title: Laparoscopic radical prostatectomy after transurethral resection of the prostate: surgical and functional outcomes.
abstract: OBJECTIVE
  To compare the morbidity and functional results after laparoscopic radical prostatectomy with and without previous transurethral resection of the prostate (TURP).
  
  
  METHODS
  From May 1998 to January 2005, 640 patients underwent laparoscopic radical prostatectomy, of whom 46 (7.2%) had previously undergone TURP. The perioperative and postoperative data were compared between group 1 (with previous TURP) and group 2 (without previous TURP). The functional results were assessed by self-administered questionnaires at 12 and 24 months after surgery.
  
  
  RESULTS
  In group 1, the operative time, hospital stay, and bladder catheterization duration was increased by 31 minutes, 1.9 days, and 2.9 days, respectively. The positive margin rate was not significantly different statistically between the two groups (P = .62). The 5-year actuarial freedom from biochemical recurrence rate was similar between the two groups (P = .86). Surgical complications occurred in 15.2% of group 1 and 5.7% of group 2 (P = .02). The risk of anastomotic stricture was 6.5% and 1.2% in groups 1 and 2, respectively (P = .02). Two years after surgery, the continence rate was 86.9% in group 1 and 95.8% in group 2 (P = .77), and the potency rate was 63.8% and 70.9%, respectively, after bilateral neurovascular bundle preservation (P = .61). However, neurovascular bundle preservation was performed after previous TURP in only 56.5% of group 1 vs 78.9% in group 2 (P = .02). The median follow-up was 50.8 months (range 30-107).
  
  
  CONCLUSIONS
  Laparoscopic radical prostatectomy can be performed after TURP without compromising the oncologic results. However, patients should be informed that the procedure is associated with worse intraoperative and postoperative outcomes. Although the urinary continence rate was not hampered by previous TURP, neurovascular bundle preservation is technically more difficult and compromises postoperative erectile function.
authors.affiliation: Department of Urology, Henri Mondor Hospital, Créteil, France. johann.menard@wanadoo.fr
authors.forename: Johann
authors.initials: J
authors.lastname: Menard
authors.forename: Alexandre
authors.initials: A
authors.lastname: de la Taille
authors.forename: Andras
authors.initials: A
authors.lastname: Hoznek
authors.forename: Yves
authors.initials: Y
authors.lastname: Allory
authors.forename: Dimitri
authors.initials: D
authors.lastname: Vordos
authors.forename: René
authors.initials: R
authors.lastname: Yiou
authors.forename: Clément-Claude
authors.initials: CC
authors.lastname: Abbou
authors.forename: Laurent
authors.initials: L
authors.lastname: Salomon