for patients with history of TURP or mixed procedures but not HoLEP.

“Previous surgery for LUTS/BPE determines an additional difficulty in performing some key steps of RP, such as identification of bladder neck and prostatic margins, apex dissection and recognition of surgical cleavage, mostly due to widespread fibrosis and inflammation,” Dr Creta noted.

This updated systematic review included more recent series of patients with history of HoLEP and permitted subgroup analyses, the investigators noted.


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. Published online May 27, 2023. doi:10.1038/s41391-023-00678-y