UROLOGICAL ONCOLOGY

Simultaneous transurethral resection of bladder tumor and benign prostatic hyperplasia: hazardous or a safe timesaver?
Tsivian A, Shtricker A, Sidi AA
Department of Urologic Surgery, Edith Wolfson Medical Center, Holon, Israel
J Urol. 2003;170: 2241-3

• Purpose: We evaluated the effect of simultaneous transurethral resection of bladder tumor (TURBT) and benign prostatic hyperplasia (TURP) on recurrences at the bladder neck and prostatic urethra.
• Materials and Methods: During the 10-year study period 51 patients fulfilled the entry criteria of past simultaneous TURBT and TURP, histologically confirmed transitional cell carcinoma of the bladder and benign prostatic hyperplasia, a preserved bladder and a minimal followup of 12 months. Their records were analyzed retrospectively. Patients were divided into 28 with single (group 1) and 23 with multiple (group 2) bladder tumors.
• Results: During the 12 to 120 months of followup (mean 37.3) the average tumor recurrence rate was 68.6%, that is 53.6% in group 1 and 86.9% in group 2. Recurrences appeared within an average of 14.9 months, that is within 18 (range 4 to 36) in group 1 and 13.5 (range 3 to 36) in group 2. Tumor recurrence was at the bladder neck and/or prostatic urethra in 11 of the 51 cases (21.5%). Average time to recurrence at the prostatic fossa was 23.8 months, that is 27 (range 13 to 46) in group 1 and 21.6 (range 4 to 60) in group 2. Only 1 patient had a single recurrence in the prostatic fossa, while the others also had synchronous and metachronous recurrences at other bladder sites. Tumor progression to invasiveness was diagnosed in 3 of the 51 patients (5.9%).
• Conclusions: Our data indicate that simultaneous TURBT and TURP do not negatively affect tumor recurrence at the bladder neck and prostatic urethra.
  
  
• Editorial Comment
  Implantation of bladder tumor cells is an interesting topic and base of renewed interest of the scientific community. Here, the authors tried to answer clinically if implantation occurs predominant at resection sites, such as the prostatic urethra after TUR of the prostate. Their data do not support the hypothesis of predominant implantation in the previously resected area. On the other hands, the biological facts of implantation are by far more complex than the clinical situation analyzed. Implantation occurs on areas coated e.g. with fibronectin, an intermediate matrix protein. Simplified, this protein is shed by bleeding and attaches on the bladder surface, not only on traumatized surfaces. Therefore, during and after resection of the prostate, large areas of the bladder are covered with this protein, representing an ideal surface for bladder tumor implantation. The recurrence rate in their analysis is very high. Given the fact that intermediate risk tumors are resected, the authors have an average recurrence rate of around 70% within a follow up of slightly more than 3 years, and even 87% in group 2. This recurrence rate seems very impressive and rather supports the notion that simultaneous transurethral resection of the prostate should not be performed because of the higher probability of an overall tumor cell implantation. This statement, however, needs to be scientifically proven.

Dr. Andreas Böhle
Professor of Urology
HELIOS Agnes Karll Hospital
Bad Schwartau, Germany