Feasibility Study Of Simultaneous Transurethral Resection For The Treatment Of Non-muscle-invasive Bladder Cancer With Benign Prostatic Hyperplasia

Objective: Observation simultaneous transurethral surgery(TUR)treatment of non-muscle invasive bladder cancer(NMIBC)combined with benign prostatic hyperplasia(BPH)patients clinical condition and surgical outcomes.To evaluate the feasibility and safety of simultaneous TUR treatment of NMIBC combined with BPH,and to improve the effectiveness of lower urinary tract symptoms(LUTS)and tumor control.To provide reference for clinical patients with simultaneous TUR in the treatment of NMIBC combined with BPH.Methods: This study used a matched case-control study to retrospectively analyze the case information of 168 NMIBC combined with BPH in our hospital from 2005 to 2016.Of these,84 patients of NMIBC combined with BPH were treated with simultaneous TUR(case group).Another 84 patients of NMIBC combined with BPH were treated with transurethral resection of bladder tumor(TURBT)alone(control group).Statistical analysis was used to analyze the case information and follow-up data of the two groups of patients.The basic data,perioperative conditions,postoperative LUTS improvement,and oncological outcomes were compared between the two groups.To evaluate the feasibility of simultaneous TUR in the treatment of NMIBC combined with BPH in comparison with not simultaneous TUR.Results: 1.The follow-up time of the case group was 67.20±42.11 months,and the follow-up time of the control group was 73.39±37.01 months(p=0.07).The average age of patients in the case group was 71.08±8.96 years,and the average age of the control group was 67.24±8.42 years(p=0.00).In medical comorbidities,the charlson comorbidity index(CCI)in the case group and the control group was 2.58 ± 1.36 and 2.18 ± 0.96,respectively(p = 0.04).2.The average international prostate symptom score(IPSS)of case group and control group was 18.50 ± 6.24 points and 15.54 ± 4.67 points respectively(p = 0.00).The average quality of life(QOL)scores were4.01±1.29 points and 3.70±0.98 points,respectively(p = 0.02).Cystoscopy during surgery revealed that the benign prostatic enlargement(BPE)was obvious significantly in the case and control groups were 58(69.05%)and 35(41.67%),respectively(p=0.00).3.The risk stratification of tumor prognpsis and the postoperative intravesical chemotherapy in the case group and the control group were consistent between the two groups.There was no statistical difference between the case group and the control group in terms of pathological staging and grading of the tumor(p values were 0.75 and 0.88 respectively).There were 72(85.71%)and 60(71.43%)patients with the largest bladder tumor diameter <3 cm in the case group and the control group,respectively(p=0.04).There were 68(80.95%)and 50(59.52%)patients with solitary bladder tumors in the case and control groups,respectively(p=0.01).There were 48(57.14%)and 32(38.10%)patients with recurrent tumors in the case and control groups,respectively(p=0.02).4.Patients in the case group and control group completed the operation successfully and there was no patient who died during perioperative period.In the case group,24 patients(28.57%)had transurethral resection prostate(TURP)that did not reach the surgical capsule of the prostate,and three of the patients(12.50%)performed a simultaneous TURP again during a follow-up period of bladder tumor recurrence.5.In terms of time,the average anesthesia time,postoperative bladder irrigation time,postoperative indwelling catheter length,and postoperative hospital stay in the case group were all longer than those in the control group(all p values are equal to 0.00).In terms of surgical complications,the case group had higher intraoperative blood loss,need for blood transfusion therapy,postoperative antibiotics,retrograde ejaculation,and transient urinary incontinence than the control group(all p values less than 0.05).There were no statistically significant differences in complications such as bladder perforation,urethral stricture,transurethral resection syndrome(TURS),postoperative admission tointensive care unit(ICU),and perioperative death.6.There were 70(83.30%)and 18(20.90%)patients with improved voiding at 3 months postoperatively in the case and control groups(p=0.00).There were 36 patients(42.86%)and 50 patients(59.52%)who received oral medication for BPH after surgery in the case group and the control group(p=0.04).Further subgroup analysis showed that in the case group TURP reached/not reached the subgroup of surgical capsules,the improvement of voiding at the 3 months postoperatively was better in the case group than in the control group(p=0.00).7.There was no significant difference in the overall recurrence rate,tumor progression,and distant metastasis between the groups during follow-up(p values were 0.49,0.77 and 1.0,respectively).Subgroup analysis showed that there was no statistical difference in tumor recurrence rates in the bladder,prostatic urethra(PU)and upper urinary tract(p values 0.50,0.51 and 1.00,respectively).The difference in recurrence of bladder,PU,and tumor progression between low-,intermediate-and high-risk NMIBC patients was not statistically significant between the two groups(all p values are greater than 0.05).Conclusions: 1.In clinical practice,for patients with NMIBC combined with BPH in clinical decision-making,patients with large age,comorbidities,severity of BPH and recurrence of low-load bladder tumors are more likely to perform simultaneous TUR.2.Simultaneous TUR treatment of NMIBC combined with BPH is feasible in surgical operation.However,in clinical practice,there may be cases where TURP does not reach the surgical capsule.3.Simultaneous TUR treatment of NMIBC with BPH is a relatively safe operation.Although simultaneous TUR prolonged the related time,it increased the risk of haemorrhage,postoperative antibiotics use,retrograde ejaculation and transient urinary incontinence.However,it did not increase the risk of serious adverse events such as bladder perforation,postoperative admission to ICU and perioperative death.etc.4.Compared with patients who did not receive TURP during the same period,simultaneous TUR treatment with NMIBC combined with BPH could improve short-term postoperative voiding and reduce BPH-related drug treatment.It is worth noting that TURP may need to be TURP again when the TURP does not reach the surgical capsule.5.Simultaneous TUR treatment of NMIBC with BPH does not affect bladder tumor recurrence in the bladder,PU and upper urinary tract,nor does it affect the progression and distant metastasis of the tumor.