The Effects Of Transurethral Resection Of Prostate On Radical Prostatectomy:a Systematic Review And Meta-analysis

Objective:The current study aimed to carry out a comprehensive meta-analysis on the existing evidence to quantify and compare the oncological,surgical and functional outcomes of radical prostatectomy(RP)in prostate cancer(PCa)patients with a history of transurethral resection of the prostate(TURP)versus PCa patients without a history of TURP.Methods:A systematic literature search was conducted on PubMed,Embase,Cochrane Library,CBM,CNKI,Wanfang databases to identify studies published between the establishment of the database and 31 October 2019.Finally,Revman 5.3 and Stata 12.0 were used for data analysis.Results:This meta-analysis included 13 studies.A total of 6903 patients were included in the final analysis.Our results suggest that TURP group demonstrates a significantly higher the positive surgical margin rate,bladder neck reconstruction rate and overall complication rate compared with Non-TURP group(OR=1.31,95%CI:1.09-1.58,P=0.004,I2=0%;OR=14.36,95%CI:2.93-70.45,P=0.001,I2=81%;OR=2.63,95%CI:1.87-3.71,P<0.00001,I2=0%);whereas TURP group demonstrates a significantly lower nerve sparing rate compare with Non-TURP group(OR=0.30,95%CI:0.22～0.43,P<0.00001,I2=40%);The operation time,blood loss and one-year urinary continence rate are same between TURP group and Non-TURP group(MD=4.25,95%CI:-0.13～8.63,P=0.06,I2=34%;MD=27.29,95%CI:-10.31~64.90,P=0.15,I2=39%;OR=0.68,95%CI:0.43～1.06,P=0.09,I2=0%).Conclusion:Non-TURP group may have have better results than the TURP group in terms of positive surgical margin rate,bladder neck reconstruction rate,overall complication rate and nerve sparing rate.The operation time,blood loss and one-year urinary continence rate are comparable between TURP group and Non-TURP group.Meanwhile,our meta-analysis also found that:according to the operation method is divided into robot assisted radical prostatectomy(RARP),laparoscopic radical prostatectomy(LRP),open radical prostatectomy(ORP)and RARP/ORP four subgroups have their own advantages and disadvantages in the combine analysis of each outcome indicator.