Introduction & Objectives: Approximately 75% of patients with bladder cancer present with a non-muscle invasive disease (NMIBC). NMIBC may relapse lifelong in many patients despite local therapy, and recurrences impair their quality of life (needing of cystoscopy follow-up and repeated surgery). Lower urinary tract symptoms due to benign prostatic hyperplasia (BPH) and obstruction (BPO) are common complaints, that bother as well adult to elderly men.Many men suffering from NMIBC and BPH/BPO require surgery for bladder outlet obstruction at some point of their life. Aim of this study was to assess oncological safety and quality of life (QL) of men undergoing simultaneous transurethral resection of bladder tumor (TURBT) and transurethral resection of the prostate (TURP) for symptomatic benign prostatic BPH.Materials & Methods: Ninety-five men with new diagnosis of bladder cancer (BC) and symptomatic BPH were randomized to receive TURBT+tamsulosin (Group 1) or TURBT+TURP (Group 2). Inclusion criteria were age ≤75 years, first diagnosis of BC up to 4 cm, and prostate volume ≤80 ml. All men patients were evaluated preoperatively with digital rectal examination, PSA, , maximal urine flow rate (Qmax), and International Prostate Symptom Score (IPSS). IPSS and Qmax, were repeated at 1-year follow up. QL was evaluated at 1-year using a modified version of the self-report bladder cancer subscale of the Functional Assessment of Cancer Therapy.Results: Forty-nine men were allocate in Group 1, and 46 in Group 2. Eighty-five men were analyzed (43 in Group 1 and 42 in Group 2). Most of complications were mild (Clavien grade I and II). Only one patient in each group needed endoscopic bleeding control under general anesthesia (Clavien grade IIIb). Adjuvant instillation therapy was given according to EAU risk of recurrence in 26 patients in Group 1, and in 27 in Group 2. Average time to first recurrence was similar in both groups, 16.64 months (5-48) in Group 1 and 17.7 (6-48) in Group 2 (p 0.29). Total and bladder neck/prostatic urethra recurrences were not statically different among groups (27 in Group 1 vs. 22 in Group 2, p 0.083; 9 in group 1 vs. 8 in Group 2, p 0.759 respectively). Multivariate analysis showed minor total recurrences in Group 2 (no statistical significance, p=0.083), with no difference in bladder neck/prostatic urethra relapses (p=0.759). The only variable, which affect relapse, was multifocality in both groups (odds ratio 7.42 in Group 1 and 6.0793 in Group 2). Quality of life, IPSS, and Qmax 12-month after surgery were better in Group 2 (p 0.004).Conclusions: Concomitant TURBT and TURP appear oncological safe procedures in terms of total and prostatic urethra recurrence, and improve QL in men with BC who require surgery for symptomatic BPH.
P42 Concomitant transurethral resection of bladder tumor and prostate are oncological safe and improve quality of life: Results from a randomized controlled trial
Castellani DWriting – Original Draft Preparation
;
2018-01-01
Abstract
Introduction & Objectives: Approximately 75% of patients with bladder cancer present with a non-muscle invasive disease (NMIBC). NMIBC may relapse lifelong in many patients despite local therapy, and recurrences impair their quality of life (needing of cystoscopy follow-up and repeated surgery). Lower urinary tract symptoms due to benign prostatic hyperplasia (BPH) and obstruction (BPO) are common complaints, that bother as well adult to elderly men.Many men suffering from NMIBC and BPH/BPO require surgery for bladder outlet obstruction at some point of their life. Aim of this study was to assess oncological safety and quality of life (QL) of men undergoing simultaneous transurethral resection of bladder tumor (TURBT) and transurethral resection of the prostate (TURP) for symptomatic benign prostatic BPH.Materials & Methods: Ninety-five men with new diagnosis of bladder cancer (BC) and symptomatic BPH were randomized to receive TURBT+tamsulosin (Group 1) or TURBT+TURP (Group 2). Inclusion criteria were age ≤75 years, first diagnosis of BC up to 4 cm, and prostate volume ≤80 ml. All men patients were evaluated preoperatively with digital rectal examination, PSA, , maximal urine flow rate (Qmax), and International Prostate Symptom Score (IPSS). IPSS and Qmax, were repeated at 1-year follow up. QL was evaluated at 1-year using a modified version of the self-report bladder cancer subscale of the Functional Assessment of Cancer Therapy.Results: Forty-nine men were allocate in Group 1, and 46 in Group 2. Eighty-five men were analyzed (43 in Group 1 and 42 in Group 2). Most of complications were mild (Clavien grade I and II). Only one patient in each group needed endoscopic bleeding control under general anesthesia (Clavien grade IIIb). Adjuvant instillation therapy was given according to EAU risk of recurrence in 26 patients in Group 1, and in 27 in Group 2. Average time to first recurrence was similar in both groups, 16.64 months (5-48) in Group 1 and 17.7 (6-48) in Group 2 (p 0.29). Total and bladder neck/prostatic urethra recurrences were not statically different among groups (27 in Group 1 vs. 22 in Group 2, p 0.083; 9 in group 1 vs. 8 in Group 2, p 0.759 respectively). Multivariate analysis showed minor total recurrences in Group 2 (no statistical significance, p=0.083), with no difference in bladder neck/prostatic urethra relapses (p=0.759). The only variable, which affect relapse, was multifocality in both groups (odds ratio 7.42 in Group 1 and 6.0793 in Group 2). Quality of life, IPSS, and Qmax 12-month after surgery were better in Group 2 (p 0.004).Conclusions: Concomitant TURBT and TURP appear oncological safe procedures in terms of total and prostatic urethra recurrence, and improve QL in men with BC who require surgery for symptomatic BPH.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
